Anode Heel Effect

It is generally accepted that an x-ray beam's intensity is not uniform throughout its entirety. As x-radiation is emitted from the target area in a conical shape, measurements have determined that the intensity in the direction of the anode (AC) is lower (over and above the difference caused by the Inverse Square Law) than the intensity in the direction of the cathode (AB). The fact that the intensities vary in such a manner causes visible differences in the density produced on the radiographs. This phenomenon is called heel effect and is illustrated below.

NOTE: A = 100-percent intensity AB = consists of a slight increase over 100-percent intensity and then a general decrease in intensity as B is approached AC = consists of a considerable decrease in intensity as C is approached The decreased intensity at C results from emission which is nearly parallel to the angled target where there is increasing absorption of the x-ray photons by the target itself. This phenomenon is readily apparent in rotating anode tubes because they utilize steeply angled anodes of generally 17 degrees or less. Generally, the steeper the anode, the more severe or noticeable the heel effect becomes. The effects of focus film distance on the visualization of heel effect are illustrated below:

Figure G shows the film plane as having a shorter focus film distance than the film plane in Figure H. Looking at Figure G, you can readily see that the x-ray beam's involvement in exposing the film runs from C to B (the full cone of radiation). Heel effect causes a greater decrease in x-ray beam intensity as one travels from the central ray to the cathode (A to B).

As you look at Figure H, note that a long focus film distance is used which results in the involvement of the x-ray beam at the film plane which does not utilize the full cone of radiation (C to B). Hence, the extremities of the beam (C and B) are not used in exposing the film. Because of this, heel effect is greatly reduced.

Anode Stator Motor

In principle, the rotating anode is the moving part of an electric motor, running in a vacuum. The rotor carries the anode. An external electromagnetic field, produced by a winding (stator) outside the glass envelope, drives the rotor. Both together work as an asynchronous motor. The air gap between rotor and stator isolates both from each other, since the winding is electrically close to ground and the anode lays on high potential during operation. On the other hand the gap reduces the efficiency of the rotating anode motor significantly. Due to this distance, the power supply for the motor must be relatively high, in order to speed up the anode in an acceptable short time

The Rotor consists of a copper cylinder and rests in ball bearings for smooth movement. The bearings cannot be lubricated with ordinary grease because it would affect the vacuum and, as a consequence, the high tension characteristics of the tube. Soft metals such as lead and silver are applied to separate the ball bearings and the running surfaces, in order to prevent the possibility of "jamming" in the vacuum. This form of lubrication limits the life time of the bearings in the x-ray tube to about 1000 hours. Therefore, the running time needs to be as short as possible, which does not allow continuous rotation. The rotation is controlled when a radiography is started.

The stator consist of several windings which are equally spread out around the neck of the tube. They induce a rotating electro-magnetic field which interacts with the rotor, causing it to rotate synchronously. The simpliest power supply is a 220 V AC source. It was used in old generators for the normal speed anode

A capacitor C provides the stator with a second phase. The current in the two phases I and II have a phase shift of 120 to each other, which produces the rotating field. The value of the capacitor depends on the type of stator coil. This stator is called "two-phase stator".

Diagram showing anode rotation speed from prep to expose to braking period

Anti - scatter Grid

Anti-scatter grids are simple and functional tools that improve the diagnostic quality of radiographs by trapping the greater part of scattered radiation. Scattered radiation is probably the biggest factor contributing to the poor diagnostic quality of radiographs. Its effect produces a general radiographic fog on the film which reduces the contrast.

The best-known way to effectively remove the greater part of radiation scatter is by the use of an x-ray anti-scatter grid. Radiation which does not travel in the same direction as the primary beam is absorbed by the lead strips of the grid. Since Dr. Gustav Bucky built the first grid in 1913, his original principle of lead

foil strips standing on edge separated by x-ray transparent interspacers has remained one of the best-known technique to trap the scatter

Types of Filter Grids

X-ray grids are commercially available with either focused or parallel lead
strips, and these two types are produced in either linear or crossed grid configuration. The focused grid has its leads angled progressively in such a way that lines drawn through each lead and continued out of the gird will intersect at a point known as the grid focus. When strips are not progressively angulated but are perpendicular to the surface of the grid, the grid is termed "parallel" ( See Figure 1).

Both the focused or parallel grids may be made in either the linear or crossed grid type. The linear grid is made with the lengths of all its leads in the same direction. The crossed grid is usually two linear grids, one on top of the other, with the leads of the top grid crossing those of the lower grid ( See Figure 2).

In general, the crossed grid will remove more scattered radiation than a linear grid of ratio equal to the combined ratios of its two parts, e.g., a crossed grid, each of whose parts has 5:1 ratio, will remove more scattered radiation than a linear grid of 10:1 ratio. This advantage is more striking at voltages under 100 KVP. The advantage of the linear grid over the crossed grid is that it may be used in tilted-tube techniques without undue "cut-off" in the radiograph. This is true with grid ratios 8:1 and lower and only if the angle of tilt of the tube is in a direction parallel to the length of the leads. Tilting the tube at an angle across the leads will result in serious density reduction (cut off) on the film. With higher ratio grids, tube angling must be slight or focal distance long to avoid marked density variation. Construction of Grids & Significance of Grid Ratio

The prime purpose of a grid being the absorption of stray radiation, lead strips
(the material which is most practical in the absorption of x-rays) are its basic component. The strips -- five hundred or two thousands or more of them -- are set on edge, properly angled to a mean focal distance and separated by x-ray transparent interspacers. The whole is bonded together into a single flat structure, suitably covered for strength, durability and protection against moisture. The ratio of a grid is defined as the relation of the height of the lead strips to the distance between them. Thus with interspacers 5 times as high as they are wide, a grid is said to be 5:1 ratio, etc. Generally speaking, the higher the ratio of a grid, the more scattered radiation is absorbed (see Diagram).

As grid ratio increases, the necessity of having the focused grid exactly centered and perfectly level under the x-ray tube becomes more and more important. Also, it becomes more necessary to use the grid as its focal distance from the tube, instead of being able to use it through a range of distances. For example, the 40" focal distance, 16:1 ratio grid must be used at 40" for satisfactory results, and must be perfectly centered and leveled. The 5:1 ratio focused grid, on the other hand, will give satisfactory results over a wide range of focal distances, and need not to be as accurately centered or leveled. Of course the 5:1 ratio linear grid will not have nearly the effectiveness of secondary removal that the 16:1 has, but in ost cases this may be willingly sacrificed to gain the latitude and ease-of-use of the low ratio grid. However, a 5:1 crossed grid will produce as good secondary removal as 16:1 grid at low kilovoltages, while retaining the latitude of the 5:1 rati o. Selection Considerations

In order to prevent the shadows cast onto the film by the grid from interfering with
visualization of diagnostic detail, certain principles must be followed: For one, the lead should be as thin as possible to be consistent with adequate absorption of scattered radiation.The thinner the lead, the narrower the shadow it will produce on the film and the less visible it will be to the eye. Also, the thinner it is the less absorption of primary radiation will be in the grid. However, it must be noted that adequate absorption of scattered radiation is the function of the grid and lead must be thick enough to provide this function. Another factor is the relative fineness of the grid. This quality is represented by the number of lines per inch. In general, the greater the number of lines per inch, the less visible will the individual lines be, but this is subject to certain practical considerations which modify it in actual use.

Practical Considerations in Grid Selection: The selection of a grid to be used for a particular radiograph will be primarily dependent on the following considerations: Relative quantity of scattered radiation produced by subject being radiographed.

Kilovoltage technique used. Capacity of x-ray generator. The quantity of scattered radiation produced is dependent on the thickness and relative density of the body being radiographed. A non-grid exposure of the chest will consist of about one half scattered radiation, while a non-grid exposure of the abdomen may consist of more than 90% scattered radiation. From this, it is apparent that for dense body sections the more effective removal of scattered radiation will provide the most striking improvement in the radiograph. This suggests the use of a high ratio grid or a crossed grid. The choice between these two grids depends on the ease of aligning the grid correctly relative to the x-ray tube, and whether a high or low voltage techniques are in use. If there are questions about the proper centering or leveling, or if low kilovoltages are in use, a low ratio grid will present much greater advantage from the point of view of positioning latitude and cleanup. For high voltage techniques, if the grid can be accurately aligned (see effect of misalignment in Figures 1 & 2 below), greater advantages will result from the use of an 8:1 ratio crossed grid or high ratio linear grid. At kilovoltages of the order of 100 KVP or more, comparable radiographic effect requires low milliampere-second values than at low kilovoltages, thus reducing the radiation dosage to the patient.

However, in order to maintain the same contrast range of the higher kilovoltage, it is necessary to use a higher ratio grid. The exposure factors are not the same for all ratios, and the increased exposure required for a high ratio grid may to some extent reduce the patient-dosage advantage gained by going to higher kilovoltage techniques. In general, in spite of the higher exposure factors involved, the use of high kilovoltage and high ratio grids will result in somewhat lower radiation dosage to the patient.

All radiographers must work within the limitations of the physical characteristics of the x-ray equipment at their disposal. While this may not be as important a consideration in the selection of a grid as some others, it is a factor to be considered. For instance, the maximum benefits to be derived from a 16:1 ratio grid will not be realized with a unit whose top limit is 90 KVP, although there will be some advantage over a lower ratio grid. In general, a 16:1 ratio grid will do the most good with equipment which can be used at kilovoltages above 100 KVP. This applies also, to a lesser extent, to the 12:1 ratio grid. With a bedside or portable unit, where the likelihood of near-perfect alignment of the grid relative to the primary beam is poor, the use of the high ratio grids is practically impossible, and difficulties may be encountered even with the 8:1 ratio grids. For such use, where wide latitude in distance, centering, and leveling is necessary, the 5:1 ratio grid is advisable, and for maximum cleanup under these conditions the 5:1 crossed grid is ideal. Selection Guidelines

Choosing the correct grid for your application may be a difficult task. MXE provides technical
advice to assist you in selecting the proper grids and evaluating their performance. (1) X-ray Grid Selection Based on Clean-up Requirements:
Cleanup Ratio/Type Positioning Latitude Distance fair; centering and leveling-slight Recommended Up To 120 KVP Remarks Not recommended for tilted tube technique

SUPERLATIVE 8:1 criss-cross

EXCELLENT

12:1 linear

Very slight

110 KVP (Suitable for Extra care required highr KV) for proper alignment; usually used in fixed mount

EXCELLENT

6:1 criss-cross

Good

100 KVP

Tube tilt limited to

GOOD

8:1 linear

Distance fair; centering and leveling-slight Good

100 KVP

five degrees For general stationary grid use Least expensive of stationary grids

MODERATE

6:1 linear

80 KVP

(2) Basic Guidelines:

ANATOMY SKULL CHEST ABDOMINAL SCOLIOSIS STUDIES SPECIAL PROCEDURES MOST STUDIES BI-PLANE SURGICAL ROOM ORTHOPEDICS CHOLANGIOGRAMS VENOUS STUDIES EMERGENCY ROOM TRANS LATERAL SKULL, SPINES, HIPS LINE 103 103 103 85-103 LINE 103 85 criss-cross LINE 85 103 LINE 60-85 RATIO 10:1 10:1-12:1 8:1 8:1 RATIO 10:1 8:1 RATIO 8:1 10:1 RATIO 6:1-8:1 DISTANCE 36-40" 60-72" 34-44" 48-72" DISTANCE 36-40" 34-44" DISTANCE 34-44" 36-40" DISTANCE 34-44"

Decubitus X-ray Grids

Designed to reduce grid cutoff, MXE decubitus grids position the lead strips
parallel to the short dimension of the grid-in line with the cathode-anode direction of the x-ray tube when in the translateral position. This allows greater positioning latitude when aligning the x-ray tube with the grid.
Difference between the standard and decubitus grid

Features of the decubitus grid:

Improved image quality-more uniform density on decubitus and BE air contrast studies. Ease of positioning with reduced cut-off.

Lines to short dimension recommended for use in translateral views of skull, spine, hips ...... emergency room and surgery. Allow portable crosswise chest radiography on large patients. Available in a full range of sizes and ratios.

Grid Labels: Grids are often marked with a series of idications about their properties K is the Contrast Improvement Factor and is the ratio of the contrast with a grid to the contrast without a grid. This factor is dependent upon kVp, field size and thickness of tissue. B is named after the celebrated Gustav Bucky and is the Bucky Factor and is the ratio of incident radiation to the grid compared with the transmitted radiation passing through the grid. It has great practical use and is a factor that you apply when converting from a non-grid technique to a grid technique or vice versa. The B is dependent upon the kVp becoming larger with increased kVp. is selectivity which is usually shown as a Sigma (like a M rotated 90 degrees anticlockwise). This is the ratio of transmitted primary radiation to transmitted scatter radiation and is very similar to the Primary transmission ratio. This is a good measure of a grid because it should be high with an efficient grid. F is the FFD or more correctly the focus grid distance, focussed grids have an optimum working distance R is the Grid Ratio, the ratio of height to width of inter space material

Grid factor

Grid Factor = Exposure(mAs) with a grid Exposure without a grid

Atomic Structure
Atoms are particles of elements, substances that could not be broken down further. In examining atomic structure though, we have to clarify this statement. An atom cannot be broken down further without changing the chemical nature of the substance. For example, if you have 1 ton, 1 gram or 1 atom of oxygen, all of these units have the same properties. We can break down the atom of oxygen into smaller particles, however, when we do the atom looses its chemical properties. For example, if you have 100 watches, or one watch, they all behave like watches and tell time. You can dismantle one of the watches: take the back off, take the batteries out, peer inside and pull things out. However, now the watch no longer behaves like a watch. So what does an atom look like inside? Atoms are made up of 3 types of particles electrons , protons and

neutrons . These particles have different properties. Electrons are tiny, very light particles that have a negative electrical charge (-). Protons are much larger and heavier than electrons and have the opposite charge, protons have a positive charge. Neutrons are large and heavy like protons, however neutrons have no electrical charge. Each atom is made up of a combination of these particles. Let's look at one type of atom:

The atom above, made up of one proton and one electron, is called hydrogen (the abbreviation for hydrogen is H). The proton and electron stay together because just like two magnets, the opposite electrical charges attract each other. What keeps the two from crashing into each other? The particles in an atom are not still. The electron is constantly spinning around the center of the atom (called the nucleus). The centrigugal force of the spinning electron keeps the two particles from coming into contact with each other much as the earth's rotation keeps it from plunging into the sun. Taking this into consideration, an atom of hydrogen would look like this: A Hydrogen Atom

Keep in mind that atoms are extremely small. One hydrogen atom, for example, is approximately 5 x 10-8 mm in diameter. To put that in perspective, this dash - is approximately 1 mm in length, therefore it would take almost 20 million hydrogen atoms to make a line as long as the dash. In the sub-atomic world, things often behave a bit strangely. First of all, the electron actually spins very far from the nucleus. If we were to draw the hydrogen atom above to scale, so that the proton were the size depicted above, the electron would actually be spinning approximately 0.5 km (or about a quarter of a mile) away from the nucleus. In other words, if the

proton was the size depicted above, the whole atom would be about the size of Giants Stadium. Another peculiarity of this tiny world is the particles themselves. Protons and neutrons behave like small particles, sort of like tiny billiard balls. The electron however, has some of the properties of a wave. In other words, the electron is more similar to a beam of light than it is to a billiard ball. Thus to represent it as a small particle spinning around a nucleus is slightly misleading. In actuality, the electron is a wave that surrounds the nucleus of an atom like a cloud. While this is difficult to imagine, the figure below may help you picture what this might look like: Hydrogen: a proton surrounded by an electron cloud

While you should keep in mind that electrons actually form clouds around their nucleii, we will continue to represent the electron as a spinning particle to keep things simple. In an electrically neutral atom, the positively charged protons are always balanced by an equal number of negatively charged electrons. As we have seen, hydrogen is the simplest atom with only one proton and one electron. Helium is the 2nd simplest atom. It has two protons in its nucleus and two electrons spinning around the nucleus. With helium though, we have to introduce another particle. Because the 2 protons in the nucleus have the same charge on them, they would tend to repel each other, and the nucleus would fall apart. To keep the nucleus from pushing apart, helium has two neutrons in its nucleus. Neutrons have no electrical charge on them and act as a sort of nuclear glue, holding the protons, and thus the nucleus, together. A Helium Atom

As you can see, helium is larger than hydrogen. As you add electrons, protons and neutrons, the size of the atom increases. We can measure an atom's size in two ways: using the atomic number (Z) or using the atomic mass (A, also known as the mass number). The atomic number describes the number of protons in an atom. For hydrogen the atomic number, Z, is equal to 1. For helium Z = 2. Since the number of protons equals the number of electrons in the neutral atom, Z also tells you the number of electrons in the atom. The atomic mass tells you the number of protons plus neutrons in an atom. Therefore, the atomic mass, A, of hydrogen is 1. For helium A = 4.

Ions and Isotopes So far we have only talked about electrically neutral atoms, atoms with no positive or negative charge on them. Atoms, however, can have electrical charges. Some atoms can either gain or lose electrons (the number of protons never changes in an atom). If an atom gains electrons, the atom becomes negatively charged. If the atom loses electrons, the atom becomes positively charged (because the number of positively charged protons will exceed the number of electrons). An atom that carries an electrical charge is called an ion. Listed below are three forms of hydrogen; 2 ions and the electrically neutral form.

H+ : a positively charged hydrogen ion

H : the hydrogen atom

H- : a negatively charged hydrogen ion

Neither the number of protons nor neutrons changes in any of these ions, therefore both the atomic number and the atomic mass remain the same. While the number of protons for a given atom never changes, the number of neutrons can change. Two atoms with different numbers of neutrons are called isotopes. For example, an isotope of hydrogen exists in which the atom contains 1 neutron (commonly called deuterium). Since the atomic mass is the number of protons plus neutrons, two isotopes of an element will have different atomic masses (however the atomic number, Z, will remain the same). Two isotopes of hydrogen

Hydrogen Atomic Mass = 1 Atomic Number = 1

Deuterium Atomic Mass = 2 Atomic Number = 1

Attenuation of X-rays
The percentage of X-ray energy absorbed by the material is due to a process known as electron ionisation , this is dependent upon the material density and atomic number. As a result the detected X-ray attenuation provides a picture of the absorbed energy on the irradiated objects. Due to the absorbed energy being relative to the atomic number, it can be used in the material discrimination process. Generally the lower the atomic number the more transparent the material is to the Xrays. Materials composed of elements with a high atomic numbers absorb radiation more effectively causing less dark shadows in an X-ray image. Substances with low atomic numbers absorb less X-ray radiation, hence their shadowgraph appears a darker colour. The absorption of the X-ray radiation by a material is proportional to the degree of Xray attenuation and is dependent on the energy of the X-ray radiation and the following material parameters: thickness; density; atomic number; The attenuation or absorption, usually defined as the linear absorption coefficient, , is defined for a narrow well-collimated, monochromatic x-ray beam. The linear absorption coefficient is the sum of contributions of types of attenuation as listed below. Mass attenuation coefficient is defined as the linear attenuation coefficient divided by the density of the medium. For a given incident gamma ray energy, the mass attenuation coefficient is independent of the physical and chemical state of the absorber. Thus, the mass attenuation coefficient is the same for water whether present in liquid or vapor form

Interactions of X-Rays with Matter The dependence of the X-ray attenuation on the atomic number relies on mainly on three phenomena: photoelectric effect, Compton effect and pair production; The photoelectric effect is predominant at low X-ray energies and with high atomic numbers. When a quantum of radiation strikes an atom, it may impinge on an electron within an inner shell and eject it from the atom. If the photon carries more energy than is necessary to eject the electron, it will transfer this residual energy to the ejected

electron in the form of kinetic energy

The Compton effect occurs primarily in the absorption of high X-ray energy and low atomic numbers. The effect takes place when high X-ray energy photons collide with an electron. Both particles may be deflected at an angle to the direction of the path of the incident X-ray. The incident photon having delivered some of its energy to the electron emerges with a longer wavelength. These deflections, accompanied by a charge of wavelength are known as Compton scattering.

Pair production is the formation or materialization of two electrons, one negative and the other positive (positron), from a pulse of electromagnetic energy traveling through matter, usually in the vicinity of an atomic nucleus. Pair production is a direct conversion of radiant energy to matter. It is one of the principal ways in which highenergy gamma rays are absorbed in matter. For pair production to occur, the electromagnetic energy, in a discrete quantity called a photon, must be at least equivalent to the mass of two electrons. The mass m of a single electron is equivalent to 0.51 million electron volts (MeV) of energy E as calculated from the equation formulated by Albert Einstein, E = mc2, in which c is a constant equal to the velocity of light. To produce two electrons, therefore, the photon energy must be at least 1.02 MeV. Photon energy in excess of this amount, when pair production occurs, is converted into motion of the electron-positron pair. If pair production occurs in a track detector, such as a cloud chamber, to which a magnetic field is properly applied, the electron and the positron curve away from the point of formation in opposite directions in arcs of equal curvature. In this way pair production was first detected (1933). The positron that is formed quickly disappears by reconversion into photons in the process of annihilation with another electron in matter.

Two less important (In diagnostic energy levels) effects Thomson scattering (R), also known as Rayleigh, coherent, or classical scattering, occurs when the x-ray photon interacts with the whole atom so that the photon is scattered with no change in internal energy to the scattering atom, nor to the x-ray photon. Thomson scattering is never more than a minor contributor to the absorption coefficient. The scattering occurs without the loss of energy. Scattering is mainly in the forward direction.

Photodisintegration (PD) is the process by which the x-ray photon is captured by the nucleus of the atom with the ejection of a particle from the nucleus when all the energy of the x-ray is given to the nucleus. Because of the enormously high energies involved, this process may be neglected for the energies of x-rays used in radiography.

Absorption Edges
If the mass absorption coefficient of a material is plotted against wavelength as shown in Figure Y for a monochromatic x-ray beam, m shows sharp discontinuities at particular wavelengths.

Fig Y

These correspond to the ionisation energy of a K shell electron and indicate the increased probability of photoelectric absorption, however this drops sharply as the difference between the photon and electron binding energy increases. The variation of m with photon energy E and atomic number Z for the various scattering and absorption processes is summarised in the following table and shown graphically in figure X:

Summary of Main Attenuation Mechanisms Mechanism Rayleigh photoelectric Compton pair production Variation of m with E 1/E 1 / E3 falls gradually with E rises slowly with E Variation of m with Z Energy range in tissue 2 1 - 30 keV Z 3 1 - 100 keV Z independent 0.5 - 5 MeV 2 > 5 MeV Z

The relative Importance of Attenuation processes Only photoelectric effect and Compton effect are significant in the production of diagnostic radiographic images

Figure X

http://img.cryst.bbk.ac.uk/www/kelly/medicalxrays.htm

Automatic Exposure Control (AEC)1

Basic X-Ray Diagram

(Siemens) Automatic exposure control using an ionisation chamber between the patient and the film cassette is used in the majority of x-ray generators. A slim panel containing three ionisation chambers (dose detector) is placed between the grid and the cassette in the bucky assembly. The chamber assembly is constructed to be of very low density so as not to interfere with the image. The principal of operation is that during an exposure the air in the chamber/s is ionised permitting a current o flow through them, this current is used to charge a capacitor. When the capacitor voltage reaches a pre determined level the voltage is used to terminate the exposure via a thyristor based additional control unit. Film Screen Control The system is set up during installation to work with the type of film screen combinations used in the department, the setup is designed to work with the film screen combination and the Kv selected to ensure a consistent film density with various film screen combinations and Kv choices. Minor density control There is a small resistor in series with the capacitor to provide the operator with a small degree of control of the resultant film density, to allow for the patient build and the amount of scatter produced by the radiographic technique. Ionization chamber patterns The unit manufacturer should provide a Perspex slide to fit the LBD to show where the chambers are sited, in general there are three chambers a central chamber and two outer chambers, care must be taken to ensure that the patient part being imaged lies under the selected chamber or chambers. The chambers are often oblong in at centre and round on the outer ones and about 7cm x 5cm and 5 cm round. Control Panel Controls

Chamber Selection AEC in use Care must be taken in the use of AEC devices to ensure that the a chamber is in the field of radiation when the exposure is made. It is also important to ensure the correct chamber/s selection is made and that the filed size is restricted to a minimum to reduce scatter but must cover the chamber. The object density and thickness must be such that the minimum response time of the system is allowed for, using high tube currents may produce exposure times shorter than the equipment can reliably cope with. There is usually some indication on the control desk when an error occurs such as too short a time or the generator cannot give enough exposure, there is usually a facility for reading the mAS given during the exposure. AEC and tomography There are some machines which have AEC on tomography these setups are different as it is not possible to reliably adjust the filament current during exposure, the exposure control is performed on the KV.

AUTOMATIC EXPOSURE CONTROL2 I. INTRODUCTION

Automatic exposure control devices can assist the radiographer in producing consistent radiographic images from patient to patient, regardless of size or presence of pathology. The advantages of this consistency are numerous and include: decreased repeat rate; decreased patient exposure; and increased department efficiency. The most important benefit being decreased repeat rate. According to Chesney's, Equipment for Student Radiographers, "Surveys conducted on a wide scale have drawn conclusions that inaccurate exposures have been the most common cause for radiographs needing to be repeated" (1994). Although automatic timers have the potential to decrease the amount of films and increase department efficiency, this can only be accomplished if the equipment is operated by a skillful technologist. Even though it is called an "automatic" exposure device, a technologist must be very knowledable about automatic timing devices to produce high quality radiographs. This course is designed to review the basic operation of Automatic Exposure Control devices and offer suggestions to the participant on how to utilize AEC devices to obtain optimum radiographs.

1.1 METHODS OF TERMINATING AN EXPOSURE

There are two ways that a radiographic exposure can be terminated: manually or automatically. When an examination is manually timed, the technologist sets the kVp, mA, and time. After the predetermined time has elapsed, the exposure is terminated. If the equipment is operating properly and the correct technique was used for the appropriate patient thickness, one can expect a properly exposed radiograph. When an AEC device is used to terminate an exposure, the technologist sets the kVp and mA, but the time of the exposure is automatically determined by the machine. The AEC device differs from a manual timer because the AEC does not stop the exposure until the film has reached an appropriate density.

Unlike manual timers, which simply stop the exposure after the preset time has elapsed. A major benefit of the AEC device is its ability to consistently obtain accurately exposed radiographs, even in the presence of pathology. While manual timers terminate the exposure at the preset time, regardless of pathology or achievement of proper film density. The following example demonstrates the difference: Two patients may come to the radiology department for chest x-rays. They both may measure 18 centimeters, one may have normal lung fields, while the other may have a pleural effusion. Since both patients measure the same thickness, the radiographer would most likely use the same technique on both patients when manually timing.

Chances are the radiograph of the fluid-filled lungs will be lighter than the healthy lungs and therefore it would have to be repeated. If AEC would have been used in this situation, the exposure time would have been automatically increased to compensate for the fluid in the lungs . A diagnostic radiograph would have been produced, therefore eliminating the need for a repeat radiograph.

II. AEC PHYSICS AND INSTRUMENTATION

AEC devices are common in today's radiographic equipment. When AEC devices were first introduced, they were strictly used for fluoroscopic spot films. As advances were made in technology, automatic timers were redesigned to be used in wall and table buckys. Today, AEC devices find application in general, fluorosopic and even portable radiographic equipment. Before discussing AEC devices any further, it is important to review the basic operation of an automatic timer.

2.1 TYPES OF AUTOMATIC EXPOSURE CONTROLS

The most common type of AEC devices used in today's radiographic equipment is the ionization chamber. In older equipment, the phototimer was most commonly used for the automatic timing mechanism.

Even though the ionization chamber and the phototimer operate differently, they both have the same function: convert radiation into an electrical signal which will be used to automatically stop the exposure when the film has reached the proper density.

2.2 THE IONIZATION TIMER

The ionization timer utilizes an ionization chamber, capacitor, and exposure terminating switch to automatically terminate the exposure after the film has reached the predetermined density. A brief review of how the ionization timer operates, will be beneficial at this point. An ionization chamber is a radiation detection device that produces a small electrical current when struck by radiation. Inside the chamber are two conducting plates which are separated by air. When radiation strikes the chamber, the air inside the chamber is ionized and the electrons migrate toward the plates, thus producing a small electrical current. This electrical current is then used to charge a capacitor. When the capacitor, an electronic storage device, reaches a predetermined charge the exposure terminating switch is activated and the radiographic exposure is terminated. It is important to remember that in this situation, the exposure was terminated by sensing the amount of radiation reaching the film, and not by a preset time. When an x-ray machine utilizes the ionization chamber as its automatic timer, three chambers are used in the configuration that is demonstrated in Figure 2.2. The ionization chambers are usually located behind the grid and in front of the cassette.

