Imaging with X-rays

Properties:
A- Contrast: the ability to distinguish between adjacent areas
B- Spatial resolution: the ability to detect fine details
 Tested with (Grid test object), consist of a number of equally spaced bars and the
space between bars is the same width of the bar.
 A bar and a space make up a line pair & spatial frequency of a pattern is given as
the number of line pairs per mm
 There is several groups of line pairs with progressively reduced spacing & the
smallest visible detail size is about half of the inverse of the given line pairs
example: with resolution 10 lp/mm, smallest detail seen about 0.05 mm ( 50 µm )
C- Noise: (See later)

Attenuation Of X-Rays By The Patient

 In conventional radiography  X-ray beam falls on the patient → differentially
absorbed by the tissues of the body  emerging from the patient carrying a pattern of
intensity which is dependent on the thickness and composition of the organs in the body
 captured on a large flat phosphor screen (which converts the invisible X-ray image
into a visible image of light), which then is either:
o Recorded as a negative image on film, to be viewed on a light box (illuminator);
or
o Displayed as a positive image on a video monitor.
LIMITING PATIENT DOSE
 THE ENTRANCE DOSE (to the skin) has to be much higher than THE EXIT DOSE
(emerging from the patient) because of the high attenuation of X-rays by the patient.
 10 times greater for PA chest,
 100 for an AP abdomen or skull,
 1000 for a lateral pelvis.
 THE AVERAGE DOSE lies somewhere between the entrance and exit doses.
 THE EFFECTIVE DOSE is smaller.
 THE ACCEPTABLE DOSE one of the limiting factors in X-ray imaging / radiation dose
that can be delivered to the patient which should be as small as possible, consistent with
producing an image satisfactory for clinical purposes.

Dr. Islam Abo Shady 1

Effect of tube kilovoltage on patient dose
 ↑↑ Kilovoltage (kV) → beam is more penetrating → ↑↑ the proportion of high-energy
photons which reach the film-screen & ↓↓ no. of low-energy photons absorbed in skin &
body soft tissue.
A lower entrance dose is needed for the same exit dose.
↑↑ kV → ↓↓ the skin dose and, to a lesser extent, the dose to deeper tissues.

 N.B.:
Whereas the output of the X-ray tube (Intensity) and the skin dose rate are proportional
to kV2, the film-screen dose is nearly proportional to kV4 (exponent is 3-5, dependent on
patient thickness and field size).

MCQ: X-ray exposure to the patient may be reduced by using a higher kVp (T) … Tricky question. It is usually
assumed that when kVp increase, the mAs is reduced and vice versa.

Effect of focus-film distance on patient dose

Increasing the focus-film distance (FFD) reduces the dose to the patient (according to
the inverse square low)

While increasing the FFD necessitates ↑↑ the charge (mAs) to produce the desired
number of photons at the film-screen (to overcome reduction in intensity with
↑distance according to inverse square low), however still the skin dose incurred in
producing an acceptable image is ↓↓, and to a lesser extent the dose to deeper tissues.

MCQ: Changes in focus-to-film distance (FFD) do not alter the entrance surface dose (ESD) because changes
in mA are required to maintain an adequate film dose (F) … Although the mA must be increased as the FFD is
increased, there is an overall reduction in the ESD due to the relationship of X-ray intensity to distance
being an inverse square law

Dr. Islam Abo Shady 2

Other factors affecting skin dose:
 ↑↑ Filtration → reduces the skin dose in spite of the fact that an increase in mAs is
needed.
 Skin dose increases linearly with mAs.

SUBJECT CONTRAST
A structure in the patient is demonstrated by two things:
 Resolution, sharpness, or lack of blurring of the image of its boundary
 Contrast between it and adjacent tissues caused by differences in the transmission of
X-rays.
We study CONTRAST first, with the aid of a very simple example.

 Contrast is due to the differential attenuation by the structure of thickness t and by

an equal thickness of the adjacent tissues.
 Accordingly, subject contrast C depends on:
 The thickness t of the structure.
 The difference in linear attenuation coefficients "μ1-μ2" of the tissues involved.
Thus
C (μ1 – μ2) t
 ↑ Structure thickness → ↑ contrast.
 As attenuation depends on tissue density and atomic number:
The more the two tissues differ in these respects → the greater the contrast.
 The higher the kV → the smaller the attenuation coefficients → the less the
contrast.

