Diagnostic Radiology

Phase I 2019
• Introduction to diagnostic radiology X-Ray production Stephen McCallum

• From x-ray tube to image receptor & Image quality & dose Lynsey McKay

• Image receptors Stephen McCallum

• Fluoroscopy and CT Lee Hampson

 Wilhelm Röntgen 1845 -1923

X-rays discovered by Roentgen in 1895

• first Nobel prize for Physics in 1901

• died of carcinoma of colon in 1923
Roentgen's X-ray picture of the
hand of Alfred von Kolliker, taken
23 January 1896
 Projection Radiography on film
• X-rays discovered by Roentgen in 1895
• demonstrated in Glasgow early 1896
• Radiology department in GRI 1896
– first in the world
• most basic radiological investigation
• most common radiological investigation
 In conventional diagnostic radiology we use
x-rays to form 2 dimension images of a 3
dimensional object

X-ray
source/
tube
Film
(or image receptor)
Forming an image
 Forming an image - film

X-rays

Low Z front

Screen
Double sided film
Screen
Felt
High Z back

Cross section of film screen

 Forming an image – Computed
Phosphor
radiography
imaging plate
Cassette

Reader
http://www.aapm.org/meetings/99AM/pdf/2795-64903.pdf
http://www.aapm.org/meetings/99AM/pdf/2795-64903.pdf
Forming an image – Digital
Radiography
Fluroscopy – live X-ray
images

Fluroscopy 1940 -
Fluoroscopy and contrast
 Often used with
contrast agents to image
bowl, intestine also
used extensively for
blood vessel imaging
Interventional
Radiology

Angiography
Intervention - Stenting 1
Intervention - Stenting 3
Intervention - Stenting 4
 Disadvantages of Projection
radiography

• 2D representation of 3D object
• limited contrast
• poor soft tissue discrimination
• poor sensitivity
 Cross-sectional Imaging
Anatomical Planes

• Axial
– top-to-bottom
• Sagittal
– side-to-side
• Coronal
– front-to-back
 Cross-sectional Imaging
Modalities

• Ultrasound (US)
• Computed tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Single Photon Emission Computed
Tomography (SPECT)
• Positron Emission Tomography (PET)
Sir Godfrey Hounsfield
 Hounsfield and CT
• youngest of 5 children
• loved making gadgets and machines
• joined RAF, learning electronics and radar
• at EMI became interested in computers
• began work on the CAT scanner in 1967
• first used in practice in 1971
• shared Nobel prize
• never married
Prototype CT scanner
EMI scanner
 Advantages of CT
• availability
• relatively non-invasive
• short examination times
• limited side-effects
• good anatomical detail
• good demonstration of pathology
• useful to guide biopsies
 Computed Tomography

• technology has advanced greatly

• latest generation have 128 and more
slices
• cardiac/coronary artery imaging possible
Dual energy CT
 Disadvantages of CT
• radiation dose
• subject to legislation, unlike US or MRI
• potential reactions to IV contrast
• artefacts from metal
– prosthetic joints
– dental amalgam
 Other modalities
• X-ray Mammography
 Other modalities
• Dental
 Other modalities
• Dual energy X-ray - DEXA
Diagnostic Radiology

X-Ray Production
Modern Diagnostic X-ray Room
This Lecture
X-ray tube

X-ray interactions
with patients

Image Receptor

Image

Subsequent
Lectures
Modern X-ray equipment

X-ray tube

Light beam diaphram

Collimator and filters
Patient

Couch

Grid

Film/Image
receptor
1899 X-ray tube
X-ray tube
X-ray tube Fixed Anode
 Inside a rotating anode X-ray Tube
A Generator applies a high voltage across the tube
 Inside a rotating anode X-ray Tube

Electrons are
produced at
the Cathode
Inside a rotating anode X-ray Tube

The high voltage accelerates the electrons

across the tube, through a vacuum
Inside a rotating anode X-ray Tube
The electrons hit the
target Anode, and
interact with the
tungsten metal to
produce X-rays
Inside a rotating anode X-ray Tube

X-rays are then emitted

from the X-ray tube,
and used to produce
medical images
 X-ray tube design

Lots of unwanted heat is produced as well as X-rays (99%

of energy is heat 1% X-rays)
The entire X-ray tube assembly is surrounded by oil to
keep it cool, and the tungsten anode target is constantly
rotated to spread out the heating effect.
The assembly is encased in lead to make sure X-rays are
only emitted in one direction.
 Operator Settings
When taking an X-ray, the controls of the X-ray set can
change the nature of the X-ray beam
 Operator Settings
Increasing the Voltage across the X-ray tube gives the electrons more
energy when they hit the target. This produces higher energy X-rays
which are more penetrating.
The Voltage is normally referred to as the “kVp” or peak kiloVoltage
 Operator Settings
Increasing the number of electrons produced will increase
the number of X-rays produced. The number of electrons
is measured as tube current, in units of mA (milliAmperes)
 X-ray Controls

