BM8702

RADIOLOGICAL EQUIPMENTS
 UNIT- 1 MEDICAL X-RAY EQUIPMENT

Introduction to the nature of X-Rays

• X rays were discovered on November 8, 1895 by Wilhelm C. Rontgen, a physicist at the
University of Wurzburg in Germany. He named his discovery “x rays” because “x” stands
for an unknown quantity. For this work, Rontgen received the first Nobel Prize in Physics
in 1901.
• Rontgen was not the first to acquire an x-ray photograph. In 1890 Alexander Goodspeed
of the University of Pennsylvania, with the photographer William Jennings, accidentally
exposed some photographic plates to x rays.
• They were able to explain the images on the developed plates only after Rontgen
announced his discovery of x rays. Invisible rays given off from Roentgen’s experiment
could penetrate a human hand and project a skeletal image onto a fluorescent screen.
• Later, he substituted photographic film to make permanent record. Since then, scientists
have discovered X-rays are a type of electromagnetic radiation.
• X-rays are electromagnetic radiation located at the low wavelength end of the
electromagnetic spectrum.
• The X-rays in the medical diagnostic region have wavelength of the order of 10-10m. They
travel with a speed of 3x1010 cm/s. their interaction with matter involves an energy
exchange and the relation between the wavelength and the photon is given by
E = hν = h ࢉ
ࣅ
-34
• Where h = Planck’s constant = 6.32 x 10 Js
c = velocity of propagation of photons = 3 x 1010 cm/s
ν = frequency of radiation
ߣ = wavelength
• To produce medical images with x-rays, a source is required that:

Produces enough x rays in a short time

Allows the user to vary the x-ray energy

Provides x rays in a reproducible fashion

Meets standards of safety and economy of operation

• In x-ray tubes, bremsstrahlung and characteristic x rays are produced as high-speed

electrons interact in a target. While the physical design of x-ray tubes has been altered
significantly over a century, the basic principles of operation have not changed.

• Early x-ray studies were performed with a cathode ray tube in which electrons liberated
from residual gas atoms in the tube were accelerated toward a positive electrode (anode).

• These electrons produced x rays as they interacted with components of the tube. The
cathode ray tube was an unreliable and inefficient method of producing x rays.

• In 1913, Coolidge improved the x-ray tube by heating a wire filament with an electric
current to release electrons.

• The liberated electrons were repelled by the negative charge of the filament (cathode) and
accelerated toward a positive target (the anode).

• X rays were produced as the electrons struck the target. The Coolidge tube was the
prototype for “hot cathode” x-ray tubes in wide use today. Heating a filament to release
electrons is called thermionic emission or the Edison effect.
 • X-rays have a number of useful physical characteristics / properties:

X-rays act like waves when traveling through space.

X-rays act like particles when interacting with matter.

They travel in straight lines. Therefore, X-rays cannot go around the corners.

X-rays diverge from a point source.

X-rays are unaffected by electric and magnetic fields.

X-rays travel at the speed of light.

They can penetrate matter which readily absorb and reflect visible light.

They are absorbed differently when passing through matter, the extent of which
depends upon the density.

They cause ionization at the molecular level.

They cause certain materials to fluoresce (give off light) which enables one to
record image.

X- Ray Absorption- Tissue Contrast

• In some radiologic examinations a substance can be introduced into the body to enhance
tissue contrast.
• This substance, termed a contrast agent (or contrast medium or dye), is selected to provide
a signal different from that of the surrounding tissues.
• In angiography, a water-soluble agent containing iodine is injected into the circulatory
system to displace blood and thereby enhance the contrast of blood vessels by increasing
the attenuation of x rays impinging on the vessels.
• This technique can be further distinguished as arteriography or venography, depending on
which side of the circulatory system the injection is made.
• The iodine attenuates x rays strongly because its K-absorption edge of 33 keV is ideally
positioned with respect to the energy distribution of x rays typically employed for
diagnosis. Several other types of contrast agents are used in diagnostic imaging.
• For example, a contrast agent can be used to displace the cerebrospinal fluid in studies of
the central nervous system. For studies of the spinal cord, the contrast agent may be “ionic”
or “nonionic,” and the procedure is termed “myelography.”
 • Contrast agents are useful in computed tomography as well as in radiography. Iodine-
containing compounds are also helpful in studies of the kidneys and urinary tract, where
the applications are known as urography.
• Compounds containing barium are frequently used for radiographic examination of the
gastro intestinal tract, with the barium compound administered orally (barium swallows)
or rectally (barium enemas).
• Solutions containing dissolved “microbubbles” of carbon dioxide are sometimes employed
as contrast agents in ultrasound, and gadolinium and other substances are increasingly
being used as contrast agents in MRI because of their influence on the relaxation constants
of tissues.

X- Ray Equipment (Block Diagram)

• Basically there are two parts of the circuit. One of them is for producing high voltage,
which is applied to the tube’s anode and cathode and comprises a high voltage step-up
 transformer followed by rectification. The current through the tube follows the HT pathway
and is measured by an mA meter.
• A kV selector switch facilitates change in voltage between exposures. The voltage is
measured with the help of a kV meter. The exposure switch controls the timer and thus the
duration of the application of kV.
• To compensate for mains supply voltage (230V) variations, a voltage compensator is
included in the circuit.
• The second part of the circuit concerns the control of heating X-ray tube filament.
• The filament is heated with 6-12 V of AC supply at a current of 3-5 amperes. The filament
temperature determines the tube current or mA, and, therefore the filament temperature
control has an attached mA selector.
• The filament current is controlled by using, in the primary side of the filament transformer,
a variable choke or a rheostat. The rheostat provides a stepwise control of mA and is most
commonly used in modern machines.
• A preferred method of providing high voltage DC to the anode of the X-ray tube is by use
of a bridge rectifier using four solid state rectifiers.

BREMSSTRAHLUNG SPECTRUM

• The conversion of electron kinetic energy into electromagnetic radiation produces x-rays.
A large voltage is applied between two electrodes (the cathode and the anode) in an
evacuated envelope.
• The cathode is negatively charged and is the source of electrons. The anode is positively
charged and is the target of electrons.
• As electrons from the cathode travel to the anode, they are accelerated by the electrical
potential difference between these electrodes and attain kinetic energy.
• The kinetic energy gained by an electron is proportional to the potential difference between
the cathode and the anode.
• For example, the energies of electrons accelerated by potential differences of 20 and 100
kilovolt peak (kVp) are 20 and 100 keV; respectively.
• On impact with the target, the kinetic energy of the electrons is converted to other forms
of energy.
• The vast majority of interactions produce unwanted heat by small collisional energy
exchanges with electrons in the target.
• This intense heating limits the number of x-ray photons that can be produced in a given
time without destroying the target.
• Occasionally (about 0.5% of the time), an electron comes within the proximity of a
positively charged nucleus in the target electrode.
• Coulombic forces attract and decelerate the electron, causing a significant loss of kinetic
energy and a change in the electron's trajectory. An x-ray photon with energy equal to the
kinetic energy lost by the electron is produced (conservation of energy).
• This radiation is termed bremsstrahlung, a German word meaning "braking radiation."
• Coulombic force of attraction increases with the inverse square of the interaction distance.
At relatively "large" distances from the nucleus, the coulombic attraction force is weak;
these encounters produce low x-ray energies (Fig. 5-2, electron no. 3).
• For closer interaction distances, the force acting on the electron increases, causing a more
dramatic change in the electron's trajectory and a larger loss of energy; these encounters
produce higher x-ray energies (see Fig. 5-2, electron no. 2).
• A direct impact of an electron with the target nucleus results in loss of all of the electron's
kinetic energy (see Fig. 5-2, electron no. 1). In this rare situation, the highest x-ray energy
is produced.
CHARACTERISTIC X-RAY SPECTRUM

• Each electron in the target atom has a binding energy that depends on the shell in which it
resides. Closest to the nucleus are two electrons in the K shell, which has the highest
binding energy.
• The L shell, with eight electrons, has the next highest binding energy, and so forth. When
the energy of an electron incident on the target exceeds the binding energy of an electron
of a target atom, it is energetically possible to eject the electron and ionize the atom.
• The unfilled shell is energetically unstable, and an outer shell electron with less binding
energy will fill the vacancy.
• As this electron transitions to a lower energy state, the excess energy can be released as a
characteristic x-ray photon with energy equal to the difference between the binding
energies of the electron shells (Fig. 5-4).
• Binding energies are unique to a given element, and so are their differences; consequently,
the emitted x-rays have discrete energies that are characteristic of that element.
• For tungsten, an L-shell electron filling a K-shell vacancy results in a characteristic x-ray
energy:
EKshell- EL-shell= 69.5 keV - 10.2 keV = 59.3 keV
• Many electron transitions can occur from adjacent and nonadjacent shells in the atom,
giving rise to several discrete energy peaks.
• The most prevalent characteristic x-rays in the diagnostic energy range result from K-shell
vacancies, which are filled by electrons from the L, M, and N shells. Even unbound
electrons outside of the atom have a small probability of filling vacancies.
• The shell capturing the electron designates the characteristic x-ray transition, and a
subscript of α or β indicates whether the transition is from an adjacent shell (α) or
nonadjacent shell (β).
• For example, Kα refers to an electron transition from the L to the K shell, and Kβ refers to
an electron transition from M, N, or O shell to K shell.
X- Ray Tube
• X-rays are produced when highly energetic electrons interact with matter and convert their
kinetic energy into electromagnetic radiation. A device that accomplishes such a task
consists of

an electron source,

an evacuated path for electron acceleration,

a target electrode, and

an external energy source to accelerate the electrons.
• Specifically, the x-ray tube insert contains

the electron source and target within an evacuated glass or metal
envelope;

the tube housing provides shielding;

a coolant oil bath for the tube insert;

collimators define the x-ray field; and

generator, which is the energy source that supplies the voltage to
accelerate the electrons.
ELECTRON SOURCE
• A metal with a high melting point is required for the filament of an x-ray tube. Tungsten
filaments (melting point of tungsten 3370◦C) are used in most x-ray tubes.
• A current of a few amperes heats the filament, and electrons are liberated at a rate that
increases with the filament current. The filament is mounted within a negatively charged
focusing cup. Collectively, these elements are termed the cathode assembly.
• The focal spot is the volume of target within which electrons are absorbed and x rays are
produced.
• For radiographs of highest clarity, electrons should be absorbed within a small focal spot.
• To achieve a small focal spot, the electrons should be emitted from a small or “fine”
filament. Radiographic clarity is often reduced by voluntary or involuntary motion of the
patient.
• This effect can be decreased by using x-ray exposures of high intensity and short duration.
However, these high-intensity exposures may require an electron emission rate that
exceeds the capacity of a small filament.
• Consequently many x-ray tubes have two filaments. The smaller, fine filament is used
when radiographs with high detail are desired and short, high-intensity exposures are not
necessary.
• If high-intensity exposures are needed to limit the blurring effects of motion, the larger,
coarse filament is used.
CONVENTIONAL X-RAY TUBES

• A heated filament releases electrons that are accelerated across a high voltage onto a target.
The stream of accelerated electrons is referred to as the tube current.
• X rays are produced as the electrons interact in the target. The x rays emerge from the target
in all directions but are restricted by collimators to form a useful beam of x rays.
• A vacuum is maintained inside the glass envelope of the x-ray tube to prevent the electrons
from interacting with gas molecules.
• The filament is constructed from a spiral of tungsten wire which is set in nickel block. This
block supports the filament and is shaped to create an electric field that focuses the
electrons into a slit beam.
• The anode has a beveled edge, which is at a steep angle to the direction of the electron
beam. The exit window accepts x-rays that are approximately at right angles to the electron
beam.
• The choice of anode angle will depend on the application. For general purpose, an angle
of about 17˚ is used. A rotating speed of about 3000 RPM and an anode diameter of about
10cm are used in general purpose units.
• The anode is usually constructed from tungsten which has an atomic number of 74,
acceptable thermal conductivity, thermal capacity and high melting point.
• The high atomic number is because the bremmstrahlung yield from the target increases
with atomic number and the x-ray spectrum from an element of high atomic number is well
suited to imaging thicker body sections. Improved life time can be obtained by using a
90/10 tungsten/rhenium alloy.
• This reduces the crazing of the anode surface by the continual heating and cooling process
to which it is subjected. A larger anode disc will have a higher rating and a shorter exposure
time and the greater thermal capacity associated with an increase in anode volume will
allow the possibility of a shorter time interval between exposures.
• The anode disc is mounted on a thin molybdenum stem. This reduces heat flow backward
and prevents the rotor bearings, which are made of copper, from overheating. The heat loss
from the rotating anode is mainly radiative.
• Anode heel effect refers to the intensity of the x-ray beam, produced from the x-ray tube,
which is not uniform in all portions of the beam. In general, the beam consists of a central
ray and a diverging beam.
 • The rays towards the cathode end of the tube have more intensity. This is because, in a
diverging beam, the rays which are parallel or near parallel to the inclined/angulated anode
get absorbed by the anode itself.
• Intensity of beam on anode side is less than cathode side -therefore place the thicker
part of body on cathode side, e.g. upper thoracic on anode side and lower thoracic or upper
abdomen should be placed on cathode side.
• Target-to-film distance - increase in distance reduces heel effect.
• Size of film (keeping target-to-film distance as constant)- smaller film has lesser heel effect
as the divergent beam does not reach the film and intensity of beam is more uniform at
centre than at the periphery.
• Line focus principle explains the relationship between the anode surface and the
effective focal spot size. A large focal spot is useful to protect the tungsten target as the
heat accumulates and dissipates within the area of focal spot. However, a small focal spot
is required to achieve a good radiographic image quality.
• Thus the line focus principle helps resolve this issue by stating that an angulation of the
anode surface will result in an apparent decrease in the focal spot size.
• The apparent focal spot (projected focal spot) size can be determined by sine of the angle
of the anode surface (apparent focal spot size = real focal spot size * sin anode angle). The
angle varies as per tube design with a range value of 6 degrees to about 20 degrees.

TUBE VOLTAGE AND VOLTAGE WAVEFORMS

 • The intensity and energy distribution of x rays emerging from an x-ray tube are influenced
by the potential difference (voltage) between the filament and target of the tube. The source
of electrical power for radiographic equipment is usually alternating current (ac).
• This type of electricity is by far the most common form available for general use, because
it can be transmitted with little energy loss through power lines that span large distances.
• X-ray production is most efficient (more x rays are produced per unit time) if the potential
of the target is always positive and if the voltage between the filament and target is kept at
its maximum value.
• In most x-ray equipment, ac is converted to direct current (dc), and the voltage between
filament and target is kept at or near its maximum value. The conversion of ac to dc is
called rectification.

FILTRATION

• An x-ray beam traverses several attenuating materials before it reaches the patient,
including the glass envelope of the x-ray tube, the oil surrounding the tube, and the exit
window in the tube housing.
• These attenuators are referred to collectively as the inherent filtration of the x-ray tube. The
aluminum equivalent for each component of inherent filtration is the thickness of
aluminum that would reduce the exposure rate by an amount equal to that provided by the
component.
• The inherent filtration is approximately 0.9 mm Al equivalent, with most of the inherent
filtration contributed by the glass envelope.
• The inherent filtration of most x-rays tubes is about 1 mm Al. Inherent filtration is also
referred to as intrinsic filtration.
• Mammography x-ray tubes often employ exit windows made of beryllium to allow low-
energy x-rays to escape from the tube. Low-energy x rays are attenuated to a greater extent
than those of high energy.
• After passing through a material, an x-ray beam has a higher average energy per photon
(that is, it is “harder”) even though the total number of photons in the beam has been
reduced, because more low-energy photons than high-energy photons have been removed
from the beam.
 • The inherent filtration of an x-ray tube “hardens” the x-ray beam. Additional hardening
may be achieved by purposefully adding filters of various composition to the beam.
• The total filtration in the x-ray beam is the sum of the inherent and added filtration.
Usually, additional hardening is desirable because the filter removes low-energy x rays
that, if left in the beam, would increase the radiation dose to the patient without contributing
substantially to image formation.
• An x-ray beam of higher average energy is said to be “harder” because it is able to penetrate
more dense (i.e., harder) substances such as bone.
• An x-ray beam of lower average energy is said to be “softer” because it can penetrate only
less dense (i.e., softer) substances such as fat and muscle.

Power Supply
 • Several x-ray generator circuit designs are in common use, including single-phase, three-
phase, constant potential, and medium/high-frequency inverter generators.
• All use step-up transformers to generate high voltage, step-down transformers to energize
the filament, and rectifier circuits to ensure proper electrical polarity at the x-ray tube.
• The filament circuit consists of a step-down transformer, a variable resistor network (to
select precalibrated filament voltage/current values), and a focal spot size selector switch
to energize either the large or the small filament.
• A selectable voltage, up to about 10 V, creates a current, up to 7 A, that heats the selected
filament and causes the release of electrons by thermionic emission.
• Calibrated resistors control the filament voltage (and therefore the filament current, and
ultimately the tube current).
• Voltages in the range of 30-200 kV are required for the production of X-rays for diagnostic
purpose, and they are generated by high voltage transformer.
• High voltage generation by self rectified circuit (one pulse) is used in mobile and dental
X-ray units. They have a maximum tube current of about 20 mA and a voltage of about
100 kV.

Bucky Grid
• Information is transmitted to an x-ray film by unattenuated primary radiation emerging
from a patient. Radiation scattered within the patient and impinging on the film tends to
conceal this information by producing a general photographic fog on the film.
• The amount of radiation scattered to a film increases with the volume of tissue exposed to
the x-ray beam. Hence a significant reduction in scattered radiation may be achieved by
confining the x-ray beam to just the region of interest within the patient.
• In fact, proper collimation of an x-ray beam is essential to the production of radiographs of
highest quality.
• Much of the scattered radiation that would reduce the quality of the radiographic image
may be removed by a radiographic grid between the patient and the x-ray film or screen-
film combination.
• A radiographic grid is composed of strips of a dense, high-Z material separated by a
material that is relatively transparent to x rays.
 The first radiographic grid was designed by Bucky in 1913. The septa (grid bars) are
usually made of lead, whereas the openings (interspaces) between the bars can be made of carbon
fiber, aluminum, or even paper.

TYPES OF GRID

• Radiographic grids are available commercially with “parallel” or “focused” grid strips in
either linear or crossed grid configurations (Margin Figures 13-17).
• When a focused grid is positioned at the correct distance from the target of an xray tube,
lines through the grid strips are directed toward a point or “focus” on the target.
• The focus-grid distance approaches infinity for a grid with parallel strips. With a parallel
grid positioned at a finite distance from an x-ray tube, more primary x rays are attenuated
along the edge of the radiograph than at the center.
• The uniformity of optical density is improved in a radiograph exposed with a focused grid,
provided that the grid is positioned correctly.
• The single most important parameter that influences the performance of a grid is the grid
ratio. The grid ratio is simply the ratio of the height to the width of the inters paces (not
the grid bars) in the grid.
• Grid ratios of 8: 1, 10: 1, and 12: 1 are most common in general radiography, and a grid
ratio of 5: 1 is typical in mammography.
• The grid is essentially a one-dimensional collimator, and increasing the grid ratio increases
the degree of collimation.
• Higher grid ratios provide better scatter cleanup, but they also result in greater radiation
doses to the patient.

• The selectivity of a grid is the ratio of primary to scattered radiation transmitted by the
grid.
• The efficiency of a grid for removing scattered radiation is described occasionally as grid
cleanup. Grids may be described as “heavy” or “light,” depending upon their lead content.
• The Bucky factor is the ratio of the entrance exposure to the patient when the grid is used
to the entrance exposure without the grid while achieving the same film density.
 • Bucky and Potter developed the moving grid, referred to as the Potter–Bucky
Potter diaphragm,
which removes the distracting image of grid strips by blurring their image across the film.

• The motion of the grid must not be parallel to the grid strips and must be rapid enough to
move the image of a number of strips across each location in the film during exposure.

• The motion of the grid must be adjusted to prevent synchronization between the position
of the grid strips and the rate of pulsation of the x-ray beam.

• The direction of motion of the grid changes very rapidly at the limits of grid travel, and the
“dwell time” of the grid at these limits is insignificant.

• Rhombic crossed grids used in “super-speed recipromatic diaphragms” provide excellent

removal of scattered radiation with no image of the grid strips in the radiograph.

Collimators
• The collimator of a scintillation camera forms the projection image by permitting xx- or
gamma-ray
ray photons approaching the camera from certain directions to reach the crystal
while absorbing most of the other photons.
• Collimators are made of high atomic number, high-density materials,
materials usually lead.
• The most commonly used collimator is the parallel-hole collimator, which contains
hole collimator
thousands of parallel holes. The holes may be round, square, or triangular; however, most
state-of the-art
art collimators have hexagonal holes and are usually made from lead foil,
although some are cast. The partitions between the holes are called septa.
• The septa must be thick enough to absorb most of the photons incident upon them. There
is an inherent compromise between the spatial resolution and efficiency (sensitivity) of
collimators.
• Modifying a collimator to improve its spatial resolution (e.g., by reducing the size of the
holes or lengthening the collimator) reduces its efficiency.
• The size of the image produced by a parallelhole collimator is not affected by the distance
of the object from the collimator. However, its spatial resolution degrades rapidly with
increasing collimator-to-object distance.
• A pinhole collimator is commonly used to produce magnified views of small objects, such
as the thyroid or a hip joint.
• It consists of a small (typically 3- to 5-mm diameter) hole in a piece of lead or tungsten
mounted at the apex of a leaded cone.
• The magnification of the pinhole collimator decreases as an object is moved away from the
pinhole.
• If an object is as far from the pinhole as the pinhole is from the crystal of the camera, the
object is not magnified and, if the object is moved yet farther from the pinhole, it is
minified.
• These are pitfalls in the use of pinhole collimators due to the decreasing magnification with
distance. For example, a thyroid nodule deep in the mediastinum can appear to be in the
thyroid itself. Pinhole collimators are used extensively in pediatric nuclear medicine.
• A converging collimator has many holes, all aimed at a focal point in front of the camera.
The converging collimator magnifies the image. The magnification increases as the object
is moved away from the collimator.
• A diverging collimator has many holes aimed at a focal point behind the camera. It
produces a minified image in which the amount of minification increases as the object is
moved away from the camera.
• A diverging collimator may be used to image a large portion of a patient on a small (25-
cm diameter) or standard (30-cm diameter) field-of-view (FOV) camera.
Digital Radiography
• Digital radiographic image receptors are gradually replacing screen-film cassettes as
radiology departments convert to an all-digital environment. Digitally formatted images
would permit digital storage, retrieval, transfer and display of X-ray images with vast
possibilities of image-related processing and manipulations.
• Digital X-ray imaging systems consist of the following two parts:
i. X-ray imaging transducer or data collection
ii. Data display, storage and processing.
• The digitally compatible X-ray imaging transducers can be divided into the following two
categories:
i. Image intensifier
ii. Radiographic systems

Discrete Digital Detectors

• The use of an array of detectors is routine for ultrasound and computed tomography (CT).
The exquisite information density of film avoided the need for such devices in radiography
until imaging demands that required digital techniques were identified.
• These demands include increased dynamic range, simultaneous viewing at multiple
locations, and the use of digital image processing and enhancement. These newer demands
have recently begun to be matched by technologic capabilities.
• A number of discrete detectors that produce electronic signals that are easily digitized have
been used, including fluorescent crystals such as sodium iodide and bismuth germanate,
photodiodes, and various semiconductor devices.
• The idea of individual detectors or groups of detectors intercepting narrowly collimated x-
ray beams for the purpose of reducing the influence of scattered photons on image
formation has been exploited in the form of line (slit) scanning and point scanning systems.
• The problem of dynamic range has been addressed in the technique of scanning
equalization radiography. This system incorporates a feedback mechanism in which the
magnitude of signals from the detector causes automatic adjustment of the output of the x-
ray tube.
• The adjustment of tube output in a scanning equalization radiography system reduces the
range of exposure rates over which the detector must respond.
• Using detectors that can be read electronically in a matter of seconds eliminates the need
for trips to a processor (as is required with film and/or a charged-plate reader used for
computed radiography).
• Also, the possibility of rapid image processing—even just window and level
manipulation—yields an overall increase in the quality of the final images.
• Only recently have advances in the technology of fabrication and manufacture allowed the
production of large-area flat panel detectors that equal, or even surpass (at least in theory),
the performance of film-screen and computed radiography systems.
• The most important feature of flat panel detectors in this comparison is the higher
quantum efficiency for detection and conversion of x rays into digital signals with
acceptably low noise over a large exposure range.
• The two basic types of large-area flat panel x-ray detection systems, direct conversion
and indirect conversion.
• The objective of a digital detector in radiography is to convert the energy of x-ray photons
into electrical signals that signify the magnitude of the exposure in different pixels.
• In direct capture systems, the energy of the x rays is converted to an electrical signal in
a single layer of a material called a photoconductor. Various materials can be used to
construct photoconductors, including amorphous selenium, cadmium zinc telluride, and
lead iodide.
• When x-rays strike a photoconductor conversion plate, electron–hole pairs are created.
Electrical fields are applied between the front and back surfaces of the photoconductor to
force separation of the electron–hole pairs and their transfer to one of the charged surfaces.
• Each surface is a thin-film transistor (TFT) array, a grid of transistors that can be
interrogated electronically (“read out”) to determine the amount of electrical charge present
above each transistor.
• The TFT array corresponds to an array of pixels in the final image, with the number of
transistors equaling the number of pixels.
• Flat-panel detectors having pixel sizes on the order of 200 micrometers (2.5 lp/mm
resolution) are available for chest imaging, and a new generation of detectors with spatial
resolution in the 50- to 100-micrometer (5- to 10 lp/mm) range is becoming available for
mammography.
• In indirect conversion systems, a scintillation material converts the energy of the x-ray
photons to visible light. Scintillation materials used for this purpose include amorphous
silicon and cesium iodide.
• The pattern of visible light produced by the scintillation conversion plate can be read out
by a photoconductor fabricated to convert visible light to electrical signals.
 • Photoconductors used in indirect conversion systems include CCDs and materials such as
amorphous silicon coupled with a TFT array.
• An important feature of the newer generation of flat-panel detectors is their higher
detective quantum efficiency (DQE).
• DQE is a measure of the detection efficiency that includes the effects of noise as well as
resolution at various spatial frequencies.
• The DQE of current flat-panel digital detectors is over 65%, while that of computed
radiography storage phosphor systems is approximately 35%, and that of screenfilm
systems is approximately 25%.
• Because of the higher DQE, flat-panel detectors are expected to use radiation dose more
efficiently, and they could theoretically provide lower noise images over the range of
spatial frequencies encountered in medical imaging.