Dr. Islam Abo Shady 3

 It will be seen that:
Contrast C between bone (Z = 13) and muscle, which is proportional to the vertical
distance between the two curves, is large but decreases noticeably when the tube kV
is increased, due to the effect of photoelectric absorption in bone;
The same is true of the contrast between iodine contrast media and soft tissue.
The contrast between the low atomic number tissues, e.g. fat (Z = 6) and muscle (Z
= 7.4), is small and does not decrease very much when the tube kV is increased.
The contrast between air and tissue, which have similar atomic numbers, is due to the
large difference in density.

MCQ: Contrast between air and soft tissue is due to differences in their density not atomic number
Contrast media
 One of the problems in radiography is the low contrast between soft tissues.
o One way of increasing contrast is to use a lower kV;
o Another is to use a contrast medium.
 Contrast-media are chosen to have
1) high atomic number to maximize photoelectric absorption
2) high density.
 Ideally, the absorption edge should lie just to the left of the major part of the
spectrum of X-rays leaving the patient. (MCQ)
 Last Figure shows that this is the case with iodine (Z = 53, EK = 33 keV).
o Barium (Z = 56, EK = 37 keV) also has a favorably placed absorption edge, and in
addition a high density.
o Air and other gases (negative contrast media) → the use as contrast media relied
on their low density.

Effect Of Scattered Radiation

 The primary radiation carries the information to be imaged, while the scattered
radiation obscures it. This is similar to the way in which the light in a room
affects the image seen on a television screen.
 The amount (S) of scattered radiation reaching a point on the film‐screen may be several
times the amount (P) of primary radiation reaching the point.
 The ratio S/P depends on the thickness of the part and the area of the beam.
 The ratio is typically 4:1 for a PA chest (only 20% of the photons recorded by the
film‐screen carry useful information) & 9:1 for a lateral pelvis.
 Since the scattered radiation is more or less uniform over the image, it acts like a veil
and reduces the contrast which would otherwise be produced by the primary rays by the
factor (1 + S/P), which may be anything up to 10 times.

Dr. Islam Abo Shady 4

  If, however, the structure is very close to the film, as in Fig.c→ the scattered rays help
to form the image → improves contrast.

MCQ: Scatter predominantly affects spatial resolution (F) … Contrast.

MCQ: Increasing kV reduce the scatter reaching the plate or detector (F) … Increasing the kV may allow a
reduction in the patient dose for the same detector, but the beam becomes more penetrating, so a greater
proportion of the scatter is formed at the exit side of the patient and so more scatter reaches the imaging
detector.

SCATTER REDUCTION AND CONTRAST IMPROVEMENT:

I- Measures to reduce the amount of scatter produced by the patient (relative

to primary):
1-  Field size:
By collimation (cones) or beam restrictors (light beam diaphragm) → reduces the
volume of scattering tissue → ↓↓ scatter & improves contrast.
2- Compression of the patient:
Compression moves overlying tissues laterally → ↓↓ the volume of scattering tissue
→ ↓↓ scatter & improves contrast.
3-  Kilovoltage:
 Less forward scatter and more side scatter.
 Less penetrating scatter, so scatter produced at some distance from the film is
less likely to reach it. In practice, these effects may not be very significant.
So, reducing the kV → increase the contrast, but primarily because of theincreased
photoelectric absorption, it also increases the patient dose.
4-  Subject-film distance: so, scattered rays help in forming the image, e.g. chest
radiogram is taken PA, so that the heart is closer to the film.
5- Use of contrast media.

Dr. Islam Abo Shady 5

II- Measures to reduce the amount of scatter after it has left the patient:
The amount of scatter (relative to the primary rays) reaching the film-screen may be
reduced and contrast increased by interposing between it and the patient:
1- Grid:
The grid acts like a Ventilation blind. The lead strips absorb (say, 90% of) the scattered
rays which hit the grid obliquely, while allowing (say, 70% of) the primary rays to pass
through the gaps and reach the film.

2- Air gap:
If, as in Fig., the film-screen is moved some 30 cm away from the patient, much of
the obliquely traveling scatter misses it, and the contrast is improved.

Due to the inverse square law, the increased distance causes

1. A small reduction in the intensity of the primary radiation which comes from
the anode, some distance away, but
2. A large reduction in the intensity of the scattered radiation, since that
comes from points within the patient, much nearer.
Disadv. of the use of an air gap
1. Necessitate an increase in the kV or mAs.
Reminder: Dose α kV2 mAs / F2

Where F is distance from source

2. Results in a magnified image.

Dr. Islam Abo Shady 6

MCQ: An air gap of >30 cm is needed.

