1.

X-Ray Physics
Discovered by Mr. Wilhelm Rortgen on November 8 , 1895
1.1The X-Ray Tube Assembly

1.1.1 X-Ray Tube

The way to produce the radiation by energy conversion has not changed.
A wide range of different x-raytubes optimized for a various range of
applications.
The principle,
First, electrons are produced by heating up a tungsten filament
which causes a thermionic emission.
Next, high voltage is applied between the filament, acting as the
negative cathode, and the positive anode. In this electrical field the
electrons are accelerated and thereby charged with kinetic energy.
When the electrons hit the anode surface the energy is converted
mainly into heat. Only a small fraction of about 1% becomes x-ray
radiation. These x-ray photons spread from the focal spot with the
speed of light.
In general diagnostics it ranges between 40kV and 150kV. In
mammography 20kV to 40kV are used.
1.1.2 Protective Housing
For radiation protection, the x-ray tube is contained in a protective
housing which is lined with lead internally. Especially at high kV the lead
lining cannot absorb the radiation completely, so leakage radiation has to
be considered. Only at the radiation window can the radiation leave the
protective housing nearly unhindered. The protective housing is filled with
oil which serves for electrical insulation and acts as a heat sink.
1.1.3 Rotating Anode
The tungsten-molybdenumrhenium alloy used as anode material can
withstand temperatures up to 3400C before starting to melt. In this case
the perfect vacuum is no longer provided and the tube starts arcing which
indicates the end of its life cycle.

With small x-ray tubes the electrical energy has to be limited to prevent
melting of the anode surface. Larger x-ray tubes providing a nominal tube
load of more than 10kW use rotating anodes.
1.1.4 Collimator
The collimator used to limit the radiation field to the size actually needed.
Sets of lead plates serve for radiation absorption and the definition of the
radiation field.
1.2X-Ray Physics

1.2.1 Bremsstrahlung Radiation

X-rays are generated by the interaction of projectile electrons charged
with kinetic energy and the atoms of the anode. The atom consists of the
electrically positive nucleus in the center and the electrically negative
electrons spinning on the shells labeled K to Q indicating the distance
from the nucleus. The electrons are held in their shells by the binding
energy which is highest at the innermost K shell.
1.2.1.1 Heat
The electrical energy is mainly converted into heat.
1.2.1.2 Low Energy Radiation
When passing the nucleus in some distance, the electron is slowed down
and its direction is changed, giving off a low energy x-ray photon. The
German word Bremsstrahlung means Braking (as in deceleration)
Radiation.
1.2.1.3 High Energy Radiation
When passing close by a nucleus, the projectile electron is slowed down
drastically and its direction significantly changed. In this case a high
energy x-ray photon results
1.2.2 Characteristic Radiation
An outer shell electron fills the vacancy in the K-shell and an x-ray photon
is emitted. This photon is the result of releasing the binding energy of the
electron. Tungsten emits a characteristic energies of 58kV and 69kV.
1.2.3 X-Ray Emission Spectrum
Sorting the photon energies, low energy photons are the majority and high
energy photons the minority.

1.2.3.1 Effect of kV
When lowering the tube voltage, both the maximum energy and the
radiation intensity are affected. The influence of kV on dose output is
nonlinear.
1.2.3.2 Effect of mA
Reducing the tube current means reducing the number of electrons.
Therefore, only the intensity of radiation is affected. Tube current has a
linear influence on radiation output.
1.2.3.3 Effect of Filtration
The emission spectrum can only exist in the vacuum of the tube .
The Photons of the radiation beam have to penetrate:
the tube envelope
the insulating oil
the tube window
and the collimator.
This effect of filtration is rather helpful since the soft, low energy, radiation is
rather harmful and contributes little to the image. The minimum filtration
must be equivalent to 2.5mm AL.
1.3X-Ray Interaction with Matter
X-rays are used to make a radiograph. It is detected and processed by the
image receiver.

