X-rays: Interactions between

X-rays and Matter,

Intensity of an X-ray Beam,
Attenuation.
S.Vidhya
Interaction of photons with
matter
• X-rays and γ-rays are ionizing waves.
• Such photons are able to ionize an atom, i.e., to release an
electron from the atom.
• Photons with energy less than 13.6 eV are nonionizing. These
photons cannot eject an electron from its atom, but are only
able to raise it to a higher energy shell, a process called
excitation.
• Ionizing photons can interact with matter in different ways.
Interaction of photons with
matter
- Photoelectric absorption
• A photon can be absorbed by an atom while its energy
excites an electron. The electron then escapes from its
nucleus in the same direction as the incoming photon was
traveling. This mechanism is called photoelectric
absorption.
- Rayleigh scattering or coherent
scattering
• The energy of X-ray photons can be absorbed by an atom
and immediately released again in the form of a new
photon with the same energy but traveling in a different
direction. This nonionizing process is called Rayleigh
scattering or coherent scattering
• It occurs mainly at low energies (<30 keV). The lower
the energy the higher is the scattering angle.
• In most radiological examinations it does not play a
major role because the voltage used is typically in the
range from 50 to 125 kV. For mammography, however,
the voltage is lower (22–34 kV) and Rayleigh scatter
cannot be neglected.
- Compton scattering
• A third possibility is that the photon transfers only part of its
energy to eject an electron with a certain kinetic energy. In that
case, a photon of the remaining lower energy is emitted and its
direction deviates from the direction of the incoming photon.
The electron then escapes in another direction.
• This process is called Compton scattering.
- Pair production
• A fourth mechanism is pair production. If the energy of a
photon is at least 1.02 MeV, the photon can be transformed
into an electron and a positron (electron–positron pair).
• A positron is the antiparticle of an electron, with equal mass
but opposite charge.
• The positron will meet another electron, and they will
annihilate each other while creating two photons of energy 511
keV that fly off in opposite directions.
• This process finds its application in nuclear medicine.
• At still higher energies, photons may cause nuclear reactions.
These interactions are not used for medical applications.
 Interaction of an X-ray beam with
tissue
• Consider an X-ray beam & a material of thickness d = xout − xin.
• Inside the material, the beam is attenuated by the different
types of interaction.
• Although the individual interactions are of statistical nature,
the macroscopic intensity of the beam follows a deterministic
exponential law: The intensity of the outgoing beam I out is
related to the intensity of the incoming beam I in by

where μ is called the linear attenuation

coefficient (typically expressed in cm−1).
This simple law is only valid when the material
is homogeneous and the beam consists
of photons of a single energy.
Actually, μ is a function of both the photon
energy and the material.

X-ray beam traveling through a slab of material

Linear attenuation coefficient for photons in aluminium and lead.
The solid curves represent the total linear attenuation coefficient. The dashed lines
show the partial linear attenuation coefficient for each of the three effects:
I for photoelectric absorption, dominant at low energies;
II for Compton scattering, dominant at higher energies;
III for pair production, dominant at very high energies.
• When a beam of single-energy photons travels through a
nonhomogeneous medium, Iout is related to Iin by

• A real X-ray beam does not contain a single photon energy but
a whole spectrum of energies. Making the intensity
distribution of the incoming beam a function of the energy,
that is,