Storage phosphor
• Another approach to digital imaging is acquisition of the image on a continuous medium
that is specially designed to be digitized. Phosphors used in screen-film radiography, such
as Gd2O2S emit light promptly (virtually instantaneously) when struck by an x-ray beam.
• When x-rays are absorbed by photostimulable phosphors, some light is also promptly
emitted, but much of the absorbed x-ray energy is trapped in the PSP screen and can be
read out later. For this reason, PSP screens are also called storage phosphors or imaging
plates.
• In storage phosphor technology (also known as computed radiography [CR]) the image is
acquired on a plate containing crystals of a photostimulatable phosphor. A material such
as barium fluorobromide (BaFBr) is capable of storing the energy from an x-ray exposure.
• When exposed to a strong light source of the appropriate wavelength, the photostimulatable
phosphor re-emits the energy as visible light that can be detected by a photomultiplier tube.
• Thus the storage phosphor plate records a latent image that may be read out sometime after
x-ray exposure. The readout may be accomplished with a well-collimated intense light
source, such as a helium–neon laser beam, so that the size of the stimulated region of the
plate remains small to yield good resolution.
 • The electrical signals from the photomultiplier or other light-sensing device are digitized
with an analog-to- digital converter. Once the image is stored in digital form, it may be
viewed on a high-resolution monitor or printed out on film.

Processing steps:
1. The cassette is moved into the reader unit and the imaging plate is mechanically removed
from the cassette.
2. The imaging plate is translated across a moving stage and scanned by a laser beam.
3. The laser light stimulates the emission of trapped energy in the imaging plate, and visible
light is released from the plate.
4. The light released from the plate is collected by a fiber optic light guide and strikes a
photomultiplier tube (PMT), where it produces an electronic signal.
5. The electronic signal is digitized and stored.
6. The plate is then exposed to bright white light to erase any residual trapped energy.
7. The imaging plate is then returned to the cassette and is ready for reuse.

• One of the advantages of a stimulatable phosphor plate system over conventional film is
an improvement in dynamic range.
 • Radiographic film operates over possible exposures ranging from the exposure required to
reach the shoulder of the characteristic curve to that required to rise above the toe. This
range typically causes exposure differences of a factor of approximately 100.
• The dynamic range of a storage phosphor is on the order of 10,000. Thus the storage
phosphor has greater latitude (i.e., is more “forgiving”) if an incorrect exposure is used.
• To preserve the information contained within such a broad dynamic range, the analog-to-
digital converter must have a sufficient bit depth.
• A typical storage phosphor readout system is capable of digitizing a 2000 × 2000 pixel
matrix or greater, with each pixel taking one of 210 = 1024 possible values.
• The images may then be processed according to a number of possible gray-scale mapping
functions or simply windowed and leveled in a fashion similar to that used for magnetic
resonance and CT images.
• Image processing techniques may also be used to enhance the appearance of edges of
structures such as tubes in chest radiographs taken in intensive care units.
• Some of the advantages of storage phosphor or CR systems over conventional film-screen
approaches include the potential for reduction of patient exposure and the virtual
elimination of retakes due to improper technique.
• There is some advantage of the storage phosphor system over other digital radiographic
techniques in that the storage phosphor plate simply replaces the screen/film cassette and
does not represent a significant change in patient positioning or other imaging procedures.

Film Scanning

• Radiographic films may be digitized after they are acquired with conventional film/screen
systems. In a typical film digitizer, a laser beam is scanned across a film. The pattern of
optical densities on the film modulates the transmitted light.
• A light detector on the opposite side of the film converts the transmitted laser light to an
electrical signal that is digitized by an analog-to-digital converter.
• Spatial resolution of a film scanner is determined by spot size, defined as the size of the
laser beam as it strikes the film.
• Spot sizes down to 50 µm (50 × 10−6 m) are available, but most clinical systems use 100
µm or larger. Because the laser spot must be scanned across the entire area of the image, a
 decrease in the diameter of the spot size by a factor of 2 requires a scan time that is 4 ×
longer, if no other adjustments are made in the system.
• Commercially available laser film scanners have matrix sizes of at least 2000 × 2000 × 10
or 12 bits.

• A film scanner has the obvious advantage over other digital radiographic techniques in that
it does not disrupt routine imaging procedures.

• All procedures (e.g., technique, patient positioning, film development) are the same up to
the point of appearance of the developed radiograph.

• Compared with other digital techniques, disadvantages of a film scanner include its
inability to correct for large variations in film density or gray-scale mapping, the need for
handling individual sheets of film, and the time required for scanning.

X- Ray Image intensifier tubes

• The x-ray image intensifier “intensifies” or increases the brightness of an image through
two processes: (1) minification, in which a given number of light photons emanates from
a smaller area, and (2) flux gain, where electrons accelerated by high voltages produce
more light as they strike a fluorescent screen.
• This same principle is employed in “night vision” devices used by the military to observe
objects in low light conditions.
• X rays impinge upon a fluorescent screen (input screen) that is from 4 inches to greater
than 16 inches in diameter and slightly convex in shape. The fluorescent emulsion is a thin
layer of CsI (cesium iodide).
• Older image intensifier input screens were composed of ZnS:CdS (zinc cadmium sulfide).
• The principal advantage of CsI over ZnS:CdS:Ag is the increased absorption of x rays
because of the presence of higher-Z components in the CsI phosphor and because of the
increased packing density of CsI molecules in the phosphor granules.
 Cross section of a typical x-ray image intensifier tube

• For each x-ray photon absorbed, 2000 to 3000 photons of light are emitted by the screen.
• These light photons are not observed directly. Instead, the light falls on a photocathode
containing the element antimony (Sb), such as antimony cesium oxide (Sb-CsO).
• Light photons released in a direction away from the photocathode are reflected toward the
photocathode by a mirrored aluminium support on the outside surface of the input screen.
• If the spectral sensitivity of the photocathode is matched to the wavelength of light emitted
by the screen, then 15 to 20 electrons are ejected from the photocathode for every 100
photons of light received.
• The number of electrons released from any region of the photocathode depends upon the
number of light photons incident upon the region. The electrons are accelerated through a
potential difference of 25 to 35 kV between the photocathode and the anode of the image
intensifier tube.
• The electrons pass through a large hole in the anode and strike a small fluorescent screen
(output screen) mounted on a flat glass support. The emulsion on the output screen
resembles that for the input screen, except that the fluorescent granules are much smaller.
• Diameters of most output screens range from 1/2 in. to 1 in. Intensifiers with small output
screens are used for television fluoroscopy because the diameter of the input screen of a
television camera is small also.
• A coating of metal, usually aluminium, is deposited on the output screen to prevent the
entrance of
 light from outside the intensifier. The metallic layer also removes electrons accumulated
by the output screen.
• With an x-ray image intensifier, four different information carriers transmit information
about the patient to the radiologist. The x-ray beam transmits information from the patient
to the input screen of the image intensifier.
• At the input screen, the information carrier is changed from x rays to photons of visible
light. As the light photons are absorbed by the photocathode, the information is transferred
to an electron beam, which is directed upon the output screen of the intensifier. The
information is transmitted as a light image from the output screen to the observer’s retina.

Fluoroscopy
• Information about moving structures within a patient may be obtained with radiographs
exposed in rapid succession. However, the interval of time between serially exposed films
may be too great to provide complete information about dynamic processes within the
body. Consequently, a technique is required to furnish images that reflect near
instantaneous changes occurring in the patient. This technique is referred to as
fluoroscopy.
• In early fluoroscopic techniques, x rays emerging from the patient impinged directly on a
fluoroscopic screen. Light was emitted from each region of the screen in response to the
rate at which energy was deposited by the incident x rays.
• The light image on the fluoroscopic screen was viewed by the radiologist from a distance
of 10 or 15 in. A thin plate of lead glass on the back of the fluoroscopic screen shielded the
radiologist from x radiation transmitted by the screen.
• Using this fluoroscopic technique, the radiologist perceived a very dim image with poor
visibility of detail. Radiologists had to “dark adapt” their eyes by remaining in the dark for
extended periods in order to view the images.
• They emphasized the need for brighter fluoroscopic images and encouraged the
development of the image intensifier.
• Image intensifiers increase the brightness of the fluoroscopic image and permit the
observer to use photopic (cone) vision in place of the scotopic (rod) vision required with
earlier fluoroscopes. Because of the brighter images, dark adaptation is not required for
fluoroscopy with image intensification.
 • Although the image intensifier has increased the cost and complexity of fluoroscopic
systems, the use of non-image-intensified fluoroscopy has been outmoded for some time.

Digital fluoroscopy
• One technique for digital fluoroscopy is digitization of the signal from the video camera.
Other techniques, in which the video camera is replaced by a digital detector such as a CCD
camera or a flat-panel detector are becoming increasingly popular and are expected
ultimately to replace digitization of the video camera signal.
• There are a number of advantages to digital fluoroscopic techniques. First, the digital still-
frame image (digital photospot) serves as an alternative to the spot film (taken from a
cassette on the input side of the image intensifier) or the analog photospot image (taken on
105-mm film on the output side of the image intensifier).
• Digital photospots have the advantages of lower patient dose and the possibility of image
processing to enhance structures of interest.
• Second, the digital image may be used for various purposes in real-time fluoroscopy.
Another possible advantage of digital techniques in fluoroscopy is the ability to perform
“road mapping,” a digital frame store-and-display mode that retains the most recent
fluoroscopic image on the screen as an aid to the placement of catheters and guidewires for
interventional procedures.
• Road mapping employing frame-hold procedures reduces the need for continuous x-ray
exposure of the patient.
• Various image processing techniques are used to enhance image quality in digital
fluoroscopy and to acquire information that would be difficult to obtain if the images were
analog (on cut film or cine film).
• One example of digital image processing in fluoroscopy is frame averaging. In digital
fluoroscopy, images are being acquired rapidly, and the level of quantum noise may be
quite high in any one frame.
• When viewed as multiple frames per second, the eye and brain of the observer do their own
“averaging” of quantum noise over several frames so that the noise is suppressed. When
viewed as individual frames, as in road mapping, a reduction in quantum noise is desirable.
This may be accomplished by averaging corresponding pixel values over several frames.
 • Over a period of less than a second, the image features may not change significantly, but
the quantum fluctuation (quantum noise) does change.
• By frame averaging, the effects of noise in each pixel may be reduced without significantly
altering the pixel value (signal) that represents the attenuation of x rays in the patient.

Angiography
• An angiogram is an X-ray test that uses a special dye and camera (fluoroscopy) to take
pictures of the blood flow in an artery (such as the aorta) or a vein (such as the vena cava).
• An angiogram can be used to look at the arteries or veins in the head, arms, legs, chest,
back, or belly.
• Common angiograms can look at the arteries near the heart (coronary angiogram), lungs
(pulmonary angiogram), brain (cerebral angiogram), head and neck (carotid angiogram),
legs or arms (peripheral), and the aorta (aortogram).
• During an angiogram, a thin tube called a catheter is placed into a blood vessel in the groin
(femoral artery or vein) or just above the elbow (brachial artery or vein).
• For angiography, a thin, soft tube (catheter) is placed in a blood vessel in the groin (such
as in the femoral vein).
• First, a doctor numbs the area with a local anaesthetic. Then, a needle is placed into the
blood vessel.
• A guide wire is put through the needle into the blood vessel and the needle is removed. The
catheter is slid over the guide wire and moved into the blood vessel.
• The catheter is guided through the blood vessels until the tip is in the area to be studied.
• Heart is a muscular pump whose primary job is to pump blood throughout your body. It
expands and contracts roughly 70 times per minute. Approximately 5 liters of blood is
pumped into our arteries every minute.
• When we are under physical or mental stress, heart has to function harder to cope with the
increased demand of blood (up to 40 liters per minute).
• Like any other organ heart needs oxygenated blood to function. Coronary arteries are the
vessels, which supply blood to the heart muscle.
• They are three in number and run on the surface of heart.
 • The left main Coronary Artery divides into two branches – the Left Anterior Descending
(LAD) and Left Circumflex (LCx) Artery. They supply the blood to the front, left side and
back of heart. The Right Coronary Artery (RCA) supplies blood to the bottom and right
side of heart.
• Coronary Artery Disease is narrowing of the coronary vessels thus affecting supply of
blood to the heart.
• There are several conditions in which the occurrence of the coronary artery disease is found
to be more common.
• Some of these conditions are smoking, diabetes, high blood pressure, hyperlipidemia
(increased fat in blood), obesity, lack of exercise, stressful life and family history of
coronary artery disease or simply ageing.
• A plaque starts getting deposited in the inner walls of the coronary arteries leading to partial
or full blockage of the arteries.
• The blood flow does not remain normal and this leads to chest pain (angina). If it is not
treated promptly, a heart attack (myocardial infarction) may result.
• Incidences of Coronary Artery Disease have become more frequent even in the middle and
young age group, more so in Indian subcontinent. Cardiologist will diagnose CAD on the
basis of symptoms, ECG, stress testing (TMT), exercise thallium scan or stress
echocardiography, and finally coronary angiography.
• Angiography till date remains the gold standard for diagnosis and decision making for
further management of the coronary artery disease.
• One can determine the following information by way of angiography: Presence, location,
severity and the extent of blockages, status of weakness of heart muscles after the heart
attack, measurement of chamber pressures if required, status of valve function.
• Angiography along with other clinical data will guide the cardiologist to take the proper
decision regarding the final treatment.

Digital Subtraction Angiography

 • Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in
interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue
environment.
• Images are produced using contrast medium by subtracting a 'pre-contrast image' or the
mask from later images, once the contrast medium has been introduced into a structure.
Hence it is termed as 'digital subtraction angiography'.
• Images (acquired pre- and post- injection of contrast material) may be subtracted digitally
to yield images of the contrast-laden vessels without the distraction of other structures in
the patient.
• Typically, a “mask” image is selected before contrast injection. The mask is subtracted
from succeeding images after contrast injection. If patient motion occurs after the mask has
been selected, then anatomical structures in succeeding images will not coincide and
artifacts will occur. If this occurs, possible solutions include:
- Remasking: If other pre-contrast images occur after motion has ceased but before contrast
injection, a new mask may be selected.
- Pixel shifting: If motion is not too complex, the mask digital image may be shifted one or more
pixels in all directions until the smoothest image is obtained. An algorithm to accomplish this task
without human intervention is available in most digital subtraction angiography systems.
DSA is primarily used to image blood vessels. It is useful in the diagnosis and treatment of:
• Arterial and venous occlusions, including
• carotid artery stenosis,
• pulmonary embolisms and
• acute limb ischemia.
• Arterial stenosis, which is particularly useful for potential renal
donors in detecting renal artery stenosis. DSA is the gold standard
investigation for renal artery stenosis.
• Cerebral aneurysms

Cine Angiography
• The use of a movie camera to film the passage of a contrast medium through blood vessels
for diagnostic purposes is called cine-angiography. The basic components include an x-ray
 tube and generator, image intensifier, video camera, cine camera (optional for cardiac
imaging), and digital image processor.

• Angiographic systems require a high-power, sophisticated x-ray generation system in order

to produce the short, intense x-ray pulses needed to produce clear images of moving
vessels.
• Required exposure times range from 100 to 200 ms for cerebral studies to 1 to 10 ms for
cardiac studies. Angiographic systems use either a constant potential generator, or,
increasingly, a medium/high-frequency inverter generator.
• Power ratings for angiographic generators are generally greater than or equal to 80 kW at
100 kW and must be capable of producing reasonably square x-ray pulses.
• The x-ray tube is of the rotating-anode variety. Serial runs of high-intensity x-ray pulses
result in high heat loads. Anode heat storage capacities of 1 mega-heat units (MHU) or
greater are required, especially in the case of cine angiography.
• Electronic “heat computers,” which calculate and display the current heat load of the x-ray
tube, are very useful in preventing damage to the x-ray tube.
• In a high-throughput angiographic suite, forced liquid cooling of the x-ray tube housing is
essential.
• Angiographic x-ray tubes are of multifocal design, with the focal spot sizes tailored for the
intended use. A 0.6-mm (50-kW loading), 1.2-mm (100-kW loading) bifocal insert is
common.

• One application where film use is still common is cardiac imaging. Cine angiography is
performed with a 35-mm motion picture camera optically coupled to the image intensifier
output phosphor.
• During cine angiography, x-ray pulses are synchronized both with the cine camera shutter
and the vertical retrace of the system video camera.
• To limit motion blurring, it is desirable to keep the x-ray pulses as short as possible, but
no longer than 10 msec. Imaging runs generally last from 5 to 10 sec in duration at a frame
 rate of 30 to 60 frames / sec (fps). Sixty fps is generally used for pediatric studies, where
higher heart rates are encountered, while 30 fps is more typical for adult studies.
• Some cine angiographic installations provide biplane imaging in which two independent
imaging chains can acquire orthogonal images of the injection sequence. Film and cine are
acquired simultaneously using the beam splitting mirror in the optical distributor.

Mammography
• Mammography is one of the principal applications of low-energy x rays. Mammography
is the process of using low-energy X-rays to examine the human breast used as a
diagnostic and a screening tool.
• The goal of mammography is the early detection of breast cancer, typically through
detection of characteristic masses.
• Like all X-rays, mammograms use doses of ionizing radiation to create images.
Radiologists then analyze the images for any abnormal findings. It is normal to use lower-
energy X-rays than those used for radiography of bones.
• In this technique, breast tissues that are similar in physical density, such as glandular tissue
and fat, are distinguishable on the basis of their atomic composition.
• When compared with glandular tissue, for example, fat has a lower effective atomic
number because it contains more hydrogen.
• The dependence of photoelectric absorption on Z3 permits delineation of these tissue
constituents in the image. Micro-calcifications in the breast can be seen because of
differences in both atomic number and physical density.
• One approach to mammography is to use a tungsten target and relatively low tube voltage
(30–45 kVp) to produce a low energy bremsstrahlung x-ray beam.
• A preferred approach is to use an x-ray target of molybdenum to produce a bremsstrahlung
x-ray beam as well as characteristic x rays of approximately 17 and 19 keV.
• By filtering this x-ray beam with a molybdenum absorber, the very low energy part of the
beam is removed so that most of the x rays are above 10 keV.
• The molybdenum K-absorption edge occurs at 19 keV. X rays with energies above the
K-absorption edge are also relatively strongly absorbed.
• The molybdenum filter is virtually transparent to characteristic x rays from the
molybdenum target that fall just below the absorption edge.
 • Hence, most of the characteristic x rays pass through the filter without attenuation.
• The glandular tissue is most always the site of carcinogenesis, and thus the preferred dose
index is the average glandular dose.
• Because the glandular tissues receive varying doses depending on their depths from the
skin entrance site of the x-ray beam, estimating the dose is not trivial. The average
glandular dose, Dg, is calculated from the following equation:
Dg = DgN * XESE
• where XESE is the entrance skin exposure (ESE) in roentgens, and DgN is an ESE to average
glandular dose conversion factor with units of mGy/R or mrad/R.

BENEFITS
• Imaging of the breast improves a physician's ability to detect small tumors.
• The use of screening mammography increases the detection of small abnormal tissue
growths confined to the milk ducts in the breast, called ductal carcinoma in situ (DCIS).
• No radiation remains in a patient's body after an x-ray examination.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

RISKS
• There is always a slight chance of cancer from excessive exposure to radiation.
• Five percent to 15 percent of screening mammograms require more testing such as
additional mammograms or ultrasound
• If there is an abnormal finding, a follow-up or biopsy may have to be performed.

UNIT – 2 COMPUTED TOMOGRAPHY

• CT images are produced by passing x-rays through the body, at a large number of angles,
by rotating the x-ray tube around the body.
• One or more linear detector arrays, opposite the x-ray source, collect the transmission
projection data.
• The numerous data points collected in this manner are synthesized by a computer into a
tomographic image of the patient.
• The term tomography refers to a picture (-graph) of a slice (tomo-). CT is a transmission
technique that results in images of individual slabs of tissue in the patient.
• The advantage of a tomographic image over projection image is its ability to display the
anatomy in a slab (slice) of tissue in the absence of over- or underlying structures.
• With plain film imaging, the three-dimensional (3D) anatomy of the patient is reduced to
a two-dimensional (2D) projection image.
• The density at a given point on an image represents the x-ray attenuation properties within
the patient along a line between the x-ray focal spot and the point on the detector
corresponding to the point on the image.
• Consequently, with a conventional radiograph of the patient's anatomy, information with
respect to the dimension parallel to the x-ray beam is lost.
• This limitation can be overcome by acquiring a series of projections at 1-degree intervals
around the patient. The tomographic image is a picture of a slab of the patient's anatomy.
• The 2D CT image corresponds to a 3D section of the patient, so that even with CT, three
dimensions are compressed into two.
• However, unlike the case with plain film imaging, the CT slice-thickness is very thin (l to
10 mm) and is approximately uniform.
• The 2D array of pixels (short for picture elements) in the CT image corresponds to an equal
number of 3D voxels (volume elements) in the patient.
• Voxels have the same in-plane dimensions as pixels, but they also include the slice
thickness dimension. Each pixel on the CT image displays the average x-ray attenuation
properties of the tissue in the corresponding voxel.
Principle of Tomography
• A narrow x-ray beam is scanned across a patient in synchrony with a radiation detector on
the opposite side of the patient. If the beam is mono-energetic, the transmission of x-rays
through the patient is
I = Io e -µx
• If the x-ray beam is intercepted by two regions with attenuation coefficients µ1 and µ2 and
thickness x1 and x2, the x-ray transmission is

• If many (n) regions with different linear attenuation coefficients occur along the path of x-
rays, the transmission is

• With a single transmission measurement, the separate attenuation coefficients cannot be

determined because there are too many unknown values of µi in the equation.
• However, with multiple transmission measurements in the same plane but at different
orientations of the x-ray source and detector, the coefficients can be separated so that a
 cross-sectional display of attenuation coefficients is obtained across the plane of
transmission measurements. By assigning gray levels to different ranges of attenuation
coefficients, a gray-scale image can be produced that represents various structures in the
patient with different x-ray attenuation characteristics.
• This gray-scale display of attenuation coefficients constitutes a CT image.
• A single transmission measurement through the patient made by a single detector at a given
moment in time is called a ray.
• A series of rays that pass through the patient at the same orientation is called a projection
or view.
• There are two projection geometries that have been used in CT imaging. The more basic
type is parallel beam geometry, in which all of the rays in a projection are parallel to each
other.
• In fan beam geometry, the rays at a given projection angle diverge and have the
appearance of a fan. The purpose of the CT scanner hardware is to acquire a large number
of transmission measurements through the patient at different positions.
• The acquisition of a single axial CT image may involve approximately 800 rays taken at
1,000 different projection angles, for a total of approximately 800,000 transmission
measurements.
• Before the axial acquisition of the next slice, the table that the patient is lying on is moved
slightly in the cranial- caudal direction (the "z-axis" of the scanner), which positions a
different slice of tissue in the path of the x-ray beam for the acquisition of the next image.