MCQ: An air gap   contrast (by reducing the amount of scattered radiation that is able to reach the film)
&  dose (As less of the primary radiation reaches the film as a result of the inverse square law, this
requires an increase in the kV/mA to compensate).
3- Flat metal filter:
Such a filter, placed on the cassette, absorbs the softer and obliquely traveling
scatter more than the harder direct rays.
This is not very effective, and necessitates an increase in the mAs.

To summarize the important points in reduction of scatter and improving contrast:

3. Collimation (decrease field size)
4. Compression
5. Low kV
6. Subject nearer to film
7. Use of contrast medium
8. Grid
9. Air gap
10. Flat metal filter

MCQ: Use of compression reduced contrast seen in the organ being imaged (F) … Not only is the amount of
scatter reduced thus improving contrast, there is less overlying soft tissue above and below the organ or
region of interest. The differing attenuation of the organ therefore becomes more pronounced as it is not
superimposed by other soft tissues.
MCQ: Scatter may be reduced by increasing the kV (F) … Increasing the kV means that any scattered
radiation is more penetrating and may reach the film.

Scatter ≠ Contrast

Dr. Islam Abo Shady 7

Anti-scatter Grids
Effect On Scattered Rays:
'Antiscatter' grid, seen in cross-section in Fig., consists of thin (0.07 mm)strips of
a heavy metal (such as lead or tungsten) sandwiched between thicker (0.18 mm)
strips of interspace material (plastic, carbon fiber, or aluminum, which are
transparent to X-rays), encased in aluminum or carbon fiber.
The orientation of the lead strips is in general parallel to the x-ray beam axis.

It absorbs oblique scatter beams, allowing the direct beam only to pass through the
interspaces

 Few of the scattered rays S can pass through the channels between the strips of lead and
reach the film (most of them are traveling obliquely and are relatively soft → will be
absorbed by the lead strips).

N.B. Aluminum interspace grids:

 Structurally stronger than grids with organic interspacers.
 Needs higher patient exposure (absorbs more 1ry radiation).
 However, it also absorbs more 2ry radiation → ↑ contrast.

Angle of acceptance θ:
Def.: The angle within which scattered rays CAN reach the film through the
interspaces (focused grids have smaller angle of acceptance)
Usually small.

Dr. Islam Abo Shady 8

Grid Ratio:
The grid ratio = depth of interspace channel / width of interspace channel
Typically = 8:1
The larger the grid ratio, the smaller the angle of acceptance, the more efficient the
grid is at absorbing scattered radiation and the greater the contrast in the image.
N.B.: Grids improve IMAGE CONTRAST (not resolution)

With very large fields, especially at a high kV, more scatter is produced, and a
high-ratio grid (12:1 or 16:1) is preferable.
No grid would generally be used with thin parts of the body (extremities), with
children or where there is an air gap.

Grid Frequency (Line Density):

Def  measure of the number of grid lines per unit distance (inches or centimeters)
Range of 40 - 50 lines/cm for low frequency grids, 50-60 lines/cm for medium frequency
grids, and 60 - 70+ lines/cm for high frequency grids.

• Low-frequency grids are used with systems having a moving grid assembly.
• Medium and high-frequency grids are typically used with stationary grid holders (e.g.,
portable radiography and many digital radiography systems)
• High-frequency grid use is particularly important for digital radiography systems to avoid
aliasing artifacts that arise from an insufficient sampling of high-frequency patterns that are
interpreted in the output signal as low frequency (aliased) signals.

Dr. Islam Abo Shady 9

Grid Pattern:
Def  Orientation of the lead strips in their longitudinal axis. It is the pattern of the
grid as we see it from a top view.
The two basic patterns are linear and crossed.

CROSSED GRIDS
 Unfortunately, scattered rays traveling obliquely to the primary beam but parallel to
the lead strips can pass through the gaps. These rays can be absorbed by the use of
crossed grids.
 Structure: two linear grids superimposed with their grid lines at right angle to each
other, having the same focusing distance.
 Adv.: More efficient than a single linear grid at removing scattered radiation, as the
pathway for radiation is now a tunnel rather than a channel.
 Disadv.:
1. Need greater radiographic exposure.
2. Require very careful centering. If the grids are not at right angles, a coarse
interference pattern (Moire fringes) may be seen on the film.
3. Grid cut-off can also be a problem.