• the intensity of the outgoing beam is equal to

X-Ray Equipment
Equipment
• complete radiographic imaging chain
Equipment
• The X-ray source.
• An aluminium filter, often complemented by a copper
filter. This filter removes low-energy photons, thus
increasing the mean energy of the photon beam. Low-
energy photons deliver doses to the patient but are
useless for the imaging process because they do not
have enough energy to travel through the patient and
never reach the detector. Because low-energy photons
are called soft radiation and high-energy photons hard
radiation, this removal of low-energy photons from
the beam is called beam hardening.
• A collimator to limit the patient area to be irradiated.
Equipment
• The patient, who attenuates the X-ray beam and
produces scatter.
• A collimating scatter grid. This is a collimator that
absorbs scatter photons. It stops photons with large
incidence angle, whereas photons with small incidence
angle can pass right through the grid. The grid can be
made of lead. A scatter grid is not always used in
paediatrics because in small children the scatter is
limited.
• The detector. This can be a screen–film combination in
which a film is sandwiched between two screens, an
image intensifier coupled to a camera, a cassette
containing a storage phosphor plate, or an active matrix
flat panel detector or dual-layer detector.
General purpose radiographic room
• The table can be tilted in any orientation, from the horizontal
to the vertical position.
• The X-ray system contains a tray for a conventional film-based
or a storage phosphor cassette, as well as an image intensifier
beneath the table.
• More recent X-ray systems contain an active matrix flat panel
detector with fast imaging capability, which replaces the
cassette and image intensifier.
Multipurpose radiographic room. The table can be tilted in any
orientation. Both an image intensifier and a storage phosphor
are available.
X-ray detectors

• To produce an image from the attenuated X-ray beam, the X-

rays need to be captured and converted to image information.
Some detectors for digital radiography are relatively recent
developments.
• Older but still in use are the screen–film detector and the
image intensifier.
Screen–film detector: Screen
• Photographic film is very inefficient for capturing X-rays. Only 2% of the
incoming X-ray photons contribute to the output image on a film. This
percentage of contributing photons corresponds to the probability that an
X-ray photon (quantum) is absorbed by the detector. It is known as the
absorption efficiency.
• The low sensitivity of film for X-rays would yield prohibitively large patient
doses. Therefore, an intensifying screen is used in front of the film. This type
of screen contains a heavy chemical element that absorbs most of the X-ray
photons.
• When an X-ray photon is absorbed, the kinetic energy of the released
electron raises many other electrons to a higher energy state. When
returning to their initial state they produce a flash of visible light, called a
scintillation.
• These light photons are scattered in all directions. Consequently, two
intensifying screens can be used, i.e., one in front and one behind the film,
to increase the absorption efficiency further. The portion of the light that is
directed toward the film contributes to the exposure of the film. In this way,
the absorption efficiency can be increased to more than 50% instead of the
2% for film.
• Because the light is emitted in all directions, a smooth light spot instead of a
sharp peak hits the film and causes image blurring.
X-ray intensifying screens
• X-ray intensifying screens consist of scintillating substances that
exhibit luminescence. Luminescence is the ability of a material to
emit light after excitation, either immediately or delayed.
• Fluorescence is the prompt emission of light when excited by X-rays
and is used in intensifying screens. A material is said to fluoresce
when light emission begins simultaneously with the exciting
radiation and light emission stops immediately after the exciting
radiation has stopped. Initially, calcium tungstate (CaWO4) was most
commonly used for intensifying screens.
• Advances in technology have now resulted in the use of rare earth
compounds, such as gadolinium oxysulfide (Gd2O2S). A more recent
scintillator material is thallium-doped cesium iodide (CsI:Tl), which
has not only an excellent absorption efficiency but also a good
resolution because of the needle-shaped or pillar like crystal
structure, which limits lateral light diffusion.
X-ray intensifying screens -
ctnd
• Phosphorescence or afterglow is the continuation of light
emission after the exciting radiation has stopped. If the delay
to reach peak emission is longer than 10−8 seconds or if the
material continues to emit light after this period, it is said to
phosphoresce.
• Phosphorescence in screens is an undesirable effect, because it
causes ghost images and occasionally film fogging.
 Screen–film detector: Film
• The film contains an emulsion with silver halide crystals (e.g., AgBr).
When exposed to light, the silver halide grains absorb optical energy
and undergo a complex physical change.
• Each grain that absorbs a sufficient amount of photons contains dark,
tiny patches of metallic silver called development centers. The
amount of photons required is independent of the grain size.
• When the film is developed, the development centers precipitate the
change of the entire grain to metallic silver. The more light reaching a
given area of the film, the more grains are involved and the darker the
area after development. In this way a negative is formed.
• After development, the film is fixed by chemically removing the
remaining silver halide crystals.
• In radiography, the negative image is the final output image. In
photography, the same procedure has to be repeated to produce a
positive image. The negative is then projected onto a sensitive paper
carrying silver halide emulsion similar to that used in the
photographic film.
Typical characteristics of a film
-graininess, speed, and contrast.
• Graininess The image derived from the silver crystals is not
continuous but grainy. This effect is most prominent in fast films.
Indeed, because the amount of photons needed to change a grain into
metallic silver upon development is independent of the grain size, the
larger the grains, the faster the film becomes dark.
Typical characteristics of a film
-graininess, speed, and contrast.
• Speed The speed of a film is inversely proportional to the amount of light
needed to produce a given amount of metallic silver on development. The
speed is mainly determined by the silver halide grain size. The larger the grain
size the higher the speed because the number of photons needed to change the
grain into metallic silver upon development is independent of the grain size.
For X-ray imaging with a screen–film combination, it makes more sense to
speak about the speed of the screen–film combination: how many X-ray
photons are needed to produce a certain density on the film. The speed then
depends on the properties of the intensifying screen and the film, but also on
the quality of film–screen contact, and on a good match between the emission
spectrum of the screen and the spectral sensitivity of the film used.
Because light is emitted in all directions, a significant proportion, about 50%,
of that light is not directed toward the film. A reflective layer behind the
screen–film–screen redirects it toward the film, ensuring that it contributes to
exposure. This has the advantage of increasing the speed of the screen–film–
screen combination with a corresponding reduction in patient dose.
Typical characteristics of a film
-graininess, speed, and contrast.
• Contrast The most widely used description of the photosensitive
properties of a film is the plot of the optical density D versus the
logarithm of the exposure E. This curve is called the sensitometric
curve. The exposure is the product of incident light intensity and its
duration. The optical density is defined by