CT Generations
First generation: Rotate/Translate, Pencil Beam
• The first generation of CT scanners employed a rotate/translate, pencil beam system. Only
two x-ray detectors were used, and they measured the transmission of x-rays through the
patient for two different slices.
• The acquisition of the numerous projections and the multiple rays per projection required
that the single detector for each CT slice be physically moved throughout all the necessary
positions.
• This system used parallel ray geometry. Starting at a particular angle, the x-ray tube and
detector system translated linearly across the field of view (FOV), acquiring 160 parallel
 rays across a 24-cm FOV. When the x-ray tube/detector system completed its translation,
the whole system was rotated slightly, and then another translation was used to acquire the
160 rays in the next projection.
• This procedure was repeated until 180 projections were acquired at 1-degree intervals. A
total of 180 x 160 = 28,800 rays were measured.
• One advantage of the first-generation CT scanner was that it employed pencil beam
geometry-only two detectors measured the transmission of x-rays through the patient.
• The pencil beam allowed very efficient scatter reduction, because scatter that was
deflected away from the pencil ray was not measured by a detector. With regard to scatter
rejection, the pencil beam geometry used in first-generation CT scanners was the best.

Second Generation: Rotate/ Translate, Narrow Fan Beam

• The next incremental improvement to the CT scanner was the incorporation of a linear
array of 30 detectors.
• This increased the utilization of the x-ray beam by 30 times, compared with the single
detector used per slice in first-generation systems.
• A relatively narrow fan angle of 10 degrees was used. In principle, a reduction in scan time
of about 30-fold could be expected.
 • However, this reduction time was not realized, because more data (600 rays X 540 views =
324,000 data points) were acquired to improve image quality.
• The shortest scan time with a second-generation scanner was 18 seconds per slice, 15 times
faster than with the first-generation system.
• Incorporating an array of detectors, instead of just two, required the use of a narrow fan
beam of radiation.
• Although a narrow fan beam provides excellent scatter rejection compared with plain film
imaging, it does allow more scattered radiation to be detected than was the case with the
pencil beam used in first-generation CT.

Third Generation: Rotate/ Rotate, Wide Fan Beam

• The translational motion of first- and second-generation CT scanners was a fundamental
impediment to fast scanning.
• At the end of each translation, the motion of the x-ray tube/detector system had to be
stopped, the whole system rotated, and the translational motion restarted.
• The number of detectors used in third-generation scanners was increased substantially (to
more than 800 detectors), and the angle of the fan beam was increased so that the detector
array formed an arc wide enough to allow the x-ray beam to interrogate the entire patient.
• Spanning the dimensions of the patient with an entire row of detectors eliminated the need
for translational motion.
• The multiple detectors in the detector array capture the same number of ray measurements
in one instant as was required by a complete translation in the earlier scanner systems.
• The mechanically joined x-ray tube and detector array rotate together around the patient
without translation.
• The motion of third-generation CT is "rotate/rotate," referring to the rotation of the x-ray
tube and the rotation of the detector array. By elimination of the translational motion, the
scan time is reduced substantially.
• The early third-generation scanners could deliver scan times shorter than 5 seconds.
Fourth Generation: Rotate/ Stationary
• Third-generation scanners suffered from the significant problem of ring artifacts, and
fourth-generation scanners were designed specifically to address these artifacts.
• Each detector and its associated electronics has a certain amount of drift, causing the signal
levels from each detector to shift over time.
• The rotate/rotate geometry of third-generation scanners leads to a situation in which each
detector is responsible for the data corresponding to a ring in the image (Fig. 13-8).
• Detectors toward the center of the detector array provide data in the reconstructed image
in a ring that is small in diameter, and more peripheral detectors contribute to larger
diameter rings.
• Third-generation CT uses a fan geometry in which the vertex of the fan is the x-ray focal
spot and the rays fan out from the x-ray source to each detector on the detector array.
• The detectors toward the center of the array make the transmission measurement It, while
the reference detector that measures Io is positioned near the edge of the detector array.
• If gl is the gain of the reference detector, and g2 is the gain of the other detector, then the
transmission measurement is given by the following equation:
ln (g1 Io/ g2It) = μt
• The equation is true only if the gain terms cancel each other out, and that happens when gl
= g2.

• If there is electronic drift in one or both of the detectors, then the gain changes between
detectors, so that gl ǂ g2.
• So, for third-generation scanners, even a slight imbalance between detectors affects the μt
values that are backprojected to produce the CT image, causing the ring artifacts.

• Fourth-generation CT scanners were designed to overcome the problem of ring artifacts.

With fourth-generation scanners, the detectors are removed from the rotating gantry and
are placed in a stationary 360-degree ring around the patient, requiring many more
detectors.
• Modern fourth-generation CT systems use about 4,800 individual detectors. Because the
x-ray tube rotates and the detectors are stationary, fourth-generation CT is said to use a
rotate/stationary geometry.
• During acquisition with a fourth-generation scanner, the divergent x-ray beam emerging
from the x-ray tube forms a fan-shaped x-ray beam.
• However, the data are processed for fan beam reconstruction with each detector as the
vertex of a fan, the rays acquired by each detector being fanned out to different positions
of the x-ray source.
• Third-generation design uses a source fan, whereas fourth-generation uses a detector fan.
The third-generation fan data are acquired by the detector array simultaneously, in one
instant of time.
• The fourth-generation fan beam data are acquired by a single detector over the period of
time that is required for the x-ray tube to rotate through the arc angle of the fan.
• With fourth-generation geometry, each detector acts as its own reference detector. For each
detector with its own gain, g, the transmission measurement is calculated as follows:

• Note that the single g term in this equation is guaranteed to cancel out. Therefore, ring
artifacts are eliminated in fourth-generation scanners.
Fifth Generation: Stationary/ Stationary
• A novel CT scanner has been developed specifically for cardiac tomographic imaging.
• This "cine-CT" scanner does not use a conventional x-ray tube; instead, a large arc of
tungsten encircles the patient and lies directly opposite to the detector ring.
• X-rays are produced from the focal track as a high-energy electron beam strikes the
tungsten.
• There are no moving parts to this scanner gantry. The electron beam is produced in a cone-
like structure (a vacuum enclosure) behind the gantry and is electronically steered around
the patient so that it strikes the annular tungsten target.
• Cine-CT systems, also called electron beam scanners, are marketed primarily to
cardiologists.
• They are capable of 50-msec scan times and can produce fast-frame-rate CT movies of the
beating heart.

Generation Configuration Detector Beam Scan Time

First Translate – 1-2 Pencil 2.5 min

Rotate

Second Translate – 3-52 Narrow Fan 10 sec

Rotate

Third Rotate – Rotate 256-1000 Wide Fan 0.5 sec

 Fourth Rotate- Fixed 600-4800 Wide Fan 1 sec

Fifth Electron Beam 1284 Wide Fan Electron 33 ns

Beam

X- ray Sources
• Both stationary- and rotating-anode x-ray tubes have been used in CT scanners. Many of
the translate–rotate CT scanners have an oil-cooled, stationary-anode x-ray tube with a
focal spot on the order of 2 × 16 mm.
• The limited output of these x-ray tubes necessitates a sampling time of about 5 ms for each
measurement of x-ray transmission.
• This sampling time, together with the time required to move and rotate the source and
detector, limits the speed with which data can be accumulated with CT units using
translational and rotational motion.
• To reduce the sampling time to 2 to 3 ms, newer CT units use 10,000 rpm rotating-anode
x-ray tubes, often with a pulsed x-ray beam, to achieve higher x-ray outputs.
• To meet the demands of high-speed CT scanning, x-ray tubes with ratings in excess of 6
million heat units are becoming standard.
• In CT units, the heel effect is eliminated by placing the anode–cathode axis of the x-ray
tube at right angles to the long axis of the patient.
• CT scanners employ compact, high-frequency x-ray generators that are positioned inside
the CT gantry. In some units the generator rotates with the x-ray tube, while in others the
generator is stationary.
• A special x-ray filter is used in CT to make the intensity of the x-ray beam more uniform.
This filter is often referred to as “bow-tie filter.”
• Multislice CT scanning has placed added demands on the capacity of x-ray tubes to sustain
high power levels over long periods of time.
• The voxel size is the major influence on image resolution in most CT units.

Collimation
• After transmission through the patient, the x-ray beam is collimated to confine the
transmission measurement to a slice with a thickness of a few millimeters.
 • Collimation also serves to reduce scattered radiation to less than 1% of the primary beam
intensity. The height of the collimator defines the thickness of the CT slice.
• This height, when combined with the area of a single picture element (pixel) in the display,
defines the three-dimensional volume element (voxel) in the patient corresponding to the
two-dimensional pixel of the display. A voxel encompassing a boundary between two
tissue structures (e.g., muscle and bone) yields an attenuation coefficient for the pixel that
is intermediate between the values for the two structures.
• This “partial-volume artifact” may be reduced by narrowing the collimator to yield
thinner slices.
• However, this approach reduces the number of x rays incident upon the detector. With
fewer x rays interacting in the detector, the resulting signals are subject to greater statistical
fluctuation and yield a noisier image in the final display.
• CT units employ two types of collimators: source (prepatient) collimators to shape the x-
ray beam and limit patient dose, and detector (postpatient) collimators to control slice
thickness.

X- ray Detectors
• To reduce the detector response time, all detectors used in CT are operated in current rather
than pulse mode.
• Also, rejection of scattered radiation is accomplished with detector collimators rather than
pulse height analyzers.
• Detectors for CT scanning include, i) gas-filled ionization chambers, ii) solid-state
detectors and iii) multiple array detectors.
• They are chosen for their detection efficiency, short response time, and stability of
operation.
• High-pressure xenon detectors provide detection efficiencies of about 50%. The detection
efficiency of solid-state detectors used in CT is about 80%.

GAS FILLED DETECTOR

• Xenon detectors use high-pressure (about 25 atm) nonradioactive xenon gas, in long thin
cells between two metal plates.
 • The metal septa that separate the individual xenon detectors can also be made quite thin,
and this improves the geometric efficiency by reducing dead space between detectors.
• The geometric efficiency is the fraction of primary x-rays exiting the patient that strike
active detector elements.
• The long, thin ionization plates of a xenon detector are highly directional. For this reason,
xenon detectors must be positioned in a fixed orientation with respect to the x-ray source.
• Therefore, xenon detectors cannot be used for fourth-generation scanners, because those
detectors have to record x-rays as the source moves over a very wide angle. Xenon
detectors can be used only for third-generation systems.

• Xenon detectors for CT are ionization detectors-a gaseous volume is surrounded by two
metal electrodes, with a voltage applied across the two electrodes.
• As x-rays interact with the xenon atoms and cause ionization (positive atoms and negative
electrons), the electric field (volts per centimeter) between the plates causes the ions to
move to the electrodes, where the electronic charge is collected.
• The electronic signal is amplified and then digitized, and its numerical value is directly
proportional to the x-ray intensity striking the detector.

SOLID STATE DETECTOR

• A solid-state CT detector is composed of a scintillator coupled tightly to a photodetector.
The scintillator emits visible light when it is struck by x-rays.
 • The light emitted by the scintillator reaches the photodetector, typically a photodiode,
which is an electronic device that converts light intensity into an electrical signal
proportional to the light intensity.
• The scintillator used includes CdWO4, yttrium and gadolinium ceramics, and other
materials being used.
• Because the density and effective atomic number of scintillators are substantially higher
than those of pressurized xenon gas, solid-state detectors typically have better x-ray
absorption efficiency.
• However, to reduce crosstalk between adjacent detector elements, a small gap between
detector elements is necessary, and this reduces the geometric efficiency somewhat.

• The top surface of a solid-state CT detector is essentially flat and therefore is capable of x-
ray detection over a wide range of angles, unlike the xenon detector.
• Solid-state detectors are required for fourth-generation CT scanners, and they are used in
most high-tier third-generation scanners as well.

MULTIPLE ARRAY DETECTORS

• Multiple detector arrays are a set of several linear detector arrays, tightly abutted.
• The multiple detector array is an assembly of multiple solid-state detector array modules.
With multiple detector arrays, slice width is determined by the detectors, not by the
collimator.
• To allow the slice width to be adjustable, the detector width must be adjustable. Therefore,
with multislice systems, the slice width is determined by grouping one or more detector
units together.
• For one manufacturer, the individual detector elements are 1.25 mm wide, and there are 16
contiguous detectors across the module.
• The detector dimensions are referenced to the scanner's isocenter, the point at the center
of gantry rotation.
• The electronics are available for four detector array channels, and one, two, three or four
detectors on the detector module can be combined to achieve slices of 4 X 1.25 mm, 4 X
2.50 mm, 4 X 3.75 mm, or 4 X 5.00 mm.
• Other manufacturers use the same general approach but with different detector spacings.
For example, one manufacturer uses 1-mm detectors everywhere except in the center,
where four 0.5-mmwide detectors are used.
• Other manufacturers use a gradually increasing spacing, with detector widths of 1.0, 1.5,
2.5, and 5.0 mm going away from the center. All currently planned multiple detector array
scanners make use of third-generation geometry.
Viewing Systems
• The numbers computed by the reconstruction algorithm are not exact values of attenuation
coefficients.
• Instead, they are integers termed CT numbers that are related to attenuation coefficients.
On most CT units, the CT numbers range from −1000 for air to +1000 for bone, with the
CT number for water set at 0.
• The relationship between CT number and linear attenuation coefficient µ of a material is
CT number = 1000 (µ − µw ) / µw
• where µw is the linear attenuation coefficient of water.
• CT numbers are often referred to as Hounsfield units. CT numbers normalized in this
manner provide a range of several CT numbers for a 1% change in attenuation coefficient.
• In a CT image, higher CT numbers are brighter and lower CT numbers are darker.
• A television monitor is used to portray CT numbers as a gray-scale visual display.
• This viewing device contains a contrast enhancement feature that superimposes the shades
of gray available in the display device (i.e., the dynamic range of the display) over the
range of CT numbers of diagnostic interest.
• Control of image contrast with the contrast enhancement feature is essential in x-ray CT
because the electron density and therefore the x-ray attenuations, are remarkably similar
for most tissues of diagnostic interest.
• The same cross- sectional CT data can be displayed at different settings of the “window”
of the contrast enhancement control.
• The viewing console of the CT scanner may contain auxiliary features such as image
magnification, quantitative and statistical data display, and patient identification data.
• Also, many scanners permit the display of coronal and sagittal images by combining
reconstruction data for successive slices through the body.
Spiral CT Scanning

Spiral CT scanning

• Several approaches to even faster CT scans have been pursued. Until recently, multiple
scan sequences to produce contiguous image “slices” required that the xx-ray tube stop its
rotation and reverse its direction because the maximum extension of the high-voltage
high
cables had been reached.
• Thus, a successive slice-by-slice
slice slice accumulation technique was used to produced multislice
images.
• In this technique, the total image acquisition time is significantly longer than the beam
beam-on
time because the table increments (moves) to the next slice location and the patient breathes
between slices.
• Spiral CT scanning was introduced in 1989 and is used almost
almost universally today for third-
third
and fourth-generation
generation CT scanning.
• In this approach, image acquisition time is decreased significantly by connecting the tube
voltage cables through a ““slip ring”” or sliding contact mounted on the rotating gantry of
the unit.
• With slip ring technology, the xx-ray
ray tube rotates while the patient table moves without
stopping.
• Hence, the patient is moved continuously through the gantry during the study, and the xx-
ray beam maps out a helical or spiral path in the patient, (as depicted in Figure).
 • Potential advantages of the spiral CT technique include a reduction of patient motion and
a general increase in patient throughput.
• A greater volume of the patient may be scanned during the passage of contrast media,
permitting reduction in the volume of contrast needed.
• Also, the continuity of data along the axis of the patient (i.e., absence of gaps between
scans) improves the quality of three-dimensional reconstruction.
• In single-slice CT scanning, pitch is defined as the patient couch movement per rotation
divided by the slice thickness.
• In multislice CT, this definition is altered slightly to patient couch movement per rotation
divided by the beam width.
• Low pitch (i.e., small increments of couch movement) yields improved spatial resolution
along the long axis (Z axis) of the patient, but also results in higher patient doses and longer
imaging times. For pitches greater than unity, the dose to the patient is less, but data must
be interpolated so that resolution along the Z axis is preserved.

Ultrafast CT Scanners
• Other approaches to fast CT scanning have involved radically different approaches to
equipment design. In the late 1970s the first approach to subsecond CT scans was proposed
by a group at the Mayo Clinic.
• This approach, known as the dynamic spatial reconstructor (DSR), incorporated 28
gantry-mounted x-ray tubes over a 180- degree arc and used an equal number of image
intensifier assemblies mounted on the opposite semicircle of the gantry.
• The entire assembly rotated about the patient at a rate of 15 rpm to provide 28 views every
1/60 second.
• Working models of the system were built for research, but the technical complexity and
cost prevented the DSR from being marketed commercially.
• Another approach to fast CT scanning eliminates mechanical motion entirely by converting
the gantry of the unit into a giant x-ray tube in which the focal spot moves electronically
about the patient.
• This device, known as ultrafast CT (UFCT), cardiovascular CT (CVCT), or “cine CT,”
incorporates a semicircular tungsten x-ray target into the gantry.
• A scanning electron beam with an energy of 130 keV is swept around the semicircular
target so that the focal spot moves around the patient.
• A stationary semicircular bank of detectors records the x-ray transmission in a fashion
similar to that of a fourth-generation scanner.
• Because of the speed with which the electron beam may be steered magnetically, a scan
may be accomplished in as little as 50 ms and repeated after a delay of 9 ms to yield up to
17 images per second.
• By using four target rings and two detector banks, eight slices of the patient may be imaged
without moving the patient.
 Fig : The UFCT unit

Image reconstruction techniques

• The data acquired for one CT slice can be displayed before reconstruction. This type of
display is called a sinogram.
• Sinograms are not used for clinical purposes, but the concepts that they embody are
interesting and relevant to understanding tomographic principles.
• The horizontal axis of the sinogram corresponds to the different rays in each projection.
• For a third-generation scanner, for example, the horizontal axis of the sinogram
corresponds to the data acquired at one instant in time along the length of the detector array.
• A bad detector in a third-generation scanner would show up as a vertical line on the
sinogram. The vertical axis in the sinogram represents each projection angle.
• A state-of-the-art CT scanner may acquire approximately 1,000 views with 800 rays per
view, resulting in a sonogram that is 1,000 pixels tall and 800 pixels wide, corresponding
to 800,000 data points.
• The number of data points (rays/view X views) acquired by the CT scanner has some impact
on the final image quality.
Simple Backprojection Reconstruction
• The preprocessed sinogram is used to reconstruct the individual tomographic images.
Simple backprojection is a mathematical process, based on trigonometry, which is designed
to emulate the acquisition process in reverse.
• Each ray in each view represents an individual measurement of µ. In addition to the value
of µ for each ray, the reconstruction algorithm also "knows" the acquisition angle and
position in the detector array corresponding to each ray.
• Simple backprojection starts with an empty image matrix (an image with all pixels set to
zero), and the µ value from each ray in all views is smeared or backprojected onto the image
matrix.
• In other words, the value of µ is added to each pixel in a line through the image
corresponding to the ray's path.
• Simple backprojection comes very close to reconstructing the CT image as desired.
• However, a characteristic 1/r blurring is a byproduct of simple backprojection.
• Imagine that a thin wire is imaged by a CT scanner perpendicular to the image plane; this
should ideally result in a small point on the image.
• Rays not running through the wire will contribute little to the image (µ = 0). The
backprojected rays, which do run through the wire, will converge at the position of the wire
in the image plane, but these projections run from one edge of the reconstruction circle to
the other.
• These projections (i.e., lines) will therefore "radiate" geometrically in all directions away
from a point input.
• If the image gray scale is measured as a function of distance away from the center of the
wire, it will gradually diminish with a 1/r dependency, where r is the distance away from
the point.
 • This phenomenon results in a blurred image of the actual object when simple
backprojection is used. A filtering step is therefore added to correct this blurring, in a
process known as filtered backprojection.

Filtered Backprojection Reconstruction

• In filtered backprojection, the raw view data are mathematically filtered before being
backprojected onto the image matrix.
• The filtering step mathematically reverses the image blurring, restoring the image to an
accurate representation of the object that was scanned.
• The mathematical filtering step involves convolving the projection data with a convolution
kernel.
• Many convolution kernels exist, and different kernels are used for varying clinical
applications such as soft tissue imaging or bone imaging.
• The kernel refers to the shape of the filter function in the spatial domain, whereas it is
common to perform (and to think of) the filtering step in the frequency domain.
• The Fourier transform (FT) is used to convert a function expressed in the spatial domain
(millimeters) into the spatial frequency domain (cycles per millimeter, sometimes
expressed as mm-1); the inverse Fourier transform (FT-1) is used to convert back.
 • The difference between filtered backprojection and simple backprojection is the
mathematical filtering operation (convolution).
• The Lak filter increases the amplitude linearly as a function of frequency and is also called
a ramp filter.
• The 1/r blurring function in the spatial domain becomes a 1/f blurring function in the
frequency domain; therefore, multiplying by the Lak filter, where L(f) = f, exactly
compensates the unwanted 1/f blurring, because 1/f X f = 1, at all f.
• This filter works well when there is no noise in the data, but in x-ray images there is always
x-ray quantum noise, which tends to be more noticeable in the higher frequencies. The Lak
filter produces a very noisy CT image.
• The Shepp-Logan filter is similar to the Lak filter but incorporates some roll-off at higher
frequencies, and this reduction in amplification at the higher frequencies has a profound
influence in terms of reducing high-frequency noise in the final CT image.
• The Hamming filter has an even more pronounced high-frequency roll-off, with better
high-frequency noise suppression.

Iterative Reconstruction Method

• All iterative reconstruction methods consist of three major steps.
• First, a forward projection of the volumetric object estimate creates artificial raw data.
• This could be an empty image or an image from initial FBP process. In general, the better
the prior images match the final images, the faster the process converges towards a stable
solution.
• Second, computing the correction term by comparing the real measured raw data with the
artificial raw data.
• Third, correction term is back projected onto the volumetric object estimate.
• The iterative process is finished when either a fixed number of iterations is reached or the
update for the current image estimate is considered small enough or when a predefined
quality criterion in the image estimate is fulfilled.
• The earliest and simplest form of iterative reconstruction is the algebraic reconstruction
technique (ART), which has been used for the first CT system.
• The consequent ART-based methods includes simultaneous algebraic reconstruction
technique (SART), order subsets simultaneous iterative reconstruction technique (OS-
SIRT), multiplicative algebraic reconstruction technique (MART).
• In general, all ART-based methods are non-statistical and could model the geometry of the
acquisition process better than FBP method.
 UNIT – III MAGNETIC RESONANCE IMAGING

Fundamentals
• Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to
investigate the anatomy and physiology of the body in both health and disease.
• MRI scanners use strong magnetic fields and radiowaves to form images of the body.
The technique is widely used in hospitals for medical diagnosis, staging of disease and for
follow-up without exposure to ionizing radiation.
• Nuclear magnetic resonance (NMR) images are essentially a map of the distribution
density of hydrogen nuclei and parameters reflecting their motion, in cellular water and
lipids.
• The total avoidance of ionizing radiation and the penetration of bone and air without
attenuation makes it an attractive non-invasive imaging technique.
• CT provides details about the bone and tissue structure of an organ whereas NMR
highlights the liquid-like areas on those organs and can also be used to detect flowing
liquids, like blood.
• An NMR scanner can produce any desired cross section, whereas an X-ray scanner can
produce an image only at right angles to the axis of the body.