1.3.1 Ionizising Radiation

The complete absorption and the unharmed passing of the patients
atoms, make up the x-ray image. The cells of the body tissue are harmed
by the ionizing of atoms. Therefore, taking a radiograph always puts harm
to the patient.
1.3.2 Scattered Radiation
Interacting with an outer layer electron, the photon only gives off a part of
its energy. It leaves the atom as scattered radiation with lower energy and
changed direction. Scattered radiation cannot be avoided. The amount
depends on the volume irradiated. Reducing the radiation field size
reduces the amount of scattered radiation.

2. Radiobiology
Effect Radiation
The radiobiological effects are caused by interaction of radiation with matter,
stimulating or ionizing atoms.

2.1Radiation Hazard
Possible for the cell to have its hereditary disposition changed (mutation)
resulting in
somatic effects (cancer) or
genetic effects (mutation) when germ cells are affected.
The radiation hazards are classified into those which are
predictable (deterministic)
may happen (stochastic)
2.1.1 Deterministic Hazard
2.1.1.1 Deterministic Somatic Radiation Hazard
The predictable radiation hazards are the result of cells that were killed.

2.1.1.2 Early Effect

Early effects are usually produced by high radiation doses and are
predictable.

2.1.1.3 Acute Radiation Hazard

In this case, the body tolerates only small levels of radiation.

2.1.1.4 Late Effects

Late effects usually are the result of low radiation exposure.
2.1.2 Stochastic Hazard
2.1.2.1 Stochastic Somatic Hazards
Here, the amount of radiation does not determine the severity of damage,
instead it increases the likeliness of the event to happen. Typical hazards
are leukemia and tumors in breast, lung, bones and thyroid glands.
2.1.2.2 Stochastic Genetic Hazards
Here a germ cell is affected and now contains modified genetic
information. The resulting
effect doesn't show up in the irradiated person. Instead it affects the next
generation.
2.1.2.3 Summary of Radiation Hazards
Regarding the stochastic radiation hazards, it is said that they disappear
in the multitude of other events, at least in the range of low doses.
Beginning at partial doses of 0.2 Gy (nuclear bomb victims) an increase of
radiation induced tumors is established. The proof of genetic hazards is
very difficult; up to now there exists no established method.

3. Radiation Protection
3.1 Controlled Area
The examination room is a Controlled Area. The walls of an examination room
are designed to absorb the scattered radiation.

3.1.1 Protection Against Scattered Radiation

Activation
Activate radiation only if really needed. For absorption, use Cufilters placed at the
collimator output. Under these conditions, no radiation is detected
outside the radiation beam.
Collimation
For some adjustments of the radiation control, water has to be used
to simulate a patient. A significant amount of scattered radiation is
produced in this case! By minimizing the field size, the amount of
scattered radiation is reduced significantly. The amount of scattered
radiation is directly proportional to the volume of material
irradiated.
Protection
Inside the control room (controlled area), the "dose equivalent" has
to be monitored using a "film badge". It doesn't protect against
radiation, it only monitors the amount of dose accumulated inside
the body. A protective apron may be uncomfortable, but it is safe.
Distance (Inverse Square Law)
The intensity of radiation decreases with increasing distance
according to the inverse square law. So, distance between the
radiation source and yourself is a sound protective measure.
3.2Protecting Device
3.2.1 Absorbing Material
Air
Air is a lousy absorber for gamma and x-ray radiation. In 5m
distance, there is no noticeable absorption.

Alumunium
Aluminum has an absorbing effect on radiation as shown by the
lower spectrum.
Soft radiation, however, is more affected than hard radiation. So it
is used as filter
material.
Copper
Copper shows a significant amount of absorption. For effective
protection against
radiation, however, thick layers of material are required. It is used
as filter material in collimators with varying thickness from 0.1mm
to 0.9mm to "harden up" the radiation beam for radiation
protection. Service engineers use Cu filters to simulate absorbers.
Lead
Due to the high atomic number, lead is a very effective absorber.
So, it's the material of choice for protective barriers.
3.2.2 Energy Dependency
The tube output drastically increases with increasing the tube voltage. We
get both
more energy and
more intensity.
In general, the amount of absorption is stated for 100kV. Reducing the tube
voltage to 70kV, as done normally during tests, increases the efficiency of a
protective barrier significantly. Under the conditions stated, no radiation can
be measured behind a protective barrier.
3.2.3 Personal Radiation Protection
as "lead equivalent" of mm Pb. Because of the energy dependency of the
absorption the
measurements are done at 100kV.