where Iin and Iout are the incoming and outgoing light intensity when
exposing the developed film with a light source. Note that Iin and Iout
are different from the incident light intensity in the definition of the
exposure E, in which it refers to the light emitted by the intensifying
screen during X-ray irradiation.
Typical characteristics of a film
-graininess, speed, and contrast.
• Contrast
Figure shows a typical sensitometric curve. It is S-shaped. In low- and high-
density areas, contrast is low and there is little information. Only the linear part
is really useful and its slope characterizes the film contrast. The maximal slope
of the curve is known as the gamma of the film. Note that a larger slope implies
a higher contrast at the cost of a smaller useful exposure range.

Typical sensitometric curve for

radiographic film. D is the optical
density and E the exposure.
Image intensifier

• A fluorescent screen converts the X-rays into visible light. The

emitted light hits a photocathode, and the energy of the
photons releases electrons from this cathode.
• A large potential difference between the cathode and the output
accelerates the ejected electrons. The resulting electron beam is
directed onto a small fluorescent screen by electrostatic or
magnetic focusing and converted to light photons again.
• This focusing makes the system suitable to be coupled to a
camera without any loss of light.
• The main advantage of an image intensifier system is that it is
capable of producing dynamic image sequences in real time at
video rate, a process known as fluoroscopy.
Scheme of an image intensifier. The camera is placed
against the output screen to minimize light loss.
Comparison with film–screen
systems
When compared with film–screen systems, the images are
degraded in three ways.
• The spatial resolution will generally be less than that of a film–
screen system because of the limited camera resolution.
• Because of the additional conversions (light → electrons →
light), the noise increases slightly.
• Geometric distortion occurs, called pin-cushion distortion,
particularly toward the borders of the image.
Detectors for digital radiography:
Storage phosphors
• A special case of phosphorescence is when part of the absorbed energy is
not released immediately in the form of light. The temporarily stored
energy can be released upon stimulation by other forms of energy such as
laser light. This phenomenon is called photostimulated luminescence and
is used in digital radiography. This type of scintillator is called a storage
phosphor or photostimulable phosphor.
• The screen– film combination is then replaced by a screen coated with
such a scintillator.
• When X-rays are absorbed by the phosphor, electrons are pumped up from
the valence band to the conduction band.
• In a classical scintillator plate such an electron falls back to the valence
band while releasing its energy in the form of a light photon. In a storage
phosphor, however, these electrons are trapped by electron traps, which
are impurities in the scintillator.
• In this way, the incident X-ray energy is converted into stored energy.
After exposure a latent image is trapped in the scintillator.
Detectors for digital radiography:
Storage phosphors
• The latent image can be stored in the phosphor plate for a
considerable period after exposure. It takes 8 hours to decrease the
stored energy by about 25%. The stored energy can be extracted by
pixel wise scanning with a laser beam. This way the trapped
electrons receive a new energy shot that allows them to escape from
their trap and fall back into the valence band. The latent image
information is thereby released as visible light, which is captured by
an optic array and transmitted to a photomultiplier.
• The photomultiplier converts the detected light into an analog
electrical signal. This analog signal is then converted in an A/D
converter to a digital bit stream. The residual information on the
scintillator screen is erased by a strong light source, after which the
screen can be reused for new X-ray exposure. As soon as the
radiologic technician puts the cassette into the scanner, this whole
laser scanning and cleaning process is done automatically.
Reading the latent image
This system scans the latent image with a laser beam
and erases the residual image on the storage phosphor after
which the screen can be reused for new X-ray exposure.
Detectors for digital radiography:
Storage phosphors
• Storage phosphor screens provide a much wider useful exposure