• Adjust tube current – mA mAs

• Adjust exposure time – s
– increase number of X-ray photons
• Adjust tube voltage – kVp
– increase penetration
 Cathode Construction
• Focusing Cup at –ve potential

End view of filament

Electron trajectory

• Filament made of tungsten. It has a high

thermionic emission with little evaporation.
• Resistance 5Ω at 2000°K
0.1Ω at room temperature
Cathode
The atom and electron shells

Nucleus – contains
protons and neutrons.

The atomic number of an

element is the number of
protons and is given the
symbol Z
 The atom and electron shells/
bands
m
l To release an electron from a
shell an energy greater than
k
the binding energy must be
delivered. The electron
binding energy increases
closer to the Nucleus

Electron shells are given

letters starting at k –
always the inner most
shell.

Electrons orbit the nucleus in shells. Electrons

in inner shells are more tightly bond than those
in outer shells
 Typical electron energy levels

Energy (keV)
Electrons Energy (keV) Electrons
0
0 2P -0.02
3M -0.005 12 O -0.07
8L -0.08 32 N -0.6

18 M -2.8

2K -1.5 8L -11.0

Aluminium Z=13
2K -69.5

Tungsten Z=74

Each energy band has a structure (sub shells) arising from small differences
in energy determined by electron quantum numbers.
 K shell interactions
• Interactions with electrons in the K shell
are very important in radiology.

• K shell interactions can be utilised to

– Produce X-rays at defined energies
– Filter the X-ray beam
– Provide contrast (e.g. iodine and barium
contrast agents)
– Use as part of the detector (intensifying
screens and scintillation detectors)
 X-Ray Photon Production

X-rays are produced when heavy metal is struck by

electrons travelling at high speed. Only about 1 % of the
electrons produce an X-ray photon; the rest is lost in
heating up the target. X-rays are produced by:

•slowing the electron down, called Bremsestrahlung

(German for "braking radiation")

•removing an inner electron. Photons are emitted as the

electrons undergo transitions from energy level to energy
level.
 Production of X-rays- electron interactions

Electron track

Bremsstrahlung
X-ray
 Production of X-rays- electron interactions

1. Accelerated electron
collides with k-shell
Electron track electron,
2. if energy > than binding
energy of k-shell both
electrons ejected
3. Electron moves from L-
shell to k-shell vacancy
excess energy given off
as x-ray photon
1

3 Characteristic X-
ray

2
 Characteristic X-rays
• X-rays emitted from the K shell are known as K
characteristic X-rays, from the L shell as L characteristic X-
rays and so on.

•The shell from which the vacancy was filled is denoted with a
subscript:
•α denotes radiation emitted between neighbouring shells
•β denotes radiation emitted from non neighbouring shells
•In addition other subscripts are used to which sub shell was
involved so

K α1 and K α2, are X-rays emitted between the K and L shells

K β1 and K β 2, are X-rays emitted between the K and higher
shells
 X-ray Spectrum
When X-rays are generated in an X-ray
tube, they do not all emerge with the same
amount of energy.

The spread of X-ray energies created is

called a Spectrum.
 A typical X-ray spectrum is shown below:

Characteristic
X-rays

High energy
cut off

Low energy
cut off
X-rays at lower energies will be attenuated by the patient, and will
therefore not reach the X-ray film / detector. As such, they will not
play a part in forming the image, but will still contribute to the
exposure of the patient.
Ideally, we would remove these unhelpful X-rays from the beam.
This is why Filtration is often used
 Continuous X ray emission
Spectrum
Consider thin Anode and x-rays

Relative Intensity
produced by electron beam. Limit set by
•Theory shows that the intensity of x- tube
rays produced up to a maximum set by voltage
the tube potential will be constant.
•Intensity is defined as number of
photons in the beam multiplied by their
energy. At higher energies there are
Energy
less photons produced but intensity
constant due to the higher energy of the (keV)
photons.
 Continuous X-ray emission
Spectrum
Limit set by
X-ray emission
tube spectrum
• A thick anode can be
thought of as composed voltage

Relative Intensity

Relative Intensity
as a large number of thin
layers.
• The maximum energy will
slowly reduce for each
layer due to the energy
lost by the electrons as
they penetrate the Anode Energy (keV) Energy (keV)
material.
X-ray production spectrum :
Spectrum modified by attenuation of the
low energy photons that are produced
deep in the anode and by the
attenuation in the tube window when
the x-rays emerge from the tube
 X-ray production spectrum

1.0 L to k

Relative Intensity Characteristic

m to k X-ray
0.6 Low energy
cut off

0.2 High energy

cut off

20 60 10
Energy 0
(keV)
100 kVp & 2.5 mm of Al filtration
 Two “changes” are referred to
with regard to X-ray spectra.