Interaction of nuclei with static Magnetic Field

• In the “classical interpretation”, the behavior of nuclear magnetic moments is presented by
using the hydrogen nucleus (i.e., a single proton) as a model.
• In the classical interpretation the position of the hydrogen nucleus can be specified with
any desired degree of precision, and its movements are assumed to be continuous and
completely predictable.
• Each proton behaves as a small magnet with a magnetic moment that has both magnitude
and direction (margin fig 23.1).
• In a typical sample of hydrogen-containing material (such as the human body), the
magnetic moments of the individual hydrogen nuclei are oriented in random directions.
• If a strong magnetic field is applied to the sample, the nuclei “align” their magnetic
moments with the direction of the magnetic field in a manner similar to a compass needle
aligned with the earth’s magnetic field.
 • The earth’s magnetic field (0.5 gauss) is not strong enough to bring protons in a tissue
sample into alignment. The field supplied by an MR system (e.g., 20,000 gauss) is strong
enough to produce alignment

Radio frequency wave –Rotation and precession

• In addition to aligning with a magnetic field, a magnetic moment also precesses about the
field. Precession is easily demonstrated in rotating objects (another reason why we infer
the property of “spin” for protons).
• A spinning top, for example, will “wobble” about a vertical axis defined by the earth’s
gravitational field. This wobbling motion is precession.
• Precession is a type of motion that is distinct from rotation. Rotation is the spinning of an
object about its axis (an imaginary line through the center of mass of the object).
• The rapid spin of a top that causes its surface to blur is rotation. Precession is a “second-
order” motion. It is the “rotation of a rotating object.”
• If you push against a ball, it will roll in the direction in which it was pushed. A gyroscope
is simply a top surrounded by a stationary framework.
• If you push against a gyroscope, it will move in a perpendicular direction (90 degrees) to
the direction of the push.
• If you push it toward the north, it will move to the east or west depending on the direction
of its spin (clockwise or counterclockwise).
• In the macroscopic world, rotating objects have the property of angular momentum that
causes them to behave as gyroscopes and tops.
• Nuclei react to forces in the microscopic world just as objects with angular momentum
respond to forces in the macroscopic world.
• Protons and other subatomic particles are assumed to rotate about their axes and are
described as having “spin.”
• Precession results from the interaction of forces with a rotating object. These forces and
the resultant motions are diagramed in fig 23-4 for a gyroscope, where the force is gravity,
and for a proton, where the force is a magnetic field.
• The frequency of precession is known as the Larmor frequency.
• The frequency f of precession of a proton in units of megahertz (106 cycles or rotations per
second) depends upon its gyromagnetic ratio γ (in megahertz per tesla) and the strength B
(in tesla, T) of the static magnetic field. This relationship is described by the Larmor
equation.
 Magnetic resonance property of selected nuclei

Nucleus Gyromagnetic Ratio

(γ/2π) (MHz/T)
1H
42.58
13
C 10.71
19F
40.05

Interaction of Nuclei with a Radio frequency wave

• There is a “third-order” property of an object that is rotating (first-order property) and
precessing (second-order property).
• This property, called nutation, is the result of forces that rotate with the precession of the
object.
• When force is applied to an object with angular momentum, the object tends to move at
right angles to the force.
• If one tries to speed up the precession of a gyroscope by using a finger to push it in a circle,
it will not affect the precessional speed.
• Instead, the angle of precession will change. That is, if we push in the direction of
precession, the gyroscope precesses at a greater angle until it finally lies flat on the table.
• In magnetic resonance of protons, the force that causes nutation is provided by a second
magnetic field that varies with time. Such a “rotating-frame-of-reference” diagram is
shown in Margin Figure 23-6.
• This diagram depicts a precessing object responding to a force by moving at a right angle
to the force, thereby changing its angle of precession. This change in angle, called nutation,
is a third-order circular motion (after rotation and precession).
• In magnetic resonance of protons, the force that causes nutation is provided by a second
magnetic field that varies with time.
• Each time the proton’s magnetic moment “comes around” during precession, the second
magnetic field is “switched on” (Margin Figure 23-7).
• As the magnetic moment rotates away, the magnetic field is “switched off.” More
precisely, the “ons” and “offs” are the peaks and valleys of a continuously varying
magnetic field.
• Larmor equation may be used to predict the frequency of precession of a proton in a
magnetic field.
• The range of static field strengths employed in clinical MRI, 0.1 to 3.0 tesla, corresponds
to precessional frequencies of 4.3 to 129 MHz for hydrogen nuclei.
• The time-varying magnetic field of an electromagnetic wave with a frequency in the
megahertz range is a suitable source for inducing nutation.
• When this wave has a frequency that matches the precession of protons in a particular
magnetic field, it is said to be in “resonance.”
• This is the origin of the term magnetic resonance. Appropriate frequencies are in the FM
radio portion of the electromagnetic spectrum. Thus, we refer to the use of RF pulses in
MR.
Induction of a magnetic resonance signal
• A changing magnetic field can induce a current in a loop of conducting wire. This principle
is known as Faraday’s law, or the law of electromagnetic induction.
• A proton has a magnetic moment and therefore acts as a small magnet. Protons that precess
so that their magnetic fields intersect the plane of a nearby coil will induce an electrical
current in the coil. This current is the MR “signal” induced in the receiver coil.
• The MR signal is greatest for precession of magnetic moments in a plane perpendicular to
the plane of the receiver coil. The imaginary plane perpendicular to the receiver coil is
known as the “transverse” or “xy” plane.
• If the magnetic moments are not precessing entirely within the transverse plane, a signal
of reduced magnitude (i.e., a “weaker” signal) is induced in the coil.
• If the magnetic moments are perpendicular to the transverse plane (i.e., parallel to the static
magnetic field), then no signal will be induced in the coil.
• In summary, it is the “component” of the magnetization in the transverse plane that is
responsible for the MR signal.
• The number of magnetic moments precessing near the coil also influences the strength of
the MR signal. With other factors constant, the strength increases linearly with the number
of magnetic moments. The magnetic moments that are used for MRI at the present time are
those of protons.
Bulk Magnetization
• The classic and quantum mechanical interpretations of MR phenomena can be reconciled
when a sample of macroscopic size consisting of millions of atoms is considered.
• In this case, the classical laws govern the composite, or “bulk,” magnetization of the
sample. It is a cornerstone principle of physics that as the quantum mechanical equations
governing the behavior of individual atoms are averaged over “large” numbers of atoms,
the classical equations of motion emerge.
• Thus, the statements about precession, nutation, and induction of signals in a coil are true
of bulk magnetization.
• When a radio wave is applied to a sample at the resonance frequency, the bulk
magnetization precesses at the Larmor frequency (margin fig 23-10).
• The angle of precession (nutation angle) is determined by the intensity of the radio wave
and the amount of time over which it is applied.

• When considering a collection of spins, as in a macroscopic sample, an important issue to

include is whether the individual magnetic moments tend to “work together” (i.e., point in
the same direction) or cancel each other (i.e., point in random directions).
 • Before a radio wave is applied, the nuclei are precessing at nearly the same frequency, but
their transverse components tend to cancel each other because they are rotating “out of
phase.” Hence the bulk magnetization is zero in the transverse plane.
• When the radio wave (RF pulse) is applied, the spins are brought into synchrony, and the
individual nuclear magnetic moments reinforce each other to produce a strong bulk
magnetic moment.
• The ability of an RF pulse to bring protons into phase is a consequence of applying a force
that acts in resonance with a physical system. As an example, consider using a long board
to simultaneously push several people who are on swings.*
• Assume that you will push at the resonance frequency. If the people are already swinging
on their own in random phases as you approach them with the board to apply “pulses” to
the system, you will bump some at just the right part of the swing cycle to give them an
effective push.
• Others will be missed or will bump against the board at the wrong part of the cycle. If you
persist over a number of cycles, those who are out of phase will be forced into phase, and
finally the force will be applied to all components of the system in resonance.
• This technique is analogous to what happens when an RF pulse is applied to a system of
precessing nuclear spins. As the nuclei begin to rotate in phase, the transverse component
of the bulk magnetization becomes apparent.

Relaxation Processes T1 and T2

• We have seen that when an RF pulse is applied to a sample, the bulk magnetization may
be nutated into the xy plane and induce an MR signal in a receiver coil positioned
perpendicular to the xy plane.
• When the radio wave is switched off, the signal decays away. This decay is the result of
the return of protons to the state that existed before the radio wave was applied.
• This return is termed relaxation of the protons. There are two basic relaxation processes
at work in the sample. Both processes account for the observed decay of the MR signal.
• One relaxation process involves a return of the protons to their original alignment with the
static magnetic field. This process, called longitudinal or spin-lattice relaxation, is
characterized by a time constant T1.
• The term spin-lattice refers to the interaction of the protons (spins) with their surroundings
(the “lattice” or network of other spins).
• This interaction causes a net release of energy to the surroundings as the protons return to
the lower energy state of alignment.
• The other relaxation process is a loss of synchrony of precession among the protons. Before
a radio wave is applied, the precessional orientation of the protons is random.
• The application of a radio wave brings the protons into synchronous precession, or “in
phase.”
• When the radio wave is switched off, the protons begin to interact with their neighbors and
give up energy in random collisions.
• In so doing, they revert to a state of random phase. As the protons revert to random
orientation, the bulk signal decreases because the magnetic moments tend to cancel each
other. This process is called transverse or spin–spin relaxation and is characterized by a
time constant T2.
• In a patient undergoing MRI, both longitudinal and transverse relaxation processes occur
at the same time. The transverse (T2) relaxation time is always shorter than the longitudinal
(T1) relaxation time.
• That is, magnetic moments dephase faster than they move into alignment with the static
magnetic field. For typical biological materials, T1 may be on the order of several hundred
milliseconds while T2 is a few tens of milliseconds Relaxation (decay) of the MR signal is
characterized by exponential expressions analogous to those used to describe radioactive
decay, absorption of photons, and growth of cells in culture.
• For longitudinal relaxation, the expression
S = S0e−t/T 1
• reveals that the MR signal S decreases exponentially in time from the signal S0 that was
present immediately following an RF pulse.
• The value of S0 is influenced by factors such as the number of protons in the sample, length
of time that the radio wave was applied to the sample, sensitivity of the receiver coil, and
overall sensitivity of the electronics.
• With special pulsing techniques the MR signal may actually appear to increase in strength
due to T1 relaxation.
• This is due to the fact that another RF pulse is applied just before the signal is received by
the coil.
• Therefore the more relaxation that has occurred, the stronger the signal will be when
flipped (nutated) by 90 degrees.
 • Therefore, the RF signal that is measured after a 90 degree spin flip increases as the time
between successive applied pulses is increased.
• The influence of relaxation parameters on the MR signal is one of the central principles of
tissue contrast in MRI.
• Any measurement technique that exploits differences in MR signal among volume
elements (voxels) of the sample enhances contrast in the image.
• Just as contrast in computed tomography is influenced by factors such as electron density
(no. of electrons per gram) and physical density (grams per cubic centimeter), contrast in
MRI is influenced by differences in the relaxation parameters T1 and T2, and in the nuclear
spin density, N(H) (number of spins per cubic centimeter).

Block Diagram approach of MRI system

System magnets
• In magnetic resonance imaging (MRI) and spectroscopy, the static magnetic field is
supplied by the main system (static) magnet.
• This magnetic field defines the axis about which protons precess. The static field direction
is also the reference axis for the nutation angle of the protons following the application of
radio-frequency (RF) pulses.
 • A range of field strengths is used for imaging, from millitesla up to 10 tesla in some
research systems, with the
the bulk of clinical imaging conducted in the range of 0.1 to 3.0
tesla.
• There are two types of main system magnets: electromagnets and permanent magnets.

Electromagnets
• An electromagnet is formed by twisting conducting wire in the shape of a coil or solenoid.
• Any wire that carries an electric current is surrounded by a magnetic field. When the
conducting wire is twisted into the shape of a coil, the magnetic field from the coil loops
reinforce each other to produce a magnetic field that is strongest in the coil center.
• Magnetic field “lines” are invisible lines in space that define the direction of force of the
magnetic field upon a ferromagnetic object such as iron.
• The magnetic field lines at the center of a solenoidal electromagnet lie along the axis of the
coil. Two types of electromagnets, resistive and superconductive,, are used in MRI.

Resistive magnet
• The field strength of an electromagnet is limited by the amount of current that may be
carried by the conducting wire. Some portion of the energy of an electric current is
dissipated as heat in the wire because the conducting material resists the flow of electrons.
• Because of this heat, resistive
resistive-type MRI magnets must be water-cooled.
cooled. The maximum
field attainable with a resistive MRI magnet is usually below 0.5 tesla. Power usage is also
an issue; a typical resistive MRI system requires approximately 30 kW of power.
Superconducting magnet
 • To achieve higher field strengths in magnets that are large enough for imaging human
patients, conducting wire must be used in which there is no resistance.
• Superconductive magnets allow higher currents and therefore higher field strengths. To
maintain superconductivity, conductors must be kept near the temperature at which the
element helium is a liquid (−269◦C). This temperature is near absolute zero (0 K, or
−273◦C).
• Liquid helium is circulated around the superconducting wire in an insulating chamber
called a dewar. A second insulating chamber, containing liquid nitrogen at −196◦C, is used
to help maintain the helium in its liquid state.

Permanent Magnets
• Permanent magnets are composed of ferromagnetic materials that maintain their magnetic
properties with no additional input of energy.
• Large assemblies of ferromagnetic materials for clinical MRI systems have field strengths
of upto 0.3 tesla.
• In such a system the patient is placed between the poles of the permanent magnet with the
direction of magnetic field lines perpendicular to the axis of the patient.

Gradient Magnetic field

• The gradients required for spatial encoding of the MR signal are provided by gradient
electromagnetic coils. The magnetic field generated by a gradient coil is substantially
smaller than the field of the main system magnet.
 • A typical rate of change of field strength is several gauss per centimeter over a distance of
100 cm.
• By applying the current in opposite directions to two loops on either side of the patient,
magnetic fields are generated to provide a range of field strengths over the patient.
• These conducting loops are oriented to provide variations in magnetic field intensity along
three orthogonal axes of the patient. An illustration of the orientation of the coils is shown
in fig 25-3.

Radiofrequency Coil
• RF coils send and receive radio waves in a fashion similar to a radio antenna.
• The term “coil” is used rather than “antenna” when the source and receiver are very close,
as is the case in MRI.
• \When pulses are sent into the patient, the coil is the source, and the patient is the receiver.
• When the MR signal is read out, the patient is the source, and the coil is the receiver. In
either case, the source and receiver are within a few coil diameters of each other.

Sending and Receiving Coils

 • The sending coil of an MRI system is usually built into the bore of the magnet. Precise
positioning of the patient within the sending coil is necessary to ensure that the anatomy of
interest appears in the image.
• In most imaging units it is difficult to visualize patient position after the patient has entered
the bore of the magnet. Therefore, a positioning system is used that involves the use of
external markers or a patient table indexing scale.
• Under some circumstances, the use of separate sending and receiving coils maybe
eliminated.
• The same coil may send and receive radio waves in the same fashion as radio antennas may
be both senders and receivers. There is some interest in eliminating the in-bore sending
coil to provide more room in the bore to help alleviate claustrophobic effects in patients.
• Alternately, deletion of the in-bore coil would allow a reduction in bore size that could
resolve some of the design problems inherent in MRI magnet construction.
• The RF pulse produced in a small surface coil is less uniform than that provided by an in-
bore solenoidal sending coil. It is possible to overcome this limitation with special pulsing
techniques.

Shim Coils
• Magnetic field homogeneity is improved by the application of additional fields via
auxillary current-carrying coils. They are called shim coils.
• Shim coils are active or passive magnetic field devices that are used to adjust the main
magnetic field and to improve the homogeneity in the sensitive central volume of the
scanner.
• The process of adjusting the shim currents to optimize the homogeneity is called shimming
the magnetic field.

Electronic Components
• The operation of an MRI system requires the use of several standard electronic
Components.
 • The transmitted radio waves originate in a device known as a signal generator. The signal
generator’s task is to produce a signal at a precise frequency and desired shape.
• The magnitude of the signal is then increased by an RF amplifier.
• The receiver electronics include a mixer that combines the received signal (MR signal
obtained from the patient by the receiver coil) with a reference signal at or near the Larmor
frequency.
• The effect of mixing the signals is to subtract out the Larmor frequency, leaving only the
small shifts in frequency.
• These frequency shifts are used for spatially encoding the MR signal. After mixing, a low-
frequency (kilohertz instead of megahertz) MR signal remains.
• The purpose of mixing is to provide a low-frequency signal that can be digitized more
precisely than a high-frequency signal.
• In a given cycle of the signal, the analog-to-digital converter (ADC) has more time to
divide the signal into successive digital values to yield greater precision.

fMRI
• Functional Magnetic Resonance Imaging (fMRI) is the use of MRI to measure the
hemodynamic response related to neuronal activity.
• fMRI measures the ratio of oxygenated haemoglobin to deoxygenated haemoglobin in the
blood with respect to a control baseline.
• Oxyhemoglobin is diamagnetic in nature, i.e. it does not have a natural magnetic
attraction.
• Deoxy-haemoglobin is paramagnetic in nature, i.e. it has natural attraction. MR signal of
blood is different depending on the level of oxygenation.
 • These different signals can be detected using BOLD contrast. Oxygenation of blood acts
as contrast agent. Higher the concentration of oxygen, greater is the intensity of BOLD
signal.
• Whenever neurons in a particular area are fired, blood flow to that area is increased. The
neuronal activity causes increase in blood flow, cerebral blood volume and oxygen
delivery.
• Increased blood flow brings more oxy-haemoglobin to that area. Hence the concentration
of deoxy-haemoglobin is reduced. Decreased concentration of deoxy-haemoglobin makes
the local magnetic field more uniform.
• When the magnetic field becomes more homogenous, MR signal increases in intensity.

TYPES OF fMRI
1. BOLD fMRI – it measures the regional differences in oxygenated blood.
2. Perfusion – it measures regional cerebral blood flow.
3. Diffusion-weighted MRI – it measures random movement of the H2O molecules.

• The most common fMRI technique used is Blood Oxygenation Level Dependent (BOLD)
fMRI. Imaging with BOLD technique uses local changes in blood flow as an indicator of
momentary activation of a region in the brain.
• Increased local neuronal activity leads to strong increase in local blood flow. This response
of the vascular system to the increased energy demand is called the hemodynamic response.
• During the hemodynamic response, the oxygenated to deoxygenated haemoglobin ratio
increases resulting in a more homogenous local magnetic field. Excited spins dephase
slower in a more homogenous magnetic field leading to a stronger measured MRI signal
in the activated state when compared to a resting state.
• The BOLD effect, thus, measures increased neuronal activity indirectly via a change in
local magnetic field homogeneity, which is caused by an oversupply of oxygenated blood.
• These filed inhomogeneties are measured by MRI because of the different magnetic
properties of oxy- and deoxygenated haemoglobin. The change in the local HbO2/Hb ratio
and its associated change in magnetic field homogeneity, thus, acts as an endogenous
marker of neural activity.
 Paradigm Design

Focal change of neuronal activity

Metabolic response

MRI signal change

Data processing

Activation Map

• Sequence of images is acquired continuously during the task conditions (rest and stimulus).
Each location in the brain may be imaged every 1-3 seconds.
• Increased blood flow to the area of the activity in the brain occurs 1-5 seconds after the
stimulation, and remains elevated or the duration of the task period and falls back to
baseline during the rest period.
• Statistical tests are used to compare the time signal from each voxel to the reference
waveform.
• Voxels that have a signal similar to the reference waveform and meet the statistical
conditions are considered ‘active’.
• Then finally, the locations of active voxels are marked on the high resolution anatomical
images.

Applications:
• Display of neutrally active regions of the brain due to sensory stimulation.
• Analysis of cerebral organization / reorganization.
• Useful in pre-surgical planning to map vital areas like language, motor, visual area.

UNIT – IV NUCLEAR MEDICINE SYSTEMS

 • Nuclear medicine uses small amounts of radiation to provide information about a person’s
body and the functioning of specific organs, ongoing biological processes, or the disease
state of a specific illness.
• In most cases, the information is used by physicians to make an accurate diagnosis of the
patient’s illness. In certain cases radiation can be used to treat diseased organs or tumours.
• Nuclear imaging is a technique that uses radioisotopes that emit gamma rays from within
the body.
• There is a significant difference between nuclear imaging and other medical imaging
systems such as CT (computerised tomography), MRI (magnetic resonance imaging) or X-
rays.
• Nuclear imaging measures the function (by measuring blood flow, distribution or
accumulation of the radioisotope) of a part of the body and does not provide highly resolved
anatomical images of body structures.
• The information obtained by nuclear imaging tells an experienced physician much about
how a given part of a person’s body is functioning.
• By using nuclear imaging to obtain a bone scan for example, physicians can detect the
presence of secondary cancer ‘spread’ up to two years ahead of a standard X-ray.
• It highlights the almost microscopic remodelling attempts of the skeleton as it fights the
invading cancer cells.
• The main difference between nuclear imaging and other imaging systems is that, in nuclear
imaging, the source of the emitted radiation is within the body.
• Nuclear imaging shows the position and concentration of the radioisotope.
• If very little of the radioisotope has been taken up a ‘cold spot’ will show on the screen
indicating, perhaps, that blood is not getting through.
• A ‘hot spot’ on the other hand may indicate excess radioactivity uptake in the tissue or
organ that may be due to a diseased state, such as an infection or cancer.
• Both bone and soft tissue can be imaged successfully with this system.

Radio Isotopes
 • Radioactive isotope or radionuclide is an isotope with an unstable nucleus, characterized
by excess energy available to be imparted either to a newly created radiation particle within
the nucleus or via internal conversion.
• During this process, the radionuclide is said to undergo radioactive decay, resulting in the
emission of gamma ray(s) and/or subatomic particles such as alpha or beta particles. These
emissions constitute ionizing radiation.
• Many radionuclides occur naturally, and others are produced artificially, for example in
nuclear reactors and cyclotrons.
• Even the lightest element, hydrogen, has a well-known radionuclide, tritium. The heaviest
elements (heavier than lead) exist only as radionuclides.
• Radionuclides can also present both real and perceived dangers to health.
• Hence, radioisotopes are atoms that contain an unstable combination of neutrons and
protons. The combination can occur naturally, or by artificially altering the atoms.
• Atoms containing this unstable combination regain stability by shedding radioactive
energy, hence the term radio-isotope.
• The process of shedding the excess radioactive energy is called decay.
• The radioactive decay of each type of radioisotope is unique and is measured with a time
period called half-life.

Alpha , beta and gamma radiations

Alpha emission
• Some heavy nuclei gain stability by a different form of radioactive decay, termed alpha (α)
decay.
• The a-decay occurs mostly in heavy nuclides such as uranium, radon, plutonium, and so
forth. Beryllium-8 is the only lightest nuclide that decays by breaking up into two a-
particles.
• The a-particles are basically helium ions with two protons and two neutrons in the nucleus
and two electrons removed from the helium atom.
• Alpha decay may be described by the following equation:
 • In this mode of decay, an alpha particle (two protons and two neutrons tightly bound as a
nucleus of helium 42He) is ejected from the unstable nucleus.
• After a-decay, the atomic number of the nucleus is reduced by 2 and the mass number by
4. The alpha particle is a relatively massive, poorly penetrating type of radiation that can
be stopped by a sheet of paper.
• An example of alpha decay is

• This example depicts the decay of naturally occurring radium into the inert gas radon by
emission of an alpha particle. Again after an emission of alpha particle Radon decays into
Polonium.
• The energy of the α-particles
particles is, as a rule, equal to the energy difference between the two
levels and ranges from 1 to 10MeV.
• The high-energy a-particles
particles normally originate from the short-lived radionuclides and vice
versa.
• The range of the α-particles
particles is very short in matter and is approximately 0.03 mm in body
tissue.

Isotope Activity Half-life Energies (keV)

Polonium-210 166500 TBq/kg (4500 Ci/g) 138 days 5304.5
Uranium-238 12580 KBq/kg (0.00000034 Ci/g) 4.468 billion years 4267

Beta Emission
• When a radionuclide is neutron rich, that is, the N/Z ratio is greater than that of the nearest

stable nuclide, it decays by the emission of a β−-particle and an antineutrino, .

• In the β−decay process, a neutron is converted to a proton, thus raising the atomic number
Z of the product by 1.

• The difference in energy between the parent and daughter nuclides is called the transition
or decay energy, denoted by Emax.
 • The β−-particles carry Emax or part of it, exhibiting a spectrum of energy. The average
energy of the β−particles is about one-third of Emax.
• After β−-decay, the daughter nuclide may exist in an excited state, in which case, one or
more γ-ray emissions or internal conversion will occur to dispose of the excitation energy.
• In other words, β−-decay is followed by isomeric transition if energetically permitted.
• Beta-minus decay can be described by the following equation:

Some examples of β—decay:

Positron (β+ ) Emission

• When a radionuclide is proton rich, that is, the N/Z ratio is low relative to that of the nearest
stable nuclide; it can decay by positron (β+) emission accompanied by the emission of a
neutrino (ν), which is an opposite entity of the antineutrino.
• Positron emission takes place only when the energy difference (transition energy) between
the parent and daughter nuclides is greater than 1.02MeV.
• In β+-decay, essentially a proton is converted to a neutron plus a positron, thus, decreasing
the atomic number Z of the daughter nuclide by 1.