range than conventional film–screen systems.
• Moreover, the storage phosphor is a linear detector. This means
there is no contrast reduction in the low- and high-density areas of
the image, as is the case with the S-shaped sensitometric curve.
• The system is much more tolerant to overexposure and
underexposure, and retakes caused by suboptimal exposure settings
(mAs, kV) are reduced.
• In theory, a reduction of the radiation dose per image is also
possible because of the available contrast at low exposure. However,
dose reduction adversely affects the SNR of the resulting image.
• Therefore, reducing the dose per examination must be considered in
relationship to the diagnostic information required. Often, the greed
for diagnostic detail slightly increases the dose rather than reducing
it.
Detectors for digital radiography:
Storage phosphors
• A second advantage of digital radiography is that the image is
available for computer post-processing such as image
enhancement and quantification. Moreover, the image can
easily be stored and transported in digital form, making the
images more accessible and making large film archives
unnecessary.
• Today, digital picture archiving and communication systems
(PACS) are part of hospital information systems, making the
medical images immediately available through the digital
network in the same way as the other patient information.
Active matrix flat panel
detectors
• Newer detector technologies for digital radiography are flat panel detectors
with fast-imaging capability. These systems produce nearly real time
images, as opposed to storage phosphor systems which require a readout
scan on the order of a minute and a workflow similar to that for screen–
film systems.
• Traditional electronic capturing devices, including CCDs(charge-coupled
devices), are almost exclusively based upon Si-crystal technology, and for
manufacturing reasons this restricts the devices to small areas. This is
because it is difficult and expensive to create a large defect-free
semiconductor crystal.
• A flat, large area integrated circuit, called an active matrix array, can easily
be made by depositing a 2D array of identical semiconductor elements onto
an amorphous material, such as hydrogenated amorphous silicon (a-Si:H).
A light-sensitive active matrix array can be produced by depositing an array
of photodiodes onto the a-Si:H substrate. By coupling it to a fluorescent
plate it functions as a large and fast flat panel X-ray detector.
Active matrix flat panel
detectors - ctnd
• A more recent technique eliminates the need for a scintillator by using
a photoconductor, such as amorphous selenium (a-Se) or cadmium
telluride (CdTe), instead of a phosphor. When exposed to radiation, the
photoconductor converts the energy of the X-ray photons directly into
an electrical conductivity proportional to the intensity of the radiation.
• To scan this latent image, the photoconductor layer is placed upon an
active matrix array that consists of a 2D array of capacitors (instead of
photodiodes) deposited onto the amorphous substrate. These capacitors
store the electric charge produced by detected X-ray photons until it is
read out by the electronic circuit of the active matrix array.
• This technology is known as direct radiography as against the indirect
approach where light is produced by a scintillator as an intermediate
step in the transformation of X-rays to a measurable signal.
• Active matrix flat panel detectors have become an accepted technology
for mammography because of their overall performance
In more recent X-ray systems the cassette and image intensifier are replaced by an
active matrix flat panel detector. This picture shows a Siemens system with large-area
amorphous silicon detector coupled to a CsI scintillator plate.
 3D rotational angiography system
(3DRA)
(a) C-arm with X-ray tube and image intensifier at both ends. (b) More recent system in which the image intensifier has been replaced by an active
matrix flat panel detector. By rotating the C-arm on a circular arc (e.g., 240◦ in 4 s) around the patient, a series of projection images are acquired that can
be used to compute a 3D image of the blood vessels.
• Images of the blood vessels can be made from any orientation by
rotating the C-arm on which the X-ray tube and image detector are
mounted at both ends.
• By continuously rotating the C-arm over a large angle (180◦ and
more), sufficient projection images are obtained to reconstruct the
blood vessels in three dimensions (3D).