Figure 2.2

2.3 THE PHOTOTIMER

Another type of automatic exposure device that may be used in radiographic equipment is the phototimer. The phototimer was commonly used in older x-

ray equipment and consisted of a fluorescent screen, photomultiplier tube, capacitor and an exposure terminating switch. Although the components of the phototimer are different, the theory of operation is similar to that of the ionization timer which is discussed in section 2.3. The ionization timer and phototimer both convert radiation into an electrical signal which is used to terminate the exposure when the film has reached the proper density. However, since the phototimer is a bit less sophisticated than the ionization chamber, there are a few more steps involved in the conversion of radiation into an electrical signal. In the phototimer assembly, a fluorescent screen is placed behind the bucky. A photomultiplier tube is then placed directly behind the fluorescent screen. The fluorescent screen converts the radiation that exits from the patient and cassette into light. The photomultiplier tube then converts the light emitted from the screen into an electrical current which is used to charge a capacitor. When the capacitor is charged to the predetermined level, the exposure is terminated. As with the ionization timer, the length of the exposure is based on the time it takes to charge the capacitor to the predetermined level and not a time set by the technologist. If a patient is larger than "average" more radiation is absorbed by the patient, and less is converted to an electrical signal. Therefore, the exposure will be longer since it will take longer to charge the capacitor to the predetermined level. Likewise, if a patient is very thin, there is minimal absorption of the beam which results in more radiation being converted into an electrical signal. This in turn will charge the capacitor more quickly and terminate the exposure more rapidly. Since the xray tube is "on " while the capacitor is being charged, it should become obvious that the length of time that it takes to charge the capacitor to the predetermined level is directly related to film density. As mentioned earlier, the ionization timer is used more commonly in modern radiographic equipment than the phototimer. However, the term "phototiming" has become synonymous with either type of automatic exposure control. Now that the basic operation of AEC devices have been reviewed, it is time to discuss how to properly use them.

III. TECHNOLOGIST'S DECISIONS

When using an automatic exposure control device, there are many important decisions a technologist must make in order to ensure that a diagnostic film will be obtained. The two most important are patient positioning and proper detector selection. As discussed earlier, the Phototimer or Ionization Chamber which are known as detectors collect the radiation coming from the patient and convert it into an electrical signal. For the film to have the proper density, the detector must sample the radiation coming directly from the area of interest. If the detector samples radiation from another area, the film will not

have the proper density. This then explains why proper positioning is so important when when using AEC devices: Incorrect positioning will lead to a film with incorrect density.

3.1 PATIENT POSITIONING

The following diagrams will help illustrate the importance of proper patient position. In the diagram of an incorrectly positioned shoulder, the radiograph will not have the proper density because the shoulder joint is not directly over the detector. Due to the poor positioning, a portion of the detector is completely outside of the body and will be directly exposed by the beam. This will charge the capacitor very quickly, resulting in a radiograph that is too light to fully demonstrate the shoulder.

In Figure 3.1-1, the lateral spine radiograph will be too light because the detector is sampling radiation from soft tissue along with radiation emerging from the spine. Because the soft tissue is easily penetrated, a "large" electric current will be produced in the timing circuit. The capacitor will be charged quickly resulting in a radiograph that is too light because the exposure time was too short.

Figure 3.1-1 Without a technologist who is very knowledgeable about anatomy and positioning, automatic timers are worthless. In fact, they may actually decrease department efficiency because of the increased amount of repeat radiographs that will result if used improperly.

3.2 DETECTOR SELECTION

Along with proper positioning, proper detector selection also influences the operation of the AEC device. Auto timers may have one to three detectors in their circuits, most table and wall buckys have three. Because there are three, the question often arises, "Which detector should I use?" If one keeps in mind that the detector must sample radiation coming from the area of interest, the decision of which detector to select becomes an easy one. Here are some general guidelines to follow for determining detector selection: When the vertebral column is the main area of interest, the center detector should be selected. When using AEC for joints such as the shoulder or knee, the center detector should be selected. If the outside detectors were selected, the radiograph may not have the proper density because the outer detectors may be collimated out of the field or they may detect too much radiation coming from the soft tissue. Either one of these situations will result in a radiograph that does not have the proper density. When the pelvis is being radiographed using AEC, the two outside detectors should be selected. When a pelvis is properly positioned the two outer detectors will be directly below the ilia. Detector selection for a chest x-ray is a bit more challenging because several factors influence this decision. Radiologist's preference, pathology, and surgical intervention play the biggest role in choosing which detector to use. When the lungs are the area of interest, the right or both outer cells may be selected. The use of both outer cells for a PA chest radiograph will result in a slightly darker radiograph, since the left cell will take longer to accumulate

radiation due to absorption by the heart. Therefore, when deciding between right or both outer cells for a PA chest radiograph, one should consider if the radiologist prefers darker or lighter chest films. As a general rule, use of the left or center detector for a PA chest radiograph will result in an over exposed radiograph except in the presence of certain chest pathology or surgical intervention. If a large pleural effusion is present in a lung and the detector over the affected lung is selected, an overexposed radiograph will result. This is explained by the fact that the fluid in the affected lung will absorb a greater amount of radiation, which in turn will result in less radiation getting to the detector. Since less radiation reaches the detector, the exposure will continue longer, and an overexposed film will result. In this situation, the cell opposite the affected lung should be selected. If a patient has undergone a pneumonectomy, the detector on the unaffected side should be selected when using AEC for the PA chest radiograph. If the cell under the affected side was selected in this situation, an underexposed radiograph would result. Since the side of the surgical intervention would offer little absorption of the radiation, the detector would accumulate radiation very rapidly resulting in a short exposure. The film would be undiagnostic because the remaining left lung and mediastinum would not be visualized adequately. The center cell should be selected if the mediastinum is of interest on the PA chest radiograph, and also for the lateral chest xray. When using AEC for the abdomen, the technologist's choice for detector selection is once again related to the radiologist's preference for darker or lighter radiographs. Although the center, outer two, or all three detectors maybe used for the KUB; selection of the outer two cells is most technically accurate. The KUB radiograph is most commonly ordered to evaluate the soft tissue structures of the abdomen. Selection of the two outer detectors will sample the radiation coming from the soft tissue structures only, resulting in a properly exposed radiograph for the area of interest. Selection of the center cell will result in a slightly darker radiograph because the lumbar spine will attenuate a greater portion of radiation compared to soft tissue, therefore resulting in a darker radiograph. Finally, use of all three detectors will result in a radiograph having density midway between a radiograph taken with the outer detectors and a radiograph taken using only the center detector. This is explained by the fact that the detectors are sampling a portion of the radiation coming from the soft tissue and bony structures. Therefore, an electronic averaging occurs between those structures. Figure 3.2-1 demonstrates the effect of proper cell selection and its affect on density. Radiograph A was taken with the the two outer cells selected, while radiograph B with take with the center cell selected.

Figure 3.2-1 When using AEC for an upright abdomen, the center detector should be selected. Use of the outer two or all three detectors is not a good choice because of the configuration of the detectors. Since the outer two detectors are positioned higher and more laterally than the center detector, there is a chance these detectors may sample radiation coming from the base of the lungs. Because the lungs are easily penetrated, the radiographic exposure will be terminated prematurely, resulting in a radiograph that is too light. Figure 3.2-2 demonstrates that when using the outer cells for an upright abdomen, the film will lack sufficient density.

figure 3.2-2 * It should be noted that these suggestions for cell selection are based on operational theory. Due to differences in equipment and calibration, results may vary from machine to machine. Cassette size is another important factor that should be considered when choosing which detector to use for an exposure. When using cassette sizes that are smaller than 10" x 12", only the center detector should be used. Cassette sizes smaller than 10" x12 " have such a small area of coverage that a portion of the two outer detectors lie outside of the collimated area. If the outer detectors where selected in this situation, a portion of the radiation

would never be able to reach the entire detector therefore resulting in a longer time to charge the capacitor. This would result in an unnecessarily longer exposure time and an overexposed film.

A thorough understanding of the AEC makes detector selection less threatening. Simply remember the AEC must sample radiation coming from the area of interest. 3.3 DENSITY SELECTOR

Along with proper positioning skills and knowledge of detector selection, the radiologic technologist must understand the function of the density selector to fully utilize AEC. When the automatic timer is installed, the capacitor in the circuit is set to terminate the exposure when it has acquired a specific charge. Remember, that as long as the capacitor is charging, the x-ray tube is producing radiation. The precise charge on the capacitor which terminates the exposure is determined by phantom studies conducted by the service engineer and radiologist input. The service engineer then adjusts the Neutral setting of the density control to correspond to an acceptable radiographic density. When a radiographic imaging unit is properly calibrated, the density selector should be kept on the "neutral" setting for the majority of procedures. If you find that you are not using the "neutral" setting for most of the exams, the unit most likely needs to be recalibrated. There are occasions when the radiographic machine is properly calibrated, but using the neutral setting does not result in properly exposed radiographs. Some of the reasons for this will now be discussed. Probably the biggest culprit of improper film density while using AEC is inaccurate positioning. As mentioned earlier, if the part is not properly positioned over the detector, the film will not have the correct density. The density control cannot be blamed for inadequate film density if the patient is not properly positioned! In figure 3.3-1, the detectors have been outlined with lead wire. These radiographs demonstrate how improper positioning affects density.

Radiograph B is properly positioned and therefore has sufficient density. In radiograph A, the central ray is directed too far posteriorly and in radiograph C, the central ray is directed too far anteriorly.

B figure 3.3-1

Poor Collimation can be another cause for obtaining improperly exposed radiographs while using the AEC The detectors cannot tell the difference between the primary radiation coming from the patient and scattered radiation. Therefore, if large amounts of scattered radiation are being produced, it will be picked up by the detector(s) and cause the exposure to terminate too soon, resulting in a radiograph that has insufficient density. This radiograph will be too light, even though it was taken with density selector set at Neutral. The radiographs in Fig. 3.3-2 demonstrate that as you increase the amount of collimation and shielding, the amount of scattered radiation reaching the detector decreases, resulting in a darker diagnostic radiograph.

Figure3.3-2

Although, little thought about, another factor that can affect the density of a radiograph while using AEC is use of the proper film/screen combination. When the automatic timer is calibrated, it is adjusted so the Neutral setting will produce a properly exposed film for a specific film/screen combination. If a cassette with a different film/screen combination is used, the film will not have the correct density because the AEC device cannot recognize changes in film/screen speed. Figure 3.3-3 demonstrates how film/screen speeds affect density.

Figure 3.3-3

The AEC device was calibrated to be used with the film screen combination demonstrated on the left. The film on the right has a film/screen speed combination that is sixteen times slower (extremity) than the film on the left. Both radiographs were taken at the "N" setting. Figure 3.3-4 is another example of how film/screen combinations affect density. The machine was calibrated to be used with the film/screen combination of the radiograph on the left. The film on the right was taken with a faster film/screen speed combination, resulting in a darker film.

Figure 3.3-4

When using AEC devices, it is important to remember to use only the film/screen combinations that were calibrated to be used with the machine.
It is evident that the previously discussed causes of improper film density can be attributed to "user error". All too frequently AEC devices "take the rap" for improperly exposed radiographs. More often than not, AEC errors are most likely the result of poor positioning and/or collimation. However, there are situations where the technologist performed the procedure correctly but ended up with an improperly exposed film when using an AEC device at the neutral density setting. Certain patient conditions such as obesity, and ascites may

affect the operation of the AEC. Because of excessive scatter produced in these situations, the AEC device may terminate the exposure prematurely. Surgical intervention may also have an affect on the ability of the AEC device to operate properly. As discussed earlier, if a patient has had a pneumonectomy and the detector that is selected is on the same side as the pneumonectomy the image will not have the proper density. Another factor that may influence the performance of the AEC is the presence of a prosthesis. Should the detector be directly behind a prosthesis, the radiograph will be too dark. This is easily explained by the fact that the prosthesis will prevent radiation from reaching the detector, which in turn increases the length of the radiographic exposure. Finally, one must also consider machine failure if films taken using an AEC device do not have the proper density.

3.3.1 CHANGING THE DENSITY SETTINGS

When a radiograph needs to be repeated because of improper density, and it is not due to user error such as incorrect positioning or improper collimation, the density selector switch must be used to change the density. Since the density of a radiograph taken using AEC is determined by how long it takes to charge a capacitor to the predetermined level, the mA and time selectors no longer control the density of the radiograph as it did in manual timing. Basically, when the density selector switch is changed, the resistance in the timer circuit is also changed. Increasing the density selector by using +1 or +2 increases the resistance in the circuit, which in turn causes the capacitor to take longer to be charged to its predetermined level. Therefore, since it will take longer to charge the capacitor, the radiograph will have greater density. Likewise, choosing -1 or -2 on the density selector, deceases the resistance in the timer circuit which allows the capacitor to be charged faster than normal. This results in a film having decreased radiographic density. At this point, it would be beneficial to review how the characteristics of kVp, mA and time change when using AEC, compared to manual timing. This will assist in understanding how to make corrections for improperly exposed radiographs obtained while using AEC devices. As with manual timing, kVp still controls contrast when using AEC devices. However, the practice does exist where technologists increase kVp to increase density when an underexposed film is obtained while using AEC. This is an incorrect solution to the problem since kVp primarily controls contrast. A repeat film taken with higher kVp may appear darker than the original, however that is due to the decreased contrast of the film. Figure 3.3.1-1 demonstrates that as you increase kVp, the films do appear darker, but as mentioned above, it is result of the change in the scale of contrast.

Figure 3.3.1-1

Increasing kVp to produce a darker film should be avoided because the resultant change in the scale of contrast may affect interpretation of the radiograph.
During the use of the AEC device, the function of the mA control changes dramatically. No longer does the mA setting govern density, as it did while using manual timing. When using an automatic timer, the mA control now influences the time of the exposure. The mA selector still controls the quantity of radiation produced, however when using AEC one must remember the length of exposure is determined by the time is takes to charge the capacitor to a specified level. Therefore when using AEC devices, milliamperage influences the time of exposure because when a higher mA is selected more radiation is present. When more radiation is present, the capacitor is charged more rapidly resulting in a shorter exposure. The timer control becomes inoperable when using AEC. This makes sense because the main purpose of the AEC is to terminate the exposure automatically. Certain manufacturers design their equipment so that when AEC is selected, the timer control becomes the backup timer control. This will be discussed in greater detail later in this unit. Based on the above information, it should become obvious that when using the AEC device, density changes should only be made by using the density selector. The density selector allows the technologist to increase or decrease the density in predetermined increments. It is a good idea to know how each density step affects the density of the radiograph so logical predictions can be made of which setting to use should a repeat be necessary. Most radiographic equipment is calibrated to that +1 corresponds to a 25% increase in density from the "N" setting and +2 corresponds to a 50% increase. The -1 setting corresponds to 25% decrease in density compared to the "N" setting, while the -2 setting corresponds to a 50% decrease. Be aware that the density settings may be adjusted for any desired increments by the service engineer.

Figure 3.3.1-2 demonstrates how density selector changes directly affect film density. The density settings are listed below each knee image. Evaluation of these images with a densitometer did indicate the following: A 50% decrease in density from Radiograph C (Neutral) B 25% decrease in density D 25% increase in density E 50% increase in density A B C D E

-2

-1

+1

+2

IV. MINIMUM RESPONSE TIME

Occasionally a technologist may obtain an overexposed film on the -2 density setting. Even if the technologist positioned the patient properly and correctly collimated, there are times when the radiograph may still be too dark. This situation is due to a property of automatic timers known as minimum response time. After the capacitor in the automatic timer circuit has been charged to the predetermined level, a signal is sent to terminate the exposure. Unfortunately, the exposure is not terminated instantaneously. Anywhere from three to thirty milliseconds may elapse before all the electronics and relays actually stop the exposure. This "lag" time is referred to as Minimum Response Time (MRT). MRT poses a problem to the radiographer when the MRT is longer than the time required for the exposure. In situations where the MRT is longer than the required exposure time, the radiograph will be too dark regardless of the density setting. An example will help clarify this concept: The minimum response time of a machine is 5 milliseconds. An elderly woman with emphysema requires a chest xray. As a result of her condition, the woman's chest x-ray will only require a 2 millisecond exposure. Even though the required time for the exposure is only 2 milliseconds, the actual exposure time will be 5 milliseconds because it takes the machine a minimum

of 5 milliseconds to terminate an exposure. Therefore, the radiograph will be dark when using the "N", "-1" or "-2" settings of the density selector because the machine simply cannot shut off in two milliseconds. Problems with MRT are more common in older equipment since the MRT of these units can be as long as 30 milliseconds. Newer equipment is not faced with MRT problems as frequently as older units because advances in technology have reduced MRT's to as little as 1 millisecond.

4.1 SOLUTIONS
Problems associated with long MRT's can be solved by the use of a lower mA setting, decreased kVp, or simply using manual timing. The use of a lower mA setting is the preferred method to correct MRT problems. When using a lower mA setting, the required time for the exposure is increased (less radiation is present, therefore a longer exposure). The goal is to make the present exposure time longer than the MRT of the machine. By making the the exposure time longer than the MRT, the automatic timer can now terminate the exposure at the proper time which in turn will result in a film with the correct density. If the mA cannot be selected while using AEC (i.e. portable units equipped with AEC), the kVp can be lowered which will lead to an increased exposure time. Lower kVp settings result in decreased x-ray production, therefore it will take longer to charge the capacitor to appropriate level resulting in a longer exposure. However one must be careful when using kVp to change exposure time because of the affect on contrast. Finally,the technologist should always consider one definite way to solve problems associated with the MRT of automatic timer and that is to use manual timing.

V. THE BACK-UP TIMER

One other feature that must addressed when discussing AEC devices is the back-up timer. In order to minimize errors which lead to repeat radiographs, the technologist must be fully aware of the purpose and operation of the backup timer. The back-up timer is a safety device which prevents the patient from receiving an excessive dose of radiation should the automatic timer fail due to mechanical or operator errors. The back-up timer automatically terminates a phototimed exposure if it exceeds 600mAs (Federally mandated). Some radiographic units allow the operator to set the back-up time, while others are fixed at 600 mAs. If the radiography machine allows the back-up time to be adjusted, a good rule of thumb to follow is to set the back-up timer for two to three times the estimated

mAs of the exposure. It is poor practice to always set the back-up timer to the maximum level because if the automatic timer fails, the patient will be unnecessarily exposed to the radiation produced by a 600 mAs exposure before radiation production is actually terminated. If the machine allows the user to select the back-up time for the exposure, the mA selector and timer control automatically become the back-up timer selector.

5.1 REASONS WHY THE BACKUP TIMER IS ACTIVATED

The are several reasons why the back-up timer may be activated and the exposure terminated. Excessively large patients or pathologic conditions may activate the back-up timer. However, it is reasonably safe to say that the main reason the back-up timer is activated during an exposure is a careless technologist. At this point, it will be helpful to review the most common errors that cause the back-up timer to be activated: Wrong Detector Selected: If a patient is being radiographed on the table and the chest board detectors are accidently selected, the film will be too dark and the back-up timer will be activated. This occurs because the selected detectors on the chest board did not receive any radiation so the exposure continued until it was terminated by the back-up timer. Unfortunately, should this occur, the patient is exposed by the primary beam much longer than is necessary. Wrong Tube Selected: If a procedure room has two radiographic x-ray tubes and the tube over the bucky is not the one that is energized, the exposure will continue until it is terminated by the back-up timer. This is explained by the fact that tube over the selected detector is not producing any radiation, therefore the exposure would continue indefinitely if not terminated by the back-up timer. Incorrect Tube/Bucky Alignment: If the x-ray tube is not centered to the bucky, the back-up timer may be activated. Since the detectors are located in the bucky assembly, they cannot sense any radiation if they are not aligned with the tube. Therefore, the exposure will continue longer than necessary. Incorrect Back-up Timer Setting: If the back-up timer is set for too short of a time, the back-up timer will terminate the exposure prematurely, resulting in an underexposed radiograph. This happens most frequently if the previous exam used a short manual time and the back-up timer was not set before the exposure was made. An important point to remember about the back-up timer is that it is a safety feature which is used to prevent the patient from receiving excessive radiation due to machine failure. More often than not, the back-up timer is activated because of technologist error instead of equipment failure. Unfortunately, when the back-up timer is activated the patient has already been improperly exposed to radiation, and a repeat radiograph will be necessary resulting in additional unnecessary radiation exposure to the patient. Therefore, a

radiologic technologist should always make sure all the automatic timer controls are properly set before the radiographic exposure is made.

VI. SUMMARY
The development of automatic exposure control has brought with it the possibility of decreased repeat rates and increased productivity. However, this is only possible with a technologist who fully understands all of the steps that are necessary to produce a diagnostic film while using AEC. Technologists who do not have a complete understanding of AEC may actually find themselves with an increased repeat rate, since its use requires precise positioning and thorough knowledge of the equipment. Perhaps a better term for automatic exposure control should be "assisted" exposure control because in reality the technologist does assist the automatic timing device in producing a diagnostic image.

The following is a summary of the steps to success when using AEC:

The performance of any automatic timer is dependent on the knowledge and skill of the technologist. Positioning is crucial when using AEC devices. Choose the detectors that are directly below the dominant area of interest. The detectors cannot differentiate between secondary and scattered radiation. Therefore, proper collimation is very important. The back-up timer is a safety feature and should be set approximately 23x greater than the estimated mAs of the exposure. Density changes should only be made by changing the density selector. When using AEC, kVp changes should only be made to vary contrast. To decrease the density of dark films due to long minimum response times, lower the mA. If used properly, automatic timers can decrease repeat rates and increase department efficiency.

Bohr's Atomic Model of the atom

A basic explanation of these processes can be accomplished without using quantum theory. A short reference to Bohr's model of the atom will suffice. According to this

model, an atom consists of a heavy nucleus and a number of electrons arranged on well defined shells around this nucleus. With increasing distance from the nucleus, these shells are designated with the letters K, L, M, N, O, P, Q, etc. All nuclei, except that of regular hydrogen, contain besides the positively charged protons an almost equal number of charge free neutrons. The number of protons in the nucleus corresponds to the element number of the material. In an electrically neutral atom, the number of protons and the number of electrons are equal. The closer the electrons are to the nucleus, the tighter they are bound to the nucleus by its' electric field, or (in other words) the more energy is needed to push them out of their place on the shell.

Boomerang Filter
Definition A filter in the shape of a boomerang made of an impregnated silicone material with a similar density to muscle tissue The filter is typicaly placed between the patient and the cassette with the thicker part overlying the less thick patient part, as illustrated in the picture with a shoulder examination. Other uses include. Lower maxilla, D1 to D1 in the AP position Cephalometry

Bremsstrahlung Radiation
If an incoming free electron gets close to the nucleus of a target atom, the strong electric field of the nucleus will attract the electron, thus changing direction and speed of the electron. The electron looses energy which will be emitted as an X-ray photon. The energy of this photon will depend on the degree of interaction between nucleus and electron, i.e. the passing distance. Several subsequent interactions between one and the same electron and different nuclei are possible. X-rays originating from this process are called bremsstrahlung. Bemsstrahlung is a German word directly describing the process: "Strahlung" means "radiation", and "Bremse" means "brake".

The process can create photons of practically all energy values between zero and the maximum determined by the total kinetic energy of the incoming electron. The chances for the generation of a photon with a certain energy by this process decreases with increasing energy and reaches practically zero for the very unlikely event that an incoming electron looses all its energy in one single interaction. Consequently, the resulting radiation contains photons of practically all energy values between zero and the maximum. The distribution of the relative number of photons with a certain energy, as a function of that energy, will decrease with increasing energy and will reach zero at the maximum energy. This is equal to the energy the electron picked up during the acceleration by the electric field between cathode and anode. This energy is conveniently measured in electron volts: one electron volt (eV) is the energy acquired by an electron traveling through a potential

difference of one volt. Therefore, accelerating electrons in an X-ray tube with a voltage of x kV will yield electrons with an energy of x keV, and this will also be the maximum energy an X-ray photon emitted by this tube can have.

Characteristic (HD) Curve D v LogE Curve for Film

Definition Characteristic curve, a curve used to show the exposure properties of a film or a film screen system. The characteristic curve, which was described in 1890 by Hurter and Driffield, is a representation of how the exposure of the film is related to the measurable signal, i.e. the blackening of the film, or film density. The characteristic curve is different for different film types but has a general shape as shown in Fig.1. The base and fog density is measured on an unexposed film. The shape of the characteristic curve tells the user the contrast properties (slope of the linear part) and the useful exposure range (length of the linear part). It also will indicate the speed of the film (or film-screen system), which can be judged from the curve's position along the horizontal axis. The speed class can also be found from the characteristic curve. Average gradient, the slope of the linear part of the characteristic curve of an X-ray film. This is normally defined from the characteristic curve of an X-ray film using the density points 0.25 and 2.0 (over the film fog) to calculate the average gradient as the slope: (2.0 - 0.25) / (logE2.0 - log E0.25) where Ex is the exposure (or mAs) needed to produce density x (over the fog level). Fog, film density caused by the development of silver halide grains that are not exposed to light or X-rays in the exposure of the patient. There are many reasons why fog is present in all X-ray images. Some of them are: -- chemical fog -- storage of the film in warm and humid locations -- storage of film in locations with a high level of background radiation -- contaminated developer solution -- too high temperature and/or prolonged time in developer

(Kodak)

Characteristic Radiation
If the energy of the incoming electrons exceeds the binding energy of the electrons on a certain shell of the target atoms, an additional process can happen: In a collision, the incoming electron (1) can push the target electron (2) out of its place on the shell. This event will leave an unstable atom behind. The gap on the shell will be filled immediately by an electron (3) from an outer shell or even from the conduction band of the target material. This replacement electron will thereby change its energy by a well defined amount depending on the binding energy levels of the electrons in the target material, which are characteristic for that material. The resulting X-rays (4) with very distinct photon energy values are therefore called characteristic radiation. As the binding energy values for the outer shells are not high enough for most elements to generate photons of noticeable energy, usually only characteristic radiation generated by electrons jumping into the K-shell is considered.

Chemical Automixer

The easiest way to deliver and mix x-ray chemicals is to utilize an automatic chemical mixing station, or an automixer. You use an automixer in much the same manner that you would use replenishment tanks. Automixers are really dual mixers in that they have separate mixing systems: one for developer and one for fixer. Both mixing systems work in an identical manner. There are several different specific gravity-type automixers on the market, all of which do basically the same thing in the same manner. Since the automixer can mix both developer and fixer, they have two sides: a developer side and a fixer side. Automixers have one common electrical connection, but everything is separate from there. Automixers are designed to fit the bottles that you are using into templates so that you can t accidentally put developer parts on the fixer side and fixer parts on the developer side. You will remove the cap and place the bottle upside-down in the template. (The bottles are sealed with a foil seal which prevents the bottle from leaking when turned upside down in addition to protecting the chemicals from exposure to air.) When inserted into the template upside-down, a knife mechanism uses the weight of the bottle to cut the foil seal and release the liquid in the bottle into the mixer. When the chemical enters the water below from the bottle you just inserted into the template, (remember that water has a specific gravity of 1.000 and the concentrated solutions you are mixing are much heavier than that) the specific gravity of the resulting solution increases to a pointwhere a specific gravity float-switch is lighter than the solution and begins to float. When the floatswitch is boyant (floating) an electrical connection is made in the switch which opens a solenoid valve allowing water to flow into the mixture. As the water enters the mixture, the solution gets lighter and lighter (closer to 1.0) until the float-switch no longer has the ability to float. The float-switch sinks which breaks the electrical connection in the switch and returns the solenoid valve to its resting state which is normally closed, shutting off flow of water. The float-switch is the key to accurate mixing. Each float-switch is custom made by the mixer manufacturer and most are made to be adjusted over a wide range of gravities. Most x-ray chemicals are designed to be mixed to have a working strength specific gravity of 1.075 and 1.085. In addition, at the proper specific gravity most x-ray chemicals are designed to mix to exactly five gallons. So, by measuring specific gravity with a calibrated specific gravity float, you will be mixing accurately to five gallons if the formula was designed for five gallons. The above process is extremely easy, and except for placing the bottles on the mixer, the process is all automatic and can be very clean. In addition, automatic chemical mixers help to reduce the odors often associated with x-ray chemicals which makes for a more pleasant and potentially healthier working environment. There are some negative features to using an automixer. Automixers are not always one hundred percent accurate. In most cases you wont see extreme variations from mix to mix, but the accuracy of automixers is dependant on incoming water pressure variability, and incoming water temperature. Water pressure which varies widely from time to time can affect the way the chemicals are mixed by affecting the motion of the specific gravity floatswitch. Variable incoming water temperature will affect the specific gravity of the mixture itself. As temperature increases, molecules expand causing the solution to lose density or become lighter. As temperature decreases, molecules get closertogether which causes the density to increase or get heavier. Water temperature will not change rapidly from mix to mix, or even from day to day, but in more northern climates, water temperature can vary from 35 degrees F. in the winter to 70 degrees F. or higher in the summer. In theory, such a larger jump in temperature from

one season to the next will cause the solutions to become heavier in the winter and lighter in the summer and the mixer should be calibrated twice per year as a result. Most mixers don t get calibrated after installation because the variability in chemical density as a result of incoming water temperature is not great enough to cause objections to film readability or processing quality. However, in some cases, you may find a heavier build-up of chemicals in the processor or even in the mixer during the winter months as a result of more densely mixed chemicals. The biggest negative feature to using an automixer is really more of a hurdle than a negative feature: someone has to put the bottles on the automixer. X-ray departments often see this as causing more work when they are already overworked. It does take time to place the bottles on the automixer, but probably no more than 60 seconds. Once the x-ray department realizes that the work involved in using an automixer really is no work at all, they love to use them. Using an automixer means being able to store more concentrated chemicals which decreases the risk of running out of chemicals. In addition, because the chemicals are delivered in bottles sealed in boxes, delivery and storage is much neater and more convenient. In addition, the chemicals are delivered in the manner that the chemical manufacturer has specified and you can depend of quality chemical manufacturers to provide consistency from case to case and from batch to batch and from year to year. So, an automixer allows the x-ray department or facility the freedom from most mistakes and the freedom to have cleaner more pleasant working environment.