3.3General Rules
Activation

Work with "SS OFF" in general. Activate radiation only if really needed.
Before activating radiation, be sure that no person will be exposed.

Duration
The personal equivalent dose accumulates with duration of exposure.
Turn off radiation when no longer needed.
Distance
The inverse square law proves distance to be a good protection. Put as
much distance as possible between yourself and the radiation beam.
Protective Device
Do use the protective devices present:
o Leaded screens
o Leaded curtains
o Lead aprons
Scattered Radiation
Whenever Radiation penetrates an absorber, scattered radiation
results. Its amount is
directly proportional to the volume irradiated. For adjustments use
copper filters, attached to the collimator output. Use water only if
absolutely necessary.
Beam Collimation
Make it a habit to limit the field size to what is really needed to cover
the dominant.
This is a must with scattered radiation.
Working in the Beam
There is no need to work in the radiation beam!
Patient Dummy
We don't use patient dummies for technical test. We use test devices
instead, getting
reliable results for image quality assessment. The radiologist, however,
requires patient radiographs for image quality evaluation. That is his
problem. We don't present ourselves as patient dummies.
Protective Apparel
If you can't avoid working close to the radiation beam, always wear a
lead apron. That may be annoying, but Radiation induced injuries are
troublesome. Consider your position to the radiation source. When
standing with your back towards the radiation, put the apron on
backwards.
Checking
Activate your brain before you activate radiation! Never turn on
radiation mindlessly! You don't see radiation. So, use your imagination!

4. Overview of an X-Ray System

4.1Components and Terms

4.1.1 Patient(1)
While not a part of the x-ray system, the patient is still the center of all
our effort. Without a
patient, there is no need for an x-ray System.
Floating Table Top
The Patient is positioned by moving the floating table top rather than
moving the patient
himself.
4.1.2 The X-Ray Tube(2)
The x-ray tube converts the energy of highly accelerated electrons into
radiation that
penetrates tissue and bones, revealing information from inside the body.
The radiation emerges from the focal spot where the electrons emitted
from the cathode hit
the anode.
4.1.3 High Voltage Transformer(3)
This is the power supply of the x-ray tube. The high voltage is rectified
and, on the cathode
side, the AC-voltage for filament heating is added.
High Voltage Cables
The specially designed high voltage cables provide insulation between the
inner core holding up to 75kV and the outer shielding. The inner core is
made of several wires with low voltage insulation, needed to connect to
the tube filament.
4.1.4 Operation Console(4)
The operation console or operation desk is the interface between the
operator and the system. Here, all the exposure data needed are entered.
kV sets the image contrast and mAs the amount of radiation.

4.1.5 Generator Console(5)

Inside the generator control the exposure data requested (kWs) are split
up into:
kW tube load
ms exposure time
kV exposure voltage
mA tube current
The concept is to provide shortest possible exposure time without
overloading the x-ray tube. For this, the tube rating must be known. Next,
the high voltage inverter and the filament control are addressed to
provide the proper function when radiation is released.
4.1.6 Tube Housing(6)
Due to the internal lead lining, the radiation diverging from the focal spot
is reduced effectively to the low level of leakage radiation. Only the tube
outlet releases radiation nearly unattenuated.
4.1.7 Collimator(7)
The collimator serves various purposes:
It collimates the radiation beam to the field size required.
It limits the field to the image receiver size.
It provides partial or complete filtration of the radiation beam.
It provides a light localizer for radiation field simulation.
4.1.8 Radiographic Cassette(8)
The light proof cassette holds the x-ray film between the intensifying
screens. Intensifying screens convert radiation into visible light which
exposes the radiographic film.
4.1.9 Anti Scatter Grid(9)
When x-rays interact with matter, scattered radiation results. It is of lower
energy than the
primary radiation and it is undirected, therefore carrying no image
information in it. Scattered radiation reaching the film causes a fog layer
on the film reducing the image contrast. The anti scatter grid, placed
between patient and cassette, acts as an filter. Direct radiation from the
focal spot passes while any undirected radiation is absorbed. The device
holding the grid and cassette is called a bucky device.
4.1.10Radiation Release(10)
Prior to making an exposure, all subsystems have to be provided with data
and return an OK
message. The final step in releasing radiation is applying high voltage to
the x-ray tube.
After it leaves the tube assembly, the radiation undergoes some changes
before it arrives at
the image receiver. We use following terms to refer to this radiation:
Incident radiation
skin dose
absorbed dose
remnant radiation