• The requirement of 1.02MeV for β+-decay arises from the fact that one electron mass has
to be added to a proton to produce a neutron and one positron is created.
• Since each electron or positron mass is equal to 0.511MeV, one electron and one positron
are equal to 1.02MeV, which is required as a minimum for β+-decay.
 • The energetic β+-particle
particle loses energy while passing through matter. The range of positrons
is short in matter.
• When it loses almost all of its energy, it combines with an atomic electron of the medium
and is annihilated, giving rise to two photons of 511 keV emitted in opposite directions.
These photons are called annihilation radiations.
• Beta-plus decay can be described by the following equation:

Some examples of β+-decay:

Isotope Activity Half-life Energies (keV)

Strontium-90 5180 TBq/kg (140 Ci/g) 28.5 years 546.0
Thallium-204 17057 TBq/kg (461 Ci/g) 3.78 years 763.4
Carbon-14 166.5 TBq/kg (4.5 Ci/g) 5730 years 49.5 (average)
Tritium (Hydrogen-3)
3) 357050 TBq/kg (9650 Ci/g) 12.32 years 5.7 (average)

Gamma Emission
• A nucleus can exist in different energy or excited states above the ground state, which is
considered as the state involving the arrangement of protons and neutrons with the least
amount of energy.
• These excited states are called the isomeric states
states and have lifetimes of fractions of
picoseconds to many years.
• When isomeric states are long
long-lived,
lived, they are referred to as metastable states and denoted
by “m” as in 99mTc.
 • An excited nucleus decays to a lower energy state by giving off its energy, and such
transitions are called isomeric transitions (ITs).
• Several isomeric transitions may occur from intermediate excited states prior to reaching
the ground state.
• A parent radionuclide may decay to an upper isomeric state of the product nucleus by a-
particle or b-particle emission, in which case the isomeric state returns to the ground state
by one or more isomeric transitions.
• Isomeric transition can be described by the following equation:

• The common mode of an isomeric transition from an upper energy state of a nucleus to a
lower energy state is by emission of an electromagnetic radiation, called the γ-ray.
• The energy of the γ -ray emitted is the difference between the two isomeric states.
• For example, a decay of a 525-keV isomeric state to a 210-keV isomeric state will result
in the emission of a 315-keV γ -ray.

Isotope Activity Half-life Energies (keV)

Barium-133 9694 TBq/kg (262 Ci/g) 10.7 years 81.0, 356.0
Cadmium-109 96200 TBq/kg (2600 Ci/g) 453 days 88.0
Cobalt-57 312280 TBq/kg (8440 Ci/g) 270 days 122.1
Cobalt-60 40700 TBq/kg (1100 Ci/g) 5.27 years 1173.2, 1332.5
Europium-152 6660 TBq/kg (180 Ci/g) 13.5 years 121.8, 344.3, 1408.0
Manganese-54 287120 TBq/kg (7760 Ci/g) 312 days 834.8
Sodium-22 237540 Tbq/kg (6240 Ci/g) 2.6 years 511.0, 1274.5
Zinc-65 304510 TBq/kg (8230 Ci/g) 244 days 511.0, 1115.5
Technetium-99m 1.95×104 TBq/g (5.27 × 107 Ci/g) 6 hours 140

Radioisotope Half-life Use

Reactor-produced Isotopes
 Chromium-51 27.7 days Used to label red blood cells and quantify gastro-
intestinal protein loss.
Iodine-131 8.02 days Used to diagnose and treat various diseases associated
with the human thyroid.
Iridium-192 73.83 days Supplied in wire form for use as an internal radiotherapy
source for certain cancers, including those of the head
and breast.
Molybdenum-99 66 hours Used as the ‘parent’ in a generator to produce
technetium-99m, the most widely used radioisotope in
nuclear medicine.
Phosphorus-32 14.28 days Used in the treatment of excess red blood cells.
Samarium-153 46.7 hours Used to reduce the pain associated with bony metastases
of primary tumours.
Technetium-99m 6.01 hours Used to image the brain, thyroid, lungs, liver, spleen,
kidney, gall bladder, skeleton, blood pool, bone marrow,
heart blood pool, salivary and lacrimal glands, and to
detect infection.
Yttrium-90 64 hours Used for liver cancer therapy.
Cyclotron produced radionuclides
Copper-64 12.7 hours Used to study genetic disease affecting copper
metabolism; in Positron Emission Tomography; and also
has potential therapeutic uses.
Gallium-67 78.25 Used in imaging to detect tumours and infections
hours
Iodine-123 13.2 hours Used in imaging to monitor thyroid function and detect
adrenal dysfunction. Thallium-
Thallium-201 72.9 hours Used in imaging to detect the location of damaged heart
muscle.
Carbon-11 20.3 min These are used in Positron Emission Tomography to
Nitrogen-13 10 min study brain physiology and pathology; for detecting the
Oxygen-15 122 sec location of epileptic foci; and in dementia, and psychiatry
 Fluorine-18 1.83 hours and neuropharmacology studies. They are also used to
detect heart problems and diagnose certain types of
cancer.
Artificially produced radionuclides
5.27 years Used in gamma radiography, gauging, and commercial
Cobalt-60 medical equipment sterilisation

Iridium-192 73.8 days Used in gamma radiography

Radiopharmaceuticals
• To make a radiopharmaceutical, a radioisotope is attached to a pharmaceutical that is taken
up by a specific organ or specific diseased tissues.
• The radiopharmaceutical is given orally, injected or inhaled, and is detected by a gamma
camera which is used to create a computer-enhanced image that can be viewed by the
physician.
• A radiopharmaceutical is a radioactive drug used for diagnosis or therapy in a tracer
quantity with no pharmacological effect.

Diagnostic radiopharmaceuticals
• Scientists have identified a number of chemicals that are absorbed by specific body tissues
and organs. They are called targeting agents or molecules.
• The brain, for example, consumes large quantities of glucose. Using similar knowledge,
radiopharmacists can choose the appropriate targeting chemical, label it with an
appropriate radioisotope and use it as a radioactive tracer for a particular body tissue, organ
or function.
• Once the substance has been tagged with a radioisotope and introduced into the body, it is
incorporated into the normal biological processes and excreted in the usual ways.
• Diagnostic radiopharmaceuticals can be used to examine blood flow to the brain; to assess
functioning of the liver, lungs, heart or kidneys; to assess bone damage; and to confirm
other diagnostic procedures. They are used in sports medicine to diagnose stress fractures,
which are not generally visible in X-rays.
 • Radiopharmaceuticals are used in very small quantities for diagnostic work – just enough
is administered to obtain the required information before the radiopharmaceutical decays
or is excreted from the body.
• The radiation dose received is similar to that from diagnostic X-rays. The non-invasive
nature of this technology, together with its ability to reveal organ function, makes it a
powerful diagnostic tool.
• The most common radioisotopes used for diagnosis are technetium-99m, distantly
followed by iodine-123, fluorine-18, thallium-201 and gallium-67.

Therapeutic Radiopharmaceuticals
• Rapidly dividing cells are particularly sensitive to damage by radiation. For this reason,
some cancerous growths can be controlled or eliminated by irradiating the area. This is
called radiotherapy.
• With internal radiotherapy, the radioisotope that generates the radiation is localised in the
affected organ.
• This is achieved by administering it as a radioactive element that is taken up by that part
of the body, or by attaching the radioactive element to a biological compound, which
lodges in the body at the disease site.
• Iodine-131 is used for internal radiotherapy, to treat thyroid cancer and hyperthyroidism
(an over-active thyroid).
Dosage
• The dosages of radiopharmaceuticals that are used to diagnose medical problems will be
different for different patients and depend on the type of test.
• The amount of radioactivity of a radiopharmaceutical is expressed in units called
becquerels (Bq) or curies (Ci).
• Radiopharmaceutical dosages given may be as small as 0.185 megabecquerels (5
microcuries) or as high as 1295 megabecquerels (35 millicuries). The radiation received
from these dosages may be about the same as, or even less than, the radiation received from
an x-ray study of the same organ.

Radiation detectors
• All detectors of ionizing radiation require the interaction of the radiation with matter.
Ionizing radiation deposits energy in matter by ionization and excitation.
• Ionization is the removal of electrons from atoms or molecules. (An atom or molecule
stripped of an electron has a net positive charge and is called a cation. In many gases, the
free electrons become attached to uncharged atoms or molecules, forming negatively
charged anions. An ion pair consists of a cation and its associated free electron or anion.)
• Excitation is the elevation of electrons to excited states in atoms, molecules, or a crystal.
Excitation and ionization may produce chemical changes or the emission of visible light.
Most energy deposited by ionizing radiation is ultimately converted to heat.
• Radiation detectors may be classified by their detection method.
• A gas-filled detector consists of a volume of gas between two electrodes. Ions produced in
the gas by the radiation are collected by the electrodes, resulting in an electrical signal.
• The interaction of ionizing radiation with certain materials produces ultraviolet and/or
visible light. These materials are called scintillators. They are commonly attached to or
incorporated in devices that convert the light into an electrical signal.
• Semiconductor detectors are especially pure crystals of silicon, germanium, or other
semiconductor materials to which trace amounts of impurity atoms have been added so that
they act as diodes.
• A diode is an electronic device with two terminals that permits a large electrical current to
flow when a voltage is applied in one direction, but very little current when the voltage is
applied in the opposite direction.
• When used to detect radiation, a voltage is applied in the direction in which little current
flows. When an interaction occurs in the crystal, electrons are raised to an excited state,
allowing a momentary electrical current to flow through the device.
• Detectors may also be classified by the type of information produced. Detectors, such as
Geiger-Mueller (GM) detectors, that indicate the number of interactions occurring in the
detector are called counters.
• Detectors that yield information about the energy distribution of the incident radiation,
such as NaI scintillation detectors, are called spectrometers. Detectors that indicate the
net amount of energy deposited in the detector by multiple interactions are called
dosimeters.
 • The signal generated by the detector passes through a series of electronic circuits, each of
which performs a function such as signal amplification, signal processing, or data storage.
• A detector and its associated electronic circuitry form a detector system. There are two
fundamental ways that the circuitry may process the signal-pulse mode and current mode.
• In pulse mode, the signal from each interaction is processed individually. In current
mode, the electrical signals from individual interactions are averaged together, forming a
net current signal.

Gas-filled detector
• A gas-filled detector consists of a volume of gas between two electrodes, with an electric
potential difference (voltage) applied between the electrodes.
• Ionizing radiation forms ion pairs in the gas. The positive ions (cations) are attracted to the
negative electrode (cathode), and the electrons or anions are attracted to the positive
electrode (anode).
• In most detectors, the cathode is the wall of the container that holds the gas and the anode
is a wire inside the container.
• After reaching the anode, the electrons travel through the circuit to the cathode, where they
recombine with the cations.
• This electrical current can be measured with a sensitive ammeter or other electrical
circuitry.
• There are three types of gas-filled detectors in common use-ionization chambers,
proportional counters, and GM counters. The type of detector is determined primarily
by the voltage applied between the two electrodes.
• Ionizing radiation produces ion pairs in the gas of the detector. If no voltage is applied
between the electrodes, no current flows through the circuit because there is no electric
field to attract the charged particles to the electrodes; the ion pairs merely recombine in the
gas.
• When a small voltage is applied, some of the cations are attracted to the cathode and some
of the electrons or anions are attracted to the anode before they can recombine.
• As the voltage is increased, more ions are collected and fewer recombine. This region, in
which the current increases as the voltage is raised, is called the recombination region of
the curve.

• As the voltage is increased further, a plateau is reached in the curve. In this region, called
the ionization chamber region, the applied electric field is sufficiently strong to collect
almost all ion pairs; additional increases in the applied voltage do not significantly increase
the current. Ionization chambers are operated in this region.
 • Beyond the ionization region, the collected current again increases as the applied voltage
is raised. In this region, called the proportional region, electrons approaching the anode
are accelerated to such high kinetic energies that they cause additional ionization.
• This phenomenon, called gas multiplication, amplifies the collected current; the amount
of amplification increases as the applied voltage is raised.
• At any voltage through the ionization chamber region and the proportional region, the
amount of electrical charge collected from each interaction is proportional to the amount
of energy deposited in the gas of the detector by the interaction.
• Beyond the proportional region is a region in which the amount of charge collected from
each event is the same, regardless of the amount of energy deposited by the interaction.
• In this region, called the Geiger-Mueller region (GM region), the gas multiplication
spreads the entire length of the anode.
• The size of a pulse in the GM region tells us nothing about the energy deposited in the
detector by the interaction causing the pulse.
• Gas-filled detectors cannot be operated at voltages beyond the GM region because they
continuously discharge.

Ionization chambers
• Because gas multiplication does not occur at the relatively low voltages applied to
ionization chambers, the amount of electrical charge collected from a single interaction is
very small and would require a huge amplification to be detected.
• For this reason, ionization chambers are seldom used in pulse mode. The advantage to
operating them in current mode is the freedom from dead-time effects, even in very intense
radiation fields.
• In addition, the voltage applied to an ion chamber can vary significantly without
appreciably changing the amount of charge collected.
• Almost any gas can be used to fill the chamber. If the gas is air and the walls of the chamber
are of a material whose effective atomic number is similar to air, the amount of current
produced is proportional to the exposure rate (exposure is the amount of electrical charge
produced per mass of air).
• Air-filled ion chambers are used in portable survey meters and can accurately indicate
exposure rates from less than 1 mR/hr to hundreds of roentgens per hour.
 • Gas-filled detectors tend to have low intrinsic efficiencies for detecting x-rays and gamma
rays because of the low densities of gases and the low atomic numbers of most common
gases.
• The sensitivity of ion chambers to x-rays and gamma rays can be enhanced by filling them
with a gas that has a high atomic number, such as argon (Z = 18) or xenon (Z = 54), and
pressurizing the gas to increase its density.
• Well-type ion chambers called dose calibrators are used in nuclear medicine to assay the
activities of dosages of radiopharmaceuticals to be administered to patients; many are filled
with pressurized argon.
• Xenon-filled pressurized ion chambers are used as detectors in some CT machines.

Proportional counters
• Unlike ion chambers, which can function with almost any gas, a proportional counter must
contain a gas with specific properties.
• Because gas amplification can produce a charge-per-interaction hundreds or thousands of
times larger than that produced by an ion chamber, proportional counters can be operated
in pulse mode as counters or spectrometers.
• They are commonly used in standards laboratories, in health physics laboratories, and for
physics research. They are seldom used in medical centers.
• Multiwire proportional counters, which indicate the position of an interaction in the
detector, have been studied for use in nuclear medicine imaging devices.
• They have not achieved acceptance because of their low efficiencies for detecting x-rays
and gamma rays from the radionuclides commonly used in nuclear medicine.
• If the potential difference between the electrodes of a chamber is raised beyond a certain
voltage, electrons liberated by radiation traversing the chamber are accelerated to a velocity
great enough to produce additional ionization.
• Most of the additional ionization occurs near the anode of the chamber. As a result, many
(106 to 107) electrons and positive ions are collected by the electrodes for a much smaller
number (103 to 105) of ion pairs produced directly by radiation entering the chamber.
• This process is referred to as gas amplification or the Townsend effect. The
amplification factor for the chamber is the ratio of the total number of ion pairs produced
within the chamber to the number liberated directly by radiation entering the chamber. The
 amplification factor depends on the construction of the chamber and the type of gas
enclosed within the chamber.
• The amplification factor varies from 102 to 104 for most proportional counters providing a
signal (approximately 1 mV) that requires only a small amount of external amplification.
• The voltage between electrodes must be regulated closely because the amplification factor
is affected greatly by small changes in voltage.
• In the proportional region, the amount of charge collected by the electrodes increases with
the number of ion pairs produced initially by the impinging radiation.
• Consequently, the size of the signal from a proportional chamber increases with the amount
of ionization produced by radiation that traverses the chamber.

GM counter
• If the potential difference between the electrodes of a gas-filled detector exceeds the region
of limited proportionality, then the interaction of a charged particle or x or γ ray within the
chamber initiates an avalanche of ionization, which represents almost complete ionization
of the counting gas in the vicinity of the anode.
• Because of this avalanche process, the number of ion pairs collected by the electrodes is
independent of the amount of ionization produced directly the impinging radiation.
• Hence the voltage pulses (usually 1 to 10 V) emerging from the detector are similar in size
and independent of the type of radiation that initiates the signal.
• The range of voltage over which signals from the detector are independent of the type of
radiation entering the detector is referred to as the Geiger–Muller (G–M) region. For
detectors operating in this voltage region, the amplification factor is 106 to 108.
• No counts are recorded if the voltage is less than the starting voltage because voltage pulses
formed by the detector are too small to pass the discriminator and enter the scaler.
• As the voltage is raised slightly above the starting voltage, some of the pulses are
transmitted by the discriminator and recorded.
• At the plateau threshold voltage, all pulses are transmitted to the scaler. Increasing the
voltage beyond the plateau threshold does not increase the count rate significantly.
• Consequently, relatively inexpensive high-voltage supplies that are not exceptionally
stable may be used with a G–M detector. G–M detectors usually are operated at a voltage
about one-third of the way up the plateau
Scintillation Detectors
• Scintillators are materials that emit visible or ultraviolet light after the interaction of
ionizing radiation with the material. Scintillators are the oldest type of radiation detector;
Roentgen discovered x-radiation and the fact that x-rays induce scintillation in barium
platinocyanide in the same fortuitous experiment.
• Scintillators are used in conventional film-screen radiography, many digital radiographic
image receptors, fluoroscopy, scintillation cameras, most CT scanners, and PET scanners.
• A scintillation detector consists of a scintillator and a device, such as a PMT, that
converts the light into an electrical signal.
• When ionizing radiation interacts with a scintillator, electrons are raised to an excited
energy level. Ultimately, these electrons fall back to a lower energy state, with the emission
of visible or ultraviolet light.
• Most scintillators have more than one mode for the emission of visible light, and each mode
has its characteristic decay constant.
• Luminescence is the emission of light after excitation. Fluorescence is the prompt
emission of light, whereas phosphorescence (also called afterglow) is the delayed
emission of light.
• When scintillation detectors are operated in current mode, the prompt signal from an
interaction cannot be separated from the phosphorescence caused by previous interactions.
• When a scintillation detector is operated in pulse mode, afterglow is less important because
electronic circuits can separate the rapidly rising and falling components of the prompt
signal from the slowly decaying delayed signal resulting from previous interactions.
• Many organic compounds exhibit scintillation. In these materials, the scintillation is a
property of the molecular structure.
• Organic scintillators are not used for medical imaging because the low atomic numbers of
their constituent elements and their low densities make them poor x-ray and gamma-ray
detectors. Most inorganic scintillation crystals are deliberately grown with trace amounts
of impurity elements called activators.
• The atoms of these activators form preferred sites in the crystals for the excited electrons
to return to the ground state.
 • The activators modify the frequency (color) of the emitted light, the promptness of the light
emission, and the proportion of the emitted light that escapes reabsorption in the crystal.
• Sodium iodide activated with thallium [NaI(Tl)] is used for most nuclear medicine
applications.

Gamma camera
• The principles of nuclear medicine studies are based on the assessment of radionuclidic
distribution in different parts of a given organ after in vivo administration of a
radiopharmaceutical to distinguish between the normal and abnormal tissues.
• Such assessment of radionuclide distribution is performed by gamma cameras that
primarily comprise NaI(Tl) detectors and the associated electronics.
• The gamma cameras permit the dynamic acquisition of the images with better spatial
resolution, and can be oriented in any direction around the patient.
• The gamma or scintillation camera is an imaging device that is most commonly used in
nuclear medicine. It is also called the Anger camera in honor of Hal O. Anger.
• Gamma cameras detect radiation from the entire field of view simultaneously and therefore
are capable of recording dynamic as well as static images of the area of interest in the
patient.
Principle of Operation
• The gamma camera usually consists of several components: a detector, a collimator, PM
tubes, a preamplifier, an amplifier, a pulsed-height analyzer (PHA), an X-, Y-
positioning circuit, and a display or recording device.
• The detector, PM tubes, and amplifiers are housed in a unit called the detector head, which
is mounted on a stand.
• The head can be moved up or down and rotated with electrical switches to position it in the
field of view on the patient.
• The X-, Y-positioning circuits, PHA, and some recording devices are mounted on a console.
• The computer is run by appropriate software in conjunction with a keyboard, a mouse, and
a video monitor.
• High voltage, window, and photopeaks are all set by the operator’s choice of parameters.
Acquisition of the data and processing of the data are carried out by the computer.

Detectors
 • Detectors used in gamma cameras are typically circular NaI(Tl) detectors, which have
dimensions of 25–50 cm in diameter and 0.64–1.84 cm in thickness. The most common
thickness is 0.95cm.
• The 0.64-cm thick detectors are used in mobile gamma cameras and are useful for 201Tl,
99mTc, and 123I radionuclides.
• Larger detectors (>40cm in diameter) are used in large field of view (LFOV) cameras.
Rectangular NaI(Tl) detectors (38.7 × 61cm or 45 × 66cm) are also available in gamma
cameras.
• Increasing the thickness of a detector increases the probability of complete absorption of
g-rays and hence the sensitivity of the camera.
• However, the probability of multiple Compton scattering also increases in thicker
detectors, and therefore the X, Y coordinates of the point of g-ray interaction can be
misplaced. This results in poor resolution of the image of the area of interest.
• For this reason, thin NaI(Tl) detectors are used in gamma cameras, but this decreases the
sensitivity of the camera, because many g-rays may escape from the detector without
interaction.

Collimators
• In gamma cameras, a collimator is attached to the face of the NaI(Tl) detector to limit the
field of view so that g-radiations from outside the field of view are prevented from reaching
the detector.
• Collimators are normally made of material with high atomic number and stopping power,
such as tungsten, lead, and platinum, among which lead is the material of economic choice
in nuclear medicine.
• They are designed in different sizes and shapes and contain one or many holes to view the
area of interest. Collimators are primarily classified by the type of focusing, although other
classifications are also made based on septal thickness and the number of holes.
• Depending on the type of focusing, collimators are classified as parallel-hole, pinhole,
converging, and diverging types. Pinhole collimators are made in conical shape with a
single hole and are used in imaging small organs such as the thyroid glands to provide
magnified images.
• Converging collimators are made with tapered holes converging to an outside point and
are employed to provide magnified images when the organ of interest is smaller than the
size of the detector. Images are magnified by converging collimators.
• Diverging collimators are constructed with tapered holes that are divergent from the
detector face and are used in imaging organs such as lungs that are larger than the size of
the detector. The images are minified with these collimators.
• Parallel-hole collimators are made with holes that are parallel to each other and
perpendicular to the detector face and have between 4000 and 46,000 holes depending on
the collimator design.
• These collimators are most commonly used in nuclear medicine procedures and furnish a
one-to-one projected image.
• Because pinhole and converging collimators magnify and the diverging collimators minify
the image of the object, some distortion occurs in images obtained with these collimators.
• Because LFOV cameras are readily available now, diverging collimators are not used in
routine nuclear medicine studies. Parallel-hole collimators are classified as high-resolution,
all-purpose, and high-sensitivity type, or low-energy, medium-energy, or high-energy type,
depending on the resolution and sensitivity they provide in imaging.
• High-sensitivity collimators are made with smaller thickness than all purpose collimators,
whereas high-resolution collimators are thickest of all.
• Several collimators are available that are designed for some specific purposes.
• Fan-beam collimators are designed with holes that converge in one dimension but are
parallel to each other in the other dimension.
• These collimators are primarily used for imaging smaller objects and hence magnify the
images.
• Cone-beam collimators are similar to fan-beam collimators and magnify the images except
that the holes are designed such that they converge in two dimensions.
Fig. Diverging collimator Fig. Converging collimator

Photomultiplier Tubes
• As in scintillation counters, PM tubes are essential in gamma cameras for converting the
light photons in the NaI(Tl) detector to a pulse.
• Instead of one PM tube, an array of PM tubes (19 to 107) are mounted in a hexagonal
fashion to the back of the detector with optical grease, or in some instances, using lucite
light pipes between the detector and the PM tubes.
• In modern gamma cameras, square or hexagonal PM tubes are used for better packing. The
output of each PM tube is used to define the X, Y coordinates of the point of interaction of
the g-ray in the detector by the use of an X-, Y-positioning circuit (see later) and also is
summed up by a summing circuit to form a pulse known as the Z pulse.
• The Z pulse is then subjected to pulse-height analysis and is accepted if it falls within the
range of selected energies.

X- , Y- Positioning circuit
• Each pulse arising out of the g-ray interaction in the NaI(Tl) detector is projected at an X,
Y location on the image corresponding to the X, Y location of the point of interaction of the
g-ray.
• This is accomplished by an X-, Y-positioning circuit in conjunction with the PM tubes and
a summing circuit.
• All PM tubes are connected through capacitors to four output leads representing four
directional signals, X+, X−, Y+, and Y−.
• The capacitance values are assigned in direct proportion to the location of the PM tube
relative to the four signals.
 • The output signals of PM tubes are weighted by the appropriate capacitance values and
then summed to form each of the X+, X−, Y+, and Y− signals individually.
• The X-, Y-designating pulses, X and Y, and the Z pulse are then obtained as follows:

• where k is a constant and k/Z is the amplifier gain. The X and Y pulses are then projected
on a CRT to depict the X, Y coordinates of the point of gray interaction, which in turn
corresponds to the coordinates of the location in the field of view from which the g-ray
originated.
• Similarly, these pulses can be stored in the computer in a square matrix so that the data can
be processed later to reproduce an image.
• The larger the number of PM tubes, the better the accuracy of the X, Y locations of all
pulses on the image; that is, the better the spatial resolution of the image.