MCQ: In case of crossed grids composed of two linear grids, the resulting grid ratio equals to the sum (not
product) of individual grid ratios
FOCUSED & UNFOCUSED "PARALLEL" GRIDS
Focused grids:
Strips are tilted progressively from the center to the edges of the grid so that they all
point toward the tube focus (N.B. most grids used in radiology are focused)
About 20% of the direct rays are removed & the rest pass.
May be linear or crossed.
Linear focused grids converge at a line in space (convergent line) while crossed
focused grids converge at a point (convergent point).
Focal distance = the perpendicular distance between the grid & convergent line or
point.
Focusing Range is wide for low grid ratio & narrow for high grid ratio.
Dr. Islam Abo Shady 10
 MCQ: For a focused grid, the focusing range depends on the grid ratio … The focusing range is wide for
low-ratio grids and narrow for high-ratio grids (the high-ratio grids therefore require more precise
positioning).

Parallel grids:
Lead strips are parallel when viewed in cross-section.
Focused at infinity → no convergent line.
Used effectively with:
1. Small x-ray fields.
2. Long target-grid distances.
It has little use in modern radiology "used in fluoroscopic spot film devices".

STATIONARY AND MOVING GRIDS

Grid lines (grid lattice) are shadows of the lead strips of a stationary grid
superimposed on the radiological image.

If the line density (number of grid lines per millimeter) is sufficiently high → reduce the
definition of fine detail.

MCQ:The line density of a grid (number of lead strips per cm) is usually 30–80 cm–1 (typically 40).
MCQ: Linear grid, reduces contrast in the direction perpendicular to the lead strips (F).
MCQ: In linear grids, it may be possible for X-ray tube to be angled without the effect of grid cut-off.
MCQ: Using grids normally leads to:
a. Reduced scatter dose to the patient (F).
b. Higher mean energy of the beam reaching the film (T).
MCQ: A focused grid may cause radiation cut-off at large field size (F).

Dr. Islam Abo Shady 11

Moving grid (Bucky) / Potter Bucky grid
Have typically 5 lines per millimeter.
During the exposure it moves for a short distance, perpendicular to the grid lines.
It can move to and fro (reciprocating) or in a circular fashion (oscillating) →
such movement blurs out the grid lines.
It is important that the grid starts to move BEFORE the exposure starts, moves
steadily during the exposure, and DOES NOT STOP moving until after the exposure
is over.

Multi-line grid:
Have 7 or more lines per millimeter together with a high grid ratio.
Can be used as a stationary grid without the lines being visible.
It is used when a moving grid cannot be used, and, being thinner, incurs less dose to
the patient.

MCQ:
 Concerning antiscatter grid:
-With parallel grid, cut off limits the max field size
-With focused grid, cut off limits the range of FFD
 Use of grid may increase patient dose by a factor of 4.
 Grid lines in an image occurs with stationary and moving grids (but to less extent).
 Use of grids normally leads to:
- scattered dose to the patient (due to  mA)
- scattered radiation reaching the film.
- mean energy of the beam reaching the film.
 In linear focused grids:
-Wrong FFD  central portion of the film will be exposed with progressive increase in cut off towards the
edges of the film.
-Decentering tends to produce overall lighter film.
 Mobile units often use stationary grids with low grid ratios.
 In single phase X-ray units, the timing of grid movement must not coincide with that of the pulses, otherwise
it will appear as if the grid is stationary (Stroboscopic effect)  not required in medium or high phase
systems.
 Grids not used in pediatrics & extremity radiography.

Dr. Islam Abo Shady 12

Evaluation of grid performance:
The 'Ideal Grid' would absorb all 2ry radiation & no 1ry radiation → so, gives max. film
contrast without unnecessary increase in patient exposure. Ideal grid is not present.

Primary Transmission (PT):

 Def  measurement of the % of 1ry radiation transmitted through a grid.
 Ideal grid will transmit 100% of the 1ry radiation which carries the radiographic image.

Primary Transmittion = Intensity with grid

/ Intensity without grid X 100

Anticipated = Thickness of interspaces (D)

/ Total surface of the grid (Thickness of interspaces D + lead septa d)
X 100

 The actual transmission is less than the anticipated "ideal " Tp

The difference between both values of Tp is due to:
1. 1ry beam absorption by the interspace material (mainly).
2. Manufacture (imperfect focusing of the lead septa).
 The use of grids necessitates increased radiographic exposure for the same film density,
because of the removal of some of the direct rays and most of the scatter.