Collimator
Typical basic collimator specification

EXTERNAL COVER IN A.B.S. PLASTIC. Multilayer, square field X-ray collimator for stationary units. The collimator enclosure is constructed of double steel, lead-lined walls for maximum X-ray

protection . X-ray field size is limited by 6 pairs of shutters four of which are lead-lined. Two pairs of shutters are positioned near the focus, two near the entrance window and two near the exit window of the X-ray beam from the collimator. The shutters are controlled by two knobs located on the front panel. Besides the minimum in-built filtration, three variable filters may be added manually. SPECIFICATIONS: External adjustment of mirror angulation. Additional filtration: 0,1mm copper in addition to the 1mm Al. Support 0,2 mm copper in addition to the 1mm Al support. 1mm aluminium in addition to the 1 mm Al support High luminosity provided by a quartz iodide lamp. Timer limiting projection lamp exposure time to 30 seconds, adjustable, thus extending lamp life and preventing overheating. 150 kVp radiation shielding. Minimum inherent filtration 2mm aluminium equivalent. (0,3mm and 1mm on request) Continuous film coverage from 0 x 0 to 43 x 43 cm, 1% FFD, at 90cm FFD (SID).

Notes

When it comes to radiation protection, the collimater plays an important role: It is used to narrow the radiation field to a size needed for the examination at hand. For this it is equipped with sets of lead plates providing either a round or a square-shaped radiation field.

These collimating plates are either motorized or operated manually. In automatic mode, the image-receiver size is detected, and the collimating plates are operated accordingly

Diagrams of collimator with (1) no light beam

(2) Light beam

Compound Anode
Compound anodes are used where there is a requirement for a high thermal capacity.

Compound anodes typically have a target area of rhenium tungsten alloy backed by molybdenum and or graphite, the tungsten rhenium alloy resists surface damage and "crazing" better than a pure tungsten surface, the molybdenum and or graphite and molybdenum has a higher heat capacity than a purely tungsten anode. The greater the volume of metal the higher the heat capacity, molybdenum has half the weight of tungsten and graphite one tenth the weight so a greater mass can be used with no increase in weight and its associated problems for rotation, construction etc.

c/o Phillips Medical

Compton Scattering

Compton Scattering, also known as incoherent scattering, occurs when the incident x-ray photon ejects a electron from an atom and an x-ray photon of lower energy is scattered from the atom. Relativistic energy and momentum are conserved in this process below) and the scattered x-ray photon has less energy and therefore a longer wavelength than the incident photon. Compton scattering is important for low atomic number specimens. The change in wavelength of the scattered photon is given by:

Theta is the scattering angle of the scattered photon. Note the fundamental constants for the speed of light, Planck constant, and electron mass.

Contrast (Image)

Contrast is the difference in density between the darkest and lightest areas of the subject image. In the diagarm below contrast is the difference in the length of line b and line a. Comparing contrast between films for the same subject In the diagram below it is obvious the the difference between density a is greater than a' there for between the two films Film A has greater contrast

Diagnostic Reference Levels Working Party Statement

IPEM/NRPB/RCR/CoR/BIR Diagnostic Reference Levels Working Party The Ionising Radiations (Medical Exposures) Regulations 2000 requires employers to establish diagnostic reference levels (DRLs) for radiodiagnostic examinations. The Institute of Physics and Engineering in Medicine (IPEM) along with the National Radiological Protection Board (NRPB), the College of Radiographers (CoR), the Royal College of Radiologists (RCR) and the British Institute of Radiology (BIR) have established a Working Party to provide guidance on the implementation of DRLs for diagnostic x-ray examinations. The membership of the Working Party is: Mr A Workman (IPEM), Dr J Kotre (IPEM), Mr A Shaw (IPEM), Ms R Fong (IPEM), Mr B Wall (NRPB), Dr R Bury (RCR), Mrs S Barlow (CoR), Dr D Sutton (BIR), Mr J Williams (BIR) and Mr S Ebdon-Jackson (DoH observer) The Working Party had its first meeting on 5 October and has issued the following preliminary guidance. Diagnostic Reference Levels should be seen as part of the overall framework for protection of the patient along with the other requirements of IR(ME)R 2000 and of Regulation 32 of IRR 99 . Membership Meetings Publications Projects News Reports Links How to join Register 1. National DRLs A Department of Health working party on DRLs, which included representation from professional bodies and other organisations associated with medical exposures, met on 13 January 2000. At this meeting it was agreed that for diagnostic x-ray examinations the rounded third quartile values from the 1995 NRPB patient dose review (NRPB-R289) [1] would be proposed as National DRLs. The values and examination types are as follows:

Radiograph/Examination National Diagnostic reference level Examination Skull AP/PA Skull LAT Chest PA Chest LAT Thoracic spine AP Thoracic spine LAT Lumbar spine AP Lumbar spine LAT Lumbar spine LSJ Abdomen AP Pelvis AP IVU Barium meal Barium enema Entrance surface dose (mGy) 4 2 0.2 0.7 5 16 7 20 35 7 5 25 17 35

It was further agreed that National DRLs would be reviewed at five-yearly intervals, and that individual medical physics departments and hospitals carrying out programmes of patient dosimetry in diagnostic radiology should be strongly encouraged to contribute data to NRPB for national collation. The list of examinations for which there are national DRLs will be extended when sufficient data on UK practice has accrued. 2. Local DRLs IR(ME)R requires the Employer to establish DRLs for radiodiagnostic examinations. Employers should adopt a set of DRLs, having regard to national and European DRLs where available. In the first instance, the examination types and DRL values adopted can be those of the established national DRLs. Where a national or European DRL is not available for an examination type, there is no requirement to set a DRL locally for this examination. Any relevant local patient dosimetry data should be reviewed to identify examinations where established local practice will support the adoption of a DRL value lower than the equivalent national DRL. The local adoption of a DRL which is higher than the respective national value will need to be justified. For example, a case-mix which consistently requires examinations of greater duration and complexity than the norm may justify a higher patient dose. However, a local DRL higher than the equivalent national value cannot be justified solely on the grounds of the use of poor equipment and/or techniques. A hospital or Trust Radiation Protection Committee, Medical Exposures Committee or their equivalent would be a suitable forum for ratifying locally adopted DRLs. Local adoption of DRLs makes employers responsible for the level at which the DRLs are set, in line with the concept of Clinical Governance. It is important to note

that this does not mean that individual Trusts must derive their own DRLs from their own locally measured patient doses. Local measurements from one Trust may not produce statistically valid DRLs. The Department of Health working party meeting in January 2000 agreed that local DRLs should be reviewed annually. Annual review of DRLs is intended to provide a formal mechanism for revision of locally adopted DRL values which may follow revised or new national DRLs, or additions to local patient dose data. Where examination protocols have been changed, the effect on the locally adopted DRLs should be considered, but it is not intended that this review requires annual patient dose surveys. 3. Reviews triggered by DRLs being 'consistently exceeded' Employers are required to undertake a review if a DRL is consistently exceeded. Because of the known wide variability in doses between individual patients for the same type of examination, DRLs are defined as dose levels for typical examinations for groups of standard-sized patients (or standard phantoms). Therefore comparing the dose to an individual patient with a DRL has limited value. Rather, the distribution of doses on a representative group of close to standard-sized patients (or on a standard phantom) should be considered. For example, the mean value of this distribution can be compared with the DRL to determine whether a DRL is being consistently exceeded. Regulation 32 of IRR 99 requires that a suitable quality assurance programme be provided for equipment used for medical exposures, which should include periodic measurements of representative doses to samples of average size patients. The basis of a suitable quality assurance programme is outlined in IPEM Report 77 [2]. This incorporates national recommendations for patient dosimetry [3] which state that measurements should be made at least every 3 years on each piece of equipment or whenever changes are made to equipment or procedures that are likely to significantly affect patient dose. The Working Party believes that these periodic patient dose assessments required by IRR 99 can usefully be used to determine whether DRLs are being consistently exceeded. The average dose to a group of standard-sized patients measured by such surveys should be compared to the respective locally adopted DRL. Where the DRL is exceeded, the employer must instigate a review of local practice to establish reasons and implement corrective action, where appropriate. It is expected that this ongoing audit of compliance with DRLs can be achieved in most Trusts by the existing rolling programme of 3-yearly patient dose measurements. This patient dose assessment programme is distinct from the annual review of locally adopted DRLs discussed in section 2. The Working Party intends to consider the application of DRLs to other types of x-ray examination, and to provide practical guidance on the required review processes. References Doses to Patients from Medical X-ray Examinations in the UK - 1995 Review. NRPB R289, 1996 Recommended standards for the routine performance testing of diagnostic x-ray

imaging systems. IPEM Report 77, 1997 National protocol for patient dose measurements in diagnostic radiology. IPSM, CoR and NRPB 1992

Digital Flat Panel (From the GE website)

The third in the series of the Revolution Digital Flat Panel Education will cover the specifics of the GE Revolution Digital Flat Panel Detector. Discover the principles, technology and design structure of the GEs Digital Flat Panel in this issue.

GEs Digital Flat Panel Detector History

Result of extensive corporate R&D since 1985, the GE Revolution Digital Flat Panel (DFP) detector replaces the film in Mammography and Rad applications as well as the analog image intensifier, with its camera optics, pickup tube or CCD camera, and analog-to-digital converter, in CardioVascular applications. Using a common technology platform that requires only limited customization for each application, GE pioneered the deployment of DFP detectors in Mammography (1999), in Rad (1999) and in Cardiac (2000). Characterized by a very high Detective Quantum Efficiency, the GE Revolution detector captures nearly all the information available at its entrance and transfers it with almost no degradation to the observer. For all applications, the result is outstanding image quality at reduced dose. GEs Digital Flat Panel Technology The principle of the flat-panel detector is illustrated in the drawing below.

Principle of the GE Revolution Digital Flat Panel Detector.

The cesium iodide (CsI) scintillator absorbs x-ray photons, converting their energy into light photons emission. This light is then channeled toward the amorphous silicon photodiode array where it causes the charge of each photodiode to be depleted in proportion to the light it receives. Each of these photodiodes is a picture element (pixel); the spatial sampling of the image, which is the first step in image digitization, is thus performed exactly where the image is formed, whereas it is realized almost at the end of the chain in an Image Intensifier (see more in part 2 of the education series). The electronic charge required to recharge each photodiode is then read by ultra-lownoise proprietary electronics and converted into digital data that are then sent to a real-time image processor. In the GE cardiac system, over 30 million pixels per second are read out, processed, and displayed in real time. GEs Digital Flat Panel Structure

The heart of the flat panel digital detector consists of a two-dimensional array of amorphous silicon photodiodes and thin-film transistors (TFTs), all deposited on a single substrate. Utilizing thin film technology similar to that used in the fabrication of integrated circuits, Mono-substrate Amorphous Silicon panel coated with CsI layers of amorphous silicon and various scintillator. metals and insulators are deposited on a glass substrate to form the photodiodes and TFTs matrix, as well as the interconnections, and the contacts on the edges of the panel.

The CsI scintillator, which converts x-ray photons into visible light photons, is deposited directly on top of the amorphous silicon structure. Using a proprietary process, it is grown in very thin needles (5m width) that channel the light photons towards the photo-diode, like a fiber optics would do. This allows one to increase the thickness of the CsI, and thus to stop and detect more X-rays, without degrading spatial resolution because of wide-spreading light scatter as observed in typical radiographic phosphor screens.

Electron microscope views of CsI needles that constitute the scintillator layer.

The photo-diode comprising each pixel is used as a bucket for electrons and each TFT behaves as a switch to access the associated photo-diode. The TFT conductive state is controlled through the voltage applied by scan electronics modules to matrix rows. When a TFT is conductive, the charge of the corresponding photo-diode can be measured through a matrix column by the readout electronics modules and converted to a digital value by the analog to digital converter attached to each colomn. The second step of image digitization after spatial sampling: pixel quantification, is thus also performed next to image formation, and not at the end of a long transformation chain like in an Image Intensifier-based system. (for more details on Image Intensifier imaging chain, see part 2 in the Digital Flat Panel education series).

Flat Panel and Imaging Scan modules and readout modules are GE proprietary designs and use state-of-theart high density packaging technology to minimize sources of noise. Associated with the optimized design of the amorphous silicon flat panel, the electronic noise generated in the entire detection chain, from the photo-diode to the output of the analog-to-digital converter, is equivalent to the signal generated by a single X-ray photon. Thus, the read-out noise added by the panel is significantly less important then the quantum noise in X-ray imaging. The image quality is therefore limited only by the X-ray quantum noise, i.e. by the dose, and not by the detector performance. This low noise performance, which is particularly important in fluoro where very low dose is required. Combined with other advantages of the flat panel detector, such as large dynamic, response stability over dose variations and time, response uniformity over the entire image area, and absence of distortion, it provides a breakthrough in image quality. All this adds not only to intrinsic image quality but also and opens new opportunities for further image processing. Processing Data with a Flat Panel

In cardio-vascular imaging, information is typically associated with small objects such as arteries, stents, guide wires, and catheters - objects that overlap each other and large organs with different contrasts such as lungs or diaphragm. Because the display has a finite number of gray levels, representing the organs at their acquired brightness levels may compromise the representation of smaller objects of clinical interest. At GE, we have developed state-of-the art computational methods to represent the information in an intelligent manner, so that features of interest are allocated optimal display values. This requires that the original image be captured with high fidelity over its entire dynamic range. As a result, the detector gives images a unique look and feel. This allows diagnostic

information to be presented with optimal utilization of display properties and human visual perception. This technology also provides the ability to selectively enhance the contrast of objects such as stents regardless of the anatomical background against which they are acquired, providing better visibility of object details across the entire image, regardless of the background anatomy. Conclusion The family of digital detectors manufactured by GE is based on a common technology platform whose heart is a two-dimensional amorphous silicon array of photo-diodes and thin-film transistors deposited on a single piece substrate and directly coated with needle grown Cesium Iodide. The technology platform strategy forced the design to be able to answer the most challenging needs of each application, such as large field of view for chest Rad, high resolution for Mammography, real time and low noise image acquisition for Cardiac. This strategy has several advantages:

fast introduction of the successive detectors customized for each application; today, more than 1,100 systems are installed worldwide and give GE a unique know-how in Digital detectors, easy cross-fertilization between customized oanel formats and designs, enables each customer to benefit from developments made to the panel for other applications; this offers the ability to enjoy performances that exceed the demands of todays practice and open the way to new breaking-through applications.

The high performances of the amorphous silicon flat panel are complemented by the proprietary electronics for detector control and readout. Associating one Analog-toDigital converter with each of the 1024 or 2048 pixels forming a single image row is a good example of a design without compromise to minimize noise sources in all conditions. All that results in a final design which offers Image Quality performances as well as simplicity, with a single large sensitive area requiring neither tile stitching with the associated lost pixels, nor detector motion prohibiting fast acquisition, and thus a reliability demonstrated by the most large and diverse installed base of Digital Detectors

Diode / rectifier
The Diode Valve Invented in 1904 by John Flemming

A tungsten filament, similar to that found in an electric light bulb is heated by an electric current, in a glass envelope containing a vacuum. This produces a cloud of electrons around it, which are negatively charged. If a positively charged metal plate is positioned near the filament, it will attract electrons from the cloud and a current will flow in the circuit. If the plate is charged negatively the electrons will be repelled and no current will flow. This is the basis of the valve rectifier. This type of valve is called a diode, the filament is called the cathode and the plate is called the anode. The diode valve was developed by Sir John Ambrose Fleming in 1904, while working for the Marconi Company.

A diode with a filament as the cathode is called a directly heated valve, but most modern valves are indirectly heated. An indirectly heated cathode consists of a nickel tube that is coated with an oxide consisting of barium, strontium and calcium. Inside the tube is the heater which consists of an insulated tungsten filament. This type of cathode has two advantages. It produces more electrons and can be operated from an AC or DC voltage.

Electronic symbols for the diode The graph below shows that voltage current relationship is not a straight on off, in reality the curved bit at the bottom is where more and more of the electrom cloud is attracted across this is called the non saturated mode then when all the electons boiled off are attracted as quickly as they are boiled off the graph is flat

Voltage current graph for a typical valve

The diode is used as a rectifier to convert an AC voltage to DC. In the circuit

below, the diode only conducts when the anode is positive with respect to the cathode, and so only conducts on each positive half cycle of the AC input. The voltage at the cathode consists of just the positive half cycles.

The capacitor charges to the peak of these half cycles to produce a smooth DC voltage.

DC output voltage shown in the graph, is not very smooth because the capacitor starts to discharge between each positive peak. This is called the ripple voltage, and it can be reduced by increasing the size of the smoothing capacitor

The diagram below shows how four diode rectifiers may be arranged in a "bridge" to produce a direct current from an alternating current

The graph below shows the unsmoothed output waveform from a bridge rectifier circuit

Dose Area Product Meter (DAP)

Dose-Area-Product (DAP) meters are large-area, transmission ionization chambers and associated electronics. In use, the ionization chamber is placed perpendicular to the beam central axis and in a location to completely intercept the entire area of the xray beam. The DAP, in combination with information on x-ray field size can be used to determine the average dose produced by the x-ray beam at any distance downstream in the x-ray beam from the location of the ionization chamber. The use of DAP is discussed further later.(2) A recent modification of the ionization chamber design used in a DAP meter has resulted in an instrument that measures both DAP and the dose delivered by the x-ray beam. This design effectively combines data from a small ionization chamber that is completely irradiated by the beam and independent of the collimator adjustments with the conventional DAP meter. Some fluoroscopic and radiographic systems have dose-area product (DAP) meters. DAP meters measure the radiation dose to air, times the area of the x-ray field. The relationship between DAP and exposure-area product (EAP) is essentially a single conversion factor that relates dose to exposure. EAP is expressed in roentgen-cm2 (Rcm2) and DAP is expressed ingray-cm2 (Gy-cm2). How is DAP measured? An ionization chamber larger than the area of the x-ray beam is placed just beyond the xray collimators. The DAP ionization chamber must intercept the entire x-ray field for an accurate reading, one proportional to the EAP. The reading from a DAP meter can be changed by altering the x-ray technique factors (kVp, mA, or time), varying the area of the field, or both. If the chamber area is larger than that of the collimators, as the collimators are opened or closed the charge collected will also increase or decrease in proportion to the area of the field. For example, a 5 x 5 cm x-ray field with an entrance dose of 1 mGy will yield a 25 mGycm2 DAP value. If the field is increased to 10 x 10 cm, with the same entrance dose of 1 mGy the DAP increases to 100 mGy-cm2, which is 4 times the DAP for the 5 x 5 cm field.

DAP meter Sensor

DAP meter display with print out (Vertec)

Why DAP? Dose-area product is relatively easy to measure. DAP meters have been around for

many years, and were actually used in the 1964 and 1970 U.S. X-ray Exposure Studies. Advocates of DAP meters contend that the DAP is a better indicator of risk than entrance dose alone, since DAP incorporates the entrance dose and field size. DAP has been shown to correlate well with the total energy imparted to the patient, which is related to the effective dose and therefore to overall cancer risk. Are there problems with DAP? There are several problems with the use of the DAP value. The configuration of the DAP meter may introduce a bias to the DAP value. For example, if any material is placed between the meter and patient, the patient will receive less than what is implied by the displayed DAP value. For an undertable fluoroscopy system this can be the tabletop and pad. Consequently, the use of DAP to estimate skin entrance exposure or skin dose is complex and should only be attempted by a qualified medical physicist. This is particularly true for fluoroscopic procedures where multiple beam directions, source-skin distances, and field sizes may be used. DAP meters are difficult to calibrate and maintain. Large changes in the DAP meter response can occur over time, particularly if meters are adjusted for couch transmission factors. Calibration should be done in the field after any changes that might alter the DAP and at least annually. 2. Dose-Area-Product Problems in usage Up to a decade ago, radiological patient safety concerns were focused on stochastic risk. Monitoring and managing stochastic risk requires estimates of the effective dose delivered to the patient. There is no need for real-time feedback. DAP is defined as the integral of dose across the X-ray beam. Therefore DAP includes field nonuniformity effects such as anode-heel-effect, and the use of semi-transparent beamequalizing shutters (lung shutter). DAP is easy to measure. The simplest method is to place a transmission full-field ionization chamber in the beam between the final collimators and the patient. DAP may also be obtained by calculation. Data is accumulated during fluoroscopy, fluorography, and radiography. Assuming that the incident beam is totally confined to the patient, the recorded value essentially provides an upper limit on the X-ray energy absorbed by the patient (i.e. there is no transmission or scatter). DAPs ability to estimate stoc hastic risk is degraded because of the lack of dose distribution information within the patient. The best that one can do is to assume an average weighting factor for all the tissues at risk. This may lead to an over or under estimate of risk in certain cases. As an example, it does not account for the differential risk of breast cancer from an AP or a PA projection. DAP rate and cumulative DAP can easily be displayed in real-time. The primary utility of DAP rate is in a teaching situation. Scattered dose rate at any place in the lab is more or less proportional to DAP rate. The trainee can be shown that reducing DAP rate reduces his or her personal exposure rate. The effect of different control options (e.g., collimation, zoom mode) on DAP rate can be demonstrated. Cumulative DAP does not provide a direct indication of the possibility of skin injury. The same DAP is observed with large fields and low skin doses as with small fields and high skin doses. Exceeding skin tolerance is more likely in the latter case. However, reasonable entrance field size estimates can be made for many procedures. These estimates are dependent on factors such as equipment configuration, patient size, and operator technique. Once known, the nominal field size can be used to obtain an estimate of skin dose. Rules-of-thumb can be established to make this conversion for typical

procedures. DAP provides no information regarding the spatial distribution of the entrance beam around the patients skin. It produces an overestimate of the po ssibility of exceeding the deterministic threshold when there is significant beam movement during the procedure. Summary: DAP meters are valuable quality control tools for monitoring changes in equipment and procedures. DAP does not represent radiation dose per se, and use of a DAP meter to determine patient dose should only be attempted by a qualified medical physicist. DAP meters need to be recalibrated on a regular basisat least annuallyto maintain adequate accuracy.

Dose Definitions
Absorbed dose: The energy imparted per unit mass by ionizing radiation to matter at a specified point. The SI unit of absorbed dose is the joule per kilogram. The special name for this unit is the Gray (Gy). Air kerma: The energy released per unit mass of a small volume of air when it is irradiated by an x-ray beam. For diagnostic x-rays, air kerma is the same as the absorbed dose delivered to the volume of air in the absence of scatter. Air kerma is measured in Gy. Biologic variation: With respect to radiation, the differences among individuals in the threshold dose required to produce a deterministic effect, or the differences in degree of effect produced by a given dose. Biologic variation may be idiopathic or due to underlying disease. Different areas and types of skin also differ in radiosensitivity. C-arm fluoroscopic system: A fluoroscopic system consisting of a mechanically coupled x-ray tube and image receptor. Such systems typically have two rotational degrees of freedom (left-right and cranial-caudal). Most such systems have an identifiable center of rotation called the isocenter. An object placed at the isocenter remains centered in the beam as the C-arm is rotated. Cumulative dose (CD): The air kerma accumulated at a specific point in space relative to the fluoroscopic gantry (the interventional reference point) during a procedure. CD does not include tissue backscatter and is measured in Gy. CD is sometimes referred to as cumulative air kerma. Deterministic effect: A radiation effect characterized by a threshold dose. The effect is not observed unless the threshold dose is exceeded. (The threshold dose is subject to biologic variation.) Once the threshold dose is exceeded in an individual, the severity of injury increases with increasing dose. Examples of deterministic effects include skin injury, hair loss, and cataracts.

Dose: As used in this document, "dose" is the same as the absorbed dose unless specified as "equivalent dose" or "effective dose." Doseareaproduct (DAP): The integral of air kerma (absorbed dose to air) across the entire x-ray beam emitted from the x-ray tube. DAP is a surrogate measurement for the entire amount of energy delivered to the patient by the beam. DAP is measured in Gycm2. Effective dose: The sum, over specified tissues, of the products of the equivalent dose in a tissue and the tissue weighting factor for that tissue. Effective dose is measured in Sieverts (Sv). Stochastic risk factors are usually stated relative to effective dose. Equivalent dose: A quantity used for radiation protection purposes that takes into account the different probability of effects that occur with the same absorbed dose delivered by radiations with different radiation weighting factors. Effective dose is measured in Sv. Fluorographic image: A single recorded image obtained using an image intensifier or flat digital panel as the image receptor. A digital angiographic "run" consists of a series of fluorographic images. Fluoroscopy time: The total time that fluoroscopy is used during an imaging or interventional procedure. Interventional reference point (IRP): For C-armtype fluoroscopic systems with an isocenter, the IRP is located along the central ray of the x-ray beam at a distance of 15 cm from the isocenter in the direction of the focal spot. The IRP is defined by International Electrotechnical Commission (IEC) standard 60601-2-43 Isocenter: For C-armtype fluoroscopic systems, the point in space between the focal spot and the image receptor through which the central ray of the x-ray beam passes, regardless of beam orientation. Kerma: Kinetic Energy Released in Matter; the amount of energy transferred from the x-ray beam to charged particles per unit mass in the medium of interest. For diagnostic x-rays, this is equivalent to absorbed dose in the specified medium (eg, air, soft tissue, bone). Kerma is measured in Gy. Peak skin dose (PSD): The highest dose at any portion of a patients skin during a procedure. Stochastic effect: A radiation effect whose probability of occurrence increases with increasing dose, but whose severity is independent of total dose. Radiation-induced cancer is an example. Threshold dose: The minimum radiation dose at which a specified deterministic effect can occur. Threshold doses differ among individuals as a result of biologic variation. The threshold dose for skin injury also differs in different anatomic sites on the same individual.

Although practicing physicians should strive to achieve perfect compliance, in practice, all physicians will fall short of this ideal to a variable extent. Indicator thresholds may be used to assess the efficacy of ongoing quality-improvement programs. For the purposes of these guidelines, a threshold is a specific level of an indicator that should prompt a review. When compliance rates fall below a minimum threshold, a review should be performed to determine causes and implement changes if necessary. If recording patient radiation dose data is one measure of the quality of radiation dose management, compliance rates lower than the defined threshold should trigger a review of policies and procedures within the department to determine the causes and implement changes to improve quality. Thresholds may vary from those listed here; for example, patient referral patterns and selection factors may dictate a different threshold value for a particular indicator at a particular institution. Because institutions and interventional fluoroscopic units vary widely in their ability to measure various metrics of patient dose, radiation dose data may be recorded with use of one or more of four different dose metrics: fluoroscopy time/number of fluorographic images, DAP, CD, and PSD. Therefore, setting universal thresholds is very difficult and each department is urged to alter the thresholds as needed to higher or lower values to meet its own quality-improvement program needs.

Exposure Factors
Kv / Kvp Potential difference between film and anode The energy (you can consider this the penetrating power) of the x-ray beam is controlled by the voltage adjustment. This control usually is labelled in keV (thousand electron volts) and sometimes the level is referred to as kVp (kilovoltage potential). Do not be confused by the different terminology, just remember there is a control by which the difference in potential between the cathode and anode can be controlled. The higher the voltage setting, the more energetic will be the beam of x-ray. A more penetrating beam will result in a lower contrast radiograph than one made with an xray beam having less penetrating power. It is probably obvious that the more energetic the beam, the less effect different levels of tissue density will have in attenuating that beam. The generator waveform if is not constant potential (medium frequency etc) will affect the effective Kv.

mA Tube Current The second control of the output of the x-ray tube is called the mA (milliamperage) control. This control determines how much current is allowed to flow through the filament which is the cathode side of the tube. If more current (and therefore more heating) is allowed to pass through the filament, more electrons will be available in the "space charge" for acceleration to the target and this will result in a greater flux of photons when the high voltage circuit is energized. The effect of the mA circuit is quite linear. If you want to double the number of "x" photons produced by the tube, you can do that by simply doubling the mA. Changing the number of photons

produced will affect the blackness of the film but will not affect the film contrast.

S Time The third control of the x-ray tube which is used for medical imaging is the exposure timer. This is usually denoted as an "S" (exposure time in seconds) and is combined with the mA control. The combined function is usually referred to as mAs or milliampere seconds so, if you wanted to give an exposure using 10 milliampere seconds you could use a 10 mA current with a 1.0 second exposure or a 20 mA current for a 0.5 second exposure or any combination of the two which would result in the number 10. Both of these factors and their combination affect the film in a linear way. That is, if you want to double film blackness you could just double the mAs.

The X-Ray beam The x-ray beam has two main properties you need to understand. 1) Beam QUALITY is the ability of the beam to penetrate an object, its all about the penetrating power of the x-ray photons, this is controlled by the KV control. 2) Beam INTENSITY this is the number of x-ray photons in the beam and is principally controlled by the mAS But note as you increase the KV not only does the QUALITY harden (more penetrating) but you do actually get more photons so INTENSITY increases too. Putting it all together the exposure Any radiographic subject has a minimum Kv required for the x-ray photons penetrate the most dense part of the subject, the most radiographicaly dense part of the subject will depend upon what the part is chemicaly composed of (Atomic number) and its thickness (remember linear attenuation coefficients and HVL!?) The thicker the subject the more absorption of x-rays so the thicker the part the more mAS you require. In theory the more Kv you use the less the contrast of the image will have However in practice film screen / processing conditions affect contrast much more In practice it is not as simple as this as scatter is produced which is not image forming but adds density to the film and needs to be controlled, if you remember all those complex diagrams about interactions of x-rays with matter you will realise the amount and direction of scatter depends on the Kv and the material absorbing the x-rays.