 attenuation factor
image receiver dose
4.1.11Exposure Control(11)
Setting kV and mAs means controlling the tube output and hoping for
correct exposure of the film. Modern systems employ automatic exposure
control instead. For this the dose is
measured directly in front of the cassette by means of an ionization
chamber. Using a light localizer for positioning and a cassette as imaging
system is called direct technique.
4.1.12Viewing Box(12)
After exposure, the x-ray film has a latent (invisible) image. Only after
processing can it be
evaluated on a viewing box.
So, the complete imaging system is comprised of:
intensifying screens,
film,
film processing and
viewing box.
4.1.13Image Intensifier(13)
The image intensifier is an alternate image receiver. The input screen
creates an electron image which is projected towards the output screen by
means of an electron lens. By concentrating the electrons on a rather
small output screen, a bright image results; hence: image intensifier.
Using an image intensifier is called indirect technique. The former Bucky
tray becomes a spotfilm device.
4.1.14TV-System(14)
The TV camera picks up the image and presents it on a monitor screen in
real time. During fluoroscopy, the patient is screened at a low dose rate
and the image is displayed on the monitor for positioning. During
exposure, the image is accumulated on the pick-up device and then
transferred into digital memory. From there it is read out continuously.
4.1.15Automatic Dose Regulation (ADR)(15)
When using the image intensifier for imaging, the exposure control is
based on the light
output of the image intensifier rather than on the dose at its input. The
electron lens allows for varying the size of the active area on the input
screen resulting in image magnification or zoom. The ratio of output
luminance to input dose rate is referred to as the conversion factor or GX.

5. Imaging Systems

5.1Film-Screen-System
5.1.1 Direct Technique
In direct technique, the film cassette holds the x-ray film that will be
exposed. After processing inside the film processor, the radiograph is
evaluated on the viewing
box. On a radiograph, unexposed areas are transparent. Every amount of
exposure
contributes to film blackening. So, bones are displayed in "white" and
tissue in all shades of gray.
5.1.2 X-ray Film
Basically, the x-ray film is composed of a (Polyester) base and the light
(radiation) sensitive
emulsion. X-rays are attenuated differently by tissue or bones resulting in
an x-ray image which is invisible for the time being. The residual radiation
is registered by silver bromide crystals inside the emulsion. Thus the
latent image is formed. It is turned visible by film development and made
durable by fixation.
5.1.3 Efiiciency
This kind of image receiver isn't very efficient. For correct exposure a lot
of radiation is
required. Because of its very high spatial resolution (ability to see small
details), this system
is still used for some dental examinations. It is also used in material
testing where dose

requirement is of no concern. For medical examinations better efficiency is

obtained by the
use of intensifying screens.
5.1.4 Intensifying Screens
Some luminescent crystals absorb radiation effectively and convert it to
visible light to which the film emulsion is far more receptive. In fact, the
film is exposed almost entirely by the light from the intensifying screens.
The remaining radiation is employed by another set of emulsion and
intensifying screen. Thus, the efficiency is increased again. The spatial
resolution is reduced by the size of the crystals and internal light scatter.
Because mammography needs to detect very small details, we use single
sided film in
combination with a single intensifying screen.
5.1.5 Film Cassette
Inside the film cassette, the double sided x-ray film is tightly squeezed
between the front and rear screen. This is achieved by a layer of foam
rubber attached to the cassette lid. The front side of the cassette is quite
transparent to x-rays. Film cassettes must be light
proof.
5.2Image Intensifier Systems
5.2.1 Indirect Technique
With the image intensifier, a small, bright image is presented at its output
screen. This is picked up, digitally processed and stored by a TVsystem,
and finally displayed on the monitor.
With the image intensifier, a small, bright image is presented at its output
screen. This is picked up, digitally processed and stored by a TVsystem,
and finally displayed on the monitor.
5.2.2 Input Screen
In the first stage, cesium iodide crystals convert the radiation into visible
light. In the next step the light is converted into electrons by means of the
photo cathode.
5.2.3 Electron Lens
The "electron image" is focused by an electron lens and projected towards
the output screen where it is converted again into a visible image of green
light. Both the electron lens and the cesium iodide crystals (they are
destroyed by oxygen) require a vacuum. The circular electrodes of the
electron lens produce electric fields to control the size and minimize
distortions of the projected image. The zoom function projects a smaller
input field to the same output screen providing a magnification effect.
5.2.4 TV-Chain
The image transfer to the TV-camera is achieved by means of a tandem
lens system.
It is composed of the
base lens of the image intensifier and the
camera lens projecting the image to the