Contrast Improvement Factor =

contrast with a grid / contrast without a grid
It equals typically between 3 & 5

Dr. Islam Abo Shady 13

  It is the ultimate test for grid performance → measure the ability of the grid to improve
contrast.
 Depends on:
1. Grid ratio (↑ grid ratio → ↑ contrast improvement factor)
2. Factors affecting the relative amount of scatter produced (& so Contrast),mainly
kVp, field size & patient thickness.

SELECTIVITY AND SPEED

The two tasks of a grid - to transmit primary radiation and absorb scattered radiation
-may be judged by its SELECTIVITY & SPEED:

Selectivity = Fraction of primary radiation transmitted /

Fraction of scattered R transmitted
Typically range from 6 ‐ 12, depending on the grid ratio and tube kV.

Speed or exposure factor = Exposure necessary with a grid /

Exposure necessary without a grid
It is also called 'Grid / Bucky factor'& typically equals 3 ‐ 5
Bucky factor is a practical measure which indicates how much the exposure factors must
be increased when we change from non-grid to a grid technique → so, it also shows how
much the patient exposure is increased.
Bucky factor is a measure of the total quantity of radiation absorbed from an X-ray beam
by a grid & so, in part, the ability of the grid to absorb scatter radiation.

Factors affecting the grid factor:

1. High-ratio grids absorb more scatter radiation & have larger bucky factor than low-
ratio grids.
2. ↑↑ beam energy "i.e. ↑ kV" → ↑ scatter radiation → needs a higher-ratio grids.
The high bucky factor have desirable & undesirable aspect:
Desirable as regarding the film quality.
Undesirable as regards the exposure factor & patient dose.
Both GRID FACTOR and CONTRAST IMPROVEMENT FACTOR depends on kV →
both decrease as kV increases
While, THE GRID RATIO doesn't have anything to do with kV.
MCQ: The contrast improvement factor of a typical grid is 2–4

N.B.:
 1ry transmission indicates only the amount of 1ry radiation absorbed by a grid.
 Bucky factor indicates the absorption of both 1ry & 2ry radiation.’

Dr. Islam Abo Shady 14

Precautions of using grids & grid cut-off:
(a) The primary disadvantage of grids is that they increase the amount of radiation
neededfor an exposure & so increase the amount of radiation to the patient.
(b) The grid must be used at a specified distance from the anode.
 Unfocused grids, in which the strips are completely parallel, may be used at
anyfocus distance but suffer severely from cut-off.
 The effect can be reduced by using a longer FFD or a grid with a lower grid ratio.
(c) The tube must be accurately centered over the grid.
The grid must not be tilted; otherwise CUT-OFF of the primary rays will occur.
GRID CUT-OFF:
Occurs due to: improper positioning of the grid device
1- Off level: Tilting the grid (non-perpendicular direction to the incident x-ray beam)
2- Off center: Not centering the grid to the x-ray beam central axis
3- Off focus: Using focused grid outside the specified focal range
4- Placing focused grid upside down (converging geometry is directed opposite of
the focal spot).

Grid-front cassette
Special X-ray cassettes with a grid build into the front of the cassette.
Used for portable radiography.
Most are focused with a low grid ratio (4:1 or 8:1) & long focal distance "focusing
range"
MCQ: Using a lead backed cassette   Compton scatter and  photoelectric effect

Dr. Islam Abo Shady 15

Limitations Of The X-Ray Tube
There are two important limiting factors in imaging with X-rays:
1. The dose of radiation delivered to the patient, and
2. The heat which inevitably accompanies the production of X-rays.
If heat accumulate in X-ray tube → shorten or damage the tube.

FOCAL SPOT (TARGET / FOCUS / FOCAL POINT) SIZE

 Not all of the anode is involved in x-ray production. The radiation is produced in a very
small area on the surface of the anode known as the focal spot.
 Actual focal spot is the area of the tungsten target bombarded by electrons from the
cathode→ the area over which heat is produced and which determines the tube rating
 Effective focal spot: the area of the focal spot that is projected out of a tube
 The size and shape of the actual focal spot are determined by the size and shape of the
electron stream when it hits the anode.
 The size and shape of the electron stream are determined by
1) dimensions of the filament tungsten wire coil
2) construction of the focusing cup
3) position of the filament in the focusing cup.
The problems posed by
1) The need for a large focal spot to allow greater heat loading.
2) The conflicting need for a small focal area to produce good radiographic detail, as
larger focal area will lead to blurring of the image "geometrical blurring".

Focal spot size is one factor that must be considered when selecting an x-ray tube for a
specific application. Tubes with small focal spots are used when high image visibility of
detail is essential and the amount of radiation needed is relatively low because of small
and thin body regions as in mammography.