Image 1 The Kv is too low the femoral condyle is under pentrated you cannot see the bone trabecualr patterns. the contrast is too high to demonstrate all the soft tissues.

Image 2 Much better the all the subject is penetrated and all the soft tissues are visible

A well exposed abdomen image demonstrating all the soft tissue structures.

A good chest image the mediastinum is pentrated the image is exposed well demonstrating the bones and soft tissues.

Under penetrated

OK

Under penetrated

Too much mAS

Too Little mAS

A few myths Changing the Kv by 2 or 3 makes almost no perceptable image change! Adding 10 Kv does not double the image density Exposure factors are an exact science ! (the image you produce must satisfy the radiologist who interprets the image - not all radiologists like the same penetration / density / contrast for the same body part)

Image Contrast Here, we need to spend a little more time discussing the issue of radiographic contrast. This is an important concept because image contrast plays a critical part in the interpreter's ability to detect abnormalities which are only slightly different from the density of the surrounding material. It is not possible to say what is the optimal contrast (or the optimal radiographic technique) for all situations. Different body parts have different inherent tissue contrast. This can be illustrated by using the extreme examples of the chest and the breast. In the chest, there is good inherent tissue contrast with densities ranging all the way from bone at the high end to air at the low end. On the other hand, the breast is inherently very low in tissue contrast only containing structures which are water density (glandular material or tumor) or fat density. For the moment, we will disregard small calcifications which are really not normal structures. Because of this difference in inherent tissue contrast, we would be likely to use a very low contrast radiographic technique for the chest because we have good tissue contrast. Conversely we would be likely to use a very high contrast technique for the breast because the breast has minimal, inherent tissue contrast. Remember, image contrast is controlled by the energy of the "x" photon beam. Therefore, high kV techniques result in low contrast images (the assumption is always made that the image will have approximately the same average film density so if kV is increased, there must be a compensation in mAs to keep film density constant). To increase image contrast in situations where there is low tissue contrast, a low kV, high mAs technique should be used. This is obvious for mammography but you should also remember this possibility for other special situations such as looking for low-density foreign bodies embedded in soft tissue. To improve film contrast for mammograms we would need to use a very low energy x-ray beam. Mammograms are frequently done with beams in the 25 keV range. For the chest x-ray, we would like to use a low contrast technique which requires a relatively high-energy beam. Chest x-rays are frequently done with beam energies above 100 keV. You should understand that for similar film densities, the high KV technique usually results in lower patient radiation exposure. Think about this long enough to clearly understand why less radiation is absorbed in the patient when a high-energy beam is used. Grids One of the problems in getting a sharply defined image in clinical radiology is the presence of scattered or secondary radiation. These photons are created in the body of the patient or closely surrounding objects by the interaction of that material and the primary "x" photons coming from the x-ray tube. Several possible interactions occur in the diagnostic energy range. At relatively low energies, the photoelectric effect is probable. The photoelectric effect is actually the desirable, photon/tissue interaction because there is complete absorption of the photon with no production of a secondary photon. The more common tissue interaction at the photon energies used for the

majority of clinical procedures is called the Compton effect or coherent scattering. In this interaction, a secondary photon is produced at the site of interaction. The secondary photon will always have lower energy than the primary photon and will be going in an altered direction. These secondary photons, if allowed to reach the film, will actually produce erroneous information by recording gray tone variation (and therefore indicating relative tissue densities) at some distance from the site at which the photon/tissue interaction actually occurred. The net result of allowing a significant number of secondary photons to reach the film is a reduction in image sharpness. There will always be a loss of spatial resolution. Several methods have been devised to reduce the problem of scattered radiation. The simplest and most direct is to simply limit the field of exposure. If a small image area is adequate to make the clinical diagnosis, the image area should be "coned down" to that small size. For instance, if you want to image the gallbladder, you will get a much sharper picture if you bring the shutters down to include an area only the size of the gallbladder instead of including the entire upper abdomen on the image. Just remember that the smaller the area of the x-ray beam the fewer scattered photons you will produce. In the typical clinical imaging situation, the most common method of reducing scatter is to use a radiographic grid. The grid looks like a flat metallic plate the size of the xray film if you look at it directly. However, it is more complicated than that. It actually is composed of alternating radiopaque (lead) and radiolucent (aluminum) strips. These are arranged on edge, sort of like looking at the strips of a venetian blind which is arranged to let light come between the strips. The edge of these strips is turned towards the source of x-rays and in the most commonly used grid, the focused grid, the anglulation of the strips is arranged to match the divergence of the x-ray beam. This arrangement of the radiographic grid will give the highest probability for primary "x" photons passing between the lead grid strips and reaching the film, while the offfocus or secondary photons are likely to interact in the lead strips and never reach the film. The use of this radiographic grid will greatly improve image sharpness when a relatively thick body part is being imaged. Unfortunately, there is always a trade off. Since the grid does stop some of the photons which would contribute to film blackening, if you just add a radiographic grid without changing the tube settings, the film will be greatly underexposed. If you decide to use a grid, you will have to increase the number of photons produced by the x-ray tube in order to get the correct film exposure. This will result in giving the patient increased radiation exposure. Remember, the position of the grid is between the patient and the film. The third method of reducing scatter or at least reducing the probability that scattered photons will reach the film is to use an air gap. This is infrequently used in clinical radiography but can still, sometimes be used to an advantage particularly when magnification of the image might be helpful. Ordinarily we would have the film positioned as close to the patient's body as possible for the radiography of any body part. With an air gap technique, the film is moved several inches away from the patient's body. That separation, (because secondary photons are likely to be lower

energy and moving at a greater angle than primary photons) will result in a decreased probability of the secondary photon hitting the film. From the diagram below, you will be able to understand that creating the air gap will also result in magnifying the radiographic image. Remember the x-ray beam is produced from almost a point source and it diverges as it goes towards the patient.

Extra focal Radiation

Extra focal radiation is radiation produced at the amode which is not from the area represented by the focal spot.

Ferlic Filter
An external beam filtration device as specified below

Improves image quality by filtering. Even density of x-ray signal and image from C1 to T1. Even density on lateral hips from acetabulum to the distal femur. Perfect compliment to Lateral Hip Support . Reduce or eliminate Swimmers view retakes. Reduce overall patient exposure and medical staff dose. Increase patient flow rates (not waiting for medical staff to apply traction etc.). Reduce costs and eliminate retakes. With conventional film, works best with L films e.g. Kodak T-mat L, Fuji HRL etc., etc.. Also works with Computerised Radiography (CR).

Film badge Holder

The photographic film dosemeter is designed to measure doses from X, beta and gamma radiations in terms of the radiation quantities specified by the Health and Safety Executive (HSE). The film badge service is approved by the HSE under Regulation 35 of the Ionising Radiations Regulations 1999. The dosemeter consists of a photographic film (manufactured by Kodak) contained in light tight wrapper. To cover the required dose range the film incorporates two emulsions, of different sensitivities. It is uniquely identified by means of a number which is stamped onto the film and wrapper. The dosemeter also bears the wearer's name or a serial number, the establishment code number, the expiry date and an optional personal identifier for each employee, e.g. department name or a works number. We also provide 'wear and care' cards for each member of staff. These are designed to help users understand more about how and why they should wear the dosemeter. The wearer places the wrapped film in a plastic holder, which is supplied by the NRPB on permanent loan. The holder contains a number of metallic and plastic

filters which are necessary to ensure that the dosemeters provide an adequate measurement over a suitably wide radiation energy range. When developed the film darkens in proportion to the amount of radiation energy received. From the differing amounts of filtration we can gain information on the energy of radiation causing the dose. Radioactive contamination of the film can be readily identified.

Film dosemeter technical specification

Detection Dose range measured Energy range detected gamma rays 0.1 mSv to 10 Sv 10 keV to 7 MeV for Hp (0.07) 20 keV to 7 MeV for Hp (10) 2, 4, 8, 13 weekly (calendar issue periods are also available) x-rays 0.1 mSv to 400 mSv 10 keV to 7 MeV for Hp (0.07) 20 keV to 7 MeV for Hp (10) 2, 4, 8, 13 weekly (calendar issue periods are also available) beta particples 0.1 mSv to 10 Sv

700 keV to 3.5 MeV (Emax) for Hp (0.07) 2, 4, 8, 13 weekly (calendar issue periods are also available)

Periods of use

Special features of the film dosemeter

Energy discriminating dosemeter
Through the use of several filters, the dosemeter is able to provide information on the type and energy of the incident radiation.

Contamination
Radioactive contamination of the film can be readily identified.

Physical record
The film forms a physical record of the dose received by the wearer. The processed film is stored by the NRPB for at least five years and may be accessed by the customer.

Film Badge Holder - Personnel radiation Monitor Badge The film holder is constructed of impact resistant plastic and features a snap-tight hinged door that allows for easy replacement of film packets. Whole body or area badges come equipped with a sturdy metal clip. Film Packet The film is wrapped in a black protective paper and then sealed in a vinyl covering that shields the sensitive material from light induced exposure. Tearing or puncturing the covering will expose the film, therefore, destroying the ability to interpret the processed film Image 1 Film Badge Holders

The film badge's multi-filter system is designed so that radiation will reach one quadrant of the exposed film after penetrating three different filter areas (plastic, cadmium and copper) and passing through an open window. A cadmium (Cd) filter absorbs particles with energies less than 2 MeV and photons with energies less than 150 keV. Exposure to photons with energies more than 150 keV is determined by comparing film response in the cadmium filter area with the equivalent response on a calibration curve developed with a Cesium-137 source. The film area under the copper (Cu) and plastic filters are used to determine radiation exposures from photons of energy levels less than 150keV. Exposure to beta particles is determined from the film response in the open window area (after correcting for response from other radiations, as measured under the Cd, Cu, and plastic filters) using the appropriate calibration curves. Image 2 Diagram of a Film Badge Holder and Film

All calculations are performed on the dosimetry service's state-of-the-art computer systems using data from calibration curves and related film response measurements for each film processed. Uniformity is important in film irradiation. Since all calibration measurements for the film are made in the designated filter areas, film packets must be exposed inside the film holder. The dosimetry service will not report results for film exposed outside the holder. The film holder is constructed of impact resistant plastic and features a snap-tight hinged door that allows for easy replacement of film packets. Whole body or area badges come equipped with a sturdy metal clip. Film Kodak Type 2 Personal Monitoring Film packets. Type 2 film consists of a single film base with a fast (sensitive) emulsion on one side and a slow (insensitive) emulsion on the other side. Therefore, a single film in a convenient-to-use packet is capable of monitoring exposures from a vast array of radiation hazards.

Film-screen Speeds
The sensitivity of a film-screen combination depends on the film, the screen, the film processing, and the beam quality, i.e. the spectrum of the X-rays exposing the film screen combination. This explains immediately, why the sensitometry of a film-screen combination with X-rays is a lot more complex than the sensitometry of a film with light, and therefore is hardly ever done outside the manufacturer's laboratory: 1. The film-screen combination has to be exposed with a standardized spectrum. This requires the use of a specified high voltage value, a specified high voltage waveform (usually DC), a specified target composition, a specified filtration, all resulting in a specified half-value layer. 2. While the film-screen combination has to be exposed with different dose values, the operating parameters of the X-ray source (tube voltage, tube current, and exposure time) must not be changed, as this is the only way to avoid measurement errors due to spectral changes and due to the reciprocity law failure. Therefore, the dose can only be varied by changing the distance between source and film-screen combination. 3. The film has to be processed under standardized conditions. The speed of a film-screen combination is stated as the inverse of the dose (in Gy) needed to obtain a film density of one above base plus fog, multiplied by 1000 Gy:

1000 Gy SPEED = ------------------------Dose for D = 1+Base+Fog

The speed is the quotient of two dose values, it does not have a dimension or unit name attached to it. As the speed is inverse proportional to the dose requirements of a film-screen combination, twice the speed is equivalent to half the dose and vice versa. With this definition, the standard or universal film-screen combinations with calcium tungstate phosphor used to have a speed of 100. With the modern rare-earth systems, the speed of the standard screen is usually 200, i.e. the film-screen combination for universal application requires 5 Gy (approximately 0.5 mR) for a film density of one plus base plus fog. The speed values of the high resolution ("detail" or "fine") resp. the high sensitivity ("high speed") film-screen combinations of one and the same product line differ from the speed (and thus, dose requirement) of the standard combination by a factor of two in either direction. Thus, a rare-earth "detail" filmscreen combination has a speed of 100, and a rare-earth "high speed" film-screen combination has a speed of 400. These are typical values, but for special applications screens with lower and higher speeds are available

Filters / Filtration
Filtration, removal of parts of the X ray spectrum using absorbing materials in the X-ray beam. The X-ray spectrum reaching the patient is filtered by attenuating material in its path. Filtering of the beam is used in order to modify the spectral or spatial distribution of X-rays, or both. Filtration is in principal divided in two parts: inherent filtration and added filtration. Among those filters added are compensation and equalization filters. Examples of compensation filters are variations of the wedge filter, which is used to compensate for the otherwise uneven X-ray fluence generated by objects with a wide thickness variation, such as hands and feet. Equalization filters follow a similar principle and are sometimes used to compensate for more irregular absorption variations in the object, such as the mediastinum in a chest frontal image. Inherent filtration, the filtration of an X-ray beam by any parts of the X ray tube or tube shield through which the beam must pass. The parts include the glass envelope of the X-ray tube, the oil cooling the tube and the exit window in the tube housing. The inherent filtration corresponds to approximately 0.51 mm of aluminium. The total filtration of the X-ray beam before it reaches the patient consists of the inherent filtration plus the added filtration. Added filtration, commonly metallic filters inserted into the X-ray beam. The inherent filtration normally consists of the filtration of the X-ray beam from the glass envelope of the X-ray tube, the oil cooling the tube and the exit window in the tube housing. In excess of this, added filtration is almost always considered needed. This filtration is for normal X-ray purposes commonly made of aluminium or copper. The purpose of inserting such extra filtration into the X-ray beam serves the following purposes: To remove the low-energy photons that never would have been able to reach the film and produce an image. These photons would, if present, only increase the radiation dose given to the patient. To remove those low-energy photons that otherwise would have reached the film but would have given rise to too high contrast in the image. The classical example of this is in chest imaging, where the contrast from ribs and shoulder blades must be reduced. In other cases, extra filtration can fulfil other purposes: In mammography, where a molybdenum anode is used, the added filtration normally is made of the same material (molybdenum Mo ). It is a fact that a material is particularly translucent to its own characteristic radiation, therefore giving an X-ray spectrum with as much (monoenergetic) characteristic X-rays

from Mo as possible and filtering more selectively on both the high- and lowenergy side of the Mo characteristic X-rays. For very special purposes, special filters can be used that will create a shape of the X-ray spectrum that to some extent will match the absorption characteristics of the X ray contrast medium, thereby selectively increasing their contrast properties.

Coppper & Aluminium Filtration All the radiation absorbed inside the body, without having a chance of penetration and forming an image, is harmfull radiation only! In order to make the radiation "less harmfull", filters are used. The soft radiation is absorbed inside the filter while the hard radiation passes only slightly effected.

As seen in the left graph, Aluminum attenuates the very soft radiation drastically. The radiation spectrum shown is the result of 100kV tube voltage in combination with a filtration equivalent to 2.5mm Aluminum. According to international regulations, this is the minimum amount of filtration and must be guaranteed by the tube assembly. Additional filtration with copper can be employed to make the radiation "safer". Notice the shift of the peak intensity to higher keV by absorbing the lower energies. So, the radiation quality is hardened-up by increasing the amount of filtration

Generators
X-Ray generators provide the tube current at the required voltage for x-ray production. In a "perfect" case this would be a constant voltage, however transformers require alternating voltages to work so some means of producing a constant voltage across the x-ray tube from the rising and falling voltage produced by the high tension transformer is required.

(Siemens) Diagram showing typical waveforms from x-ray generator output circuits Ripple The deviation of the voltage waveform across the x-ray tube from constant voltage is named ripple .the variation in the high-voltage expressed as the percentage of the maximum highvoltage across the X ray tube during X-ray production: Ripple factor (%) = 100 x (Vmax - Vmin)/Vmax The ripple causes corresponding but relatively higher variations in the X-ray output. It is an unwanted phenomenon in the X-ray production due to the lengthening of the exposure time and the reduction in the average kV. The ripple is theoretically 100% for the old-fashioned single phase X ray generator (in practice, it is less, however, due to the smoothening effect of the high-voltage cable capacitance). The three-phase Xray generator have ripple factors in the range of about 3 25% (3-phase 6-pulse generator: 1325%, 3-phase 12-pulse generator: 310%). In the medium frequency generator, the ripple factor decreases with increasing kVp. In this type of generator (also named high frequency or inverter generator), the kV is controlled by adjusting the frequency of the current prior to high-voltage transformation. Ripple is usually in the range of 415%. There is practically no ripple in the constant potential X ray generator Constant potential x-ray generator, An X ray generator providing a nearly flat high voltage waveform for the X ray tube. The term may refer to 1) any generator providing high voltage with a ripple factor less than a certain limit, e.g. 5%, or 2)* a special generator type briefly mentioned below.

1) A voltage ripple limit of 5% would include the 3-phase 12-pulse generator and the medium frequency generator. 2)*The so-called constant potential X-ray generator is a very large and expensive generator that provides the highest average X-ray energy of any X-ray generator type. It is now used only for the most demanding applications. This generator uses a threephase line voltage coupled directly to the primary windings of the high-voltage transformer, i.e. without an intermediate autotransformer. Regulation of the kilovolt peak kVp and exposure time is done on the secondary (high voltage) side of the transformer by means of high voltage electron tubes (triodes or tetrodes). The high voltage supplied to the X-ray tube has a nearly flat waveform with a ripple less than 2%. (http://www.amershamhealth.com/medcyclopaedia) -------------------------------------------------------------------------------------------------------1) One pulse self rectified In the simplest case the tube acts as a rectifier and the - a self rectified circuit (Stylised graph of voltage v Time)

-------------------------------------------------------------------------------------------------------2) One pulse half wave rectified In order to prevent the anode producing electrons as it becomes hotter and the electrons flowing backwards and striking the filament a single rectifier can be placed in series with the x-ray tube to ensure current flows only from filament to anode. -

(Stylised graph of voltage v Time) Advantages and Disadvantages Inefficient use of power no x-rays produced in negative half cycle Possibility of reverse conduction - low power output - unless a rectifier is used Minimum exposure time 0.02 S to include one whole AC cycle However the unit can be made relatively small and cheaply for situations requiring limited output.

-------------------------------------------------------------------------------------------------------3) Two pulse full wave rectified

(http://www.amershamhealth.com/medcyclopaedia)

A bridge rectifier circuit (see rectification) inverts the negative half cycles and double the number of positive cycles are produced per unit time compared with a single rectifier. - the ripple is said to be 100%.

http://www.eleinmec.com/ Advantages and Disadvantages The principal disadvantages are the inefficiency of radiation production due to the pulsating waveform no providing enough voltage to produce x-rays for a portion of the time, and the inability to select short exposure times. -------------------------------------------------------------------------------------------------------4) Constant potential x-ray generator The constant potential generator circuit has two capacitors across the output from the rectifiers to smooth the pulsating waveform. To further condition the waveform, there is a triode valve in series with each lead and these control the output via a grid connection which has control signals fed to it from a high resistance across the output of the triodes. Once the tube voltage has been monitored via the high resistance potential divider it is constantly corrected by the control unit attached to the triode valve control grids. The triode valves also from part of the timer switching and can operate at microsecond intervals with good accuracy. The high voltage supplied to the X-ray

tube has a nearly flat waveform with a ripple less than 2%.

Block Diagram of Constant potential x-ray generator circuit

Output waveform from the rectifiers and the smoothed output across the x-ray tube

http://www.eleinmec.com/ Advantages and Disadvantages High x-ray output per mAS Smaller range of x-ray energies Very small exposure times possible However these generators are very expensive and tend to be large and have the possibility of more to go wrong. -------------------------------------------------------------------------------------------------------

-5) Three phase 6 Pulse Generator Commercial electric power, the line voltage, is usually produced and delivered as three phase alternating current. The period of each single phase may be 50 or 60 Hz. The period of a 50 Hz AC has a duration of 1/50 s, or 20 ms. The three phase X ray generator transforms and rectifies this AC into a high-voltage direct current (DC) with either six or twelve forward pulses per 20 ms period. As compared to the 100% ripple factor of single-phase generators, three-phase generators dramatically reduces voltage ripple (1325% for 3-phase 6-pulse, 310% for 3-phase 12-pulse). X-ray production is therefore much more efficient. The so-called constant potential X ray generator produces a voltage ripple less than 2% (hence the name), and it produces the highest average X-ray energy of any X-ray generator type, with exposure times less than 1 ms. This kind of generator is, however, very bulky, with high costs and inefficient power consumption. The preferred modern generator today, is therefore the almost equally efficient, much smaller and less costly mediumfrequency generator (also known as high frequency and inverter generator). An X ray generator using a 3-phase alternating current (AC) line source, i.e. three wires, each with a single phase AC that is one third cycle (120) out of phase with the other two (Fig.1). The three-phase transformer used in this generator has three sets of primary windings and three sets of secondary windings, i.e. in effect three separate high-voltage interconnected transformers. The three primary and secondary windings are connected either in a wye1 configuration or a delta2 configuration. In the threephase six-pulse generator, rectifiers in the high-voltage circuit produce two pulses for each line, resulting in a total of six pulses. Waveforms from the various circuit in a 3 phase unit parts

Star and delta

windings (http://www.amershamhealth.com/medcyclopaedia) Wye or Star configuration, 1 a star-shaped configuration or interconnection of the three windings in the primary or secondary of a transformer in a three phase X ray generator. Delta configuration, 2 one possible configuration of the windings in the primary or secondary side of a threephase transformer. The windings in this transformer can be arranged as a Combinations of these configurations in the primary and secondary windings of a transformer will give rise to a phase shift of 30. Using one delta and one wye configuration as secondary windings and (usually) a delta configuration as primary winding will therefore give twelve pulses per period of mains AC voltage. Advantages and Disadvantages High x-ray output per mAS Smaller range of x-ray energies However these generators are expensive and tend to be large and have the possibility of more to go wrong. ------------------------------------------------------------------------------------------------------Three-phase twelve-pulse generator In the three-phase twelve-pulse generator, a different configuration of transformers, one of each one star and delta wound secondaries and rectifiers resulting in a total of twelve pulses per cycle. These generators have very low ripple factor. ------------------------------------------------------------------------------------------------------Falling Load Generator -------------------------------------------------------------------------------------------------------See the Mobile Generator notes in the Tutorials section for details of generators used in Mobile equipment -------------------------------------------------------------------------------------------------------Medium-frequency generator, A state of the art generator design, also named high-frequency generator and inverter generator, which uses a high-frequency current to produce nearly constant potential

voltage to the X ray tube with a transformer of much smaller size than found in ordinary X-ray generators. The incoming power supply to a medium frequency generator may be an ordinary 50 Hz (230 V) single phase current (Fig.1). This current is rectified and smoothed and then fed to a chopper and inverter circuit which transforms the smooth, direct current (DC) into a high-frequency (5 - 100 kHz) alternating current (AC). (The chopper "chops" the continuous DC into high-frequency DC pulses and the inverter transforms this into AC.) A transformer converts this high-frequency low-voltage AC into highvoltage AC, which then is rectified by half wave rectification and smoothed to provide a nearly constant potential high voltage to the X-ray tube. The voltage is controlled by varying the frequency of the chopper/inverter circuit, which determines the frequency of the current delivered to the transformer. Fast exposure switching, in the order of 1 ms, is easily obtained with the medium frequency generator. Outline of a medium frequency generator

(Siemens)

Waveforms from the various circuit parts

(http://www.amershamhealth.com/medcyclopaedia)

Advantages and Disadvantages One of the great benefits of this generator design, is the reduced weight and size. The main components of the generator may be placed within the same enclosure as the Xray tube, or in e.g. the C-arm of the equipment. This generator principle was previously used only in small mobile and/or battery-powered generators with low power rating, but today it is applied to all modern high-voltage generators up to the highest needed power ratings above 100 kW. Typical Generator Diagrams (Siemens)

Typical Fluoroscopy Unit Block Diagram (Siemens)

------------------------------------------------------------------------------------------------------Advantages and Disadvantages of different generator types The design of a generator needs to optimise the following points, and be matched as closely as possible to the clinical requirements of the generator usage, a point to note is that the late 1990 saw the pinnacle of development of film screen radiography with exposure values required for typical examinations being much less than even ten years earlier, thus a typical chest x-ray in 1979 before rare earth screens may have been

around 25 mAS @70Kv whilst today this may have dropped to as little as 2mAS@90 Kv, interestingly some of the new Digital radiography systems require more exposure than the film screen combinations they replace. Efficiency of conversion of electrical energy to useful x-ray energy Maximum dose rate per mAS Power output Low Ripple Cost Size / weight Minimum exposure time Reliability Advantages and Disadvantages of Constant Potential and multiphase generators compared with a basic single phase generator. (Stockley) Advantages More efficient conversion of electrical power to x-ray energy More x-rays generated per mAS Shorter exposure times possible Sleeplessly variable range of exposure times Disadvantages More expensive to purchase X-ray tube to cope with higher loading required Lower image contrast Shorter tube life Equipment larger and heavier Possibly more prone to failure due to greater complexity

Gradient Screens
In certain imaging situations, the attenuation of the X-rays by the human body varies extremely within the body sections to be imaged on one and the same film. The lateral views of the lumbar spine and of the transition between the thoracic spine and the cervical spine are prominent examples for this dramatic variation in attenuation. It is virtually impossible to image these areas adequately without special aids. One way to overcome the problem caused by the extreme variation in transparency is the use of a shaped filter with varying thickness. The thicker area of the filter is placed in the beam where the object is more transparent. Thus, the beam intensity at the film will be more uniform. Another approach to achieve a more uniformly exposed image is the use of a screen set with varying sensitivity. This type of screens is called gradient screens. Two different basic designs are available: Either the thickness of the phosphor layers varies

across the screens, or the screens have a uniform phosphor layer thickness, but are covered with a laquer layer of varying transparency to the light emitted by the screen. In order to obtain a more uniformly exposed image, the less sensitive screen areas have to be placed under the more transparent sections of the object.

Grid-controlled x-ray tube

Grid-controlled x-ray tube, an X-ray tube which is equipped with a grid, i.e. an extra electrode between the cathode and anode to control the flow of electrons. The third electrode is actually the focusing cup that surrounds the filament. Normally, the focusing cup is kept at the same negative potential as the filament. In a grid-controlled tube, the focusing cup may be negatively charged (as compared to the filament) to such an exist that the flow of electrons from the filament is completely stopped. The voltage applied between the focusing cup and filament may thus act like a switch to turn the tube current on and off. This is particularly useful when very short exposures are needed, e.g. in cinefluorography. Grid-controlled X-ray tubes provide secondary switching as opposed to the primary switching provided by e.g.the silicon controlled rectifier SCR . See also exposure switching

Gurney Mott hypothesis

The theory concerning the formation of electron traps in a silver halide crystal which is exposed to light or X-rays. The traps can capture electrons released by ionization in the crystal. These negatively charged electron traps which are produced during film exposure, can attract the interstitial silver ions in the crystal. The silver ions are then reduced to atomic silver in the traps. These few silver atoms present in a silver halide grain following exposure act as catalyst in the development process, so that the rest of the silver ions in the grain are reduced to metallic silver.

Half-Value Layer
A simple and commonly accepted way of characterizing the hardness or penetrating power of an X-ray beam is determining and stating the thickness of aluminum filtration required to cut the intensity of the beam in half. This filtration is called the half-value layer (HVL). The higher the half-value layer is, the harder is the beam. The penetration power increases with increasing half value layer, but at the same time the achievable contrast decreases. The latter, however, is not true, if edge filtration is used, as then increased filtration by the edge filter will

increase the half-value layer of the primary beam hitting the object, but at the same time narrow the spectrum and thus improve the contrast in the image.

The half-value layer can also be used for an indirect determination of the total filtration an X-ray beam has been subjected to (cf. aluminum equivalent). The actual value of the filter thickness will depend somewhat on the type of aluminum used. Pure aluminum will yield slightly higher values than aluminum alloys, e.g. 1100 aluminum, which usually contain some copper. For the spectra used in general radiography, this difference is practically irrelevant, but in mammography with acceleration voltages between approximately 25 and 30 kV, the results differ appreciably and the aluminum type used is of importance.

Introduction to x-ray film

INTRODUCTION
Photographic film can be exposed directly to X-rays but its sensitivity is very low and prohibitively large patient exposures would result if this appraoch was implemented on its own. Therefore, almost all conventional radiographic examinations require that the image be converted to light by an intensifying screen before being recorded by the film. We will consider pertinent features of both Intensifying Screens and X-ray film below.