 CCD-chip of the TV-camera.

5.2.5 Exposure Control
The image is taken from the "parallel" light path of the tandem lens and
projected onto a
photo diode array (PDA) by means of a small optical system. By means of
the photo diodes, the light intensity can be measured at specific parts of
the image. This is used to control image brightness and keep the light
level to the TV-camera constant, which is important for good image
quality.
5.3Flat Panel Detector

5.3.1 Digital Radiography

This system combines a space-saving, "cassette like" image receiver with
the
advantages of digital imaging. The flat panel detector sort of converts the
xray
image directly into an electronic one, which is then processed digitally.
5.3.2 Detector
Cesium iodide crystals convert radiation into light which is detected by a
matrix of picture elements (pixels) transforming it into an electrical
charge. A matrix of driver ICs forms an analog image signal. The analog
signal is digitized by an analog to digital converter and transferred to
memory.
5.3.3 Scintillator
An incoming x-ray photon is converted into a large number of light
photons by means of a needle shaped Cesium Iodide crystal. The crystals
act like fiber optic and the light photons are contained within the crystal.
Thus light scatter is significantly reduced.
5.3.4 Pixel Matrix
The individual picture elements are spaced with a pixel pitch of about
150m while the actual size of the individual photodiode is somewhat
smaller. Prior to exposure the capacitance of the photodiode is charged.
During exposure the photodiode becomes conductive and discharges the

capacitance somewhat. The residual charge represents the pixel

information and is measured after exposure.
5.3.5 Image Processing
The flat panel detector provides a so called raw image containing the xray image superimposed to an image containing all the imperfections of
the detector and its electronic components. It takes several steps of digital
image processing to separate and optimize the x-ray image for display on
the monitor.

6. The X-Ray Beam

6.1Geometry
6.1.1 Focal Spot Size
A focal spot of some dimensions gives off radiation from all points of its
surface. Thus, numerous images are projected to slightly different
locations resulting in a small amount of blurring. A large focal spot
increases the amount of blurring.

6.1.2 Magnification
The geometrical magnification is given by the ratio of
Source-Image-Distance to
Source-Object-Distance.
Since over-table units provide larger SIDs (i.e. less magnification) than undertable units the image quality in general is better with OT-units. The amount of
blurring increases with the distance from the object. For geometrical
magnification techniques, with a large distance between object and image
receiver, the large focal spot is useless. With the image receiver just behind
the patient, however, the amount of blurring is drastically reduced. Here, the
large focal spot proves helpful providing short exposure time minimizing
blurring due to organ movement. For good image quality, the spotfilm device
should provide a short distance between patient and image receiver.

6.2Heel Effect
6.2.1 Radiation Intensity
This is true for the nominal focal size as well as for the radiation intensity.
Radiation spreads out from the focal spot linearly and with the speed of
light. The rays emerging perpendicular to the anode surface are of highest
intensity. Obliquely emerging radiation is of less intensity, while rays
nearly parallel to the anode surface are already absorbed by the anode.
The resulting intensity curve resembles the shape of a heel.

6.2.2 Anode Shadow

On large film formats, a significant drop in density from cathode side
towards the anode side is noticed. At close SID, part of the anode side film
is not exposed at all. This effect is called anode shadow.
6.2.3 Anode Angle
Undertable units, which usually have short working SIDs, are equipped
with tubes that have a steep anode angle to overcome this problem. A
steep anode angle shifts the range of heel effect significantly and serves
for a homogeneous exposure distribution on large formats.