Pulse-Height Analyzer
• After the Z pulses are formed by the summing circuit, the PHA analyzes their amplitude
and selects only those of desired energy by the use of appropriate peak and window
settings.
• In many gamma cameras, the energy selection is made automatically by push-button–type
isotope selectors designated for different radionuclides such as 99mTc, 131I, and so on.
• In modern cameras, isotope peak and window settings are selected by the mouse-driven
menu on a computer monitor interfaced with the camera.
• In some gamma cameras, two or three PHAs are used to select simultaneously two or three
g-rays of different energies.
• These types of cameras are useful in imaging with 111In and 67Ga that possess two or three
predominant gamma rays.
 • The window settings are provided in percentages of the peak energy by a control knob. For
most studies, a 15% to 20% window centered symmetrically on the photopeak is employed.
• It should be noted that X and Y pulses are accepted if the Z pulse is within the energy range
selected by the PHA.
• If the Z pulse is outside this range, then X and Y pulses are discarded.

Tomographic Imaging - Introduction

• Conventional gamma cameras provide two-dimensional planar images of three-
dimensional objects.
• Structural information in the third dimension, depth, is obscured by superimposition of all
data along this direction. Although imaging of the object in different projections (posterior,
anterior, lateral, and oblique) gives some information about the depth of a structure, precise
assessment of the depth of a structure in an object is made by tomographic scanners.
• The prime objective of these scanners is to display the images of the activity distribution
in different sections of the object at different depths.
• The principle of tomographic imaging in nuclear medicine is based on the detection of
radiations from the patient at different angles around the patient.
• It is called emission computed tomography (ECT), which is based on mathematical
algorithms, and provides images at distinct depths (slices) of the object.
• In contrast, in transmission tomography, a radiation source (x-rays or a radioactive source)
projects an intense beam of radiation photons through the patient’s body, and the
transmitted beam is detected by the detector and further processed for image formation.
• In nuclear medicine, two types of ECT have been in practice based on the type of
radionuclides used: single photon emission computed tomography (SPECT), which uses
gamma emitting radionuclides such as 99mTc, 123I, 67Ga, and 111
In, and positron emission
tomography (PET), which uses β+-emitting radionuclides such as 11C, 13N, 15O, 18F, 68Ga,
and 82Rb.

SPECT
Design and Principle of Operation
• Single photon emission computed tomography (SPECT) generates transverse images
depicting the distribution of x- or gamma-ray emitting nuclides in patients.
 • Standard planar projection images are acquired from an arc of 180 degrees (most cardiac
SPECT) or 360 degrees (most noncardiac SPECT) about the patient. SPECT systems use
one or more scintillation camera heads that revolve about the patient.
• The SPECT system's digital computer then reconstructs the transverse images, using either
filtered backprojection, as does the computer in an x-ray CT system, or iterative
reconstruction methods.

Image Acquisition
• The camera head or heads of a SPECT system revolve about the patient, acquiring
projection images from evenly spaced angles. The head or heads may acquire the images
while moving (continuous acquisition) or may stop at predefined angles to acquire the
images ("step and shoot" acquisition).
• Each projection image is acquired in a computer in frame mode. If the camera heads of a
SPECT system produced ideal projection images (i.e., no attenuation by the patient and no
degradation of spatial resolution with distance from the camera), projection images from
opposite sides of the patient would be mirror images and projection images over a 180-
degree arc would be sufficient for transverse image reconstruction.
• However, in SPECT, attenuation greatly reduces the number of photons from activity in
the half of the patient opposite the camera head, and this information is greatly blurred by
the distance from the collimator.
• Therefore, for most noncardiac studies, such as brain SPECT, the projection images are
acquired over a complete revolution (360 degrees) about the patient.
• However, most nuclear medicine laboratories acquire cardiac SPECT studies, such as
myocardial perfusion studies, over a 180-degree arc from the 45-degree right anterior
oblique (RAO) view to the 45-degree left posterior oblique (LPO) view.
• SPECT projection images are usually acquired in either a 642 or a 1282 pixel format.
• Using too small a pixel format reduces the spatial resolution of the projection images and
of the resultant reconstructed transverse images. Using too few projections creates radial
streak artifacts in the reconstructed transverse images.
 • The camera heads on older SPECT systems followed circular orbits around the patient
while acquiring images.
• Circular orbits are satisfactory for SPECT imaging of the brain, but cause a loss of spatial
resolution in body imaging because the circular orbit causes the camera head to be many
centimeters away from the surface of the body during the anterior and posterior portions of
its orbit (Fig. 22-3).
• Newer SPECT systems provide noncircular orbits (also called "body contouring") that keep
the camera heads in close proximity to the surface of the body throughout the orbit.

Transverse Image Reconstruction

• After the projection images are acquired, they are usually corrected for axis-of-rotation
misalignments and for non
non-uniformities.
• Following these corrections, transverse image reconstruction is performed using either
filtered backprojection or iterative methods.
 • Filtered backprojection consists of two steps. First, the projection images are
mathematically filtered.
• Then, to form a particular transverse image, simple backprojection is performed of the row,
corresponding to that transverse image, of each projection image.
• A SPECT study produces transverse images covering the entire field of view (FOV) of the
camera in the axial direction from each revolution of the camera head or heads. The actual
projection images contain considerable statistical noise.
• If they were filtered using a ramp filter kernel and then backprojected, the resultant
transverse images would contain an unacceptable amount of statistical noise.
• Typically, a different filter kernel is selected for each type of SPECT study; Filtered
backprojection is computationally efficient. In SPECT, iterative reconstruction methods
are increasingly being used instead of filtered backprojection.
• In iterative methods, an initial activity distribution in the patient is assumed. Then,
projection images are calculated from the assumed activity distribution, using the known
imaging characteristics of the scintillation camera.

SPECT Collimators
• The most commonly used collimator for SPECT is the high-resolution parallel-hole
collimator. However, specialized collimators have been developed for SPECT.
• The fan-beam collimator is a hybrid of the converging and the parallel-hole collimators.
• Because it is a parallel-hole collimator in the y-direction, each row of pixels in a projection
image corresponds to a single transaxial slice of the subject.
• In the x-direction, it is a converging collimator, with spatial resolution-efficiency
characteristics that are superior to those of a parallel-hole collimator.
• Because a fan-beam collimator is a converging collimator in the cross-axial direction, its
FOV decreases with distance from the collimator.
• For this reason, the fan-beam collimator is mainly used for brain SPECT; if the collimator
is used for body SPECT, portions of the body are excluded from the FOV, creating artifacts
in the reconstructed images.
Multihead SPECT Cameras
• To reduce the limitations imposed on SPECT by collimation and limited time per view,
camera manufacturers provide SPECT systems with two or three scintillation camera heads
that revolve about the patient.
• The use of multiple camera heads permits the use of higher resolution collimators, for a
given level of quantum mottle in the images, than would a single head system.
• Doublehead cameras fixed in a 180-degree configuration are good for head and body
SPECT and whole-body planar scans.
• Triple-head, fixed-angle cameras are good for head and body SPECT, but less suitable for
whole-body planar scans because of the limited widths of the crystals.

PET
• Positron emission tomography (PET) generates images depicting the distributions of
positron-emitting nuclides in patients.
• In the typical scanner, several rings of detectors surround the patient. PET scanners use
annihilation coincidence detection (ACD) instead of collimation to obtain projections of
the activity distribution in the subject.
• The clinical importance of PET today is largely due to its ability to image the
radiopharmaceutical fluorine 18 fluorodeoxyglucose (FDG), a glucose analog used for
differentiating malignant neoplasms from benign lesions, staging malignant neoplasms,
differentiating severely hypoperfused but viable myocardium from scar, and other
applications.

Principle of Operation
• Positrons emitted in matter lose most of their kinetic energy by causing ionization and
excitation.
• When a positron has lost most of its kinetic energy, it interacts with an electron by
annihilation.
• The entire mass of the electron-positron pair is converted into two 511-keV photons, which
are emitted in nearly opposite directions.
• In solids and liquids, positrons travel only very short distances before annihilation. If both
of these annihilation photons interact with detectors, the annihilation occurred close to the
line connecting the two interactions.
• Circuitry within the scanner identifies interactions occurring at nearly the same time, a
process called annihilation coincidence detection (ACD).
• The circuitry of the scanner then determines the line in space connecting the locations of
the two interactions.
• Thus, ACD establishes the trajectories of detected photons, a function performed by
collimation in SPECT systems.
• However, the ACD method is much less wasteful of photons than collimation.
Additionally, ACD avoids the degradation of spatial resolution with distance from the
detector that occurs when collimation is used to form projection images.

• A true coincidence is the simultaneous interaction of emissions resulting from a single

nuclear transformation.
 • A random coincidence (also called an accidental or chance coincidence), which mimics
a true coincidence, occurs when emissions from different nuclear transformations interact
simultaneously with the detectors (Fig. 22-15).
• A scatter coincidence occurs when one or both of the photons from a single annihilation
are scattered, but both are detected (Fig. 22-15).
• A scatter coincidence is a true coincidence, because both interactions result from a single
positron annihilation.
• Random coincidences and scatter coincidences result in misplaced coincidences, because
they are assigned to lines of response that do not intersect the actual locations of the
annihilations. They are therefore sources of noise, whose main effect is to reduce image
contrast.

Design of PET scanner

• Scintillation crystals coupled to photomultiplier tubes (PMTs) are used as detectors in PET;
the low intrinsic efficiencies of gas-filled and semiconductor detectors for detecting 511-
keV photons make them impractical for use in PET.
• The signals from the PMTs are processed using pulse mode (the signals from each
interaction are processed separately from those of other interactions) to create signals
identifying the position, deposited energy, and time of each interaction.
• The energy signal is used for energy discrimination to reduce mis-positioned events due to
scatter and the time signal is used for coincidence detection.
• The scintillation material must emit light very promptly to permit true coincident
interactions to be distinguished from random coincidences and to minimize dead-time
count losses at high interaction rates.
 • Most PET systems today use crystals of bismuth germanate (BGO). The energy signals
from the detectors are sent to energy discrimination circuit, which can reject events in
which the deposited energy differs significantly from 511 keV to reduce the effect of
photon scattering in the patient.
• The time signals of interactions not rejected by the energy discrimination circuits are used
for coincidence detection.
• When a coincidence is detected, the circuitry or computer of the scanner determines a line
in space connecting the two interactions. This is called a line of response.
• The number of coincidences detected along each line of response is stored in the memory
of the computer.
• Once data acquisition is complete, the computer uses the projection data to produce
transverse images of the radionuclide distribution in the patient, as in x-ray CT or SPECT.

Collimator
• In two-dimensional (slice) data acquisition, coincidences are detected and recorded within
each detector ring or small groups of adjacent detector rings.
• PET scanners designed for two-dimensional acquisition have thin annular collimators,
typically made of tungsten, to prevent most radiation emitted by activity outside a
transaxial slice from reaching the detector ring for that slice (Fig. 22-18).
• The fraction of scatter coincidences is greatly reduced in PET systems using two-
dimensional data acquisition and axial collimation because of the geometry.
 • Consider an annihilation occurring within a particular detector ring with the initial
trajectories of the annihilation photons toward the detectors.
• If either of the photons scatters, it is likely that the new trajectory of the photon will cause
it to miss the detector ring, thereby preventing a scatter coincidence.
• Furthermore, most photons from out-of-slice activity are absorbed by the axial collimators.

Transverse Image Reconstruction

• After the projection data are acquired, the data for each line of response is corrected for
random coincidences, scatter coincidences, dead-time count losses, and attenuation.
• Following these corrections, transverse image reconstruction is performed. For two-
dimensional data acquisition, image reconstruction methods are similar to those used in
SPECT.
• As in SPECT, either filtered backprojection or iterative reconstruction methods can be
used.
• For three-dimensional data acquisition, special three-dimensional analytic or iterative
reconstruction methods are required.
• An advantage of PET over SPECT is that, in PET, the correction for non-uniform
attenuation can be applied to the projection data before reconstruction.
• In SPECT, the correction for non-uniform attenuation is intertwined with and complicates
the reconstruction process.
 UNIT V RADIATION THERAPY AND RADIATION SAFETY

• Radiation therapy or radiotherapy is therapy using ionizing radiation, generally as part of

cancer treatment to control or kill malignant cells.
• Radiation therapy may be curative in a number of types of cancer if they are localized to
one area of the body.
 • It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery
to remove a primary malignant tumor.
• Radiation therapy uses high-energy radiation to shrink tumors and kill cancer
cells. Ionizing radiation works by damaging the DNA of cancerous tissue leading
to cellular death.
• To spare normal tissues (such as skin or organs which radiation must pass through to treat
the tumor), shaped radiation beams are aimed from several angles of exposure to intersect
at the tumor, providing a much larger absorbed dose there than in the surrounding, healthy
tissue.
• X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment.
The radiation may be delivered by a machine outside the body (external-beam radiation
therapy), or it may come from radioactive material placed in the body near cancer cells
(internal radiation therapy, also called brachytherapy).

Linear accelerator
• A linear accelerator (LINAC) is the device most commonly used for external beam
radiation treatments for patients with cancer.
• The linear accelerator is used to treat all parts/organs of the body. It delivers high-energy x-
rays to the region of the patient's tumor.
• These x-ray treatments can be designed in such a way that they destroy the cancer cells
while sparing the surrounding normal tissue.
• The LINAC is used to treat all body sites. The components of linear accelerator include
Radiofrequency power source, modulator, electron gun and accelerator guide.
Principle
• The modulator amplifies the AC power supply, rectifies it to DC power, and produces high
voltage DC pulses that are used to power electron gun and RF power source.
• High voltage cable electrically connects the electron gun and RF power source to the
modulator.
• The electron gun injects electrons into the accelerator guide in pulses of the appropriate
duration, velocity, and position to maximize acceleration.
• The RF power source, either a magnetron supplies high frequency electromagnetic waves
which accelerate the electrons injected from the electron gun down the accelerator guide.

Working
• The linear accelerator uses microwave technology (similar to that used for radar) to
accelerate electrons in a part of the accelerator called the "wave guide," then allows these
electrons to collide with a heavy metal target to produce high-energy x-rays.
• These high energy x-rays are shaped as they exit the machine to conform to the shape of
the patient's tumor and the customized beam is directed to the patient's tumor.
• The beam may be shaped either by blocks that are placed in the head of the machine or by
a multileaf collimator that is incorporated into the head of the machine. The patient lies
 on a moveable treatment couch and lasers are used to make sure the patient is in the proper
position.
• The treatment couch can move in many directions including up, down, right, left, in and
out. The beam comes out of a part of the accelerator called a gantry, which can be rotated
around the patient.
• Radiation can be delivered to the tumor from any angle by rotating the gantry and moving
the treatment couch.

Procedure
• Before treatment is delivered to the patient, a treatment plan is developed and approved by
the radiation oncologist in collaboration with the radiation dosimetrist and physicist.
• The plan is double-checked before treatment is given and quality-control procedures ensure
that the treatment is delivered as planned.
• Quality control of the linear accelerator is also very important. There are several systems
built into the accelerator so that it will not deliver a higher dose than the radiation
oncologist has prescribed.
• Each morning before any patients are treated, the radiation therapist performs checks on
the machine using a piece of equipment called a "tracker" to make sure that the radiation
intensity is uniform across the beam and that it is working properly.
• In addition, the radiation physicist conducts more detailed weekly and monthly checks of
the linear accelerator.
• Modern linear accelerators also have internal checking systems that do not allow the
machine to be turned on unless all the prescribed treatment requirements are met.
• During treatment, the radiation therapist continuously observes the patient using a closed-
circuit television monitor.
 • There is also a microphone in the treatment room so that the patient can speak to the
therapist if needed.
• Port films (x-rays taken with the treatment beam) or other imaging tools such as cone beam
CT are checked regularly to make sure that the beam position doesn't vary from the original
plan.
• Safety of the staff operating the linear accelerator is also important. The linear accelerator
sits in a room with lead and concrete walls so that the high-energy x-rays are shielded and
no one outside of the room is exposed to the x-rays.
• The radiation therapist must turn on the accelerator from outside the treatment room.
Because the accelerator only emits radiation when it is actually turned on, the risk of
accidental exposure is extremely low.

SRS - SRT
• Stereotactic radiosurgery (SRS) is a type of radiation therapy that uses narrow beams of
radiation coming from different angles to very precisely deliver radiation to a brain tumor
while sparing the surrounding normal tissue.
• Stereotactic radiosurgery delivers a higher, more targeted dose of radiation than external
beam radiation therapy.
• SRS is a non-surgical procedure that delivers precisely-targeted radiation at much higher
doses, in only a single or few treatments, as compared to traditional radiation therapy.
• This treatment is only possible due to the development of highly advanced radiation
technologies that permit maximum dose delivery within the target while minimizing dose
to the surrounding healthy tissue.
• The goal is to deliver doses that will destroy the tumor and achieve permanent local control.
SRS rely on several technologies:

three-dimensional imaging and localization techniques that determine the exact
coordinates of the target within the body

systems to immobilize and carefully position the patient and maintain the patient
position during therapy

highly focused gamma-ray or x-ray beams that converge on a tumor or abnormality

image-guided radiation therapy (IGRT) which uses medical imaging to confirm the
location of a tumor immediately before, and in some cases, during the delivery of
radiation. IGRT improves the precision and accuracy of the treatment.
• Three-dimensional imaging, such as CT, MRI, and PET/CT is used to locate the tumor or
abnormality within the body and define its exact size and shape.
• These images also guide the treatment planning—in which beams of radiation are designed
to converge on the target area from different angles and planes—as well as the careful
positioning of the patient for therapy sessions.
• SRS commonly refers to a one-day treatment, physicians sometimes recommend multiple
stereotactic delivered treatments. This is important for tumors larger than one inch in
diameter as the surrounding normal tissue exposed to the single high dose of radiation must
be respected and limited, and the volume of normal tissue treated increases proportionally
to the tumor size.
• Delivering the radiation in a few sessions as opposed to one, can improve safety and allow
the normal tissue to heal in between treatments. Therefore, fractionating the treatment
allows for high doses to still be delivered within the target, while maintaining an acceptable
safety profile.
• This procedure is usually referred to as fractionated stereotactic radiotherapy (SRT), and
typically refers to the delivery of two to five treatments of focused radiation.

• SRS and SBRT are important alternatives to invasive surgery, especially for patients who
are unable to undergo surgery and for tumors and abnormalities that are:

hard to reach

located close to vital organs/anatomic regions

subject to movement within the body
• SRS is used to treat:
many types of brain tumors including:

benign and malignant

primary and metastatic

single and multiple

residual tumor cells following surgery

intracranial, orbital and base-of-skull tumors

arteriovenous malformations (AVMs), a tangle of expanded blood
vessels that disrupts normal blood flow in the brain and sometimes
bleeds.

other neurological conditions like trigeminal neuralgia (a nerve disorder
in the face), tremor, etc.
• SBRT is currently used and/or being investigated for use in treating malignant or benign
small-to-medium size tumors in the body and common disease sites, including the:

lung

liver

abdomen

spine

prostate

head and neck
• SRS fundamentally works in the same way as other forms of radiation treatment. It does
not actually remove the tumor; rather, it damages the DNA of tumor cells. As a result, these
cells lose their ability to reproduce.
• Following treatment, benign tumors usually shrink over a period of 18 months to two years.
• Malignant and metastatic tumors may shrink more rapidly, even within a couple of months.
• When treated with SRS, arteriovenous malformations (AVMs) may begin to thicken and
close off slowly over a period of several years following treatment.
• Many tumors will remain stable and inactive without any change. Since the aim is to
prevent tumor growth, this is considered a success.
• In some tumors, like acoustic neuromas, a temporary enlargement may be observed
following SRS due to an inflammatory response within the tumor tissue that overtime either
stabilizes, or a subsequent tumor regression is observed called pseudoprogression.

• There are three basic kinds of equipment, each of which uses different instruments and
sources of radiation:

The Gamma Knife®, which uses 192 or 201 beams of highly focused gamma
rays all aiming at the target region. The Gamma Knife is ideal for treating small
to medium size intracranial lesions.

Linear accelerator (LINAC) machines, prevalent throughout the world, deliver
high-energy x-rays, also known as photons. The linear accelerator can perform
SRS on larger tumors in a single session or during multiple sessions, which is
called fractionated stereotactic radiotherapy. Multiple manufacturers make this
type of machine, which have brand names such as Novalis Tx™, XKnife™,
Axesse™ and CyberKnife®.

Proton beam or heavy-charged-particle radiosurgery is in limited use, though
the number of centers offering proton therapy has increased dramatically in the
last several years.

Side Effects

Swelling: As with all radiation treatments, the cells of the irradiated tumors
lose their ability to regulate fluids, and edema or swelling may occur. This
does not happen in all treatments. If swelling does occur, and it causes
symptoms that are unpleasant, then a mild course of steroid medication may
be given to reduce the fluid within the tumor cavity.

Necrosis: The tumor tissue that remains after the radiation treatment will
typically shrink. On rare occasions this necrotic or dead tissue can cause further
problems and may require removal. This occurs in a very small percentage of
cases.

Other Effects: Other side effects may occur dependent upon the target site and
the dose of radiation received.

Recent techniques in radiation therapy

3D CRT
• 3D conformal radiation therapy (3D CRT) is a type of external beam radiation which can
be used to treat and/or reduce the symptoms associated with cancer. With this precise
treatment, 3D images of the tumor are integrated into an advanced computer system to help
develop an exact plan for delivering radiation to the target area.
• The goal of 3D CRT is to maximize the dose to the cancer while minimizing the exposure
of normal, healthy tissue.
• 3D CRT is delivered using a machine located outside the body called a linear accelerator.
Each day the patient is situated in exactly the same position on the treatment table prior to
starting the actual therapy.
• Once the patient is in the correct treatment position, the linear accelerator rotates around
the patient’s body aiming multiple beams of radiation from many different angles to the
targeted site.
• The use of patient specific 3D images in the treatment planning process distinguishes 3D-
CRT from conventional radiotherapy. Typically CT and/or MRI images are used for
defining the areas of concern as well as adjacent normal structures.
• Based on this, complex plans are developed to deliver a radiation dose distribution within
the patient, where the regions of high dose are concentrated within the tumors.
• Higher doses of radiation can be delivered to cancer cells while significantly reducing the
amount of radiation received by surrounding healthy tissues.
• 3D-CRT is used to treat tumors that in the past might have been considered too close to
vital organs and structures for radiation therapy.
• For example, 3D-CRT allows radiation to be delivered to head and neck tumors in a way
that minimizes exposure of the spinal cord, optic nerve, salivary glands and other important
structures.
• The radiologist will take a 3D image of the tumor, often using one of the following imaging
technologies: Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron
emission Tomography (PET) or PET-CT.
• Then, a computer program analyzes the 3D image and designs radiation beams that follow
the shape of the tumor. The exact number of treatments and the overall duration of therapy
will depend on many factors such as the type of cancer, the location and size of the target
area, and the goals for treatment.
• Therapy may be delivered once or twice a day, five days a week with each session lasting
around 15-30 minutes.
• It is generally used to treat

Head and neck cancer

Breast cancer

Lung cancer

Gynecologic cancer

Prostate cancer

Lymphoma

Colorectal cancer

Brain tumors

• Generally the side effects of radiation therapy are mild, especially with the use of 3D CRT
which reduces side effects by minimizing the exposure of surrounding, normal tissue. Side
effects may vary depending on the specific area receiving radiation and may include:

Fatigue

Skin irritation

Loss of appetite
• Side effects usually peak within the second or third week of treatment. Patients
experiencing discomfort should communicate any questions or concerns to the treatment
team. Most of the side effects can be managed through medications or changes in diet.

IGRT
• Image-guided radiation therapy allows the patient
to be imaged before each radiation treatment is delivered. With traditional external
beam radiation, cancer patients are diagnosed, staged, and imaged prior to the start of
therapy. During the initial planning process, a CT is performed to precisely locate the tumor
and determine where the radiation beams should be directed. With advances in imaging, it
has been established that many tumors are not stationary.
• In a situation like this, the movement could cause the radiation beam to miss its target. If
this is the case, due to these variations, the original treatment plan created for the patient
may not be appropriate.
• With the addition of IGRT, the original planning CT is still performed; however, daily CTs
are compared to the original, and adjustments are made to compensate for any tumor
motion.
• IGRT allows the radiation oncologist to track tumor movement and tumor changes on a
daily basis and ensure the treatment plan is precisely delivered to the target.
• IGRT more accurately delivers the radiation to the tumor by using tighter margins and
ultimately reducing side effects to significantly enhance quality of life.
 • A treatment plan will be determined based on the cancer type and location as well as tumor
size. Most treatments take place five days a week for a period of six to seven weeks. Each
session typically lasts between ten and fifteen minutes.