FLUORESCENCE
We have seen previously that luminescence refers to the stimulated (by light, ionising radiation, chemical reactions etc.) emission of light by certain materials. If the light is emitted instantaneously, that is within 10 nanoseconds, the phenomenon is called fluorescence. If the emission is delayed somewhat, it is called

phosphorescence. More particularly, in radiology, fluorescence is the term used to describe the ability of certain inorganic phosphors to emit light when excited by Xrays. Until the early 1970s the only phosphor of note was calcium tungstate (CaWO4), but since then a plethora of rare-earth phosphors with improved efficiency have appeared on the scene. No matter what type of phosphor material is used, the conversion of a relatively small number of X-ray photons of high energy to a large number of light photons of low energy is due predominantly to X-ray absorption via the photoelectric effect in the high Z components of the phosphor. The incident X-ray photons are absorbed either totally or partially in the phosphor layer. The absorbed energy is transferred to electrons which in turn deposit their energy by ionisation and excitation. The energy added to the atoms of the phosphor raises the atomic electrons to excited states. Most of this added energy is then dissipated as heat but a fraction (5% - 20%) is radiated as electromagnetic radiation in the visible or near visible wavelengths and it is this radiation which is utilised in the production of the latent image on the X-ray film.

INTENSIFYING SCREENS
The use of intensifying screens has three major benefits:
o o o

Reduction of patient dose Reduction of tube and generator loading and Reduction of patient motion artifacts.

However, there is one disadvantage that is occasionally relevant to radiology which is that the image clarity is degraded in comparison with a directly exposed film. Figure 1 gives a schematic of a typical screen. The thin protective layer provides protection for the phosphor and can easily be cleaned. In some screens, the reflecting layer is not included. In a typical situation, two screens are used, one on either side of a double emulsion film To compensate for the absorption of some X-rays by the front screen, the back screen may be thicker than the front screen.

Figure 1: Cross-section of a typical intensifying screen. 1 micron = 1 mm.

The isotropic emission and scattering of light photons in the phosphor results in the lateral diffusion of the scintillation pulse before it escapes the screen. This results in a loss of resolution or sharpness and becomes increasingly important as the screen thickness is increased. This can be compensated for by using light absorbing dyes in the screen which will preferentially absorb the photons that travel the greatest distances.

RARE EARTH SCREENS

We have already noted that the interaction of diagnostic X-rays with screens occurs primarily via the photoelectric effect. Therefore we can say that we need our phosphors to have K-edges appropriately matched to the X-ray photon energies. More explicitly, this means that we want a phosphor whose K-edge is between 25 and 50 keV. You may recall that the photoelectric effect interaction probability is a maximum at energies just above the K-edge. A look at Figure 2 establishes that Gd2O2S has a significant advantage over calcium tungstate for photon energies between 50 and 70 keV. The same is true of other rare-earth type screens such as BaSrSO4 to a slightly lesser extent. It is also useful to note that Gd-based phosphor screens are more favourably disposed to the detection of primary radiation than scatter radiation as a greater proportion of the primary spectrum is above the K-edge of Gd than of the scatter spectrum.

Figure 2: Approximate Screen Absorption as a Function of Photon Energy for pairs of CaWO 4, Gd2O2S and BaSrSO4 screens. The spectrum from an X-ray tube operated at 80 kVp with 12.5 cm of perspex as phantom is also illustrated.

Most inorganic phosphors (calcium tungstate is an exception) do not emit light efficiently unless doped with a small quantity of activator. For example, the activator in the rare-earth oxysulphides is terbium (Tb). The concentration of the activator not only affects the amount of light emitted but the spectral emission as well. This can be used to advantage to achieve better spectral matching between the phosphor and the film response. Certainly, the use of these activators is the reason for the substantially improved conversion efficiency of the rare-earth screens compared with the old

calcium tungstate screens.

X-RAY FILM
The major recording medium used in radiology is X-ray film - although the situation is changing with the introduction of new technologies in recent years. The film can be exposed by the direct action of X-rays, but more commonly the X-ray energy is converted into light by intensifying screens and this light is used to expose the film, as described above. The basic structure of the film is outlined in Figure 3 below.

Figure 3: Cross-section through a double emulsion film

The film base provides the structural strength for the film. However, the base must be flexible for ease of processing, essentially be transparent to light and be dimensionally stable over time. Early base materials were glass and cellulose nitrate, but more recently cellulose triacetate and polyester have been adopted. A thin layer of adhesive is then applied to the base and this binds the emulsion layer. Covering

the emulsion is a thin supercoat that serves to protect the emulsion from mechanical damage. The two most important ingredients of a photographic emulsion are gelatin and silver halide. With most X-ray film the emulsion is coated on both sides of the film but its thickness varies with the nature and type of the film, but is usually no thicker than 10 mm. Photographic gelatin is made from bone and is ideal as a suspension medium in that it prevents clumping of grains. In addition, processing chemicals can penetrate gelatin rapidly without destroying its strength or permanence. Silver halide is the light sensitive material in the emulsion. In X-ray film, sensitivity is increased by having a mixture of between 1% and 10% silver iodide and 90 to 99% silver bromide. In photographic emulsion the silver halide is suspended in the gelatin as small crystals (called grains). Grain size might average one to 2.3 mm in diameter with up to a billion silver ions per grain and billions of grains per ml of emulsion. In its pure form the silver halide crystal has low photographic sensitivity. The emulsion is sensitised by heating it under controlled conditions with a reducing agent containing sulphur. This results in the production of silver sulphide at a site on the surface of the crystal referred to as a sensitivity speck. It is the sensitivity speck that traps electrons to begin formation of the latent image centres. Silver bromide is cream coloured and absorbs ultraviolet and blue light, but reflects green and red light. Historically, this was fine since the principle emission from calcium tungstate screens is blue light. Films for photography of image intensifier images and films for use with rare earth screens need to have their spectral sensitivity broadened to encompass the longer wavelengths associated with the emissions from these screens. This is accomplished by the addition of suitable dyes. Thus, we have green sensitive orthochromatic film and red sensitive panchromatic film.

FILM PROCESSING
Film processing is a multi-stage process involving development, fixing, washing and replenishment (Figure 4). In development, the exposed grains are preferentially reduced to black metallic silver. In fixing the remaining unexposed grains are dissolved so that they can be removed from the emulsion by washing. Replenishment ensures that chemical balance is maintained with usage of the processing solutions.

Figure 4: Schematic of an automatic film processor, showing the pathway followed by film as it is guided by roller mechanisms through the processing solutions.

PHOTOGRAPHIC CHARACTERISTICS OF X-RAY FILM

When the X-ray beam passes through body tissues, variable fractions of the beam will be absorbed, depending on the composition and thickness of the tissues and the quality (kVp & filtration) of the beam. The magnitude of this variation in intensity is the mechanism by which the X-ray beam emanating from the patient produces diagnostic information. The information content of this X-ray image must be transformed into a visible image on the X-ray film with minimal information loss. In general radiography, the X-ray image is first converted to a light image using intensifying screens, which in turn produce a visible pattern of metallic black silver on the X-ray film. Ultimately, the degree of blackening is related to the intensity of the radiation reaching the intensifying screen. The amount of blackness on the film is called the optical density, D, which is defined in Figure 5. For example, if 100 light photons are incident on a film and only one is transmitted the film density would be log10(100) or 2. Useful densities in diagnostic radiology range from about 0.2 to about 2.5. High density means black films.

Figure 5: The definition of optical density, D.

If the relationship between the logarithm of the radiation exposure and the optical density is plotted we obtain a curve known as the Characteristic Curve. For film exposed with an intensifying screen, this curve is essentially sigmoidal in shape (Figure 6). It is characterised by:
o o

a toe or region of low gradient at low exposures, a region of relatively steep increase in density for minimal exposure increases, and o a third relatively flat region called the shoulder at high exposures. The important part of the curve diagnostically is the approximately linear region between the toe and the shoulder where the density is proportional to the logarithm of the exposure.

Figure 6: The Characteristic Curve of X-ray film.

The information content resulting from the radiograph arises from differences in the film density, which we can define as radiographic contrast. Radiographic contrast depends on subject contrast and film contrast. For the moment you should recall that subject contrast depends on the differential attenuation of the X-ray flux as it passes through the patient and is affected by thickness, density and atomic number of the irradiated parts of the subject, the kVp, the presence of contrast medium and scattered radiation. For example, relatively few X-ray photons pass through bone compared with soft tissue but care must be taken in selecting the correct kVp in order to produce an X-ray image of high information content for the screen-film to record. That is, the kVp influences the magnitude of the subject contrast. Film contrast depends on four factors:
o o o o

the characteristic curve of the film, the film density, use of intensifying screens or direct exposure and the film processing.

The slope of the straight line portion of the characteristic curve tells us how much change in film density will occur as exposure changes. The slope or gradient of the curve may be measured and the maximum gradient is called the film gamma, which tells us how well the film will amplify the subject contrast. X-ray film will fog slowly with time, the extent depending markedly on how well it is stored. This fogging, along with the optical density of the film base, will generate a low density in the toe section of the Characteristic Curve. The shoulder region of the curve indicates over exposure

Ion
Definition Ion, any atom or electron which has a positive or negative electric charge owing to an electrical imbalance between its atomic protons and electrons Ionization The removal of an electron from an atom causing the electrical balance to be net positive

Newton's Inverse Square Law

Any point source which spreads its influence equally in all directions without a limit to its range will obey the inverse square law. This comes from strictly geometrical considerations. The intensity of the influence at any given radius (r) is the source strength divided by the area of the sphere. Being strictly geometric in its origin, the inverse square law applies to diverse phenomena. Point sources of gravitational force, electric field, light, sound, or radiation obey the inverse square law.

As one of the fields which obey the general inverse square law, a point radiation source can be characterized by the diagram above whether you are talking about Roentgens, rads, or rems. All measures of exposure will drop off by the inverse

square law. For example, if the radiation exposure is 100 mR/hr at 1 inch from a source, the exposure will be 0.01 mR/hr at 100 inches.

To calculate a new exposure maS ie one at a new distance using the old exposure maS New mAs = Old mAs x (New distance2/Old distance2) eg A Chest x-ray at 180 cm and using 5 mAS What mAS would be needed supine on a trolley at 100cm? New mAS = 5 [old mAS] x (10000 [New d2] / 32400 [Old d2] New mAS = 5 x [10000 / 32400] 0.3 = 1.5 mAS

Optical Density
The relative darkness of an image in a finished film is called simply density. Photographic density for film is determined by measuring the incident to transmitted light ratio and expressing the value as a logarithm Density (D) = Log (Intensity of Incident Light / Intensity of Transmitted Light) For example if 100 is the intesity of the viewing bow and 10 is the value transmitted through a film the film density = Log (100/10) =1

Photostimulable phosphor plate

A radiographic screen containing a special class of phosphors which when exposed to X-rays, stores the latent image as a distribution of electron charges, the energy of which may later be freed as light by stimulation with a scanning laser beam. The light is directed to a photomultiplier tube, and the output electrical signal is digitized. The final result is a digital projection radiograph. The photostimulable phosphor plate is also known as an imaging plate, storage phosphor imaging plate, and digital cassette. The technique has also been termed computed radiography (CR) (after the introduction of the imaging plate in 1981 by the Fuji company, who named the new technique FCR). The photostimulable phosphors in the imaging plate have a property termed phosphorescence or photoluminescence (see luminescent screen) which in this context means they are able to store X-ray energy and later, when stimulated by (laser)light, free the energy as emitted light. The phosphors used in radiography are mixtures of

three different barium fluorohalides doped with europium as an activator; BaFI:Eu2+, BaFCl:Eu2+, and BaFBr:Eu2+. To prepare the imaging plate for an X-ray exposure, the plate is exposed to intense light to erase any previous image. For X-ray imaging, the plate is placed in a cassette and is used just like a film screen cassette with standard radiographic euipment. When exposed to X-rays, the europium atoms in the phosphor crystalline lattice are ionized (converted from 2+ to 3+), liberating a valence electron. These electrons are raised to a higher energy state in the conduction band (see solid and photoconduction for an explanation of conduction band). Once in the conduction band, the electrons travel freely until they are trapped in a so-called Fcentre in a metastable state with an energy level slightly below that of the conduction band, but higher than that of the valence band. The number of trapped electrons is proportional to the amount of X-rays absorbed locally. The trapped electrons constitute the latent image. Due to thermal motion, the electrons will slowly be liberated from the traps, and the latent image should therefore be read without too much delay. At room temperature, the image should, however, be readable up to 8 hours after exposure. Reading of the exposed imaging plate is performed by scanning the plate with a small (50200 mm) dot of light from a helium-neon laser. The laser light stimulates the trapped electrons up to the conduction band, where they are free to move to the europium atoms, thereby leaving the high energy conduction band to return to the lower energy valence band. The transformation of europium from the 3+ to the 2+ state therefore involves liberation of energy, and this is done by emission of light. Since there is a larger energy difference between the conduction band and the valence band than between the conduction band and the F-centres, the (green) light emitted has a higher energy than the (red) laser light needed to stimulate the trapped electrons. The difference in wavelength between the two lights is critical for detection of the emitted light. By using a filter that absorbs red light but is transparent to green light, the emitted light is selectively detected. The laser beam scans the imaging plate in a transverse direction while the plate is moved past the scanning beam. The emitted light is collected using a light guide and is fed to a photomultiplier tube where the light is converted to an electrical signal which is amplified to an electric output signal. This signal is digitized, and the image is stored in a computer as a digital matrix, each pixel having a gray scale value determined by the amount of light emitted from the corresponding dot on the imaging plate. The imaging plate has a much wider dynamic range than film-screen systems, with a linear characteristic curve (see digital radiography (I), Fig. 2), giving the system a much wider exposure latitude than film-screen systems. Because of certain pre-scan operations performed prior to the actual read-out of the imaging plate, an automatic gain control is achieved; overexposed images are recorded with equal "brightness" as underexposed images. The required amount of radiation to the plate is, however, in average the same as needed with film-screen systems. Due to the wide exposure latitude and "automatic gain control", doses may be reduced, but at the cost of increased noise. The uniform density despite over- and underexposure is one of the great benefits of the system as compared to conventional film-screen systems; almost no retakes due to incorrect exposures are necessary. Additional benefits are those common to all digital techniques, including postprocessing such as changing window level and width, exact measurement of distances, angles, and areas, zooming, panning, and not the least, digital archiving and communication (see PACS).

Production and Properties of X Rays

X rays are produced when fast moving electrons hit a piece of metal (called the target). Electrons are thermionically emitted by the filament (cathode). The accelerating voltage is about 100kV. Less than 1% of the kinetic energy of the electrons is converted into x rays so the anode (target) must be cooled during operation. X rays are not deflected by electric or magnetic fields but can be diffracted suggesting that they have wave-like properties. X rays are electro-magnetic radiations having wavelengths in the range 10 -11 m to 108 m. X rays cause certain substances to fluoresce, they affect photo-graphic emulsions and can ionise atoms. These three properties can be used to detect x rays. The intensity of the beam of x rays (Wm-2) depends on the number of electrons hitting the target per unit time. This depends on the temperature of the filament. The penetrating power of the beam of x rays depends on the kinetic energy of the electrons. This depends on the accelerating voltage.

Quality & intensity of an X-Ray Beam

The intensity of the beam of x rays (Wm-2) depends on the number of electrons hitting the target per unit time ie the number of electrons flowing through the tube the tube current. This depends on the temperature of the filament. The penetrating power of the beam of x rays depends on the kinetic energy of the electrons. This depends on the accelerating voltage.

A useful analogy of this can be made with light. Intensity can be equated to colour and penetrating power to brightness.
Increase of the accelerating voltage applied between filament and target is found to increase the penetrating power of the Xrays. Since the maximum loss of kinetic energy at a single collision is now higher (=eV), the highest frequency emitted is also higher as expected. Thus the quality of the emitted X rays is altered. These are called hard Xrays. It is found that an increase of the heating voltage increases the intensity of Xrays without any change in the hardness or penetrating power. The high intensity spikes characteristic of the target material are also of unchanged wavelengths

Relative film speed test

Split phantom test and how is it used to test sensitometric differences between different emulsions or batches of film? (From the Kodak website) A split phantom test should be performed to radiographically determine relative speed differences between two different boxes of film, one of which is suspected of being much faster or slower than the film in current use for either clinical films or for processor quality control. Speed comparisons made using a sensitometer may not accurately reflect the differences in speed between two films exposed by light from an intensifying screen. The procedure is as follows: 1. 2. Assemble the tools that are needed for the test: o A phantom used for mammography quality control testing

The 18 x 24 cm mammography cassette normally used for the phantom test o A piece of cardboard from the film box cut in half to use as a guide o A pair of scissors o A lead pencil The mammography x-ray unit and the processor will also be used for this test. 3. In the darkroom (in total darkness to reduce any additional density added to the films due to long safelight exposure) cut a sheet of film from the current or "normal" box in half by using the cardboard as a guide. (This can be done by lining up the 18 cm edges of the cardboard and film so that the film is closest to the countertop and the cardboard half is on top. Be careful cutting the film in the dark.) 4. Place the film--emulsion side up--in the cover of the opened cassette with the film on the right side and the cut edge toward the right edge of the cassette; use a lead pencil to mark the corner "N" for normal. 5. Cut a sheet of film from the "suspect" box in half by using the cardboard as a guide. 6. Place the film--emulsion side up--in the cover of the opened cassette with the film on the left side and the cut edge toward the left edge of the cassette; use the lead pencil to mark the corner "S" for suspect. 7. Before closing the cassette, make sure the film edges in the center of the cassette are directly adjacent to one another and not overlapping.

8. Place the cassette with the two film halves in the grid of the mammography xray unit. 9. Place the phantom on top of the grid in the standard location used for mammography quality control testing. 10. Position the photocell beneath the center of the phantom (standard location), assuming the phantom exposure is always made using the phototimer. 11. Select the same technique factors usually employed when imaging the phantom (same kVp, etc.). 12. Make the exposure and immediately process the two film halves in the same manner (e.g., emulsion side up and on the right side of the processor). 13. Use a densitometer to take two optical density readings in the center of the phantom, just to the right and left of the cut edges (one on the "normal" and one on the "suspect" film). 14. Calculate the density difference by subtracting the optical density value of the "suspect" film from the optical density value of the "normal" film.

If the density difference is a negative value and the "suspect" film is darker than the "normal" film, the "suspect" film is faster. If the density difference is a positive value and the "suspect" film is lighter than the "normal" film, the "suspect" film is slower. According to the American College of Radiology in Recommended Specifications for New Mammography Equipment :

"A density difference of 0.30 between any two films of the same type from the same manufacturer, exposed and processed together, is a reasonable maximum to be expected from manufacturing variability for films of roughly the same age and storage conditions." "If the difference between the two film densities exceeds 0.30 at a density of approximately 1.25, then the film supplier should be contacted to determine the source of the problem."

Note that a difference of 0.30 at a density of approximately 1.25 may translate into a bigger difference for clinical films exposed at a greater optical density. For example, high-contrast mammography films, such as KODAK MIN-R 2000 Film, are frequently exposed at an optical density between 1.50 and 2.00 in order to maximize contrast. The density difference at this optical density level will be greater due to the increased contrast.

The Photographic Latent Image

As shown in earlier figures, a photographic emulsion consists of a myriad of tiny crystals of silver halide--usually the bromide with a small quantity of iodide-dispersed in gelatin and coated on a support. The crystals--or photographic grains-respond as individual units to the successive actions of radiation and the photographic developer. The photographic latent image may be defined as that radiation-induced change in a grain or crystal that renders the grain readily susceptible to the chemical action of a developer. To discuss the latent image in the confines of this siterequires that only the basic concept be outlined. A discussion of the historical development of the subject and a consideration of most of the experimental evidence supporting these theories must be omitted because of lack of space. It is interesting to note that throughout the greater part of the history of photography, the nature of the latent image was unknown or in considerable doubt. The first public announcement of Daguerre's process was made in 1839, but it was not until 1938 that a reasonably satisfactory and coherent theory of the formation of the photographic latent image was proposed. That theory has been undergoing refinement and modification ever since.

Some of the investigational difficulties arose because the formation of the latent image is a very subtle change in the silver halide grain. It involves the absorption of only one or a few photons of radiation and can therefore affect only a few atoms, out of some 109 or 1010 atoms in a typical photographic grain. The latent image cannot be detected by direct physical or analytical chemical means. However, even during the time that the mechanism of formation of the latent image was a subject for speculation, a good deal was known about its physical nature. It was known, for example, that the latent image was localized at certain discrete sites on the silver halide grain. If a photographic emulsion is exposed to light, developed briefly, fixed, and then examined under a microscope (see the figure below), it can be seen that development (the reduction of silver halide to metallic silver) has begun at only one or a few places on the crystal. Since small amounts of silver sulfide on the surface of the grain were known to be necessary for a photographic material to have a high sensitivity, it seemed likely that the spots at which the latent image was localized were local concentrations of silver sulfide.

Electron micrograph of exposed, partially developed, and fixed grains, showing initiation of development at localized sites on the grains (1 = 1 micron = 0.001 mm).

It was further known that the material of the latent image was, in all probability, silver. For one thing, chemical reactions that will oxidize silver will also destroy the latent image. For another, it is a common observation that photographic materials given prolonged exposure to light darken spontaneously, without the need for development. This darkening is known as the print-out image. The printout image contains enough material to be identified chemically, and this material is metallic silver. By microscopic examination, the silver of the print-out image is discovered to be localized at certain discrete areas of the grain (see the figure below), just as is the latent image.

Electron micrograph of photolytic silver produced in a grain by very intense exposure to light.

Thus, the change that makes an exposed photographic grain capable of being transformed into metallic silver by the mild reducing action of a photographic developer is a concentration of silver atoms--probably only a few--at one or more discrete sites on the grain. Any theory of latent-image formation must account for the way that light photons absorbed at random within the grain can produce these isolated aggregates of silver atoms. Most current theories of latent-image formation are modifications of the mechanism proposed by R. W. Gurney and N. F. Mott in 1938. In order to understand the Gurney-Mott theory of the latent image, it is necessary to digress and consider the structure of crystals--in particular, the structure of silver bromide crystals. When solid silver bromide is formed, as in the preparation of a photographic emulsion, the silver atoms each give up one orbital electron to a bromine atom. The silver atoms, lacking one negative charge, have an effective positive charge and are known as silver ions (Ag+). The bromine atoms, on the other hand, have gained an electron--a negative charge--and have become bromine ions (Br -). The "plus" and "minus" signs indicate, respectively, one fewer or one more electron than the number required for electrical neutrality of the atom. A crystal of silver bromide is a regular cubical array of silver and bromide ions, as shown schematically in the figure below. It should be emphasized that the "magnification" of the figure is very great. An average grain in an industrial x-ray film may be about 0.00004 inch in diameter, yet will contain several billions of ions.

A silver bromide crystal is a rectangular array of silver (Ag +) and bromide (Br-) ions.

A crystal of silver bromide in a photographic emulsion is--fortunately--not perfect; a number of imperfections are always present. First, within the crystal, there are silver ions that do not occupy the "lattice position" shown in the figure above, but rather are in the spaces between. These are known as interstitial silver ions (see the figure below). The number of the interstitial silver ions is, of course, small compared to the total number of silver ions in the crystal. In addition, there are distortions of the uniform crystal structure. These may be "foreign" molecules, within or on the crystal, produced by reactions with the components of the gelatin, or distortions or dislocations of the regular array of ions shown in the figure above. These may be classed together and called "latent-images sites."

"Plain view" of a layer of ions of a crystal similar to that of the previous figure. A latent-image site is shown schematically, and two interstitial silver ions are indicated.

The Gurney-Mott theory envisions latent-image formation as a two-stage process. It will be discussed first in terms of the formation of the latent image by light, and then the special considerations of direct x-ray or lead foil screen exposures will be covered

THE GURNEY-MOTT THEORY

When a photon of light of energy greater than a certain minimum value (that is, of wavelength less than a certain maximum) is absorbed in a silver bromide crystal, it releases an electron from a bromide (Br -) ion. The ion, having lost its excess negative charge, is changed to a bromine atom. The liberated electron is free to wander about the crystal (see the figure below). As it does, it may encounter a latent image site and be "trapped" there, giving the latent-image site a negative electrical charge. This first stage of latent-image formation--involving as it does transfer of electrical charges by means of moving electrons--is the electronic conduction stage.

Stages in the development of the latent image according to the Gurney-Mott theory.

The negatively charged trap can then attract an interstitial silver ion because the silver ion is charged positively (C in the figure above). When such an interstitial ion reaches a negatively charged trap, its charge is counteracted, an atom of silver is deposited at the trap, and the trap is "reset" (D in the figure above). This second stage of the Gurney-Mott mechanism is termed the ionic condition stage, since electrical charge is transferred through the crystal by the movement of ions--that is, charged atoms. The whole cycle can recur several, or many, times at a single trap, each cycle involving absorption of one photon and addition of one silver atom to the aggregate. (See E to H in the figure above.) In other words, this aggregate of silver atoms is the latent image. The presence of these few atoms at a single latent-image site makes the whole grain susceptible to the reducing action of the developer. In the most sensitive emulsions, the number of silver atoms required may be less than ten. The mark of the success of a theory is its ability to provide an understanding of previously inexplicable phenomena. The Gurney-Mott theory and those derived from it have been notably successful in explaining a number of photographic effects. One of these effects--reciprocity-law failure--will be considered here as an illustration. Low-intensity reciprocity-law failure (left branch of the curve ) results from the fact that several atoms of silver are required to produce a stable latent image. A single atom of silver at a latent-image site (D in the figure above) is relatively unstable, breaking down rather easily into an electron and a positive silver ion. Thus, if there is a long interval between the formation of the first silver atom and the arrival of the second conduction electron (E in the figure above), the first silver atom may have broken down, with the net result that the energy of the light photon that produced it has been wasted. Therefore, increasing light intensity from very low to higher values increases the efficiency, as shown by the downward trend of the left-hand branch of the curve, as intensity increases. High-intensity reciprocity-law failure (right branch of the curve) is frequently a consequence of the sluggishness of the ionic process in latent-image formation (see the figure above). According to the Gurney-Mott mechanism, a trapped electron must be neutralized by the movement of an interstitial silver ion to that spot (D in the figure above) before a second electron can be trapped there (E in the figure above); otherwise, the second electron is repelled and may be trapped elsewhere. Therefore, if electrons arrive at a particular sensitivity center faster than the ions can migrate to the center, some electrons are repelled, and the center does not build up with maximum efficiency. Electrons thus denied access to the same traps may be trapped at others, and the latent image silver therefore tends to be inefficiently divided among several latent-image sites. (This has been demonstrated by experiments that have shown that high-intensity exposure produces more latent image within the volume of the crystal than do either low- or optimum-intensity exposures.) Thus, the resulting inefficiency in the use of the conduction electrons is responsible for the upward trend of the righthand branch of the curve.

X-RAY LATENT IMAGE

In industrial radiography, the photographic effects of x-rays and gamma rays, rather than those of light, are of the greater interest. At the outset it should be stated that the agent that actually exposes a photographic grain, that is, a silver bromide crystal in the emulsion, is not the x-ray photon itself, but rather the electrons--photoelectric and Compton--resulting from the absorption event. It is for this reason that direct x-ray exposures and lead foil screen exposures are similar and can be considered together. The most striking differences between x-ray and visible-light exposures to grains arise from the difference in the amounts of energy involved. The absorption of a single photon of light transfers a very small amount of energy to the crystal. This is only enough energy to free a single electron from a bromide (Br-) ion, and several successive light photons are required to render a single grain developable. The passage through a grain of an electron, arising from the absorption of an x-ray photon, can transmit hundreds of times more energy to the grain than does the absorption of a light photon. Even though this energy is used rather inefficiently, in general the amount is sufficient to render the grain traversed developable--that is, to produce within it, or on it, a stable latent image. As a matter of fact, the photoelectric or Compton electron, resulting from absorption or interaction of a photon, can have a fairly long path in the emulsion and can render several or many grains developable. The number of grains exposed per photon interaction can vary from 1 grain for x-radiation of about 10 keV to possibly 50 or more grains for a 1 meV photon. However, for 1 meV and higher energy photons, there is a low probability of an interaction that transfers the total energy to grains in an emulsion. Most commonly, high photon energy is imparted to several electrons by successive Compton interactions. Also, high-energy electrons pass out of an emulsion before all of their energy is dissipated. For these reasons there are, on the average, 5 to 10 grains made developable per photon interaction at high energy. For comparatively low values of exposure, each increment of exposure renders on the average the same number of grains developable, which, in turn, means that a curve of net density versus exposure is a straight line passing through the origin (see the figure below). This curve departs significantly from linearity only when the exposure becomes so great that appreciable energy is wasted on grains that have already been exposed. For commercially available fine-grain x-ray films, for example, the density versus exposure curve may be essentially linear up to densities of 2.0 or even higher.

Typical net density versus exposure curves for direct x-ray exposures.

The fairly extensive straight-line relation between exposure and density is of considerable use in photographic monitoring of radiation, permitting a saving of time in the interpretation of densities observed on personnel monitoring films. It the D versus E curves shown in the figure above are replotted as characteristic curves (D versus log E), both characteristic curves are the same shape (see the figure below) and are merely separated along the log exposure axis. This similarity in toe shape has been experimentally observed for conventional processing of many commercial photographic materials, both x-ray films and others.

Characteristic curves plotted from the data in the previous figure.