7. The Generator
Basically, the generator is the power supply to the x-ray tube. It's main tasks
are to set the
radiation quality (kV)
the dose (mAs)
provide shortest possible exposure time (ms)
without destroying the anode
7.1Focal Spot

7.1.1 Electrical Focal Spot

The standard x-ray tube has a large and a small focal spot providing
different tube load. Both filaments differ in size. They are positioned next
to each other and operate on a common focal track. With the filament
voltage applied and the filament heating up, electrons are generated.
They are attracted by the positive anode voltage, take up velocity and hit
the target at a high speed. Since the high voltage is distributed evenly all
over the anode, the target area is not well defined. A well defined target
area is obtained by focusing the electron beam. For this, the filament is
positioned inside a specially shaped metal bracket, the focusing cup. Both
filament and focusing cup are at the same electrical potential.

7.1.2 Tube Load

Because of the large target area, the large focal spot can handle a higher
amount of tube load before the anode material starts melting. The
concentration of the electron beam on a small target area like with the
small focal spot restricts the tube current. Because of the better spatial
resolution, the small focal spot is selected by default. If, however, a short
exposure time is needed because of organ movement, the large focal spot
is the better choice.
7.1.3 Nominal Focal Spot
Under given geometrical conditions - filament size and anode angle - a
large and a small
focal spot result. The size is determined in the center beam. This is the
beam emerging from the center of the focal spot, directed perpendicularly
to the tube axis, passing the outlet window of the tube assembly centrally.
This is the nominal focal spot size as is stated in the specifications and
printed on the x-ray tube housing.
7.1.4 Effective Focal Spot
The effective focal spot size is governed by geometric conditions. Towards
the cathode, the
focal spot projected increases in both size and intensity of radiation. At the
anode side however, both focal spot size and intensity of the radiation are
reduced. The focal spot size dominates the spatial resolution of the x-ray
image. Spatial resolution means how small of details you can see. The
human body is set symmetrically to the body axis. So, on a large
radiograph, structures in the left and right side of the body should be
presented with the same spatial resolution. Therefore, tube axis and table
axis should have the same orientation in an examination unit. In this case,
the different spatial resolution is between the top and bottom side of the
radiograph and will not be noticed.
7.1.5 Electrical Circuit
The heating filaments inside the tube are supplied via the cathode side
high voltage cable. Insulating transformers provide the insulation between
high voltage level and control circuits.
The high voltage power supply is designed symmetrically using two
cascading rectifier
stages. One stage supplies the anode, and the cathode voltage is
connected to the common
connection of the heating filaments. Thus there are three current circuits
mixed together:
tube current
filament current large focal spot
filament current small focal spot
Both high voltage and tube current are measured providing the feedback
signals required by the control circuits.
7.2Radiation Generation

In an x-ray system, the generators task is to produce the radiation quality

desired without overloading the x-ray tube. The operational parameters are
calculated and provided by the system controller, while the correct
performance is supervised by the generator control
(Master). These are the subassemblies required to operate an x-ray tube:
Filament heating
High voltage control
Anode starter

7.3Subassemblies
7.3.1 Filament Heating
The emission of electrons required to provide the tube current selected is
obtained by heating up the filament to a specific temperature. The
filament current to produce the tube current desired is calculated by the
controller. Measuring the inverter current, the filament is heated up to the
correct temperature. During radiation the actual tube current is
measured and used to control the filament heating. So, there is no direct
control of the
tube current. It can be done only indirectly by controlling the filament
current.

7.3.2 High Voltage Control

The DC-voltage required is provided by the intermediate circuit. This is
obtained by

rectifying the mains voltage and storing it in a bank of capacitors. The

high voltage is then produced by using an inverter which drives the High
Voltage Transformer. The Inverter consists of a rectifier bridge directing
the swing current with alternating polarity through the primary winding of
the high voltage transformer. Capacitors are used to store the rectified
high voltage induced in the secondary transformer side. The output kV is
controlled by comparing the actual kV signal to a reference kV signal.