• 1. Quantity – this change is produced

when all of the spectrum changes by the
same factor. Produced by a change in
tube current.

• 2. Quality – this change is produced when

the shape of the X-ray spectrum changes.
Produced by a change in tube kVp or
filtration.
 Requirements of Anode
• 1. High conversion efficiency for electron
energy into X-Ray photons
(The intensity is proportional to Z)
• 2. High melting point.
• 3. High conductivity.
• 4. Low vapour pressure.
• 5. Suitable mechanical construction.
 Anode Construction
• Built to allow rotation.
• On molybdenum (Mo, Z=42) stem and with main disc
of tungsten or molybdenum (or occasionally carbon).

W/Re
Molybdenum 6° - 20 °

• Target on anode a mixture of tungsten (W, Z=74) and

Rhenium (Re, Z=75) 90%/10% (Re increases
ductility of W at high temperatures)
• Tungsten melting point 3370°
• Speed of rotation normally up to 3000 rpm but can
now go up to 8000 rpm in some tubes.
• Heat loss must be by radiation.
 Intensity Distribution of X-ray
Photons
1. Most produced in angles between 45° and
90° to direction of electron travel.
2. Those produced at a depth in the anode
are attenuated.
3. At a distance from the X-ray tube fall off in
intensity occurs across the beam due to
the inverse square law.
Spatial distribution of X-rays produced from a thin metal target

Johns and Cunningham

 Heel Effect
If the anode is
damaged the
Incident Electrons distribution will
be increasingly
non uniform
Tube shield

Intensity

Distance across
beam
 Filters
• Filters are used
to modify the
shape of the X-
ray spectrum.

• They are placed

at the output of
the X-ray tube
 Filters Points to Note
• 1. An element is effectively almost
transparent to its own characteristic X-
rays.

• 2. The large increase in attenuation just

above the binding energy effectively
produces a window in the transmission;
known as the Absorption edge.
 Absorption edge
When ever the photon energy is
slightly higher than the energy
required to removed an electron
from a shell then there is a sharp
increase in the photoelectric
30 absorption coefficient. This is
know as the absorption edge.
Attenuation
As mention previously absorption
edges associated with the K shell
5 have a number of important
applications in radiology

keV

Interaction photon Energy

 Filters
• Aluminium filter(Z=13) used normally
because K-edge at 1.6 keV
• If specific keV required then by using other
materials e.g. palladium (K-edge 24.3 keV)
a window can be created.
• Molybdenum is used in mammography to
obtain photons at 19-20 keV.
Values of Atomic Number and
K-Adsorption Edge
Element Atomic K-Adsorption
Number (Z) Edge keV
Iodine 53 33.2
Caesium 55 36.0
Aluminium 13 1.6
Molybdenum 42 20
Gadolinium 64 50.2
Erbium 68 57.5
Barium 56 37.45
Ytterbium 70 61.3
Holmium 67 55.6
Tungsten 74 69.5
 Effect of Filtration with Aluminium
Before After

Cut off with With 2mm of

ideal filter Aluminium filter
The number of low
energy X-rays is
reduced, although so
is the overall beam
Intensity

Intensity
intensity

20 40 60 80 100 20 40 60 80 100
Photon energy (keV)
Curves showing the relative absorptions of lanthanum
oxybromide (LaOBr) and calcium tungstate (CaWO4) as a
function of X-ray energy in the vicinity of their absorption
edges (not to scale).
 K edge
filter
Mass
Atten. Intensity
Coeff.

kVp
Energy Energy
 Molybdenum anode
Ka 0.05 Molybdenum filter

Tungsten anode
30 kVp 0.05
Palladium filter
Kb

10 20 30 10 20 30
Photon Energy
 Use of K-Edge Filters
1. Children
Tungsten Anode
Erbium Filter 57.5 keV
2. Mammography
Molybdenum Anode
Molybdenum Filter 20 keV

Tungsten Anode
Palladium Filter 24.3 keV
Light beam diaphragm and
collimators
 Radiographic tube

LBD controls
Tube

Angulation handles

Locks
LBD