Definition
• IGRT is defined as external beam radiation therapy with positional verification using
imaging prior to each treatment fraction. It is the use of the image in the actual treatment
room as a tool for tracing and verification of the tumor volume immediately before or
during treatment.

Treatment with IGRT

• Prostate cancer
• Lung cancer
• Head and neck cancer
• Gynecologic cancer
• Pancreatic cancer
• Liver cancer
• Brain tumors
• Spinal tumors
• Breast cancer
Techniques
• The most commonly used imaging technologies in IGRT are F-FDG PET, MR and 4DCT.
The most commonly treated sites are lung, CNS, head and neck tumors. A wide variety of
in-room IGRT technologies are used, with the three most common modalities being MV
planar, kV planar and volumetric based approaches.
• The linear accelerator mounted imaging systems are called on-board imagers. Kilovoltage
(KV) and megavoltage (MV) are used in x-ray imager. Modern accelerators are equipped
with various imaging systems like,

Portal and Radiographic Imagers

In-room CT scanner

Cone beam Computer Tomography

Helical Tomotherapy

Ultrasound

 Portal and Radiographic Imagers

KV x-ray imager with x-ray tube is mounted on the gantry with an opposing flat-panel image
detector. MV Electronic Portal Imaging Device (EPID) is mounted with its own flat-panel image
detector. The flat-panel image detector in both cases is a matrix of detectors with amorphous
silicon (a-Si) photodiodes. KV images have better contrast than the MV imagers of the EPIDs.

 In-room CT scanner
It combines a CT scanner with a Linac for radiation therapy. CT scanner is used to obtain CT
images before each treatment. The couch is moved in the axial direction to take CT images. It is
then rotated back into alignment with the accelerator gantry for treatment.

 Cone Beam Computed Tomography

This technique integrates CT imaging with a LINAC for visualization of the exact tumor location.
KV or MV cone beam rotates 360 about the patient to acquire multiple planar images. Filtered
back projection algorithm is used to reconstruct the volumetric images of the target volume.

Advantages of MV-CBCT over KV-CBCT

1. Less susceptibility to imaging artifacts due to metallic objects such as hip implants, dental
fillings and surgical clips.
2. There is no need for extrapolating attenuation coefficients. CT numbers in MV-CBCT
correlate directly with electron density.
3. The known dose distribution characteristics of the therapeutic beam allow more accurate
calculation of imaging dose in the MV-CBCT acquisition process.

Advantages of KV-CBCT over MV-CBCT

1. Better contrast and spatial resolution
2. Better soft tissue visibility at much lower doses.
3. Good compatibility of KV-CBCT images with the reference treatment plan images for
patient setup verification and correction.
  Helical Tomotherapy
Helical Tomotherapy is an IMRT (Intensity Modulated Radiation Therapy) delivery technique that
combines features of a linear accelerator and a helical CT scanner. The Linac is mounted on a CT-
like gantry and rotates through a full circle simultaneous with the gantry rotation. The couch is
translated slowly through the doughnut aperture. It creates a helical motion of the beam with
respect to the patient. Computer controlled multi-leaf collimator can deliver IMRT as well as
generate CT images from the same megavoltage x-ray beam it uses for therapy. Thus it is a unique
device that is capable of delivering both IMRT and IGRT services with the same gantry.

 Ultrasound
It is a non-radiographic real time imaging technique for localizing soft-tissue structures and
tumors. It is primarily used in the regions of abdomen, pelvis and breast. Transabdominal
ultrasound systems have been widely used for localizing prostate. One such system is the NOMOS,
B-mode Acquisition and Targeting (BAT) system. BAT provides a rapid means of localizing
prostate before each treatment and making corrections for interfraction variation of prostate
position.

Benefits
• Safe delivery of higher radiation doses ultimately leading to improved local control rates
• Capacity to track and treat the tumor on a daily basis which significantly reduces side
effects and enhances quality of life
• Ability to precisely target tumors which were not considered treatable by conventional
therapy due to proximity to critical structures.
The images that were acquired during the treatment period helps to:

Detect systematic error

Position the patient, target or organ at risk

Modify the treatment plan or choose an appropriate plan

Detect changes in tumor size.

Side-effects
 • IGRT is generally well-tolerated, and some patients will not experience side effects.
Fatigue, skin irritation, and loss of appetite are the most commonly reported side effects,
but additional side effects may be specific to the area where the radiation is being delivered.
• Side effects usually peak within the second to third week of treatment. If they do occur, it
is important for patients to discuss this with the treatment team. Many side effects can be
managed through medications and changes in diet.

IMRT
• Intensity Modulated Radiation Therapy aims to deliver radiation more precisely to the
tumor while relatively limiting the dose to the surrounding normal tissues. \
• Conventional radiotherapy treatments are delivered with radiation beams that are of
uniform intensity across the field.
• Wedges or compensators are used to modify the intensity profile to offset contour in
irregularities and produce more uniform composite dose distributions such as in techniques
using wedges.
• This process of changing beam intensity profile to meet the goals of a composite plan is
called intensity modulation.
• With IMRT the radiation beam is segmented into several smaller beams. The physician is
able to adjust the intensity of each beam to tightly conform to the shape of the tumor.
• This allows for delivery of the highest possible dose to the tumor while sparing
surrounding, healthy tissue.
• This specialized technology increases the rate of tumor control, improves quality of life,
reduces side effects and preserves normal organ function.

Definition
• IMRT refers to a radiation therapy technique in which non-uniform fluence is delivered to
the patient from any given position of the treatment beam to optimize the composite dose
distribution.

Principle
• The optimal fluence profiles for a given set of beam directions are determined through
inverse planning. The fluence files thus generated are electronically transmitted to the
 linear accelerator, which is computer controlled, to deliver intensity modulated beams
(IMBs) as calculated.
• IMRT is an approach to conformal therapy that not only conforms (high) dose to the target
volume but also conforms (low) dose to sensitive structures. IMRT is especially useful
when the target volume has a concavity in its surfaces and/or closely juxtaposes OARs.

Delivery of IMRT
• IMRT is delivered using a machine called a linear accelerator. The patient will be
positioned in a specific way on the treatment table each day before the treatment is started.
Once the patient is positioned, the linear accelerator will rotate around the patient’s body,
delivering multiple beams of radiation from many different angles.

Application of IMRT
1. Brain tumors:
IMRT can treat
• Intracranial tumors (benign and malignant)
• Large, irregular and solitary, or smaller & multiple brain lesions.
• IMRT limit the dose to surrounding normal tissues; optic nerve, chiasm, lens, and
brainstem.
2. Head and Neck Cancer
• Many of the technique issues for brain tumors also apply to head and neck
• Limiting dose to the parotid gland to prevent xerostomia, or permanent dry mouth
that occurs with typical head and neck radiotherapy.
3. Prostate cancer
• Radiotherapy has been a mainstay of localized prostate therapy for several decades.
• Higher doses to the prostate and better shielding of the rectum and bladder to
minimize morbidity.
4. Breast Cancer
• IMRT is the better treatment
• It gives more even dose to the breast with fewer hot spots and less dosing to normal
tissues (lung and heart)
 • Common side effect of radiation, like swelling, breast heaviness and sunburn like
changes can be reduced with IMRT.

Cyber Knife
• CyberKnife is a noninvasive alternative to surgery for treating cancerous and noncancerous
tumors anywhere in the body.
• CyberKnife delivers beams of high-dose radiation to tumors with extreme accuracy,
offering hope to patients whose tumors were previously inoperable.
• CyberKnife treatment involves no incision. In fact, it is the world's first and only robotic
radiosurgery system designed to noninvasively treat tumors throughout the body.
• It provides a pain-free, non-surgical option for patients who have inoperable or surgically
complex tumors, or who may be looking for an alternative to surgery.
• The CyberKnife System uses image guidance software to track and continually adjust
treatment for any patient or tumor movement.
• This sets it far ahead of other similar treatments. It allows patients to breathe normally and
relax comfortably during treatment. some forms of radiosurgery require rigid head-frames
that are screwed into the patient’s skull to minimize any movement.
• The CyberKnife System does not require such extreme procedures to keep patients in place,
and instead relies on sophisticated tracking software, allowing for a much more
comfortable and non-invasive treatment. unlike some radiosurgery systems, which can
only treat tumors in the head, the CyberKnife System has unlimited reach to treat a broad
range of tumors throughout the body, including the prostate, lung, brain, spine,
liver, pancreas, and kidney.
• The CyberKnife System’s treatment accuracy is unrivaled. Its ability to treat tumors with
pin-point accuracy is unmatched by other radiation therapy and radiosurgery systems.
• The CyberKnife System can essentially “paint” the tumor with radiation allowing it to
precisely deliver treatment to the tumor alone, sparing surrounding healthy tissue.
• CyberKnife is a frameless radiosurgery system consisting of integrated parts. The central
component is a lightweight linear accelerator mounted on a robotic arm. The mobility of
CyberKnife enables it to treat tumors and lesions from a variety of angles without clinician
intervention or treatment interruption.
 • The radiation beams from CyberKnife adjust in real-time to a patient's breathing cycle.
Many tumors, even when their movement has been restricted, continue to move during
treatment delivery.
• CyberKnife's advanced robotic technology and ability to track tumor movement throughout
the treatment, allows it to deliver radiation with extreme accuracy.
• By dramatically reducing the planning margins and accounting for patient movement,
CyberKnife minimizes damage to the surrounding healthy tissue.

Treatment Process
• Prior to the procedure, the patient is imaged using a high-resolution CT scan, to determine
the size, shape and location of the tumor.
• Following scanning, the image data is digitally transferred to the CyberKnife System’s
workstation, where the treatment planning begins.
• A qualified clinician then uses the CyberKnife software to generate a treatment plan.
• The plan is used to match the desired radiation dose to the identified tumor location while
limiting radiation exposure to the surrounding healthy tissue.
• Once the treatment plan has been developed, the patient is ready to undergo the CyberKnife
procedure.
• After arriving at the CyberKnife Center, patients are comfortably positioned on the
treatment table.
• Then the CyberKnife System’s computer-controlled robot will slowly move around the
patient to the various locations from which it will deliver radiation to the tumor.
• Each treatment session will last between 30 and 90 minutes, depending on the type of tumor
being treated. If treatment is being delivered in stages, patients will need to return for
additional treatments over several days (typically no more than five), as determined by the
patients doctor.
• Patients may experience some minimal side effects, but those often go away within the first
week or two after treatment.

Advantage
• Non-invasive, so no incision, no pain, no blood loss.
 • Treats hard-to-reach tumors.
• Does not require anaesthesia
• Performed as an outpatient procedure
• Effective for lesions previously treated with radiation therapy

Radiation Measuring Instruments

• Personnel working with radiation installations require continuous monitoring of the dose
received and recording of the cumulative dose throughout the individual's life time.
• This is commonly known as personnel monitoring.
• The assessment of radiation levels at different locations in the vicinity of radiation
installations is generally known as area monitoring.

Film Badges
• The film badge is most popular and cost-effective for personnel monitoring and gives
reasonably accurate readings of exposures from β-, γ- and x-radiations.
• The film badge consists of a radiation-sensitive film held in a plastic holder. Filters of
different metals (aluminum, copper, and cadmium) are attached to the holder in front of
the film to differentiate exposure from radiations of different types and energies.
• The filters are selected to make the sensitivity of the film independent of radiation energies.
The paper wrapped film (double coated emulsion) is placed inside the badge.
• The radiations passing through the filter cause formation of latent image (silver deposition)
in the film which after due processing forms blackening.
• Computation of densities under different filters gives the amount of dose received. After
exposure the optical density of the developed film is measured by a densitometer and
compared with that of a calibrated film exposed to known radiation.
• Film badges are usually changed monthly for each radiation worker in most institutions.
Film badges provide an integral dose and a permanent record.
• The main disadvantage of the film badge is the long waiting period (a month) before the
exposed personnel know about their exposure.
 • The film badge also tends to develop fog resulting from heat and humidity, particularly
when in storage for a long time, and this may obscure the actual exposure reading.
• The film badges of all workers are normally sent to a commercial firm that develops and
reads the density of the films and sends back the report of exposure to the institution.
• The commercial firm must be approved by the National Voluntary Laboratory Accredition
Program (NVLAP) of the National Institute of Standards and Technology.

Pocket Dosimeter
• Pocket dosimeters are of fountain pen size and can conveniently be kept in the pocket.
Basically, the dosimeter is an ionization chamber which is charged to a suitable voltage
obtained from a separate charger (150-200V).
• The chamber is coupled to a built-in-electrometer (quartz fiber electrometer) and a
microscope to view the electrometer having a reticle calibrated in terms of roentgen.
• In non-self reading type dosimeter, the measurements are made with a reading device
which has a built-in charger.
• The dosimeter is initially charged so that the deflection of the quartz fiber is at zero on the
scale when viewed in the charger or in charger-reader.
• The dosimeter is then ready for use. The self reading type is viewed against light and the
non-self reading type is fitted back to the charger-reader and viewed for the dose
measurement.
ThermoLuminescent Dosimeter
• A thermoluminescent dosimeter (TLD) consists of inorganic crystals (chips) such as
lithium fluoride (LiF) and manganese-activated calcium fluoride (CaF2 : Mn) held in
holders like the film badges and plastic rings.
• When these crystals are exposed to radiation, electrons from the valence band are excited
and trapped by the impurities in the forbidden band.
• If the radiation- exposed crystal is heated to 300°C to 400°C, the trapped electrons are
raised to the conduction band; they then fall back into the valence band, emitting light.
• The amount of light emitted is proportional to the amount of radiation absorbed in the TLD.
The amount of light is measured and read as the amount of radiation exposure by a TLD
reader, a unit that heats the crystal and reads the exposure as well.
• The TLD gives an accurate exposure reading and can be reused after proper heating
(annealing).
• It should be noted that exposure resulting from medical procedures and background
radiations are not included in occupational dose limits. Therefore, radiation workers should
wear film badges or dosimeters only at work.
• These devices should be taken off during any medical procedures involving radiation such
as radiographic procedures and dental examinations, and also when leaving after the day’s
work.
• Also radiation workers should not wear these badges for certain period of time after
undergoing a diagnostic or therapeutic nuclear medicine procedure or radiation therapy
permanent implant procedure.
Electronic Dosimeter
• Gamma photons interact with detector (Silicon) to produce electron-hole pairs. By
applying reverse bias to silicon diode, make a depletion layer with extremely low electrons,
and take it as a sensing assembly.
• From a simplistic viewpoint, the silicon detector acts as a solid state ion chamber operating
in pulse mode. With optimization of composite metal filter shielding and electrical
thresholds (to minimize noise), energy response can be flattened. We obtain a dose
equivalent response by counting detector pulses.

Dose of γ-rays ＝ γ-ray detection constant ｘ γ-ray counting value after discrimination.
• X-ray is similar to gamma and is detected by the silicon detector. The electronic dosimeter
contains a sounder and alarm LED which are activated together when certain alarm
conditions occur.
• Alarms are also indicated in various ways on the LCD. Under alarm conditions the LED
illuminates red and the audible sounds generated from sounder.
• Alarms are acknowledged by pressing the button (long press). This action will extinguish
the alarm LED and mute the audible sound.
• Alarms can be adjusted via the IR communications link. Dose alarms are calculated against
a preset alarm threshold set in the electronic dosimeter.
• When the dose equals or exceeds the dose threshold the LED will illuminate, the audible
sound will activate and the appropriate alarm flag on the LCD will be displayed.

Radiation Protection in Medicine

• Radiation can cause death, skin burns, cataract, infertility (deterministic effects), cancer
and genetic effects (stochastic effects).
• The objectives of radiation protection are the prevention of deterministic effects and
limiting the probability of stochastic effects. It is generally assumed that even very small
doses of ionizing radiation can potentially be harmful.
• Therefore, persons must be protected from ionizing radiation at all dose levels. The patient
and his family, workers and the public must be protected from the radiation.
• Various agencies play some role in limitation of radiation dose to the general public and to
occupationally exposed individuals.
 • There are two types of agencies, advisory and regulatory.
• Advisory agencies assemble teams of experts in epidemiology, public health, radiobiology,
and other fields to publish analyses of the world’s literature on radiation bioeffects and to
recommend guidelines, limits, and procedures that would lead to the most effective use of
radiation for the public while minimizing the hazard.
• Regulatory agencies make laws, inspect facilities, review records, levy fine, and issue and
cancel licenses.
Some of the Advisory agencies are:
► National Council on Radiation Protection and Measurements (NCRP)
► International Commission on Radiological Protection (ICRP)
► United Nations Scientific Committee on the effects of Atomic Radiation (UNSCEAR)
► National Academy of Sciences (NAS)
► Conference of Radiation Control Program Directors (CRCPD)
Some of the regulatory agencies are:
► Nuclear Regulatory Commission (NRC)- radioactive materials used or produced in nuclear
reactors (source or by product radioactive materials)
► State Health Departments-x ray producing equipment and, in some states, radioactive
materials.
► Environmental Protection Agency (EPA)- radioactive materials and sources that affect the
environment
► Food and Drug Administration (FDA) – manufacture of x-ray producing equipment
ICRP defined the system of radiological protection as
• Optimize protection
• Justify the exposure
• Dose limitations

Radiation Protection Principles

• Of the various types of radiation, the α-particle is most damaging because of its charge and
great mass, followed in order by the β-particle and the γ-ray.
• Heavier particles have shorter ranges and therefore deposit more energy per unit path
length in the absorber, causing more damage.
 • On the other hand, γ-rays and x-rays have no charge or mass and therefore have a longer
range in matter and cause relatively less damage in tissue.
• Knowledge of the type and energy of radiations is essential in understanding the principles
of radiation protection.
• The cardinal principles of radiation protection from external sources are based on four
factors: time, distance, shielding, and activity.

Time
• The total radiation exposure to an individual is directly proportional to the time of exposure
to the radiation source.
• The longer the exposure, the higher the radiation dose.
• Therefore, it is wise to spend no more time than necessary near radiation sources.

Distance
• The intensity of a radiation source, and hence the radiation exposure, varies inversely as
the square of the distance from the source to the point of exposure.
• It is recommended that an individual should keep as far away as practically possible from
the radiation source.
• Procedures and radiation areas should be designed so that individuals conducting the
procedures or staying in or near the radiation areas receive only minimum exposure.
• The radiation exposure from γ-ray and x-ray emitting radionuclides can be estimated from
the exposure rate constant, Γ, which is defined as the exposure from g-rays and x-rays in
R/hr from 1 mCi (37 MBq) of a radionuclide at a distance of 1cm.
• Each γ- and x-ray emitter has a specific value of Γ, which has the unit of R ·cm2/mCi· hr
at 1 cm.
• The exposure rate X from an n-mCi radionuclide source at a distance d cm is given by

Shielding
 • Various high atomic number (Z) materials that absorb radiations can be used to provide
radiation protection. Because the ranges of α- and β- particles are short in matter, the
containers themselves act as shields for these radiations. γ- radiations, however, are highly
penetrating.
• Therefore, highly absorbing material should be used for shielding of γ–emitting sources,
although for economic reasons, lead is most commonly used for this purpose.
• The half-value layer (HVL) of absorbent material for different radiations is an important
parameter in radiation protection and is related to linear attenuation coefficient of the
photons in the absorbing material.

Activity
• It should be obvious that the radiation exposure increases with the intensity of the
radioactive source.
• The greater the source strength, the more the radiation exposure.
• Therefore, one should not work unnecessarily with large quantities of radioactivity.
 BM8702-RADIOLOGICAL EQUIPMENT TWO MARKS

UNIT I- Medical X-Ray Equipment

PART A
1. List out the properties and nature of X-rays?

• X-rays are electromagnetic wave.

• X-rays can ionize atoms and molecules of matter.
• They travel by a velocity of light i.e. 3×108ms-1 in vacuum or air.
• They are not deflected by magnetic or electric fields and, therefore, do not possess any charge.
• X-ray can produce the photoelectric effect.
• X-rays can ionize a gas through which they pass

2. Which material used as anode and cathode in X-ray tube?

• Cathode: Nickel and stainless steel

• Anode: Tungsten and molybdenum
3. What is angiography?

• Angiography or arteriography is a medical imaging technique used to visualize the inside, or

lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins,
and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent
into the blood vessel and imaging using X-ray.
4. Define Digital Subtraction Angiography?

• Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in

interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue
environment. Images are produced using contrast medium by subtracting a 'pre-contrast image'
or the mask from later images, once the contrast medium has been introduced into a structure.
5. Mention the objectives of mammography?

• A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in
women who have no signs or symptoms of the disease. It can also be used if there is a lump or
other sign of breast cancer.
6. Write down the merits and demerits of storage phosphor?

Merits (or) Advantages Demerits (or) Disadvantages

1. Digital imaging 1. High cost
2. Reusable 2. Typical designing
3. Higher resolution 3. Needs an external image processing device.
7. Define Radiography.

• Radiography is an imaging technique that uses electromagnetic radiation other than visible light,
specifically X-rays, to view the internal structure of a non-uniformly composed and opaque
object (i.e. a non-transparent object of varying density and composition) such as the human body.
8. What is Fluoroscopy?

• Fluoroscopy is a study of moving body structures--similar to an X-ray "movie." A continuous X-

ray beam is passed through the body part being examined. The beam is transmitted to a TV-like
monitor so that the body part and its motion can be seen in detail.
9. Write any two functions of Image intensifier tube?
I. Image Intensifiers are used to amplify low light level images in a wide wavelength range to
observable levels.
II. They operate by converting photons of light into electrons, amplifying the electrons (usually
with a micro channel plate), and then converting the amplified electrons back into photons for
viewing.
10. State the purpose of using Grids in X ray

• Grids are placed between the patient and the X-ray film to reduce the scattered radiation
(produced mainly by Compton Effect) and thus improve image contrast. They are made of
parallel strips of lead with an interspace having an aluminum or organic spacer.
11. Define collimator?

• A collimator is a device that narrows a beam of particles or waves. To narrow can mean either to
cause the directions of motion to become more aligned in a specific direction (i.e., make
collimated light or parallel rays), or to cause the spatial cross section of the beam to become
smaller (beam limiting device).
12. Why we need grids in X-ray machine?

• X-rays from tube will be both low energy and high energy x-rays, high energy x-ray’s plays
important role in obtaining image, whereas low energy x-ray is absorbed by the body and not
useful in imaging, this results in unwanted exposure. To avoid those low energy x-rays grids are
used, it is made up of lead blocks.
13. List out the components of an X-ray machine.
a) Vacuum glass tube (Pyrex)
b) Anode(tungsten and copper)
c) Cathode(tungsten filament)
d) Rectifier
e) Grid
f) Filter
g) Collimator
 h) High voltage supply

14. Mention and explain the effects of electron interacts the anode.

Two major effects take place in anode while high energy electron from cathode interacts,
• Photoelectric effect
• Bremsstrahlung effect

15. Define Bremsstrahlung radiation.

• In the Bremsstrahlung process, a high speed electron approaches an atom, it will interact with
the electrons of the atom, and it may be slowed or completely stopped. This energy cannot be
lost and must be absorbed by the atom or converted to another form of energy. The energy used
to slow the electron is excessive to the atom and the energy will be radiated as x-radiation of
equal energy
16. What is the use of hard x-rays?

• Hard X-rays are widely used to image the inside of objects, e.g., in medical radiography and
airport security.
• Directing Hard X-rays at cancerous tumors, the abnormal cells can be killed.
17. What is a heel effect? ŀ

• In X-ray tubes, the heel effect or more accurately, the anode heel effect is a variation of the
intensity of X-rays emitted by the anode depending on the direction of emission.
18. What is the need for cooling system in X r-ray machines?

• An x-ray tube cooling system including a heat sink at least partially disposed within an evacuated
housing of the x-ray tube and having a cooling block partially received within the bearing
housing so as to absorb heat transmitted to the bearing assembly and bearing housing. Extended
surfaces, are disposed in a coolant chamber cooperatively defined by the cooling block and a shell
within which the cooling block is partially received.
19. Define Detector quantum efficiency (DQF)?

• Detective quantum efficiency (DQE) is one of the fundamental physical variables related to
image quality in radiography and refers to the efficiency of a detector in converting incident x-
ray energy into an image signal
20. Why do you require image intensifier?