7.3.3 Anode Starter

Basically, the rotating anode is a three phase AC-motor. It is operated by
variable frequencies provided by a switched three phase generator
connected to the intermediate circuit. The anode stator is supplied with
artificial three phase current of any frequency by suitable control of the
three phase generator. During start-up, the current in phase II is
measured. After acceleration, the supply is terminated and the frequency
generated by the free wheeling anode is measured. If required in
fluoroscopy or series mode, the anode is sped up again.

7.4Collimator
7.4.1 Multileaf Collimator
The simple collimator provides one set of collimating plates only. Because
all parts of the focal spot emit radiation, the edges of the radiation field
are blurred. The field collimation is improved by use of a second set of
collimation plates located somewhat distant. Both sets of plates are
operated synchronously.
7.4.1.1 Rectangular Collimation

Operating the horizontal and vertical sets of plates separately, any width
and height of radiation field can be set. For radiation protection, the
maximum field size is limited to the cassette format.
7.4.1.2 Iris Collimation
In combination with an image intensifier, an additional set of collimating
plates, rotated by
45, serves for a nearly round field of radiation. For radiation protection
and to verify the
correct function, the limiting plates should just be visible at the image
border.
7.4.2 Filtration
Due to radiation protection regulations the inherent filtration of the tube
assembly has to be equivalent to 2.5mm Al or greater. Using additional
filters, the amount of soft radiation can be reduced further making the
radiation less harmful. The loss of intensity is compensated by the
Automatic Dose rate Control. The beam hardening effect becomes
apparent.
7.4.3 Light Localizer
With exposure units providing no fluoroscopy, a light localizer is used to
simulate the size and location of the radiation field.
7.5Anti Scatter Grid
Whenever X-rays penetrate a patient, scattered radiation is produced. The
scattered radiation
causes a fog-like layer over the entire image reducing the image contrast.
Using an anti scatter
grid, this effect is minimized. The grid is composed of fine lead stripes held in
place by interspacing material that is radio-lucent. The lead stripes are
aligned towards the focal spot,
allowing the radiation to pass nearly unhindered. The undirected scattered
radiation emerging from the patient, however, is absorbed by the lead
stripes. The grid can be moved during exposure, so the lead stripes do not
show up on the film.

7.6X-Ray Measurement
7.6.1 kV Measurement
There are two ways to measure the tube
voltage.
The direct measurement, preferred by the service engineer and
The non invasive measurement used by the physicist.

7.6.2 mA Measurement
For the tube current measurement a test point is provided in the
generator. The tube current is a vital parameter for the operation of the xray tube. However it is not really necessary to measure it. More important
may be the measurement of the mAs product which can also be measured
at a test point provided.
7.6.3 Dose Measurement
Dose Terms
For reliable dose measurement, radiation quality and test conditions have
to be specified.
This is what we use:

7.6.4 Dose Yield

Inside the X-ray tube the electrical energy is converted into radiation. The
output, the dose yield, is dependent on anode material, the kV, the
inherent filtration of the tube assembly and the mAs. The graphic is based

on tungsten as anode material. The inherent filtration is 3.0mmAl

normally. With an exposure at 80kV and 10mAs a dose of
600Gy is measured at 1,0m distance or
2,4mGy at a distance of 0,5m. This is due to the inverse square law.
A deviation from the expected value indicates a different filtration,
assuming that the kV and mAs have been adjusted correctly.

8. Mammography
8.1.1 Compression
The standard range of exposure voltages doesn't give assessment of the
glandular tissue of the breast; only extreme low voltage in the range of 20
to 30kV makes the structures show up. However, the inherent
characteristics of this soft radiation are worth noticing. This very low
energy radiation is not able to penetrate thicker tissue and contribute to
the radiograph, but only damages cells in the breast tissue. An
improvement is achieved by compressing the breast. With the maximum
absorber at 4.5cm, sufficient dose levels are to be expected throughout
the image

8.1.2 X-Ray Contrast

The subject contrast and the associated dose requirements are
investigated.
In our example, a cancer of 1cm is surrounded by 4.5 cm of tissue. The
film-screen combination requires a dose of 100Gy for correct film
density. The energies of 20keV and 18keV provide sufficient contrast while

the absorbed dose is still acceptable. Lower energies would provide better
contrast, however, at unacceptable levels of absorbed dose.