The line focus principle → the surface of target is inclined so that it forms an angle with the
plane  to incident beam.

Dr. Islam Abo Shady 16

  The target anode angle = 6 - 20°.
 This angulation makes the effective 'or apparent' focal spot foreshortened & is
considerably smaller than that of the actual focal spot & is square in shape.
This makes the focal spot blurring small and fixed whatever the orientation of a
structure.
 The effective focal spot varies across the film → elongated from the cathode side of the
film & contracted from the anode side.

 Angle θ → the angle between the central ray and the target face
 The size of the projected focal spot is directly related to the sine of the angle of the
anode.
The smaller the angle of the anode, the smaller the apparent focal spot
🟉 There is a limit to which the anode angle can be decreased as dictated by the heel effect
(the point of anode cutoff).

MCQ: For general diagnostic radiography done at a 40-inches focus-film distance (1 m), the anode angle
is usually no smaller than 15°.
MCQ: The focal spot size increases with as increase in the tube current … due to Blooming.
MCQ: The effective focal spot is governed by:
a. the target size (F).
b. the applied kV (T).

 Focal spot size is expressed in terms of the apparent / projected / effective focal spot;
sizes of 0.3, 0.6, 1.0, and 1.2 mm are commonly employed.
 Usually, an X-ray tube has two filaments and two focal spots of different sizes which
are selected from the control panel.
 The smaller focal spot is selected where small fields are needed & for better resolution
"in mammography and in cineradiography with a small field image intensifier" and the
larger one for thicker parts of the body where a greater intensity of X-rays is needed "in
general radiography using large films"

Dr. Islam Abo Shady 17

Regarding focal spot:

 The focal spot size can limit the spatial resolution "geometric unsharpness", depends on the
location of the object in the source-to-detector direction.
 The resolution impact of the focal spot increases with geometric magnification, i.e.increasing
distance between the object and the film or detector if FFD is fixed.
Thus, a small focal spot is desired in order to optimize spatial resolution.

 The focal spot size also sets the upper limit on X-ray tube current or output rate (heatloading).
 If an X-ray tube is operating at its instantaneous power limit, decreasing the size of thefocal spot will
require a decrease in the tube current (radiation output).
 There is a trade-off between spatial resolution due to the size of the focal spot & imagenoise in a
fixed exposure time due toTypical
the decreasedeffective focal
X-ray intensity sizestime.
and imaging (mm)
Macromammography 0.1
Mammography 0.3
Macroradiography 0.3
Radiography 0.6-1.2
Fluoroscopy 0.6
MCQ: X-ray output DOES NOT depend on focal size, only sharpness and effective field of view do.
 The focal spot is shorter when measured at the anode side than cathode side.
 A small focal spot means a sharp image
 As focal spot increase   local heating of X-ray tube /  geometrical unsharpness.
 Measured by  Pinhole camera : for actual focal spot size
 Star test object: measure resolving capacity of focal spot.
 The effective focal spot is governed by:
- Target angle (not target size)
- Line focus principle
- Filament size
- Applied KV
Dr. Islam Abo Shady 18
 Target angle  angle between the target surface and the central beam.
  the anode angle  actual focal spot size
 Typical size of focal spot in general radiography is 1 mm.
 Focal spot size has no effect on contrast.
BLOOMING
 Def  unwanted increase in focal spot size which occurs when the tube is operated
at high mA. Occurs particularly at low kV values and with small focal spots.
 Occurs because the negative charge of the focusing cup is less effective, so electrons
emitted from the filament are not well focused in a regular beam → hit a larger area
> actual focal spot.

Rotating Anode:
 Rotating anode is used to produce x-ray tubes capable of withstanding the heat
generated by large exposures.
 The anode of a rotating anode tube consists of a large disc of tungsten or an alloy of
tungsten "tungsten-rhenium alloy" → better thermal characteristics than pure
tungsten and does not roughen with use as quickly.
 Typical disc diameters measure 75, 100, or 125 mm.
The diameter of the tungsten disc determines the total length of the target track→
affects the maximum permissible loading of the anode.
Any area of the tungsten disc is found opposite the electron stream only once every 1/60
sec & during the remainder of the time heat generated during the exposure can be
dissipated.
 The tungsten disc has a beveled edge. The angle of the bevel may vary from 6 to 20°.
The bevel is used to take advantage of the line focus principle.
 The purpose of the rotating anode is to spread the heat produced during an exposure
over a large area of the anode while the apparent or effective focal spot size has
remained the same.