Because a grain is completely exposed by the passage of an energetic electron, all xray exposures are, as far as the individual grain is concerned, extremely short. The actual time that an x-ray-induced electron is within a grain depends on the electron velocity, the grain dimensions, and the "squareness" of the hit. However, a time of the order of 10-13 second is representative. (This is in distinction to the case of light where the "exposure time" for a single grain is the interval between the arrival of the first photon and that of the last photon required to produce a stable latent image.) The complete exposure of a grain by a single event and in a very short time implies that there should be no reciprocity-law failure for direct x-ray exposures or for exposures made with lead foil screens. The validity of this has been established for commercially available film and conventional processing over an extremely wide range of x-ray intensities. That films can satisfactorily integrate x-, gamma-, and betaray exposures delivered at a wide range of intensities is one of the advantages of film as a radiation dosimeter. In the discussion on reciprocity-law failure it was pointed out that a very short, very high intensity exposure to light tends to produce latent images in the interior of the grain. Because x-ray exposures are also, in effect, very short, very high intensity exposures, they too tend to produce internal, as well as surface, latent images.

DEVELOPMENT
Many materials discolor on exposure to light--a pine board or the human skin, for example--and thus could conceivably be used to record images. However, most such systems reset to exposure on a "1:1" basis, in that one photon of light results in the production of one altered molecule or atom. The process of development constitutes one of the major advantages of the silver halide system of photography. In this system, a few atoms of photolytically deposited silver can, by development, be made to trigger the subsequent chemical deposition of some 10 9 or 1010 additional silver atoms, resulting in an amplification factor of the order of 109 or greater. The amplification process can be performed at a time, and to a degree, convenient to the user and, with sufficient care, can be uniform and reproducible enough for the purposes of quantitative measurements of radiation. Development is essentially a chemical reduction in which silver halide is reduced or converted to metallic silver in order to retain the photographic image, however, the reaction must be limited largely to those grains that contain a latent image. That is, to those grains that have received more than a certain minimum exposure to radiation. Compounds that can be used as photographic developing agents, therefore, are limited to those in which the reduction of silver halide to metallic silver is catalyzed (or speeded up) by the presence of the metallic silver of the latent image. Those compounds that reduce silver halide in the absence of a catalytic effect by the latent image are not suitable developing agents because they produce a uniform overall density on the processed film.

Many practical developing agents are relatively simple organic compounds (see the figure below) and, as shown, their activity is strongly dependent on molecular structure as well as on composition. There exist empirical rules by which the developing activity of a particular compound may often be predicted from a knowledge of its structure.

Configurations of dihydroxybenzene, showing how developer properties depend on structure.

The simplest concept of the role of the latent image in development is that it acts merely as an electron-conducting bridge by which electrons from the developing agent can reach the silver ions on the interior face of the latent image. Experiment has shown that this simple concept is inadequate to explain the phenomena encountered in practical photographic development. Adsorption of the developing agent to the silver halide or at the silver-silver halide interface has been shown to be very important in determining the rate of direct, or chemical, development by most developing agents. The rate of development by hydroquinone (see the figure above), for example, appears to be relatively independent of the area of the silver surface and instead to be governed by the extent of the silver-silver halide interface. The exact mechanisms by which a developing agent acts are relatively complicated, and research on the subject is very active. The broad outlines, however, are relatively clear. A molecule of a developing agent can easily give an electron to an exposed silver bromide grain (that is, to one that carries a latent image), but not to an unexposed grain. This electron can combine with a silver (Ag+) ion of the crystal, neutralizing the positive charge and producing an atom of silver. The process can be repeated many times until all the billions of silver ions in a photographic grain have been turned into metallic silver. The development process has both similarities to, and differences from, the process of latent-image formation. Both involve the union of a silver ion and an electron to produce an atom of metallic silver. In latent image formation, the electron is freed by the action of radiation and combines with an interstitial silver ion. In the development

process, the electrons are supplied by a chemical electron-donor and combine with the silver ions of the crystal lattice. The physical shape of the developed silver need have little relation to the shape of the silver halide grain from which it was derived. Very often the metallic silver has a tangled, filamentary form, the outer boundaries of which can extend far beyond the limits of the original silver halide grain (see the figure below). The mechanism by which these filaments are formed is still in doubt although it is probably associated with that by which filamentary silver can be produced by vacuum deposition of the silver atoms from the vapor phase onto suitable nuclei.

Electron micrograph of a developed silver bromide grain.

The discussion of development has thus far been limited to the action of the developing agent alone. However, a practical photographic developer solution consists of much more than a mere water solution of a developing agent. The function of the other common components of a practical developer are the following: An Alkali The activity of developing agents depends on the alkalinity of the solution. The alkali should also have a strong buffering action to counteract the liberation of hydrogen ions--that is, a tendency toward acidity--that accompanies the development process. Common alkalis are sodium hydroxide, sodium carbonate, and certain borates. A Preservative This is usually a sulfite. One of its chief functions is to protect the developing agent from oxidation by air. It destroys certain reaction products of the oxidation of the developing agent that tend to catalyze the oxidation reaction. Sulfite also reacts with the reaction products of the development process itself, thus tending to maintain the development rate and to prevent staining of the photographic layer.

A Restrainer A bromide, usually potassium bromide, is a common restrainer or antifoggant. Bromide ions decrease the possible concentration of silver ions in solution (by the common-ion effect) and also, by being adsorbed to the surface of the silver bromide grain, protect unexposed grains from the action of the developer. Both of these actions tend to reduce the formation of fog. Commercial developers often contain other materials in addition to those listed above. An example would be the hardeners usually used in developers for automatic processors.

Transmission, absorption, scatter and attenuation

Transmission X-ray photons that pass through the patient unchanged Absorption X-ray photons that transfer their energy to the patient The absorption of the X-ray radiation by a material is proportional to the degree of Xray attenuation and is dependent on the energy of the X-ray radiation and the following material parameters: Thickness; Density; Atomic number Scatter Radiation that, during its passage through a substance, has been changed in direction. It may also have been modified by a decrease in energy Attenuation, The process by which radiation loses power as it travels through matter and interacts with it. Attenuation of x-rays in solids takes place by several different mechanisms, some due to absorption, and others due to the scattering of the beam. HVT That thickness of a specified material (usually a metal) which reduces the exposure rate to one-half its initial value. Intensity Relative number of x-ray photons in the x-ray beam Quality Quality is a measurement of the penetrating power of the X-Ray photons. The quality of the beam increases as the proportion of high energy photons increases. Factors affect the quality and intensity of the beam kV - the greater the potential difference across the tube, the faster the electrons move

and the higher the energy of the X-Ray photons. Thus the quality and intensity are increased mA- the higher the tube current, the greater the intensities of all the photon energies, and the intensity of the beam is increased time - the longer the exposure, the greater the time during which X-Rays are produced, and the greater the beam intensity. The time (seconds) and mA are generally considered together as the composite factor mAs distance - increasing distance from the source of radiation results in a decrease in the intensity of the beam, according to the inverse square law. Hence doubling the distance from the tube head will result in a beam of one quarter its original intensity. Example values of linear coefficient of attenuation Electron Density -3 density g cm x 1023 g-1 1.0 1.65 11.35 3.343 3.19 2.38 Effective atomic number 7.5 12.3 82 Photon energy 100 keV 10 MeV Bone Lead 100 keV 10 MeV 100 keV 10 MeV

Material Water

cm
0.17 0.03 0.3 0.04 62 4.3

For example, for a 100 keV x-ray beam, 1 cm of water will attenuate 17% (0.17) of the x-ray photons in the beam. The attenuation or absorption, usually defined as the linear absorption coefficient, , is defined for a narrow well-collimated, monochromatic x-ray beam. The linear absorption coefficient is the sum of contributions of the following: 1. Thomson scattering (R) (also known as Rayleigh, coherent, or classical scattering) occurs when the x-ray photon interacts with the whole atom so that the photon is scattered with no change in internal energy to the scattering atom, nor to the x-ray photon. 2. Photoelectric (PE) absorption of x-rays occurs when the x-ray photon is absorbed resulting in the ejection of electrons from the atom, resulting in the ionization of the atom. Subsequently, the ionized atom returns to the neutral state with the emission of an x-ray characteristic of the atom. 3. Compton Scattering (C) (also known as incoherent scattering) occurs when the incident x-ray photon ejects an electron from an atom and an x-ray photon of lower energy is scattered from the atom. 4. Pair Production (PP) can occur when the x-ray photon energy is greater than 1.02 MeV, when an electron and positron are created with the annihilation of the x-ray photon (absorption).

5. Photodisintegration (PD) is the process by which the x-ray photon is captured by the nucleus of the atom with the ejection of a particle from the nucleus when all the energy of the x-ray is given to the nucleus (absorption). This process may be neglected for the energies of x-rays used in radiography. There are three main processes that may occur resulting in exponential attenuation of x-ray energy:

Photoelectric absorption Compton (inelastic scatter) Pair production

If we compare the probability of each of these processes in water at different x-ray photon energies, we would see something like this: X-ray photon energy 10 keV 25 keV (Mammography) 60 keV 7% (Diagnostic) 150 keV 4 MeV 10 MeV 0 (Therapy) 24 MeV 0 50% 50% 77% 23% 0 0 100% 94% 0 6% 93% 0 Photoelectric absorption 95% 50% Compton scatter 5% 50% Pair production 0 0

Photoelectric absorption Photoelectric (PE) absorption of x-rays occurs when the x-ray photon is absorbed resulting in the ejection of electrons from the inner shell of the atom, resulting in the ionization of the atom. Subsequently, the ionized atom returns to the neutral state with the emission of an x-ray characteristic of the atom. This subsequent emission of lower energy photons is generally absorbed and does not contribute to (or hinder) the image making process. Photoelectron absorption is the dominant process for x-ray absorption up to energies of about 500 KeV.

Photoelectron absorption is also dominant for atoms of high atomic numbers. Photoelectric Effect is dependent on Z3 (Atomic number z)

Photoelectric absorption is a process of total absorption

Note that an ion results when the photoelectron leaves the atom.

Two subsequent points should also be noted: Firstly, the photoelectron can cause ionisations along its track, Secondly, X-ray emission can occur when the vacancy left by the photoelectron is filled by an electron from an outer shell of the atom. There are a number of rules which govern the probability of a photoelectric event: The incident photon must have sufficient energy to overcome the binding energy of the electron. Once the threshold imposed by the binding energy has been exceeded, then the interaction probability is at a maximum. The probability of an interaction is greatest if the electron is deeply bound. That is, the larger the atomic number, Z, the greater is the probability of a photoelectric process

Compton Scattering Compton Scattering, also known as incoherent scattering or inelastic scattering, occurs when the incident x-ray photon ejects an outer shell electron from an atom and an x-ray photon of lower energy is scattered from the atom. Relativistic energy and momentum are conserved in this process and the scattered x-ray photon has less energy and therefore greater wavelength than the incident x-ray photon. Compton Scattering is important for low atomic number specimens. At energies of 100 keV -10 MeV the absorption of radiation is mainly due to the Compton effect.

The scattered x-ray photon has an energy which is dependent on its angle of emission and on the incident photon energy. The probability of a Compton event depends on the number of electrons in an absorber, which depends on the density of the absorber and the number of electrons per unit mass. Now with the exception of hydrogen, all elements contain approximately the same number of electrons per unit mass. Therefore the number of Compton reactions is independent of atomic number. However, for tissues of biological interest, the probability of an interaction does decrease slowly with increasing photon energy above about 50 keV. Compton scatter is an attenuation process of partial absorption and partial scatter

Pair Production (PP) is of particular importance when high-energy photons pass through materials of a high atomic number. Energy: > 1.02 MeV

When the energy of the incident photon is greater than 1022 keV, the photon may be absorbed through the process of Pair Production. When such a photon passes near the

nucleus of the atom it experiences the strong field of the nucleus and may be absorbed with the creation of a positive and negative electron pair. This is an example of conversion of energy to mass as espoused by Albert Einstein. No electronic charge is created since the positron and electron are equal and oppositely charged. Ignoring the tiny amount of energy given to the recoiling nucleus we may write:

E = 2mc2 + E+ + Ewhere:
o o o o

m: electron rest mass, c: the speed of light, E+: kinetic energies of the positron, and E-: kinetic energy of the electron.

The total energy given to the electron-positron pair can be divided randomly although there is a slightly greater probability that the positron will carry off more energy than the electron because it experiences the repulsive Coulomb force of the nucleus' positive charge. The most important feature to note is that the process is not possible unless the photon energy is greater than the rest mass energy of the electron-positron pair, i.e.

2 x 511 keV = 1022 keV.

The fate of the positron has an important bearing on the ultimate decay products. In travelling through matter, the positron excites and ionises atoms, just as an electron does, until it is finally brought to rest. Then it combines or annihilates with a free electron with the production of two 511 keV photons. In order to conserve momentum and energy the two photons move essentially at an angle of 180 o to each other. A forth process called Coherent Scattering occurs mainly at low energies and large values of Z and is typically a just small proportion of the total number of interaction Here a gamma-ray or X-ray photon undergoes an interaction where it changes its direction without loss of energy. In the idealistic situation of the interaction being between a photon and a single free electron the process is called Thomson Scattering. This should be contrasted with the real world situation where photons are scattered by bound electrons. The electrons are set vibrating by the oscillating electromagnetic field associated with the photon. Subsequently, a photon of radiation is emitted with the same wavelength as the incident radiation leaving the atom in its original undisturbed state. The waves from electrons within the atom combine with each other to form the scattered wave. The scattering is a cooperative phenomenon and the process is called Coherent Scattering. There is no net ionisation in the process, a property which distinguishes coherent scattering from other photon interactions. A fifth process Nuclear Photodisintegration

At extremely high energies ( > 8 MeV), a photon may interact directly with the nucleus of an atom and eject a neutron, proton or on rare occasions even an alpha particle. Summary

Photoelectric (PE) absorption of x-rays occurs when the x-ray photon is absorbed resulting in the ejection of electrons from the atom, resulting in the ionization of the atom. Subsequently, the ionized atom returns to the neutral state with the emission of an x-ray characteristic of the atom. Compton Scattering (C) (also known as incoherent scattering) occurs when the incident x-ray photon ejects an electron from an atom and an x-ray photon of lower energy is scattered from the atom. Pair Production (PP) can occur when the x-ray photon energy is greater than 1.02 MeV, when an electron and positron are created with the annihilation of the x-ray photon (absorption). Photodisintegration (PD) is the process by which the x-ray photon is captured by the nucleus of the atom with the ejection of a particle from the nucleus when all the energy of the x-ray is given to the nucleus (absorption). This process may be neglected for the energies of x-rays used in diagnostic radiography. Thomson scattering (R) (also known as Rayleigh, coherent, classical, elastic scattering) occurs when the x-ray photon interacts with the whole atom so that the photon is scattered with no change in internal energy to the scattering atom, nor to the x-ray photon

X-ray dose concept and reduction measure

Hand X-ray of Mrs. Roentgen, spouse of Wilhelm Conrad Roentgen, the German physicist who accidentally discovered unknown rays on November 8, 1895 and called them... "X-rays".

This tutorial is intended to familiarize you with the dose concept. The purpose is to give you a quick overview of the whole topic of x-ray dose through a simple explanation of the technology and to expose the different techniques available to reduce dose.

The Dose Concept When an X-ray tube is in operation, so-called X-ray beams, a type of radiation, are released. Using these beams, the technician can create images of whatever is being examined. This radiation penetrates objects and human bodies, passes through them, and is weakened in the process. In simple terms, this weakening is equivalent to a reduction in the number of individual radioactive particles. A statement concerning the amount of radiation, which is

Fig. 1: Determining Dose Parameters measured at a site, produces the concept of "dose".

Because not all the radiation particles generated during an X-ray are used to produce the resulting images, and because radiation can cause damage to the human body, we

try to achieve the greatest possible effect, that is the best possible image with the smallest possible dose of radiation.

In general, the concept of "dose" can mean different things according to the circumstance, for example according to the site where the dose is measured. For this reason, the dose concepts most commonly used in radiology will be explained here.

Dose Parameters Incident dose The incident dose is the dose measured in the middle of a radiation field on the surface of a body or a phantom. However, it is only measured at this point if there is no body in the path of the x-ray beam. Thus, there is no scatter radiation from the body during this measurement. When radiation strikes a substance, there is always a certain scattering of radioactive particles. This is comparable to light striking a glass surface; a certain portion of the light is always reflected. The unit used to measure the incident dose is joules per kilogram, and is known as "Gray" where 1 Gray (Gy) = 1 J/kg. The former unit used to measure the incident dose was the "Rad," and using this unit, 1 Rad (rd) = 0.01 Gy, or 1 Gy = 100 rd. But because today's doses are generally very small, they are usually described using the unit "uGy", that is, 0.000001 Gy. Incident dose = the dose measured on the intended surface of the patient, but without the presence of the patient The System International unit (SI unit) used to measure the incident dose is the Gray, where 1 Gy = 1 J/kg

Surface dose

The surface dose is measured with the body in the path of the beam. Because of the scattered radiation that results on the surface and in the depths of the body, the surface dose differs from the incident dose by including the amount of scattered radiation. Thus we can say: Surface dose = incident dose + scattered radiation from the body The SI unit used to measure the surface dose is the Gray (Gy)

Exit dose The exit dose serves in the evaluation of the X-ray image. It is measured in the radiation field in immediate proximity to the surface of the body where the beams exit from the body. On the basis of the exit dose and the surface dose, we can calculate how much radiation must have remained in the patient's body.

Radiation in the body = surface dose - exit dose The SI unit used to measure the exit dose is the Gray (Gy)

Image receptor dose The image Receptor dose is measured at the film cassette, X-ray system's image intensifier assembly or Digital Detector. The image receptor dose is generally smaller than the exit dose, because the radiation weakens before it reaches the image receptor, for example by encountering objects behind the patient's body such as the radiation protection grid, anti-scatter grid or the table. Image receptor dose <= exit dose

The SI unit used to measure the image receptor dose is the Gray (Gy)

Dose rate at image receptor In order to measure a dose, the beam must operate for a certain period of time. The dose rate therefore represents the measured dose for the amount of time required to complete the dose measurement. If the image receptor dose is measured in the process, then the dose rate is the image receptor dose rate. If the dose is measured at a different site, then the dose rate is determined using one of the previously mentioned dose parameters. measured dose Dose rate = ------------------------required time The SI unit used to measure the dose rate is Gray per second: (Gy/s) or (mGy/s) Dose-area product The dose-area product is a measurement of the amount of radiation that the patient absorbs. It is usually measured behind the multi-leaf collimator, that is, on the side of the patient where the radiation enters the body, by attaching a measuring device in front of the X-ray tube and passing a beam through it. The dosearea product is independent of the distance between the X-ray tube and the measuring device because the further away from the X-ray tube this measurement is taken, the more the size of the device increases, and the dose itself decreases (see diagram). The dose to the patient can be calculated from the dose-area product, the size of the measuring device, and the distance to the X-ray tube and the patient. Dose-area product = dose * surface area of the measuring device The SI unit used to measure the dose-area product is the Gray * centimeter2 (Gy*cm2)

Fig. 2: Dosearea produ ct The dosearea produ ct at 50 cm from X-ray tube is just as great as dose-area for 100 cm or 200 cm, because the size of the measuring device increases with greater distance to the X-ray tube. But the dose itself decreases with greater distance to the tube. Thus the dose-area product is the same at each position if the size of the measuring device enables it to detect all of the radiation.

Body dose and effective dose The body dose is the comprehensive concept for the organ or partial-body dose equivalent and the effective dose. In the practical application of radiation protection, however, local and individual doses are monitored, because body doses cannot be measured directly. The Radiation Protection Regulations therefore use the concept of effective dose, in which all the individual doses to the irradiated organs or parts of the body are multiplied by a factor and then added together. The resulting value may not exceed the dose limit for the effective dose that a patient is allowed to receive. Body dose = sum of all organ or partial-body doses Effective dose <= patient dose limit The SI unit used to measure the body dose and the effective dose is the sievert, where 1 sievert = 1 Sv = 1 Joule/kilogram = 1 Gray

Legal provisions In many countries or states, by means of rules, guidelines or regulations, lawmakers have contributed to improving radiation protection for patients and medical personnel; after all, medical exposure to radiation is the single largest source of radiation exposure among the general population. On an international level, guidelines are laid down by the International Commission on Radiological Protection (ICRP). Many of

the rules, guidelines or regulations are governed by the ALARA concept ( As Low As Reasonably Achievable), meaning the production of a diagnostically relevant image at minimum possible dose.

Special cases Pediatrics Because children have a greater sensitivity to radiation than adults, special conditions apply to pediatric radiology. In particular, an attempt should be made to avoid X-ray examinations altogether and to use alternative procedures instead, such as nuclear spin tomography or sonography. Erroneous X-ray exams should be avoided and the dose measurement should be taken with special pediatric measuring devices. Special X-ray intensifying screens should be used as well to reduce additional dose. And because children have a lower body thickness, the operator generally does not use an antiscatter grid, which is used when adults are X-rayed. Of additional benefit is a more precise collimation of the area through which the beam will pass; this also reduces the dose. Beam filtration is performed with a pediatric filter consisting of 0.1 mm copper and 1 mm aluminum. It is especially important to use a gonad shield and to time a child's inhalations exactly when making thoracic X-ray images. Cardiology Cardiology is another special case. The generator output must reach at least 100 kW, and there must be an additional filter of 0.1 mm copper available for fluoroscopy as well as an appropriate system of collimators for the radiation area. This should include an iris diaphragm, and rectangular and semi-transparent collimators. Calculation of the dose-area product during application has been prescribed by some laws.

General dose reduction measures Inverse square law A bundle of X-rays corresponds to the shape of a cone, with the tube at its tip. The intensity or dose of the radiation emitted from the source of the X-ray beam diminishes with the square of its distance from the source. If you double the distance x, the dose changes by a factor of 1/(2), and if you triple it, the dose changes by a factor of 1/(3).

Fig. 3: Inverse square law In general, the dose amounts to 1/x. Therefore, if you double the film-to-target distance, you will need four times as much radiation to achieve the same image blackening. If you did not change the patient's position, this would lead to radiation stress in the patient; thus, increasing the distance between X-ray tube and patient helps to reduce the dose. Collimation at film Collimation at the site of the film cassette does not result in any dose reduction, because the radiation is not collimated to the appropriate film format until it has passed through the patient. It merely serves to improve image quality by reducing scattered radiation and thereby improving contrast. Collimation at target Collimation at the target brings about a genuine dose reduction and also produces better image quality. Collimation is performed using cones and collimators (multi-leaf collimators or iris diaphragms) that are attached directly in front of the X-ray tube. Collimation at the target is the most effective radiation protection for the patient and personnel, because it narrows the area that the radiation can strike. Compression Because radiation scatters in a body exposed to X-rays, compression of the body is another way to reduce the radiation dose. Scattered radiation also produces an undesirable reduction in contrast in the X-ray image. With compression, the thickness of the body is reduced, and so a lower dose is absorbed by the body. Additionally, compression ensures that less scattered radiation occurs. Anti scatter grid

The anti-scatter grid is located between the patient and the image intensifier, or Cassette or Digital Detector. It is the most effective method of reducing scattered radiation. The grid absorbs a portion of the scattered radiation in its lead plates. This absorbed dose therefore does not reach the image intensifier, Cassette or Digital Detector, even though it has already passed through the patient. Thus, the use Fig. 4: Cross section of an anti scatter grid of an anti-scatter grid leads to an increase in the dose, because the amount of radiation that reaches the image intensifier, cassette or Digital Detector, is not reduced until it has passed through the patient: if the anti-scatter grid is used, the patient must be exposed to a higher dose of radiation in order for the minimum dose to reach the Image intensifier, Cassette or Digital Detector. We can differentiate between individual anti-scatter grids using their grid ratios. This is the relationship between the height of the plates to their distance from each other. The greater the grid ratio, the greater the grid's effect. Thus, the required dose increases with the grid ratio. The typical grid ratio is 8:1 for Radiography and 5:1 for Mammography. Kilovolt adjustment The adjustment of the kilovolt values at the operating console also has an important effect on the dose, because if a high kilovolt setting is chosen, the radiation is "harder," that is, richer in energy and more able to pass through the body. High kilovoltage and strong filtration are therefore similar in their dose reduction effects, except that image contrast decreases with high kilovoltage.

Fig. 5: Rhodium and Molybdenum energy

For Mammography, the traditional X-ray tube target material is molybdenum, but some equipment feature an additional tube target material, Rhodium or Tungsten, in order to slightly harden the X-ray beam to better penetrate dense breast without compromising image quality or contrast. spectrums for GE Mammography X-ray tube.

Radiation filtration / hardening The quality of the X-rays also plays a great role in the size of the administered dose. X-ray radiation normally has so-called "hard" and "soft" particles, that is, particles with a lot of energy and particles with little energy. Hard particles are better for the patient, because they pass through the body. Soft particles, by contrast, get caught inside the body because they are too weak to pass through and out of it. Therefore, it is primarily soft radiation that creates unnecessary exposure to the patient. For this reason, copper and aluminum (Molybdenum and Rhodium in the case of Mammography) are used as filters in front of the X-ray tube. The soft radiation is caught in the filter plates, and the remaining radiation emerging from the filter is "harder." This additional filtration can also reduce the dose to the patient without diminishing image quality, because in any case only the "hard" rays reach the image intensifier, film cassette, or Digital Detector.

Because the GE Senographe DMR+ and 2000D (Mammography Systems) feature a double Molybdenum / Rhodium X-ray tube tracks as well as two different filters, they provide a good example of the impact of different X-ray target/filtration materials on dose (fig. 6).

Fig. 6: Target/filtration materials impact on dose

Film/screen combinations Choosing the right film/screen combination can greatly influence the required dose. In general, the dose is a function of the sensitivity of the combination. This sensitivity is

the quotient of 1000 uGy and the required dose in uGy. 1000 uGy Sensitivity = ------------------------Required dose in uGy or: 1000 uGy Required dose in uGy = ------------------Sensitivity For example, a combination with a sensitivity of 400 requires 2.5 uGy in dose. The sensitivity is greatly dependent on the intensifying screen that is used, because the screen is the principal component in image blackening. We differentiate mainly between screens using traditional fluorescent materials such as calcium tungstate, and screens made of so-called rare earths. These rare earths intensify better, which means they transform more X-ray beams into light. They can therefore reduce the dose by up to 50%, because the operator can select a lower dose and still get the same image quality that would be attainable using traditional screens. These screens are stipulated in pediatrics, for example. Image intensifier input screen At the input screen of the image intensifier there is a situation similar to that of the screen-film combinations. The input fluorescent screen substantially determines the intensification, that is, the transformation of the X-rays into light. In conjunction with the X-ray image intensifier, the age of the X-ray system plays a role, because the properties of intensification decrease considerably with age. In addition, the radiation field adapts automatically to the format of the image intensifier, which also lowers the dose, because only small portions of the patient are irradiated instead of the patient's entire body. The choice of a small input screen causes collimation, and this too leads to a reduction in the dose. Automatic exposure timing The automatic exposure timer or Automatic Exposure Control (AEC) measures the dose of radiation that strikes the X-ray film behind the patient, and turns the X-ray system off when the predetermined dose for that screen-film combination has been reached. This assures that only the smallest required dose is administered. The resulting images all show a uniform blackening, and the danger is reduced that the Xray examination might have to be repeated owing to an error in the image. In this way, automatic exposure timing also indirectly reduces the dose. Automatic dose rate adjustment The dose rate is the dose over the total time in which the patient is exposed to radiation. If the radiation exposure time to the body can be reduced, this leads to a decrease in the total dose to the patient. By automatic dose rate adjustment, the operator tries to reduce the time during which the dose rate is measured at the input of

the image intensifier and the kilovolt and milliamp values are, in turn, adjusted at the generator. In the process, the dose rate should be kept as low as possible. Automatic dose rate adjustment is comparable to automatic exposure timing for images made using a screen-film combination. Tabletop The material from which the tabletop is constructed is also significant for the required dose, because the tabletop is penetrated by the radiation and weakens it before it reaches the image intensifier. Therefore, if at all possible the tabletop should not contain any material that strongly weakens the radiation or absorbs it well, such as lead or metals in general. Carbon fiber has proven to be the best material for X-ray system tabletops because its radiation absorption is minimal and the tabletop can take a great amount of stress; today a tabletop is expected to be able to support a patient weighing 120 - 150 kg (up to 330 lbs).

Special dose reduction measures Low-dose fluoroscopy Fluoroscopy using a reduced dose has become possible primarily through digital technology. Principally, parts of the body with low levels of spontaneous movement are well suited to this method of examination. A few digital fluoroscopy procedures will be described in the following paragraphs. Pulsed fluoroscopy In pulsed fluoroscopy, X-rays are no longer delivered continuously; they are delivered in pulses that follow in rapid succession. This reduces the amount of time during which radiation is released. The resulting radiation-free gaps in the imaging process are filled with the last stored digital image until a new and more current image is available. The short X-ray pulses mean that the dose is significantly reduced; additionally, image definition is increased. Pulsing can take place either by using a pulse control at the X-ray generator, or with a grid-controlled X-ray tube; however, the grid control leads to a lower level of radiation exposure.

Fig. 7a: Pulse Fluoroscopy The illustration shows the advantages of grid control of the X-ray

Fig. 7.a Top, we tube (top) compared to control at the generator (bottom). can clearly see the exact pulses through the grid control; moreover, they allow rapid switching times. Fig. 7a Bottom in contrast, we can see that during pulsing controlled at the generator, the kilovolt values move more slowly toward the correct value and away from it again, resulting in the patient receiving an unnecessary dose of pulses with a low kilovolt value. Low kilovolt values contribute to radiation exposure but do not result in usable images.