• An x-ray image intensifier (XRII) is an image intensifier that converts x-rays into visible light
at higher intensity than mere fluorescent screens do.
• Such intensifiers are used in x-ray imaging systems (such as fluoroscopes) to allow low-
intensityx-rays to be converted to a conveniently bright visible light output.
 • The device contains a low absorbency/scatter input window, typically aluminum, input
fluorescent screen, photocathode, electron optics, output fluorescent screen and output
window.
• These parts are all mounted in a high vacuum environment within glass or more recently,
metal/ceramic.

UNIT-II
1. List out the Components of CT?

I. X-ray tubes II Gantry III. Detectors IV. Data acquisition system

V. Image reconstruction VI. Imaging console
2. Write down the function of Filtered back projection in reconstructing an image?

• Filtered back projection as a concept is relatively easy to understand. Let's assume that we havea
finite number of projections of an object which contains radioactive sources. The projections of
these sources at 45 degree intervals are represented on the sides of an octagon. The basic idea
behind back projection, which is to simply run the projections back through the image (hence the
name ``back projection'') to obtain a rough approximation to the original. The projections will
interact constructively in regions that correspond to the emotive sources in the original image.
3. Define collimator? ŀ

• A collimator is a device that narrows a beam of particles or waves. To narrow can mean either to
cause the directions of motion to become more aligned in a specific direction (i.e., make
collimated light or parallel rays), or to cause the spatial cross section of the beam to become
smaller (beam limiting device).

4. Point out the Advantages and Disadvantages of spiral CT?

Advantages of Spiral CT Disadvantages of Spiral CT
Spiral CT can achieve improved complex structure
image resolution for a given radiation
dose,
compared to individual slice acquisition.
Patients remain static. Not Economical comparing to normal CT

5. Define CT?

• Radiography in which a three-dimensional image of a body structure is constructed by computer

from a series of plane cross-sectional images made along an axis — called also computed axial
tomography, computerized axial tomography, computerized tomography.
6. Compare X-ray and CT.
X-Ray CT
X-rays are a type of radiation, and when they A computed tomography (CT) scan (also known
pass through the body, dense objects such as as CAT scan) is similar to an MRI in the detail
bone block the radiation and appear white on the and quality of image it produces, yet the CT
x-ray film, while less dense tissues appear gray scan is actually a sophisticated, powerful x-ray
and are difficult to see. X-rays are typically used that takes 360-degree pictures of internal
to diagnose and assess bone degenerationor organs, the spine, and vertebrae.
disease, fractures and dislocations,
infections, or tumors.

7. Show the Advantages of ultrafast CT

• Ultrafast CT is a quick, easy, and relatively inexpensive technique which allows the arteries to
the heart to be directly visualized.
• It images calcium in the vessel wall as well as the arterial channel to some degree. It can
overcome some of the deficiencies of the other techniques.
• This allows for simple, early detection of atherosclerosis and the potential to follow the course
of the process over time.

8. Name the different generations of CT.

• First generation : Parallel beam geometry

• Second generation: Fan beam, Multiple detectors
• Third generation: Fan beam, Rotating detectors
• Fourth generation: Fan beam, Fixed Detectors
• Fifth generation: Scanning electron beam
• Spiral/helical CT

9. Write down few advantages of Spiral/Helical CT.

• Faster Scanning
• No need for power and signal cable to wound
• The reconstruction algorithm are more sophisticated
• Projects data for one slice per second
10. Write the reconstruction algorithm used in CT.

• Back projection algorithm and Iterative algorithm

11. Review the construction of CT.

• The gantry houses and provides support for the rotation motors, HV generator, X-ray tube (one
or two), detector array and preamplifiers (one or two), temperature control system and the slip
rings. Slip rings enable the X-ray tube (and detectors in a third-generation system) to rotate
continuously.
12. Give the generations of CT.

13. List out the requirements of a Detector used in CT.

• Have a high overall efficiency to minimize the patient radiation dose, have a large dynamic
range,
• Be very stable with time, and
• Be insensitive to temperature variations within the gantry
14. What is the function of a scintillating material?

• A material that absorbs the radiation and converts that radiation into light, the intensity of the
light depends on the intensity of radiation exposed to the scintillating material.

EX: Thallium doped Sodium Iodide, Cadmium Tungstate, and

Bismuth Germinate
15. What is CT?

• In computed tomography (CT), the picture is made by viewing the patient via X-ray imaging
from numerous angles, by mathematically reconstructing the detailed structures and displaying the
reconstructed image on a video monitor.
16. What are the different artifacts during CT imaging?

• The types of artifacts that can occur are as follows: (a) streaking, which is generally due to an
inconsistency in a single measurement; (b) shading, which is due to a group of channels or views
deviating gradually from the true measurement; (c) rings, which are due to errors in an individual
detector calibration; and (d) distortion, which is due to helical reconstruction.
17. What is a Tomogram?

• Tomography is a process in which two-dimensional image of a slice or section through a three-

dimensional object is obtained. Tomogram is a record obtained by tomography. Tomography
achieves this remarkable result by simply moving an X-ray source in one direction as the X-ray
film is moved in the opposite direction during the exposure to sharpen structures in the focal
plane, while structures in other planes appear blurred.
18. Define Hounsfield unit.

• The Hounsfield unit (HU) scale is a linear transformation of the original linear attenuation
coefficient measurement into one in which the radio density of distilled water at standard
pressure and temperature (STP) is defined as zero Hounsfield units (HU), while the radio density
of air at STP is defined as -1000 HU.
19. Which type of detector is currently used in CT imaging system?

• The more modern version of the CT detector is a solid-state detector. This form of detector is
similar to the screen-film system used in radiography. The solid-state detectors consist of a
scintillator and a photo detector. When the x-ray photons interact with the scintillator, light is
emitted. This light interacts with the photo detector, which converts the light into an electrical
signal, which is sent to a computer to determine how much of the x-ray beam was attenuated by
the body and generate an image. Although this type of detector is more expensive, it has an
extremely high quantum detection efficiency (98-99.5%), thus this is the dominant detector type
that is used in present-day CT scanners.
20. Mention the need for sectional images.

• For each rotation of the X-ray source and detector assembly, the image data are sent to a
computer to reconstruct all of the individual "snapshots" into one or multiple cross-sectional
images (slices) of the internal organs and tissues.

UNIT-III
1. What is the basic principle of MRI?

• The basis of MRI is the directional magnetic field, or moment, associated with charged particles
in motion. Nuclei containing an odd number of protons and/or neutrons have a characteristic
motion or precession. Because nuclei are charged particles, this precession produces a small
magnetic moment.
2. Discuss Larmor frequency?

• The rate at which the magnetic dipole moment of a particle precession in an applied magnetic
field. It is proportional to the field strength and is 42.58MHz for protons in a 1-T magnetic field.
• The frequency of Larmor precession is proportional to the applied magnetic field strength as
defined by the Larmor frequency, ω = γB
• Where ω is the Larmor frequency in MHz, γ is the gyromagnetic ratio in MHz/tesla and B is
the strength of the static magnetic field in tesla.
3. How would you determine Free Induction Decay?

• Free induction decay (FID) is the observable NMR signal generated by non-equilibrium
nuclear spin magnetization processing about the magnetic field (conventionally along z). This
non- equilibrium magnetization can be induced, generally by applying a pulse of resonant
radio- frequency close to the Larmor frequency of the nuclear spins.
4. Compile the available image reconstruction technique associated with NMR imaging?

Classification of various NMR imaging methods

(I) sequential-point method (ii) sequential-line method, (iii) sequential plane measurement,
(iv) Simultaneous measurement.
5. Recover the components of NMR imaging and list out?

• A magnet, which provides a strong uniform, steady, magnet field B0;

• An RF transmitter, which delivers radio-frequency magnetic field to the sample;
• A gradient system, which produces time-varying magnetic fields of controlled spatial non
uniformity;
• A detection system, which yields the output signal; and
• An imaging system, including the computer, which reconstructs and displays the images.
6. Lookout for various magnets that can be used in MRI machine.

• Permanent magnet – Alnico or Neodymium iron – 0.2 to 0.7 Tesla

• Magnet - large current-carrying coils of Aluminum strips or copper tubes – 0.2 Tesla
• Electromagnet – Soft iron – 0.3 Tesla or Less
• Super conducting magnet - Niobium Titanium alloy – 0.5 to 2 Tesla
7. Reframe T1 Relaxation time.

• The T1 relaxation time, also known as the spin-lattice relaxation time, is a measure of how
quickly the net magnetization vector (NMV) recovers to its ground state in the direction of B0.
The return of excited nuclei from the high energy state to the low energy or ground state is
associated with loss of energy to the surrounding nuclei. Nuclear magnetic resonance was
originally used to examine solids in the form of lattices, hence the name "spin-lattice"
relaxation.

8. Say what a T2 relaxation time is also called as? And explain?

• T2 Relaxation time is also called as transverse relaxation and as Spin – Spin relaxation time.
 • T2 relaxation is the process by which the transverse components of magnetization decay or
dephase. T2 relaxation is considered to follow first order kinetics, resulting in a simple
exponential decay (like a radio-isotope) with time constant T2.
9. Integrate and deliver the T1 & T2 relaxation time of biological Tissue
Tissue T1 (msec) T2 (msec)
Water 4000 2000
Grey matter 900 90
Muscle 900 50
Liver 500 40
Fat 250 70
Tendon 400 5
Proteins 250 0.1 -1
Ice 5000 0.0001

10. State any few medicinal applications of MRI.

MRIs are administered to patients suffering from the following:

a) Inflammation or infection in an organ b) Degenerative diseases c) Strokes d)
musculoskeletal disorders
e) Tumors and other irregularities that exist in tissue or organs in their body.
11. CT and MRI are different, prove?

Computed Tomography Magnetic Resonance Imaging

A CT Scan (or CAT Scan) is best suited for viewing An MRI is suited for examining soft tissue in
bone injuries, diagnosing lung and chest problems, ligament and tendon injuries, spinal cord
and Detecting cancers. injuries, brain tumors, etc.
CT scans are widely used in emergency rooms An MRI, on the other hand, can take up to 30
because the scan takes fewer than 5 minutes. minutes.
CT works with ionizing radiation MRI Works with Non – ionizing radiation

12. Defend the Shim coils plays important role in NMR?

• Shim (magnetism) is a device used to adjust the homogeneity of a magnetic field. Coils used to
adjust the homogeneity of a magnetic field by changing the current flowing through it were
called "electrical current shims" because of their similar function.
13. Have you understood the term precession? If so explain.

• The term used to describe the motion of the magnetization about an applied magnetic field. The
vector locus traverses a cone. The precession frequency is the frequency of the magnetization
components perpendicular to the applied field. The precession frequency is also called the
Larmor frequency ω0
14. Illustrate the Significance of Gradient fields in the NMR Principle?
 • Gradients are loops of wire or thin conductive sheets on a cylindrical shell lying just inside the
bore of an MR scanner. When current is passed through these coils a secondary magnetic field is
created. This gradient field slightly distorts the main magnetic field in a predictable pattern,
causing the resonance frequency of protons to vary in as a function of position. The primary
function of gradients, therefore, is to allow spatial encoding of the MR signal. Gradients also are
critical for a wide range of "physiologic" techniques, such as MR angiography, diffusion, and
perfusion imaging

15. Short Note on NMR.

• A technique for observing and studying nuclear magnetism. It is based on partially aligning the
nuclear spins by use of a strong, static magnetic field, stimulating these spins with a
radiofrequency field oscillating at the Larmor frequency, and detecting the signal that is induced
at this frequency.
16. Deduce the significance of RF coils in NMR imaging.

• A coil designed to excite and/or detect NMR signals. These coils can usually be tuned to
resonate at the Larmor frequency of the nucleus being studied.
17. We know Pixel, but what is a Voxel?

• The volume element associated with a pixel. The voxel volume is equal to the pixel are a
multiplied by the slice thickness.
18. Define FID associated with MRI?

• Free induction decay (FID) refers a short-lived sinusoidal electromagnetic signal which appears
immediately following the 90° pulse. It is induced in the receiver coil by the rotating component
of the magnetization vector in the x-y plane which crosses the coil loops perpendicularly. It does
not contribute to MR image but is used for single voxel MR spectroscopy.
19. Define chemical shift associated with NMR. Nov/Dec 2012

• In nuclear magnetic resonance (NMR) spectroscopy, the chemical shift is the resonant frequency
of a nucleus relative to a standard in a magnetic field. Often the position and number of chemical
shifts are diagnostic of the structure of a molecule.

20. What is Larmour frequency? May/June 2013, Nov/Dec 2013

• The processional path around the magnetic field is circular like a spinning top. The Larmor or
processional frequency in MRI refers to the rate of precession of the magnetic moment of the
proton around the external magnetic field. The frequency of precession is related to the
strength of the magnetic field, B0
UNIT-IV

1. What are Radio isotopes?

• Radioactive isotopes have an unstable atomic nucleus (due to the balance between neutrons and
protons) and emit energy and particles when it changes to a more stable form. The energy
liberated in the form change can be measured with a Geiger counter or with photographic film.
2. What is radiation therapy?

Radiotherapy uses high-energy rays to treat disease. It can be given both externally and internally.
• External radiotherapy aims high-energy x-rays at the affected area using a large machine.
• Internal radiotherapy involves having radioactive material placed inside the body.

3. What are the characteristics needed for the radionuclide to be used for imaging?

• The radionuclide must have lesser half-life,

• The radionuclide remains should be less hazardous
• There should be higher yield of energy for lesser material.

4. What is the use of position logic circuit in nuclear imaging?

Signals from the Photomultiplier tubes are fed to electronic or digital position logic circuits,
which determine the X-Y location of each scintillation event, as it occurs, by using the weighted
average of the Photo multiplier tube signals.
5. List the characteristics of Alpha radiation.

• Alpha particles are composed of two protons and two neutrons

• They are least penetrating and cannot be absorbed or stopped by air
• They are harmful for human tissue.

6. What is the principle of ionization chambers?

The ionization chamber is the simplest of all gas-filled radiation detectors, and is widely used
for the detection and measurement of certain types of ionizing radiation; X-rays, gamma rays
and beta particles. Conventionally, the term "ionization chamber" is used exclusively to
describe those detectors which collect all the charges created by direct ionization within the gas
through the application of an electric field.
7. List out the applications of a radiation detector.
 • It is used to detect the exposure of radiation in X-ray, CT, SPECT, and PET... Etc.
• These detectors used in space crafts
• Used in industries handling radiation causing elements.
8. Write the basic principle behind Photomultiplier tube.

• The light radiation strikes photocathode, the photocathode converts the light in to equivalent
electrons, these electrons enter dynode which has electro reflecting mirrors, and these mirrors
reflect as well multiply the number of electrons to the anode.

9. Compare SPECT and PET.

Factor SPECT PET
Energy: 78-140 KeV 511 KeV
Attenuation correction: Sometimes Always
Protocol Start to finish: 2 to 2 ½ hours 30 to 45 mins
Resolution: Poor Good
Cost: Less High
Sensitivity: Less High

10. Mention the Advantages of a Gamma camera.

• The gamma camera is a stationary device

• The whole organ is viewed during the entire period of data collection.
• This camera can be used to study the rapidly changing distribution of activity,
• Dynamic studies can be performed.

11. Mention few radiation detectors.

• Ionization chamber
• Scintillation detector
• Semiconductor detectors
• Solid state detectors
• Geiger – Muller Detectors

12. Write down the various clinical application of PET?

• Study various biological processes (glucose, amino acid, phospholipids, receptors etc.)
• It can demonstrate biological function, physiology and pathology as well
• Its non-invasive, so can be used in neural imaging
• Enable to get clear picture of a cancer tumor.

13. List out few of the scintillating materials.

 • Cesium iodide (CsI) in crystalline form is used as the scintillator for the detection of protons and
alpha particles.
• Sodium iodide (NaI) containing a small amount of thallium is used as a scintillator for the
detection of gamma waves
• zinc sulfide (ZnS) is widely used as a detector of alpha particles.
• Lithium iodide (LiI) is used in neutron detectors.
14. Write about pulse height analyzer?

• A Pulse Height Analyzer (PHA) is an instrument used in nuclear and elementary particle
physics research which accepts electronic pulses of varying heights from particle and event
detectors, digitizes the pulse heights, and saves the number of pulses of each height in registers
or channels for later spectral analysis.

15. Compare Alpha, beta particles and Gamma rays

16. List out the components present in Detectors of a gamma camera.

• The detector consists of collimator, thallium activated sodium iodide (NaI (Ti))
crystal, photomultiplier tubes, position logic circuit.
17. What are Radioscopes?

• Radioscope is an instrument used for the electronic production of a visual image by ionizing
radiation on a radiation detector and displayed on a monitor or similar screen.

18. Why technetium 99m mostly used in nuclear imaging?

• Technetium-99m is a widely used radioactive tracer isotope in Nuclear Medicine. Its gamma ray
energy of about 140 keV is convenient for detection. The fact that both its physical half-life and
its biological half-life are very short leads to very fast clearing from the body after an imaging
process.
19. What is REM and RAD?

• REM is a unit of radiation dosage (such as from X rays) applied to humans. It is defined as
the dosage in rads that will cause the same amount of biological injury as one rad of X rays or
gamma rays.
• Rad is the unit of absorbed dose of ionizing radiation, equal to the amount of radiation that
releases an energy of 100 ergs per gram of matter. One rad is equal approximately to the
absorbed dose delivered when soft tissue is exposed to one roentgen of medium-voltage
radiation.

20. Give the properties of alpha radiations.

• Alpha particles have the least penetration power but the greatest ionization power. They have
the ability of ionizing numerous atoms in a short distance. It is due to this reason that the
radioactive substance that releases alpha particles needs to be handled with rubber gloves. It
should not be inhaled, eaten or allowed near open cuts.

21. Indicate various isotopes used in radiation therapy?

The radioactive isotopes used for systemic radiation therapy include:

• Iodine.
• Strontium.
• Phosphorus.

22. List the properties of Beta emission. .

• Beta particles are energetic electrons; they are relatively light and carry a single negative charge.
• The beta particles follow a very zig-zag path through absorbing material. This resulting path of
particle is longer than the linear penetration (range) into the material.

UNIT-V
1. What is radiation therapy?

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of
radiation to kill cancer cells and shrink tumors. At low doses, radiation is used in x-rays to see
inside your body, as with x-rays of your teeth or broken bones.
2. List out the applications of LINAC?

• It is used as a primary therapy for the treatment of malignant tumors.

• It is also used in combination with surgery, chemotherapy and hormone therapy.
 • Strontium 89 and samarium 153 are radiopharmaceuticals commonly used for tumors that have
spread to the bone (bone metastasis).
• The thyroid gland absorbs nearly all of the iodine in the blood. Because of this, I 131 can be used
to destroy the thyroid gland and thyroid cancer with limited effects on the rest of the body.
• Radioactive phosphorus can be infused into the abdominal cavity or the linings around the lungs
to treat malignant fluid accumulation in these cavities.
• Radiolabeled monoclonal antibodies attach only to their specific target, bringing radiation
directly to the site.
3. Abbreviate 3DCRT, IGRT, IMRT, SRS and SRT

3DCRT Three-dimensional
conformal radiotherapy
IGRT Image-guided radiation
therapy
IMRT Intensity-modulated
radiation therapy
SRS Sterotactic radiosurgery
SRT stereotactic radiation
therapy

4. Compare SRS and SRT.

SRS SRT
SRS involves a single radiation treatment SRT uses a series of treatments over time.
SRS is delivered in one high dose treatment SRT delivers radiation therapy in smaller amounts
over several treatment sessions

5. What are the different dosimeters used to measure radiation.

• Electronic personal dosimeter (EPD)

• MOSFET dosimeter.
• Film badge dosimeter.
• Quartz fiber dosimeter (QFD)
• Thermoluminescent dosimeter (TLD)
• Dosimeter calibration.
6. List out the merits of Cyber knife.

• The Cyber Knife System is a non-invasive treatment for cancerous and non-cancerous tumors
and other conditions where radiation therapy is indicated.
• It is an important alternative to surgery or an option to treat patients who have exhausted
other treatment methods.
• The Cyber Knife system represents an entirely new approach to SRS – one that does not require
an external frame temporarily affixed to the skull for targeting (as is necessary for Gamma Knife)
and offers superior accuracy, making it appropriate for a wide range of treatment options
7. Write about pathways of radiation exposure.

• The intake of radioactive material can occur through four pathways:

• Inhalation of airborne contaminants such as radon
• Ingestion of radioactive contamination in food or liquids
• Absorption of vapors such as tritium oxide through the skin
• Injection of medical radioisotopes such as technetium-99m.
8. Define Dosimeters?

• A radiation dosimeter is a device that measures exposure to ionizing radiation. It has two main
uses: for human radiation protection and for measurement of dose in both medical and
industrial processes.
9. List the significance of radiation protection.

• Reducing radiation exposure will reduce the risk of cancer

• It provides hazard free environment
• Certain skin defects were avoided.
10. Justify the uses of film badges?

• The film badge dosimeter or film badge is a personal dosimeter used for monitoring cumulative
radiation dose due to ionizing radiation. It is also used in nuclear power plants, Radiotherapy,
PET and SPECT Chambers.
11. Enlist the applications of cyber knife?

• It is used to treat conditions throughout the body, including tumors of the prostate, lung, brain,
spine, head and neck, liver, pancreas, kidney, and certain gynecologic applications.
12. Clarify the recommended limits of dose uptake.

• Planned exposure – limits given for occupational, medical and public exposure. The
occupational exposure limit of effective dose is 20 mSv per year, averaged over defined periods
of 5 years, with no single year exceeding 50 mSv. The public exposure limit is 1 mSv in a year.
• Emergency exposure – limits given for occupational and public exposure
• Existing exposure – reference levels for all persons exposed
13. Mention few radio nuclides used for radiation therapy.

• CALCIUM – 47 – Important aid to Bio-medical research peoples to study cellular and

bone formation in mammals.
• CHROMIUM – 51 – Used in research in Red Blood cell survival studies.
• GALLIUM – 67 – Used in medical diagnosis.
• IODINE – 123 – Widely used in diagnosis of thyroid disorder.
• PHOSPHORUS – 33 – Used in molecular biology and genetic research.
• XENON – 133 – Used in Nuclear medicine for Lung ventilation and blood flow studies.
 • COBALT – 60 – Used in cancer treatment and radiography studies.

14. Give the need for cyclotron in radiation therapy?

• A cyclotron is used to accelerate charged particles. Cyclotrons are the best source of high energy
beams for nuclear physics experiments. It can also be used to treat cancer. Ion beams from
cyclotrons can be used, as in proton therapy, to penetrate the body and kill tumors by radiation
damage, while minimizing damage to healthy tissue along their path.
15. What is the principle of radiation therapy?

• Radiation therapy uses high energy light beams (X-rays or gamma rays) or charged particles
(electron beams or proton beams) to damage critical biological molecules in tumor cells.
• If enough damage is done to the chromosomes of a cell, it will spontaneously die or it will die
the next time it tries to divide into two cells. Radiation therapy is usually done on an outpatient
basis with treatment occurring each workday for a period of several weeks.
16. What is area monitoring?

The valuation of radiation levels at different locations in the vicinity of radiation installation is
known as area monitoring or radiation survey. These valuations give the details about the
integrity of the radiation facility or installation. Instruments used for the above purposes are
called radiation survey meters and area monitors.
17. What are radiation measuring units?

• Radioactivity or the strength of radioactive source is measured in units of Becquerel (Bq).

• 1 Bq = 1 event of radiation emission or disintegration per second.
• One Becquerel is an extremely small amount of radioactivity. Commonly used multiples of the
Bq unit are kBq (kilo Becquerel), MBq (mega Becquerel), and GBq (giga Becquerel).
• One curie is a large amount of radioactivity. Commonly used subunits are mCi (micro curie),
µCi (micro curie), nCi (Nano curie), and pCi (picocurie).
18. What is electronic dosimeter?

• A dosimeter used to measure radiation dose in soft tissue should absorb an amount of energy
equal to that absorbed by the same mass of soft tissue. When this requirement is satisfied, the
dosimeter is said to be tissue equivalent. Few dosimeters are exactly tissue equivalent, and
corrections must be applied to most direct measurements of absorbed dose in tissue
19. Why is radiation safety important?

• Any exposure to ionizing radiation carries a risk of causing cancer and above certain levels there
is also a risk of tissue effects such as erythema, hair loss and cataracts. For most common
radiographic exposures, this risk is extremely small. However, as the risk is proportional to the
level of exposure, it's important to ensure exposures are kept as low as possible.
20. What is stochastic effects of radiation?

• It is common knowledge that the incidence of leukemia among atomic bomb survivors in Hiroshima and
Nagasaki began to increase a few years after the explosions. This increase has been associated with
exposure to ionizing radiation produced by the blasts. Leukemia is one example of a long-term
consequence of radiation exposure