MCQ: In X-ray tube, a rotating anode:

a. Results in a large focal spot (F) … No difference in size of focal spot.
b. Reduces heat input to the X-ray tube (F).
c. Is constructed from molybedenum with a tungsten target (F).
d. Heat is removed from the anode mainly by thermal conduction (F).
e. Heat is removed more efficiently when a low current is used (F) … High current.

Dr. Islam Abo Shady 19

Heat Production:

Heat loading:
measure of amount of energy deposited during an exposure
The heat loading of an X-ray tube (calculated in joules or heat unit HU)
= kV x mAs for a constant potential (three phase).
= 0.7 x kV x mAs for a pulsating single-phase generator.
Heat capacity:
A higher heat capacity means the temperature of the material rises only a small amount with
a large increase in heat input.
Temperature rise = energy applied / heat capacity

Heat (Tube) rating: Maximum allowable power (kV and mA) that can be used for a given
exposure time (0.1 sec) before the system overloads.
Each machine has a different capacity for dissipating heat before damage is caused. The
capacity for each focal spot on a machine is given in tube rating graphs provided by the
manufacturer.
Remember, heat rating is different from tube to tube, heat capacity is fixed
Heat loading (opposite of) Tube rating / Heat rating

Single radiographic exposure:

 In order to 'freeze' and display movement, individual exposures should be as short
as the heating of the X‐ray tube permits.
 Any combination of kV, mA, and exposure time should be such that, at end of the
exposure, the temperature of the anode does not exceed its safe value, i.e. there should
be no risk of the target melting, vaporizing or roughening.

Dr. Islam Abo Shady 20

  Factors affecting tube rating:
 Decreases as the exposure time is increased.
 Decreases as the kV is increased.
 Increases with the effective focal spot size (because increase effective focal
spot means increase actual focal spot for a fixed anode angle).
 Increases with smaller target angles for a fixed effective focal spot.
 Greater for a rotating than a stationary anode.
 Greater for a 10 cm disk than a 7 cm disk.
 Greater for a high‐speed anode.
 Greater for a three‐phase constant potential than for a single‐phase pulsating
potential (because the former produces heat more evenly throughout the
exposure).
The foregoing information is stored on a microprocessor in the control circuit which
prevents any exposure being made which would exceed the rating of the tube.
MCQ: Heat radiation to the insulating oil is the main method for heat dissipation. This is aided by blackening
the anode surface. This loss of heat by radiation increases as the temperature of the anode increases. Heat
loss is proportional to Temp 4 (Kelvin).
MCQ: Heat produced in the focal spot is transferred to the glass envelope by convection (F) … It cannot be
transferred between the anode and glass by convection as the tube is evacuated.
MCQ: The thermal rating of X-ray tube:
a. Is limited by the maximum allowable filament current at high kV (F).
b. Is, with respect to multiple exposures, dependent on the weight of the anode (T).
c. During screening, the heat capacity of the tube housing limits max tube current at a given kVp (F) …
Anode.
d. At very short exposures, 3-phase rectified tube are rated higher than full wave rectified tube (T).
e. When multiple short exposures are taken, more heat may arise from the anode motor than from X-
ray production (T).
f. Decreases as the kV is increased (T) … As kV increase, mAs is decreased. The higher mAs used, the
more effective heat removal is.

Repeated radiographic exposures:

 To display movement, e.g. angio‐ or cineradiography, a rapid series of exposures is
made.
 Each exposure must be sufficiently short & within the rating of the focal area.
 For repeated exposures → depends also on the ability of the anode assembly and the
oil to accumulate heat → both not allowed to exceed its maximum safe temperature.

 The rapidity with which a series of such exposures can be made depends on:
a) The maximum amount of heat that can be temporarily stored in the anode in
particular & the tube housing as a whole; and
b) The rate at which they lose heat by cooling.
Dr. Islam Abo Shady 21
  The heat storage capacity of the anode may be increased by soldering to the back of
the tungsten plate a disk of molybdenum and/or solid graphite (both have a higher
heat capacity per unit mass than tungsten).
 Microprocessor in control circuit calculates the max. total number of exposures
allowed.
 If the anode heat capacity (typically 0.2 MJ) has been reached → need at least 15 min
to cool down completely;
& the entire assembly (typical heat capacity 1.0 MJ) may need an hour.