Grid control can itself be subdivided into pulse frequency control and pulse width control (Fig 7b). The frequency of pulse frequency control can be varied for example, Fig. 7b: Pulse Fluoroscopy 12 b/s or 3 b/s, and it The Diagram shows the constant pulse width of the selected frequency during pulse frequency control (top), controls the X-ray tube continuously. Pulse width and the constant frequency with variable pulse width control, on the other hand, using pulse width control (bottom). changes the duration of the individual pulses while at a constant frequency, for example, 25 b/s. Image integration Image integration means adding together two or more individual images to create a single image. The dose rate can either be kept the same, resulting in images that are clearer because there is less noise in the image, or the dose can be reduced. This is accomplished by reducing the dose rate and adding individual images to each other until the same image quality is achieved without image integration, but with a reduction in total dose. Combining individual images does result, however, in fewer finished images for viewing at the monitor. The gaps that occur with this method are filled by outputting the same image twice in a row, similar to the method used for pulsed fluoroscopy. The reduction in dose with this method is approximately 50%. A disadvantage of the method is the stroboscopic impression that can arise with fast moving objects. Digital filtering / SMART Fluoro With digital filtering, also known as recursive filtering, a fluoroscopy image is mixed or overlaid with one or more previously stored images. The proportion of the previous images is smaller the farther back or longer ago that they were acquired. On the whole, there is flexibility in choosing the proportional mixture of images, and the process represents a compromise between dose reduction and the lag effects that result when mixing images. However, the dose rate can be significantly lowered since the images that are produced are only new, or newly made, to a certain degree; that is, combining

individual images means that less overall dose is required. The image mixture proportion can be monitored using a motion detector that lowers the image mixture proportion in the event of a strong shift in the gray scale values in the image, for example when there is movement, so that the output predominantly reflects the current gray scale value. Last image hold Last image hold means that the last image obtained during a fluoroscopy is stored until a new image is produced. The physician can then study the image without further radiation exposure. This can lead to a reduction in radiation exposure since the total fluoroscopy time is reduced, and with it, the total dose. Frame grabbing Frame grabbing means that the physician can "grab" or extract and view a chosen image from a fluoroscopic series without the necessity of additional radiation. Additionally, spot film radiography can be reduced because the physician can use the "frozen" images from the fluoroscopic series. This dose reduction is particularly well suited to pediatrics. Roadmapping Roadmapping is the overlaying of two images. A stored image is superimposed upon a current fluoroscopic image, or a current image can be copied for storage and later used in roadmapping. This is useful primarily in viewing blood vessels, because an existing image of a blood vessel filled with contrast medium can be superimposed on a catheter image made during fluoroscopy. This can save time and contrast medium, and reduce the radiation dose. Digital Fluoro imaging techniques Due to digital correction functions and the superior quality of modern X-ray image intensifiers, it is possible to produce spot films from previously captured fluoroscopy images instead of making new images with screen-film systems. Thus, the additional dose that would be needed for new spot film radiography can be completely eliminated, which means a significant reduction in dose. The somewhat lower quality of the fluoroscopy-generated images, which stems from the lower dose used for fluoroscopy, is usually accepted as a reasonable compromise. Dose levels The subdivision of the dose into individual levels permits finer gradation. With this practice, the minimum dose for optimum image quality can be selected for every kind of examination. In addition, the standard examination protocols can be individually adapted to the patient. Virtual collimation Virtual collimation is a term used to describe the possibility of positioning the

collimators via a display or at the monitor. Pre-setting the collimators this way does not require an X-ray beam, and thus reduces the time that the patient is exposed to radiation and consequently, the entire administered dose. Solid State detector Another possibility for dose reduction is provided by the use of an electronic flat bed detector, also known as a solid state detector. These silicon-base detectors have a higher degree of effectiveness than traditional detectors, which is expressed in Detective Quantum Efficiency (DQE). The patient dose is in direct proportion to this quantum efficiency: Image Quality ------------------------Detective Quantum Efficiency (DQE)

Patient Dose

proportional to

On the basis of this equation, we can see that the greater the Detective Quantum Efficiency, the smaller the dose for the patient, yet with the same image quality. An electronic flat bed detector therefore means that a larger amount of the released radiation is actually used, so that from the outset a smaller dose of radiation is needed to produce a comparable image. Also, because Solid State detectors feature a high dynamic range, they can accommodate for less X-ray and compensate for the lack of film blackening through appropriate Brightness and Contrast adjustment techniques. For some Solid State detectors, the Image Quality does not suffer from a higher energy X-ray beam, thus contributing to a decrease of the overall patient dose.

GE X-ray equipment and dose reduction measures Revolution XQ/i and XR/d Digital X-ray Systems The digital radiography systems from GE are designed to meet your clinical requirements today and to address the trends that will make digital x-ray a logical imperative over the next decade. The Revolution XQ/i is designed to improve clinical effectiveness and productivity of Chest Exams The Revolution XR/d includes a four-way float-top elevating table. The Revolution XQ/i and XR/d feature a high DQE that can contribute to reduction of dose.

Senographe 2000D and DMR+ Senographe 2000D is the new Digital Mammography System from GE Medical Systems. It is a complete, modular system that eliminates the need for film cassettes and takes full advantage of digital technology from on-screen image display to Networking, Filming and Archiving. The Senographe DMR+ employs a unique, patented bi-metal mammography tube with a Rhodium track for superior imaging of the most challenging breast tissues. The Senographe 2000D feature a Solid State Detector with High DQE in addition to the dose reduction measures already incorporated into the Senographe DMR+: Additional Rhodium target X-ray tube Rhodium filter

X-Ray Image Intensifier

The x-ray image intensifier has been used for almost fifty years to produce sequences of x-ray images. Its origins lie in low light level imaging, for example, night vision devices, to which an x-ray intensifying screen has been added. The construction, mode of operation and performance characteristics of x-ray image intensifiers are considered on this page, under the following headings:

Construction and Mode of Operation

The x-ray image intensifier (XII) is generally a cylindrically-shaped device containing a number of components housed in a vacuum. Figure 4.1

Fig 4.1 shows a cross-section through this cylinder. X-rays emerging from the patient enter at the input window and strike the input phosphor. The input phosphor scintillates and light photons strike the photocathode, which emits electrons. These electrons are accelerated and focussed by the electron optics onto the output phosphor which emits light. This light provides an image of the x-ray pattern that emerged from the patient which has a substantially greater intensity than when an intensifying screen is used on its own. This description of its operation is summarised in figure 4.2 .

Fig 4.2 The major components inside the XII include:

Input Window

The input window in older XIIs was made from glass and their performance suffered from x-ray scattering and absorption effects in this material. This limitation has been overcome in modern devices by using a relatively thin sheet (e.g. 0.25 - 0.5 mm) of aluminium or titanium where good strength is achieved for containing the vacuum with minimal x-ray attenuation.

Input Phosphor

The input phosphor is made from CsI, doped with Na, which is deposited on an aluminium substrate. The CsI:Na is grown in a structure of monocrystalline needles, each about 0.005 mm in diameter and up to 0.5 mm long. The aluminium substrate is about 0.5 mm thick ( figure 4.3 - note that dimensions in the figure are not to scale). The input phosphor is typically 15 to 40 cm in diameter, depending on the XII.

Fig 4.3 Both Cs and I are good absorbers at diagnostic x-ray energies having K-edges at 36 and 33 keV, respectively. The CsI:Na phosphor produces a blue light when x-rays are absorbed and this light is guided along the needles in a fibreoptic fashion (i.e. without much lateral spread) to the photcathode. A photograph of a glass-envelope XII which has been cut in half to expose the inner side of the input components is shown in figure 4.4.

Photocathode

An intermediate layer (less than 0.001 mm thick) is evaporated onto the inner surface of the CsI:Na phosphor and a photcathode (about 2 nm thick) is deposited on this layer (figure 4.3).

The intermediate layer (e.g. indium oxide) has a high optical transmission and is used to chemically isolate the phosphor and photocathode materials. The photocathode typically consists of an alloy of antimony and caesium (e.g. SbCs3). Light photons emitted by the input phosphor are absorbed via the phototelectric effect in the photocathode to release photoelectrons.

Vacuum & Electron Optics

The vacuum is required so that the electrons can travel unimpeded - as in the case of the x-ray tube. A voltage of 25 to 35 kV is used to accelerate the electrons and the electon optics is used for focussing them onto the output phosphor. A current of about 10-8 to 10-7 A results and it is the acceleration and focussing of these electrons which gives rise to the image intensification. Note that a cross-over point exists so that the image at the output phosphor is inverted relative to that at the input phosphor. Note also that the input phosphor and photocathode are in fact curved ( i.e. not perfectly straight as shown in figure 4.1) so as to equalise the electron path lengths and hence minimise image distortion.

Image magnification can be achieved by varying the voltages on the electrodes of the electron optics, so that a 38 cm XII can also be used to image field sizes of 26 cm and 17 cm, for instance. Three discrete field sizes are typical of many systems although XIIs with a continuous zoom feature are also available. Image brightness decreases as the field size is reduced when the input exposure rate is maintained constant. Most XIIs also feature mechanisms for establishing and maintaining the vacuum, but this aspect of their construction is beyond the scope of the treatment here.

Output Phosphor

The output phosphor is made from ZnCdS: Ag (e.g. a P20 phosphor) deposited on the ouput window (figure 4.5 - note that dimensions, once again, are not to scale).

This phosphor emits a green light when it absorbs the accelerated electrons, and is typically about 0.005 mm thick and 25 to 35 mm in diameter. In addition, a thin aluminium film is placed on the inner surface of the phosphor, which serves both as the anode and to reflect light back towards the output window - so as to increase the output luminance and to prevent these light photons exciting the photocathode.

Output Window

A number of designs of output window exist and include a glass window (e.g. 15 mm thick) with external anti-reflection layers, a tinted glass window and a fibre-optic window - the objective of these designs being to minimise light diffusion and reflections. The resulting image is fed to an optical system to be viewed by a cine-camera, photographic camera, video camera or combinations of these cameras. Orthochromatic film is needed for the film-based cameras.

In summary, consider the fate of a 50 keV x-ray photon which is totally absorbed in the input phosphor:
o

The absorption will result in about 2,000 light photons, and about half of these might reach the photocathode. o If the efficiency of the photocathode is 15%, then about 150 electrons will be released. o If the acceleration voltage is 25 kV, the efficiency of the electron optics is 90% and each 25 keV electron releases 2,000 light photons in the output phosphor, then about

270,000 light photons will result. Finally, if 70% of these are transmitted through the output window, the outcome is a light pulse of about 200,000 photons produced following the absorption of one 50 keV x-ray.

The XII envelope is made from glass or non-magnetic stainless steel, and the input window is welded to this envelope. The assembly is housed inside a metal container which contains lead, for radiation shielding, and mu-metal, to shield the electron optics from external magnetic fields. The input window is typically protected by an aluminium faceplate (e.g. 0.5 mm thick) which also serves as a safety device in case of implosion of the XII. Many systems also feature a scatter-reduction grid mounted at the faceplate. A 15 cm XII assembly is shown in figure 4.6, with the faceplate at the top of the photograph, and the optical system and a video camera towards the bottom.

Performance Characteristics
Brightness Gain The gain in image brightness results from the combined effects of image minification and the acceleration of the electrons:
o

Minification Gain

This results because electons from a relatively large photocathode are focussed down to the smaller area of the output phosphor which gives rise to an increase in the number of electrons/mm2. The gain is given by the ratio of the areas of the input and output phosphors and can be expressed as:

Thus.....
for input phosphors with diameters between 15 and 40 cm and an output phosphor of 2.5 cm diameter, the minification gain is between 36 and 256. o Flux Gain

This results from the acceleration given to the electrons as they are attracted from the photocathode to the output phosphor. It is dependent on the applied voltage and is typically between 50 and 100.

Brightness Gain The overall brightness gain is the product of the minification gain and the flux gain, i.e. . Brightness Gain = (Minification Gain) x (Flux Gain) .

Thus, when:
Minification Gain = 100 and Flux Gain = 50 then the Brightness Gain = 5,000 Brightness Gains to more than 10,000 are achievable

Conversion Factor The brightness gain is not easily measured and serves simply to illustrate the performance of an XII. A more readily measured parameter is the conversion factor, which relates what the XII delivers (i.e. luminance) relative to the input (i.e. radiation exposure), and is useful for comparing the performance of XIIs as well as that of a given XII over time. The output luminance is measured using a photometer, the radiation exposure with a ionization chamber and the conversion factor is expressed as:

This factor is typically 7.5 - 15 Cd m-2/Gy s-1 and higher. Note that the resulting image is relatively dim. For example the luminance of a standard domestic light bulb is about 106 Cd m-2. The green output image therefore needs a darkened room and dark-adapted eyes for direct viewing, or a sensitive video camera for remote viewing. Contrast Ratio This parameter expresses the broad-area, high contrast performance of an XII. Various scattering effects inside the XII result in a radio-opaque object not being completely opaque in the image. The contrast ratio can be measured by imaging a lead disk and expressing the luminance of its image relative to that of an open field image. For standardization purposes, the size of the disk is typically 10% of the field size and it is placed centrally in the field of view. It is expressed as follows:

Typical values are 20:1 to 30:1 or greater. The contrast is affected by factors which include:
o o o o o o

X-ray scattering in the input window X-ray scattering in the input phosphor Light scattering in the input phsophor Electron scattering in the electron optics Light scattering in the output phosphor Light scattering in the output window

and these scattering effects are collectively referred to as veiling glare. The output phosphor has generally been regarded as the major source of veiling glare although recent work has indicated that the input components may also contribute significantly. Limiting Spatial Resolution This parameter can be assessed using a Pb bar test pattern by determining the highest spatial frequency - in line pairs per mm (lp/mm) - that can be resolved. Images of such a test pattern are shown in figure 4.7, where a 23 cm XII is operated in a 23 cm (left), a 15 cm (middle) and an 11 cm (right) mode. The parameter is generally expressed for the centre of the field of view, since it decreases towards the image periphery depending on the quality of the electron optics.

The performance is dependent on the field size and the type of imaging camera used, and the table below shows some typical results. Note that each of the cameras degrades resolution to some extent and that the XII itself has a lower resolution than screen/film devices. Field Size (cm) 15 - 18 23 - 25 Output Phosphor 5 lp/mm 4.2 lp/mm 100/105 mm Camera 4.2 lp/mm 3.7 lp/mm 35 mm Camera 2.5 lp/mm 2.2 lp/mm Conventional Video System 1.5 - 1.3 lp/mm 1.0 - 0.9 lp/mm

Spatial Non-Uniformity XII images of a uniform object are generally brighter in the centre than in the periphery due to an unequal brightness gain in different regions of the field of view.

This effect is also called vignetting and is illustrated in figure 4.8. The image is of a uniform object acquired with an XII coupled to a video camera, and the graph on the right shows the brightness profile for a horizontal line through the centre of the image. The vignetting effect is quite apparent. Note that this parameter is not widely assessed for XII systems - in contrast to nuclear medicine where image uniformity of gamma cameras is rigorously controlled - and a standardized measurement technique is not in widespread use. Note also that the image data in the figure reflects the combined effects of the spatial uniformity of the detected radiation beam, the coupling optics and the video camera, and not solely the XII.

Spatial Distortion
The final performance characteristic to be considered is spatial distortion. All XIIs suffer from this effect, where images do not faithfully reproduce the spatial relationships in an object because of unequal magnification in different regions of the field of view.

The effect is illustrated in figure 4.9, where images of a regular wire matrix acquired with a modern (on the right) and an older XII are shown. The distortion is typically 'pincushion' in nature - as readily seen in the image on the left. Notice, for example, that straight lines are reasonably straight in the centre of this image and change to curves towards the peripheral regions. Notice, also, that image areas measured in the centre of the field will be less than those measured in the periphery. One approach to assessing this characteristic is to determine the integral distortion, which is expressed as follows:

where:
o o o

D1: diagonal length of the central square in the image of the matrix D2: diagonal length of the largest square in the image n: a factor to account for the relative sizes of these squares in the object.

The distortion expressed using this approach is 8.5% for the image on the right in figure 4.9, and 3.5% for the image on the right.

Film-screen Speeds
The sensitivity of a film-screen combination depends on the film, the screen, the film processing, and the beam quality, i.e. the spectrum of the X-rays exposing the film screen combination. This explains immediately, why the sensitometry of a film-screen combination with X-rays is a lot more complex than the sensitometry of a film with light, and therefore is hardly ever done outside the manufacturer's laboratory: 1. The film-screen combination has to be exposed with a standardized spectrum. This requires the use of a specified high voltage value, a specified high voltage waveform (usually DC), a specified target composition, a specified filtration, all resulting in a specified half-value layer. 2. While the film-screen combination has to be exposed with different dose values, the operating parameters of the X-ray source (tube voltage, tube current, and exposure time) must not be changed, as this is the only way to avoid measurement errors due to spectral changes and due to the reciprocity law failure. Therefore, the dose can only be varied by changing the distance between source and film-screen combination. 3. The film has to be processed under standardized conditions. The speed of a film-screen combination is stated as the inverse of the dose (in Gy) needed to obtain a film density of one above base plus fog, multiplied by 1000 Gy:

1000 Gy SPEED = ------------------------Dose for D = 1+Base+Fog

The speed is the quotient of two dose values, it does not have a dimension or unit name attached to it. As the speed is inverse proportional to the dose requirements of a film-screen combination, twice the speed is equivalent to half the dose and vice versa. With this definition, the standard or universal film-screen combinations with calcium tungstate phosphor used to have a speed of 100. With the modern rare-earth systems, the speed of the standard screen is usually 200, i.e. the film-screen combination for universal application requires 5 Gy (approximately 0.5 mR) for a film density of one plus base plus fog. The speed values of the high resolution ("detail" or "fine") resp. the high sensitivity ("high speed") film-screen combinations of one and the same product line differ from the speed (and thus, dose requirement) of the standard combination by a factor of two in either direction. Thus, a rare-earth "detail" filmscreen combination has a speed of 100, and a rare-earth "high speed" film-screen combination has a speed of 400. These are typical values, but for special applications screens with lower and higher speeds are available.

Relay
It is often desirable or essential to isolate one circuit electrically from another, while still allowing the first circuit to control the second. For example, if you wanted to control a high-voltage circuit from a control desk, you would not want to connect it directly to control panel in case something went wrong and the high voltage became connected to the control desk. One simple method of providing electrical isolation between two circuits is to place a relay between them, as shown in the circuit diagram of figure 1. A relay consists of a coil which may be energised by the low-voltage circuit and one or more sets of switch contacts which may be connected to the high-voltage circuit.

How Relays Work In figure 2a the relay is off. The metal arm is at its rest position and so there is contact between the Normally Closed (N.C.) switch contact and the 'common' switch contact. If a current is passed through the coil, the resulting magnetic field attracts the metal arm and there is now contact between the Normally Open (N.O.) switch contact and the common switch contact, as shown in figure 2b.

Advantages of Relays The complete electrical isolation improves safety by ensuring that high voltages and currents cannot appear where they should not be. Relays come in all shapes and sizes for different applications and they have various switch contact configurations. Double Pole Double Throw (DPDT) relays are common and even 4-pole types are available. You can therefore control several circuits with one relay or use one relay to control the direction of a motor. It is easy to tell when a relay is operating - you can hear a click as the relay switches on and off and you can sometimes see the contacts moving.

Disadvantages of Relays Being mechanical though, relays do have some disadvantages over other methods of electrical isolation: Their parts can wear out as the switch contacts become dirty - high voltages and currents cause sparks between the contacts. They cannot be switched on and off at high speeds because they have a slow response and the switch contacts will rapidly wear out due to the sparking. Their coils need a fairly high current to energise, which means some micro-electronic circuits can't drive them directly without additional circuitry. The back-emf created when the relay coil switches off can damage the components that are driving the coil. To avoid this, a diode can be placed across the relay coil.

X-Ray beam modification in general radiography Filtration

1) Filter: piece of metal (typically aluminum) located between the x-ray tube and the collimator box and in the path of the primary beam Purpose: to remove non-diagnostic, low-energy photons from the primary beam which in turn reduces skin dose to the pt Filters will cause partial absorption/attenuation of the x-ray beam a) Attenuation/absorption: reduction in the total number of x-ray photons remaining in the beam after passing through a given thickness of material

2)

3)

4)

Inherent vs added filtration a) Inherent: caused by glass, oil, tube housing, port or window i) Roughly 0.5 mm Al equivalent

b) c)

Added: caused by collimator thin sheets of ~1.0 mm Al NCRP recommendations i) 2.5 mm Al equivalence filtration for tubes operating above 70 kVp

5) 6)

Filtration will reduce exposure rate Filtration affects beam quality/energy/penetrating ability a) Average beam energy/penetrability i) Depends on: (1) kVp (2) Amount of total filtration in the beam ii) iii) kVp also determines the minimum wavelength of the beam Filtration determines the maximum wavelength of the beam

iv) Increasing either kVp or filtration will increase the average energy of the beam, allowing it to be more penetrating and of higher quality b) Beam quality is measured by its half-value layer (HVL) i) HVL directly measures beam quality by determining actual penetrating ability (1) Federal regulation states that at 80 kVp, the half-value layer must be 2.34 mm equivalent (2) Mammography has different standards because of the desire to keep the softer x-rays; regulation call for an HVL of 40 mm equivalence at 30 kVp ii) HVL: that thickness of a specified material (usually a metal) which reduces the exposure rate to one-half its initial value The HVL principle is utilized when extending technique charts

iii) c)

Because filtration causes the beam to be more penetrating, increasing filtration: i) ii) iii) Decreases density Decreases exposure rate Decreases contrast

7)

Types of filters a) Thoreaus i) ii) Compound filter used in therapy Compound materials include tin, copper, and aluminum

iii)

250 450 kVp

iv) The layering order of these metals (tin is closest to the tube, aluminum closest to the pt) is important due to characteristic radiation; new x-rays formed in the first layer are absorbed by the next layer; aluminums characteristic radiation is absorbed in the air (1) Characteristic radiation (a) Incoming electron collides with an inner shell electron of the target material, displacing that electron from its shell (b) An electron from a higher shell will drop down to fill the newly created space (c) Energy given off is a characteristic x-ray, called characteristic because its energy is characteristic of the target element and its involved electron shell b) Compensating filter i) ii) May be made of metal or a plastic compound (EX: boomerang) Used where there is difficulty imaging body parts due to varying tissue thickness and composition A wedge filter, shaped as it is named, allows for greater attenuation of the beam at its thicker end (1) Usually made of aluminum iv) A trough filter, lower in the middle than at sides, is used in chest radiography to allow for greater filtration over the lung tissue and less over the mediastinum v) Computer radiography incorporates its own compensating filtration

iii)

Scatter Radiation
1) Factors affecting the amount of scatter: a) b) Patient thickness Tissue density i) Total volume of body tissue = length x width x height (1) Length is determined by the thickness of the part (2) Height and width are determined by collimation (3) Controlling tissue volume is done via tissue compression and/or adjusting field size c) d) Field size KVp

i)

As kVp is increased, more energy is able to reach the film and so more scatter is produced

Beam Limitation
1) Volume of tissue determines the amount of s/s radiation a) 2) Volume = thickness x area

Increased collimation means: a) b) c) d) e) f) Decreased volume of tissue irradiated Decreased s/s radiation Decreased fog Decreased density Increased contrast The effects of collimation are more evident with thick body parts and non-grid exposures

3) 4) 5)

Beam limitation protects the patient from unnecessary radiation Increasing beam limitation will decrease density, with all other factors constant Beam limitation improves visibility of detail with technique compensation a) Needed only with extreme increases in collimation, such as going from a collimation of 14x17 to collimation of 5x5

6) 7)

Beam limitation is the most effective method for limiting scatter Beam limiting devices include a) Aperture diaphragm i) ii) Essentially a metal disk with a hole in its center Major disadvantage is that the aperture diaphragm allows more penumbra and off-focus radiation

b)

Collimator i) ii) Comprised of 2 independently-acting sets of adjustable lead shutters A mirror angled 45 and light bulb are set up to indicate alignment of the central ray (1) If the mirrors angulation is off, the collimator light will not be true to the actual exposure field

iii)

Adjustable shutters allow collimated shapes to match the shapes of cassettes

iv) Helps to limit penumbra v) c) The collimator is the most effective of beam limiting devices

Cone i) ii) Disadvantage includes allowing a penumbra Cones are useful for headwork, L5-S1 spot, sunrise, and other small parts

8)

Positive beam limitation (PBL): automatic collimation which automatically adjusts to the cassette size

Grids
1) 2) 3) 4) The purpose of the grid is to absorb scatter and increase image contrast Grids are located between the patient and the film Grids absorb scatter which has already been produced Construction: a) b) Thin lead strips alternate with interspacing material Interspacing i) Organic (carbon-based) interspacing absorbs moisture and can potentially warp (EX: fiber, paper, cardboard, plastic) Inorganic interspacing is much more durable and absorbs more radiation (EX: aluminum and the less-visible lead)

ii)

5)

Types of grids a) Linear i) ii) b) Comprised of one set of lead strips extending in parallel fashion in one direction Strips are aligned with the long axis of the grid or the long axis of the table

Crossed / cross-hatch i) ii) A second set of lead strips is set perpendicular to the first set This grids will not allow for the use of any tube angle

c)

Parallel i) Lead strips are set parallel to one another

ii) d)

These grids allow cut-off along the edges at shorter SIDs

Focused i) Grid strips are angled progressively as they move further from the grid center in order to coincide with the shape of the beam Convergence line: imaginary line in space created by extending the edges of angled lead strips until they meet Grid radius / focusing distance: distance from the convergence line to the grid (1) A focal range will be given on the grid iv) Stationary and bucky grids use linear focused grids

ii)

iii)

e)

Rhombic i) A type of crossed grid in which grid strips are angled with respect to one another

6)

Grid characteristics a) Grid ratio i) ii) Grid ratio = height of lead strips / distance between strips The grid ratio indicates how well the grid cleans up scatter (1) Higher ratios mean higher absorption of scatter iii) Higher grid ratio means greater need for precision when centering in order to avoid grid cut-off (increased ratio means decreased latitude)

iv) As grid ratio increases, mAs will need to be increased to maintain density v) b) As grid ratio increases, contrast will increase

Bucky factor / grid factor (bf) i) The bucky factor defines the requirement for increasing exposure factors to maintain density with the use of a grid

c)

Grid frequency (gf) i) ii) iii) Grid frequency indicates the number of lead strips in an inch or centimeter As frequency increases, the strips get thinner Grid frequencies most used in diagnostic radiography are 85 103 lines per inch

iv) Thinner strips are not as visible on images, but they are not as effective in cleaning up scatter v) If two grids have an equal ratio, the one with the fewer, and thus thicker, strips will be the more efficient grid, although its gridlines will be more visible

d)

Contrast improvement factor (gk) i) ii) iii) GK = contrast with a grid / contrast without a grid Useful GK numbers range from 1.5 to 3.5 As the grid factor increases, the contrast improvement factor increases

e)

Grid selectivity (g) i) ii) iii) Grid selectivity = % of primary beam transmitted / % of scatter transmitted This number describes grid efficiency Grids absorb around 20% to 40% of the primary beam

7)

Grid selection and use a) b) Use a grid with body parts measuring 10 centimeters or more Use a grid with kVp values over 60

Air Gap
1) 2) Air gap is defined by a 6 to 10 OID Air gap may be used in consideration of scatter reduction over use of a grid since the space traversed by scatter radiation allows it to miss striking the image receptor One disadvantage of air gap technique is magnification

3)

Rectification
Rectifier The purpose of a rectifier is to convert an AC waveform into a DC waveform. There are two different rectification circuits, known as 'half-wave' and 'full-wave' rectifiers. Both use components called diodes to convert AC into DC. A diode is a device which only allows current to flow through it in one direction. In this direction, the diode is said to be 'forward-biased' and the only effect on the signal is that there will be a voltage loss of around 0.7V. In the opposite direction, the diode is said to be 'reverse-biased' and no current will flow though it.

The Half-wave Rectifier The half-wave rectifier is the simplest type of rectifier since it only uses one diode, as shown in figure 1.

Figure 2 shows the AC input waveform to this circuit and the resulting output. As you can see, when the AC input is positive, the diode is forward-biased and lets the current through. When the AC input is negative, the diode is reverse-biased and the diode does not let any current through, meaning the output is 0V. Because there is a 0.7V voltage loss across the diode, the peak output voltage will be 0.7V less than Vs.

While the output of the half-wave rectifier is DC (it is all positive), it would not be suitable as a power supply for a circuit. Firstly, the output voltage continually varies between 0V and Vs-0.7V, and secondly, for half the time there is no output at all. The Full-wave Rectifier

The circuit in figure 3 addresses the second of these problems since at no time is the output voltage 0V. This time four diodes are arranged so that both the positive and negative parts of the AC waveform are converted to DC. The resulting waveform is shown in figure 4.

DC TESLA COIL DESIGN

This page discusses the application of a DC supply to Tesla Coiling. This page covers the simple resistive charging arrangement and contains a link to the more complex DC resonant charging topology. The latter was used by Greg Leyh in his Electrum coil design. Although the title says "DC Tesla Coil Design", the Tesla Coil itself is still inherently an AC device. The tank capacitor still sees a polarity reversal during ringdown, regardless of the type of supply used to charge it. However, there are several benefits to using a DC supply to charge the tank capacitor. As with AC charging, a high voltage power supply is used to charge the tank capacitor of the Tesla Coil. However the main difference is that the source of power is a smooth DC supply, rather than an AC supply operating at the mains frequency. This results in some significant differences in behaviour, most of which are advantageous.