3D image of the cerebral blood vessels

reconstructed
from a series of 2D projection images around the
patient, obtained
with the 3DRA system
Clinical use
• X-ray images can be static or dynamic.
• Static or still images are made with a film–screen combination or with
digital radiography, whereas dynamic images are obtained with an image
intensifier or an active matrix flat panel detector and viewed in real time
on a TV monitor or computer screen.
• Dynamic image sequences are commonly known as fluoroscopic images
as against radiographic images, which refer to static images.
• In X-ray images, the attenuation differences of various nonbony matter
are usually too small to distinguish them.
• A contrast agent or dye (i.e., a substance with a high attenuation
coefficient) may overcome this problem. It is especially useful for
intravascular (blood vessels, heart cavities) and intracavitary (kidney,
bladder, etc.) purposes.
• They are subdivided into
• Radiographic images
• Fluoroscopic images
Radiographic images- skeletal X-rays

(a) Double mandibular fracture with strong displacement to the left. (b)
Solitary humeral bone cyst known as ‘‘fallen leaf sign’’.
(Courtesy of Dr. L. Lateur, Department of Radiology.)
Radiographic images- chest images
(radiographs of the thoracic cavity and heart)

Radiographic chest image showing multiple lung metastases. (Courtesy of

Professor J. Verschakelen, Department of Radiology.)
Radiographic images- mammography
(images of the breasts)

(a) Dense opacity in the cranial part of the right breast; histological proven invasive
ductal carcinoma.
(b) Cluster of irregular microcalcifications suggesting a low differentiated carcinoma.
(Courtesy of Dr. Van Ongeval, Department. of Radiology.)
Fluoroscopic images
• These are image sequences produced in real time.
• Their application field focuses on investigations in which
motion or the instant availability of the images, or both, are
crucial.
Fluoroscopic images- Interventional
fluoroscopy
This application is responsible for the majority of fluoroscopic
sequences. Typically, the images are used to guide and quickly
verify surgical actions, particularly in bone surgery, such as for
osteosynthesis (traumatology, orthopedics).

Postoperative fluoroscopic control of bone fixation

with plate and screws after a complete fracture of the
humerus.
(Courtesy of Dr. L. Lateur, Department of Radiology.)
Fluoroscopic images-
Angiography
• This takes images of blood vessels through the injection of an iodine containing fluid
into the arteries or veins.
• Usually, subtraction images are made to increase the image contrast of the vessels.
• The result is an image in which the blood vessels appear as contrasting line patterns
on a homogeneous background. Obviously, it is essential that the patient does not
move during the imaging procedure, to avoid motion blurring and subtraction artifacts
in the images.

Cerebral angiogram showing an

aneurysm or sacculardilation of a
cerebral artery.
Fluoroscopic images- Double contrast
• Barium fluoroscopy of the gastrointestinal tract after the patient
swallows barium contrast solution and/or where the contrast is
instilled via the rectum.

(a) Double contrast (barium + gas insufflation) enema with multiple diverticula in
the sigmoid colon (arrows). (b) Polypoid mass
proliferating intraluminally (arrowhead on the spotview).