Continuous operation (fluoroscopy):

 Heat must be removed at the same rate as it's produced from the housing "not allowed
to accumulate in the oil".
 The rating depends only on the cooling rate (and whether or not the fan is on) and
NOT at all on the focal spot size or the type of generator.
 In fluoro, the anode is stationary or rotating at reduced speed, to ↓ bearing
wear.
Other ratings:
 Maximum kV also depends on the insulation of the tube, cables, etc.
 Maximum mA → is low at a low kV than at a high kV (d.t. 'space charge effect').
N.B. allowable mA (tube rating) is low at high kV.
Anode cooling chart:
As well as withstanding high temperatures an anode must be able to release the heat quickly
too. This ability is represented in the anode cooling chart. It shows how long it takes for the
anode to cool down from its maximum level of heat and is used to prevent damage to the
anode by giving sufficient time to cool between exposures.
THE HEEL EFFECT
The intensity of the x-ray beam that leaves the x-ray tube is not uniform but
depends on the angle at which the x rays are emitted from the focal spot.
 Mechanism:
 Electrons penetrate a few micrometers
into the target before being stopped →
so; the X-rays produced are attenuated
and filtered by the target material on
their way out.
 X-rays traveling toward the anode edge
of the field have more target material to
cross → attenuated more than those
traveling toward the cathode edge →
the intensity of the beam  toward the
anode end of the fields

(Less importantly, the HVL increases because of the

filtration effect).

Dr. Islam Abo Shady 22

Factors affecting the heel effect:
1. Anode angle: the steeper the target → ↑↑ heel effect.
2. FFD: ↑↑ FFD → ↓↓ heel effect "with fixed film size" (because only the central ,
more uniform part of the beam is used)
3. Film size: ↓↓ film size → ↓↓ heel effect "with fixed FFD".
4. Roughening of the target surface → ↓↓ X-rays output & ↑↑ the heel effect.
 In radiographs of body parts of different thicknesses → the thicker parts
should be placed toward the cathode (filament) side of the x-ray tube.

MCQ:
Heal effect
 Only occurs along the anode cathode line (axis)  occurs in direction parallel to anode cathode axis
 Variation in beam attenuation  beam change in hardness (quality) and intensity (quantity)
 It is more noticeable at low KVp, as photons are less penetrating & the differences in attenuation on the
cathode anode side are more pronounced.
 It is useful in spine radiographs.
 Used in mammography  higher beam intensity on cathode side is directed towards chest wall where
greater penetration is required.

 Some compensation of heal effect can be achieved by tilted / wedge filters.

 Is due to attenuation of electrons in the target material (F) … It is due to attenuation of X-ray photons
produced by the target material.
 It is more noticeable at low kVp, as the photons are less penetrating and the differences in attenuation on
the cathode and anode sides are more pronounced.
 Results in higher mean energy spectrum of the beam on the anode side compared to the cathode side …
Because photons penetrating through the target material in addition to attenuation also undergo filtration

Dosimetry:
- Tube KV  tested by: digital KV meter
-Tube output  tested by: ionization chamber or solid state detectors
-Tube filtration  tested by: HVL
-Light beam diaphragm alignment should be checked every 1-2 m.

Dr. Islam Abo Shady 23

Dual energy radiography:
 Based on the differences in the degree to which different tissues attenuate high & low
energy photons.
 Most commonly used in chest imaging.
 In chest radiography, tube potentials of 60 & 120 KV are used.
 It requires slightly high radiation dose than conventional radiography.
 May be used to produce selective tissue images (eg. Bone / soft tissue) by subtracting
images obtained at high & low KVp.
 Dual exposure system produces selective tissue images with better S/N ratio than
single exposure system.
 Prone to misregistration artefact.
 Helps defect Ca+ within soft tissue structures.
 3 images are typically produced for reporting (unsubstracted image / selective soft
tissue image / selective bone image).

MCQ: Subtraction of the high kV image from the low kV image will improve detection of calcified structures
(calcified lung nodule) … not the opposite.
MCQ: Dual-energy radiography always requires two separate exposures (F) … This is true for dual-exposure
systems that obtain two radiographs sequentially at different kVp. There are also single-exposure systems
where two image plates divided by a copper filter (‘sandwiched detectors’) are simultaneously exposed, with
the back detector receiving filtered, higher energy photons.
MCQ: In dual-exposure systems for chest radiography, tube potentials of 60 and 120 kV are usually used
MCQ: Dual-exposure systems produce selective tissue images with a better signal-to-noise ratio than single-
exposure systems

Dr. Islam Abo Shady 24