(See advantages and disadvantages section later.) In particular the removal of the line frequency from the charging circuit can allow the firing rate of the rotary spark gap to be varied over a wide range without encountering any beating or surging problems. The DC charging arrangement can be broken down into two separate stages:

1. The High Voltage DC supply. (H 2. The charging circuit. Both of these stages will be described in in the sections that follow

HVDC SUPPLY
The job of the HVDC supply is to provide a constant high voltage output of fixed polarity to the charging circuit that follows. A perfect supply would provide its rated voltage with no ripple, and its output voltage would not drop when current is drawn from it. In practice this ideal supply can rarely be realised, and a compromise must be made. It is in the areas of ripple and regulation where this compromise is made. There are many different ways to build a HVDC supply. Possible designs stretch from simple single phase supplies to elaborate 3-phase arrangements. There is a trade-off between simplicity of the design and the performance. Some of the more common alternatives are shown below.

Single phase supply

One of the simplest arrangements for a HVDC supply is shown below:

This design uses a step-up transformer followed by a bridge rectifier and a smoothing capacitor. The rectifier converts the high voltage AC from the transformer into pulsed DC, and the smoothing capacitor acts like a reservoir and holds the peak voltage for the time between peaks

The DC output voltage from this arrangement is equal to 1.41 times the RMS voltage rating of the transformer. (i.e. It is equal to the peak output voltage from the secondary winding of the transformer.)

Although this circuit is cheap and simple, it exhibits a few shortfalls. The output from the rectifier pulses at twice the supply frequency, (100Hz in the UK), and falls to zero between peaks. This means that the supply would exhibit 100% voltage ripple without the inclusion of the smoothing capacitor. In addition to this the relatively long duration between peaks means that the smoothing capacitor needs to be large to "hold up" the supply and achieve an acceptably low amount of ripple.

We can estimate the size of smoothing capacitor required to obtain a particular percentage of ripple. This is done by assuming that a constant current is drawn from the capacitor over the 10ms time between charging pulses. For example: A 10kW 10kV supply must supply 1A average current. If we are prepared to accept 10% ripple, then the voltage across the smoothing capacitor is permitted to fall by 1kV over the 10ms duration between charging peaks. We can use the equation:

C=Ixt/V
to find the required smoothing capacitance. C = 1 x 0.01 / 1000 = 10 uF This is a big capacitor which implies high cost. The 500 Joules of energy that it stores are also highly dangerous. Clearly a trade-off exists between voltage ripple, and the size and cost of the smoothing capacitor. Fortunately the demands made of the smoothing capacitor and the resulting voltage ripple can both be reduced by choosing a more elaborate supply arrangement.

3-pulse rectifier supply

The circuit below shows a simple 3-phase HVDC supply:

This design uses 3 independent step-up transformers followed by a 3-pulse rectifier and a smoothing capacitor. This 3-pulse rectifier essentially consists of 3 identical half-wave supplies feeding into one smoothing capacitor. Since the phases are spaced at 120 degrees relative to each other, then the capacitor sees 3 charging pulses during each cycle of the mains supply.

The DC output voltage from this arrangement is also equal to 1.41 times the RMS voltage rating of the transformer.

There are two advantages of this arrangement compared to the single phase supply described previously. Firstly, the duration between charging pulses is now only 6.67ms instead of 10ms when used on a 50Hz supply. This means that the smoothing capacitor does not need to be as big because it does not need to hold up the voltage for so long. Secondly, the output voltage from this 3-pulse rectifier does not fall right down to zero between pulses. This is because the 3-phases overlap slightly, and the voltage ripple is actually 50% if no smoothing capacitor is used.

Clearly we are heading in the right direction by reducing the time between charging pulses, and by reducing the "un-smoothed" ripple. Both of these things reduce the demands on the smoothing capacitor. This reduces the system cost, and ultimately will give superior performance.

Although the 3-pulse rectifier circuit is superior to a single phase supply, I would not recommend actually building this supply for a number of reasons. The 3-pulse rectifier only uses 3 HV diodes, so it is simple and cheap, but it is not very efficient because it only makes use of the positive half-cycles from each transformer. Secondly, the fact that it only uses the positive cycles from each transformer implies an asymmetric loading on the secondaries of each transformer. This DC current component is undesirable as it can result in saturation of the transformer cores. A far more efficient supply can be built by using only 3 more diodes

6-pulse rectifier supply

The circuit below shows a 3-phase supply using a 6-pulse rectifier:

This design uses 3 independent step-up transformers followed by a 6-pulse bridge rectifier and a smoothing capacitor. This 6-pulse rectifier is like a "full-wave" version of the 3-pulse design shown above. Since both positive and negative half-cycles are used from all 3 phases, the capacitor now sees 6 charging pulses during each cycle of the mains supply

The DC output voltage from this arrangement is 73% higher than that obtained from the 3-pulse and single phase designs, because the 6-pulse rectifier extracts the maximum phase-to-phase voltage. A 73% increase in voltage implies a tripling of the energy in the Tesla Coil's primary capacitor, just for the cost of 3 additional HV diodes ! The output voltage for this arrangement is equal to 2.45 times the RMS voltage rating of the transformer.

There are a number of other advantages of this 6-pulse arrangement compared to the two supplies discussed previously. Firstly, the duration between charging pulses is now only 3.33ms with a 50Hz supply. This means that the size of the smoothing capacitor can be reduced again, because it does not need to hold up the voltage for so long. Secondly, the output voltage from this 6-pulse rectifier only falls to 86% between peaks. This is because the 6 pulses overlap considerably, and the ripple is only 14% without any smoothing capacitor. The reduced ripple means that the 6-pulse supply could be used for Tesla Coil purposes without requiring any smoothing capacitor. Eliminating the smoothing capacitor represents a significant cost reduction in the HVDC supply, and also removes a potentially dangerous source of stored energy from the system. For this reason the author recommends the 6-pulse HVDC supply for DC Tesla Coil use.

12-pulse rectifier supply

The process of using more charging pulses per supply cycle can be taken further in order to reduce the "un-smoothed" ripple at the output of the supply. The circuit below shows a more elaborate supply using a 3-phase supply and a 12-pulse rectifier:

This design uses 6 separate step-up transformers followed by a 12-pulse rectifier and a smoothing capacitor. The top half of the circuit is the same as the 6-pulse rectifier described above. (The secondary windings of the three transformers are connected in Star Y configuration.) The bottom half of the circuit is basically another 6-pulse rectifier, however the secondary windings of these transformers are connected in Delta configuration. This has the effect of shifting the phase of the bottom rectifier pulses by 30 degrees so that they interleave perfectly between the pulses from the top rectifier. When the outputs from the two 6-pulse rectifiers are combined, the smoothing capacitor sees a total of 12 charging pulses during each cycle of the mains supply ! The DC output voltage from this arrangement is also equal to 2.45 times the RMS voltage rating of the transformer, so there is no voltage gain in moving from the 6pulse arrangement to the more complex 12-pulse arrangement. However the duration between charging pulses is now only 1.67 ms with a 50Hz supply, making life very easy for any smoothing capacitor, if one is required at all.

The output from the 12-pulse rectifier only falls to 97% of its maximum voltage between peaks. This equates to a ripple of only 3.5% compared to 14% for the 6-pulse design above. Such a low ripple percentage makes this arrangement more than adequate for our application without employing any smoothing capacitor at all

It should be realised that the lower 3 transformers in the circuit above, need to have their secondary windings rated at 1.73 times the voltage of the upper 3 transformers. This is because the secondary windings of the lower transformers are connected in Delta configuration, and the upper ones are connected in Star (Y) configuration. If the output voltages of the lower transformers are not scaled up accordingly, the 12-pulse rectifier circuit will not function correctly. Although the 12-pulse rectifier represents a technically elegant HVDC supply, with minimal ripple, and no smoothing capacitor, the Tesla Coil designer must consider whether the added cost, complexity (and weight) can be justified by the low ripple at the DC output. For most applications the moderate ripple from the 6-pulse arrangement is likely acceptable, but if you happen to come across a surplus 12-pulse HVDC supply for the right price... (Note that dedicated 3-phase transformers could be used instead of three discrete transformers in most of the circuits above. However careful attention must be paid to the way in which the 3 HV secondary windings are connected together. Most of

the circuits show here require that they are connected in star configuration as access is required to the neutral for them to work correctly. Whether using separate transformers or a single 3-phase unit, always pay attention to the dots next to the windings in these circuits to ensure correct phasing.)

Scattered Radiation
Is radiation which arises from interactions of the primary radiation beam with the atoms in the object being imaged. Because the scattered radiation deviates from the straight line path between the X-ray focus and the image receptor, scattered radiation is a major source of image degradation in both X-ray and nuclear medicine imaging techniques. When X-ray radiation passes through a patient, three types of interactions can occur, including coherent scattering (coherent scatter), photoelectric absorption and Compton scattering . Of these three events, the great majority of scattered X-rays in diagnostic X-ray imaging arise from Compton scattering. In coherent scattering, the energy of the primary X-ray photon is first completely absorbed and then re-emitted by the electrons of a single atom. Because no net energy is absorbed by the atom, the re-emitted X-ray has the same energy as the original Xray, however the direction of re-emission is totally arbitrary. In photoelectric absorption, the energy of the X-ray photon is completely absorbed as it ejects a tightly bound electron from one of the atom's inner shells. The excess energy of the photon over that of the binding energy of the electron is carried off as kinetic energy by the ejected electron. Low energy characteristic radiation is generated as an electron from an outer shell falls into the vacated lower shell. Finally, in Compton scattering, the interaction can be considered as a collision between a high energy X-ray photon and one of the outer shell electrons of an atom. This outer shell electron is bound with very little energy to the atom and essentially all of the energy lost by the X-ray photon in the collision is transferred as kinetic energy to the electron, and the electron is ejected from the atom. Because energy and momentum are both conserved in this collision, the energy and direction of the scattered X-ray photon depend on the energy transferred to the electron. When the initial X-ray energy is high, the relative amount of energy lost is small, and the scattering angle is small relative to the initial direction. When the initial X-ray energy is small, the scattering is more isotropic in all directions. At X-ray energies on the order of 1 MeV (the energy range used in radiation therapy), the scattering is mostly in the forward direction. At X-ray energies of 100 keV (the diagnostic imaging range), the scattering is more isotropic. The relative probability of the three types of interactions for different materials is shown in Fig. 2. It is seen that in the diagnostic imaging range, near 100 keV, Compton scattering comprises the great majority of interactions for normal tissues in the body. The probability of photoelectric interactions increases as the substance atomic number increases (going from water to bone for example) and as the X-ray energy decreases. Coherent scattering is seen to be a very small fraction of the total number of scattering events.

Scattered X-rays that arise from Compton scattering constitute a serious problem in diagnostic imaging. Although the scattered X-ray photons are nearly isotropic in direction at diagnostic energies, the scattered X-ray detected in the image are primarily forward directed and thus have energies and angles of incidence near those of the primary X-rays. Thus, these scattered X-rays cannot be completely removed by the use of antiscatter grids or energy filters. The residual scatter reduces radiographic contrast in X-ray imaging and contributes to image intensity distortion in computed tomography CT .

Spectral sensitivity Film / Screen

Introduction A film used in an X-ray cassette must have a spectral sensitivity that is matched to the emission spectrum of the intensifying screen. Light emitted from an intensifying screen in general can be either of two types; a continuous spectrum, as in the case of CaWO0, or a band spectrum, as in the case of Gd2O2S:Tb (Lanex screens) (Fig.1).

A standard silver halide film will be sensitive to light up to a wavelength of 520 nm, but will be almost insensitive to most of the light emitted by a gadolinium oxisulfide screen (540 nm). For this type of screen another type of film must be used. This type is called orthochromatic film and is made sensitive to the green light from the screen by a sensitizing dying agent in the emulsion that absorbs the green light and then transfers the energy to the silver halide grains. The spectral output of the phosphor must be matched to the response of the film (Fig. 2). Calcium tungstate screens emit blue light of continuous spectrum with a peak

wavelength at about 430 nm. The term "blue screen" refers both to the screen itself and to the blue sensitive film used together with the CaWO4 screen. Rare earth screens emit light in narrow lines with strong peak(s) in the green part of the spectrum but smaller ones also in the blue, blue-green and yellow regions. The term "green screen" may be used. It is absolutely necessary to use green sensitive film with these screens to make sure that useful transmitted radiation is not lost.

Types of film and their sensitivity spectra

Monochromatic Orthochromatic Orthochromatic Orthochromatic Long Panchromatic sensitive to all wavelengths

300 - 500 nm 300 - 520 nm 300 - 580 nm 300 - 615 nm 300 - 760 nm

Thermo luminescent Dosimeter TLD

The thermoluminescent dosemeter (TLD) is designed to measure doses from X-, beta and gamma radiations in terms of the radiation quantities specified by the Health and Safety Executive (HSE). The TL dosimetry service is approved by the HSE under Regulation 35 of the Ionising Radiations Regulations 1999. The dosemeter consists of two thermoluminescent detectors containing the radiationsensitive material lithium fluoride. The detectors are located in a plate which is identified uniquely by means of an array of holes. The lithium fluoride stores the energy it receives from ionising radiations until it is heated during processing (in this case to about 250C) when the energy is released as light. The amount of light released is proportional to the radiation dose. The plate is supplied to the wearer in a plastic wrapper which protects the detectors from light and contaminants. This bears the wearer's name, an establishment code, the expiry date and an optional personal identifier for each employee, e.g. department name or a works number. If the name is not required a serial number is printed instead. The wearer places the wrapped plate in a plastic holder,which is supplied by the NRPB on permanent loan and is available with safety pin or clip attachments. We also provide 'wear and care' cards for each member of staff. These are designed to help users understand how and why they should wear the dosemeter. The dosemeter measures two quantities. The first is the personal dose equivalent Hp (10), which is often referred to as the 'whole body' dose which results from penetrating radiation. It is measured by the detector behind the domed part of the holder. The second quantity is the personal dose equivalent Hp (0.07) which is an assessment of the dose equivalent to the skin from both weakly and strongly penetrating radiations. This is measured by the detector behind the circular window.

TLD technical specification

Detection Dose range measured Energy range detected Periods of use x rays and gamma rays 0.05 mSv to 10 Sv beta particles 0.05 mSv to 10 Sv

10 keV to 10 MeV for Hp (0.07) 700 keV to 3.5 MeV (Emax) for 15 keV to 10 MeV for Hp (10) Hp (0.07) 2, 4, 8, 13 weekly (calendar issue periods are also available) 2, 4, 8, 13 weekly (calendar issue periods are also available)

Special features of the TLD

Tissue equivalence
The detectors absorb radiation energy in the same way and to the same extent as human tissue. This enables us to evaluate doses of complex mixtures of radiations in a simple and straightforward manner, thus keeping errors of measurement to a minimum.

Life span
The detector is capable of retaining the stored dose information for extended periods before assessment. Even in conditions of relatively high temperature (40C) and high humidity (up to 100%), the information can be stored for up to one year. Issue periods of up to 13 weeks can be offered thus keeping the cost of monitoring low.

Reassessment of TLD
TL glow curves of all dosemeter readings are kept for at least five years. This allows retrospective investigation in the event of a customer query. The glow curves for dosemeters with assessments in excess of 15 mSv are all checked. For doses over 25 mSv, it is possible to verify the original assessment using a special technique, at no extra cost.

Image 1& 2 Typical TLD holder & card

The TLD Card

The TLD Holder

Image 3 TLD Badges

Image 4 TLD Ring types

Image 4 A selection of TLDs from Canada

Tomography
Tomography otherwise known as body section radiography, planigraphy, laminography or stratigraphy, is the process of using motion of the X-ray focal spot and image receptor (e.g. film) in generating radiographic images where object detail from only one plane or region remains in sharp focus Fig. 1. a and b

Two lateral tomograms of the temporal bone 6 mm apart, acquired with hypocycloidal tomography. The more external tomogram (a) shows the midpart of the

temporomandibular joint, and the more medial tomogram (b) shows an exostosis in the anterior part of the external auditory canal (arrow). Fig 2

Tomography, Fig. 2 The motion of X-ray tube and film in linear tomography. Details from other planes in the object which would otherwise contribute confounding detail to the image, are blurred and effectively removed from visual consideration in the image. A variety of tomography techniques have been developed, which differ primarily in the manner in which the X-ray source and film move. Linear tomography is one of the most basic techniques (Fig. 2). As the tube and film move from the first position to the second, all points in the focal plane project to the same position on X-ray film. Thus, points a, b and c project to points a', b' and c' in the first position and a", b" and c" in the second position. Points above or below the focal plane do not project to the same film positions and are blurred. By changing the relative motion of the film and tube, the focal plane can be adjusted upward or downward. In addition to linear tomography, other types of tube and film motion have been used. These motions include circular, elliptical, figure-8, hypocycloidal, trispiral (Fig. 3). Each of these motions has advantages regarding the way in which out of plane structures are blurred. For example, a linear structure which is aligned with the linear motion of a linear tomograph, will not appear blurred, except at the ends, whereas such a structure will be blurred by the circular motion of a circular tomograph.

Fig 3

Tomography, Fig. 3 Alternative tomographic motions. circular tomography and hypocycloidal tomography. Circular tomography, a tomographic method where the X-ray focus and the film cassette are moved in circular patterns. The X ray tube and cassette holder are mechanically connected and move in a pattern as demonstrated in Fig.1. As can be seen from the figure, the film cassette does not rotate along its path.When grids are used, the grid lines must follow the rotation in order to prevent grid cut off. The advantage of circular tomography is that a uniform body section thickness is obtained in the image. The disadvantages are

the long exposure time and the complex design of the equipment.

Hypocycloidal tomography Hypocycloidal tomography, tomography in which the X-ray tube and film move in a hypocycloidal path. Conventional tomography can be made using several movement patterns for the X-ray tube and the film. The common linear movement is mechanically easy to produce but will give rise to rather thick tomographic sections and a short blurring path (the length of the tomographic section). If thinner sections and longer blurring paths are required, more complex movements are needed. Circular motion will for the same angulation of tube and film produce three times longer blurring paths than the linear motion and thinner sections. However, artefacts can be generated for circular-shaped objects in the tomographic plane. Spiral movement, which is a combination of circular and radial movement, will overcome the artefacts, but requires that the tube (and film) speed decreases when the tube is spiralling out from the centre of the spiral. This is difficult to achieve mechanically. The hypocycloidal movement is also a combination of a circular and radial movement (Fig. 1). The pattern can be produced by letting an inner gearwheel rotate inside another gearwheel with teeth on the inside. The proportion of "teeth" inner/outer wheel is 2/3. If the tube and film support is connected to the centre of the inner wheel, it will describe a hypocycloidal movement. This movement is fairly easy to achieve mechanically and performs superior to all others. It will produce thin sections with a blurring path five times longer than for linear movement with the same angulation. No object should present a hypocycloidal shape, so virtually no artefacts will be produced. The only disadvantage is that the tomographic section produced is extremely thin, which imposes the need for very high precision with regard to the film position.

Notes - Zonography - a form of tomography where the tomographic angle is small, on the order of 10, resulting in a thick plane of focus. The technique is sometimes used to better delineate suspected pathology. Pantomagraphy - a special tomography technique where panoramic roentgenograms of curved surfaces are obtained by rotating the X ray tube and film-screen holder around the patient, who is usually in a sitting position (Fig.1). The film holder, which is much longer than the film, has a protective lead front with a narrow slit. The film is exposed through this slit starting from one end. The film moves across the slit as the X-ray tube and film holder rotate around the patient. The result is a PA image of a curved surface, e.g. the mandible, flattened out on the two-dimensional film. In dentistry radiology, the technique is also called orthopantomography and is there still in much use, while other conventional tomographic techniques have been mostly replaced by computed tomography CT .

Transformers
A transformer consists of two coils (often called 'windings') linked by an iron core, as shown in figure 1. There is no electrical connection between the coils, instead they are linked by a magnetic field created in the core.

Transformers are used to convert electricity from one voltage to another with minimal loss of power. They only work with AC (alternating current) because they require a changing magnetic field to be created in their core. Transformers can increase voltage (step-up) as well as reduce voltage (step-down). Alternating current flowing in the primary (input) coil creates a continually changing magnetic field in the iron core. This field also passes through the secondary (output) coil and the changing strength of the magnetic field induces an alternating voltage in the secondary coil. If the secondary coil is connected to a load the induced voltage will make an induced current flow. The correct term for the induced voltage is 'induced electromotive force' which is usually abbreviated to induced e.m.f. The iron core is laminated to prevent 'eddy currents' flowing in the core. These are currents produced by the alternating magnetic field inducing a small voltage in the core, just like that induced in the secondary coil. Eddy currents waste power by needlessly heating up the core but they are reduced to a negligible amount by laminating the iron because this increases the electrical resistance of the core without affecting its magnetic properties. Transformers have two great advantages over other methods of changing voltage: 1. They provide total electrical isolation between the input and output, so they can be safely used to reduce the high voltage of the mains supply. 2. Almost no power is wasted in a transformer. They have a high efficiency (power out / power in) of 95% or more.

Types of Transformer Mains Transformers Mains transformers are the most common type. They are designed to reduce the AC mains supply voltage (230-240V in the UK or 115-120V in some countries) to a safer low voltage. The standard mains supply voltages are officially 115V and 230V, but 120V and 240V are the values usually quoted and the difference is of no significance in most cases. To allow for the two supply voltages mains transformers usually have two separate primary coils (windings) labelled 0-120V and 0-120V. The two coils are connected in series for 240V (figure 2a) and in parallel for 120V (figure 2b). They must be wired the correct way round as shown in the diagrams because the coils must be connected in the correct sense (direction) :

Most mains transformers have two separate secondary coils (e.g. labelled 0-9V, 0-9V) which may be used separately to give two independent supplies, or connected in series to create a centre-tapped coil (see below) or one coil with double the voltage. Some mains transformers have a centre-tap halfway through the secondary coil and they are labelled 9-0-9V for example. They can be used to produce full-wave rectified DC with just two diodes, unlike a standard secondary coil which requires four diodes to produce full-wave rectified DC. A mains transformer is specified by: 1. Its secondary (output) voltages Vs. 2. Its maximum power, Pmax, which the transformer can pass, quoted in VA (volt-amp). This determines the maximum output (secondary) current, Imax...

3. ...where Vs is the secondary voltage. If there are two secondary coils the maximum power should be halved to give the maximum for each coil. Its construction - it may be PCB-mounting, chassis mounting (with solder tag connections) or toroidal (a high quality design).

Turns Ratio and Voltage The ratio of the number of turns on the primary and secondary coils determines the ratio of the voltages...

where Vp is the primary (input) voltage, Vs is the secondary (output) voltage, Np is the number of turns on the primary coil, and Ns is the number of turns on the secondary coil. Power and Current The very small power loss in a transformer means that we can assume that power in = power out. Power = voltage x current, so we can use this to show that the current ratio is the inverse of the voltage ratio. For equal power the current increases as the voltage decreases

so...

where Ip is the primary (input) current, and Is is the secondary (output) current. The current in the primary coil I p is determined almost entirely by the current I s drawn by the load connected to the secondary coil. With no load connected, I s = 0 and Ip is very small indeed because the alternating magnetic field created by the primary current induces a voltage in the primary coil which almost exactly matches the supply voltage. If a load is connected current will flow in the secondary coil, creating a magnetic field which opposes and partly cancels out the field created by the primary coil. The resulting weakened field induces a smaller voltage in the primary coil to oppose the supply voltage and this means that a larger primary current flows.

Unsharpness
There are three pricipal types of unsharpness associated with traditional imaging methods Motion Geometric Photgraphic Note CR and DR imaging have other causes of unsharpness

Unsharpness, a quantitative measure of the loss of edge detail which is due to geometric properties of the object and imaging system and not due to image noise or X-ray scatter. It is usually expressed as the width of the band of changing density or brightness arising from a sudden change in the intensity of the radiation incident on the film or fluorescent screen. From this definition it can be understood that unsharpness and resolution are different concepts. It is possible for an edge to be "spread" by one of many factors, and at the same time for two such edges to be resolved in the image. The factors which contribute to the total image unsharpness include geometric unsharpness, movement unsharpness, absorption unsharpness, image receptor unsharpness, and parallax unsharpness. The various unsharpness factors all contribute to the observed unsharpness of structures in an image. However, the quantitative manner in which the factors combine is in general complicated and is not completely understood. It is known from observation that the total unsharpness is not the direct sum of the contributing factors. In general, it appears that the total image unsharpness is dominated by the unsharpness of the largest individual factor.

Motion artefact, artefact occurring whenever image acquisition takes longer than the time over which physiological motion occurs in the body region of interest. Motion artefacts are usually not a problem in imaging the brain and the extremities, except when the patient cannot lie still during the examination, but they can be prominent when imaging the trunk. Typical periods over which physiological motion occurs and an approximate severity scale for the motion effects on image quality are given in table 1. Motion artefact, Table 1 Examples of physiological motion, its duration and effect on imaging Body region Type of motion Severity of effect Period of motion Brain Cerebrospinal fluid (cardio-sync.) + 100 ms Blood flow + 100 ms Spine Cerebrospinal fluid (cardio-sync.) + - ++ 100 ms Neck Glutition + suppressible Respiration ++ 4 s Blood flow ++ 100 ms Thorax Respiration +++ 4 sec Cardiac motion ++++ 50 ms (sys.) - 400 ms (diast.)

Blood flow +++ Upper abdomen Peristalsis ++ 10 s Respiration ++ - +++ 4 s Blood flow ++ 100 ms Lower abdomen and pelvis Peristalsis + 30 s Blood flow + 100 ms Extremities Blood flow + 100 ms The best way of suppressing image motion artefacts is to acquire data faster than the typical periods given in Table 1. However this does not work for all imaging modalities. For different imaging techniques, and particularly for MRI, various ingenious ways have been devised to suppress motion artefacts such as cardiac gating, respiratory gating and motion compensation.

Photgraphic unsharpness Photographic unsharpness factors in Film screen radiography Film emulsion grain size thickness of the emulsion layer single vs double emulsion film cross-over in double emulsion Screens thickness of the phosphor layer size of the phosphor crystals reflective layer absorbing layer dye tint

Screen unsharpness, the contribution to image blurring or unsharpness due to spreading or diffusion of light within the intensifying screen and between the screen and film surfaces. Because the screen has a finite thickness, the X-ray absorption event which generates the emission of light within the screen may occur at some small distance from the film. The light diverges from that point and has spread a small

distance, related to the screen thickness, by the time it reaches the film surface

Parallax unsharpness, an image unsharpness seen only in double emulsion film. In principle, there is an image in both emulsions, separated by the thickness of the film base, about 0.1-0.2 mm. If the film is looked at from an angle, these two images do not overlap exactly causing parallax unsharpness. Its influence to total image unsharpness is negligible. Parallax, the apparent displacement of an object when viewed from two different angles, e.g. when observing an object first with the right eye and then with the left eye (Fig.1). In Figure 1, the apparent position of object A with respect to object B changes when the view shifts from one eye to the other. Due to the shorter distance to object A than to object B, the convergent angle from object A (a) is larger than that from object B (b). The difference in angles (a - b) is called the angle of instantaneous parallax Geometric unsharpness, unsharpness in the image caused by the fact that the X-rays are emitted from an area rather than from a point. Regions at the edges of an object will be formed in which the X-ray intensity will be gradually increasing (or decreasing), causing unsharpness (see geometric magnification (I), Fig. 1). These regions are generally referred to as penumbra. The magnitude of the penumbra is dependent on the focal spot size and the ratio focus-object distance/focus-film distance. Geometric magnification, the (theoretical) magnification in an X-ray image that occurs when the focal spot is assumed to be a point and not an area. The magnification of an object is easy to calculate, given the focus-object and focus-film distances, respectively, and assuming

that the focal spot is a point (Fig. 1, left). The magnification M, is then:

M = d/c = (a+b)/a However, if the actual size of the focal spot is taken into account, the geometry is not the same. The image will now be slightly more magnified having, however, a more diffuse edge due to the penumbra present . The magnification is now: M = [(a+b)/a] + {[(a+b)/a] - 1}(f/c) where f is the diameter of the focal area. When the focal spot size is accounted for, the magnification is referred to as "true magnification". Turbidity image unsharpness due to radiation scattered by the photographic emulsion

X-Ray Spectrum
The distribution of the number of X-ray photons with a certain energy as a function of the energy is called the photon spectrum or quantum spectrum of the radiation. Graphs of spectra usually show only relative or normalized numbers of photons, as this is the only information needed for most applications, e.g. in order to calculate contrast values in X-ray imaging. By multiplying the photon numbers with the associated values of the individual photon energy, another type of spectrum can be obtained: the intensity spectrum. This spectrum directly shows, which fraction of the total beam intensity stems from the various photon energy ranges of the spectrum, and, therefore, allows an immediate calculation of total signal intensity (or energy) by mathematical integration. The graphical representation of the integral is simply the area under the curve. Both types of spectra look very similar. For qualitative

discussions of spectral effects, it usually is rather unimportant which type of spectrum is used, but for a quantitative analysis, it is essential.