8.1.3 Radiation Quality

In mammography, soft radiation -below 30kV- is used to get the desired
contrast. At this extremely low range of energies, the dose yield is close to
nonexistent. One solution is the molybdenum anode with its two peaks of
characteristic radiation at 18 and 20keV; providing extra intensity in just
the desired range of energies in spite of its lower dose yield in general.
With characteristic radiation, changing the anode voltage or tube current
only changes the
quantity, but not the quality of the radiation. Therefore, the molybdenum
anode is the proper choice for mammography. As mentioned in the
compression chapter, high energy radiation easily penetrates glandular
tissue even at low intensity levels, resulting in a significant drop in
contrast. For the benefit of image quality, energies exceeding 20keV
should be suppressed. This is done by a K-edge filter, which has a
selective characteristic. High absorption of low, harmful energies.
Transparent in the diagnostic range of energies.
Starting with the K-edge of the filter, which is at 20keV with molybdenum,
the energies reducing image contrast are cut off. When more penetration
is needed, a 25m rhodium filter with its K-edge at 23keV is used. The
effective radiation spectrum is defined by the combination of anode
material and edge filter with the location of the K-edge depending upon
the material again. In this case, the anode voltage primarily affects the
intensity of the radiation not the quality of it.

8.1.4 Subject Thickness

Here the absorption of the different radiation qualities by a massive

absorber of 10cm of tissue is evaluated.

Mo/Mo
Starting with a combination of molybdenum anode and molybdenum filter
at 26kV. Notice the significant amount of imaging photons in the range of
20 to 26keV, which was only a minor part of the original spectrum.

Mo/Ro
For medium dense breasts, the molybdenum spectrum can be utilized far
better by shifting the k-edge towards higher energies. This is done by
switching the molybdenum filter with a rhodium filter, having its k-edge at
23keV. With this combination of a molybdenum
anode and a rhodium filter a third peak shows up in the range from 20
through
23keV, which reduces both the absorbed dose and the exposure time
without sacrificing the image quality significantly.

W/Ro
The best match for this heavy absorber is the combination of tungsten
anode and rhodium filter since the tungsten spectrum isn't dominated by
the characteristic radiation. Additionally, the higher dose yield of the
tungsten anode allows for more effective filtration.

8.1.5 Radiation Geometry

In mammography, an asymmetrically operated xray tube is used, with the
cathode side grounded. A special flat field cathode is employed to provide

more uniform distribution of electrons compared to a conventional type of

cathode. Normally, the filter is positioned perpendicular to the center
beam, resulting in increased absorption of oblique beam directions. And a
pronounced heel effect. Positioning the filter obliquely to the center beam
compensates the heel effect somewhat.

8.1.6 Magnification
If an area of micro calcifications is examined under standard geometric
conditions, the very small size of the structures makes evaluation difficult.
In this case, magnification may be helpful. The amount of blurring can be
reduced by using the micro focus. Which is used only in combination with
magnification technique. Due to the short focus-skin distance, the
glandular dose is significantly increased. Which is compensated by the
small image size used with magnification. An anti scatter grid is not
needed in this case.

8.1.7 Stereotactic Biopsy

8.1.7.1 System of Coordinates

The spatial location of an object is determined by a system of coordinates
originating from a
reference point.
X = horizontal component
y = depth
z = height
8.1.7.2 Stereoscopic Projection
In a single exposure, the shadow cast onto the floor reflects the object's
position, however,
falsified by the projection geometry. Unfortunately, all positions along the
same projection ray result in the same shadow coordinates. So far, the
system doesn't give the desired result. A second projection pinpoints the
object location by casting another shadow. Now, every spatial location is
clearly defined by two sets of coordinates. Due to the location of the
spotlights, the Y-values are always identical.
8.1.7.3 Calculation of Coordinates
Knowing the coordinates and the geometric layout and using the method
of back projection, a computer is able to calculate the depth Y and the
height Z as well as the horizontal
displacement X. Our objective is met: the object's spatial position has
been calculated from the results of two stereoscopic images.
8.1.7.4 Needle Positioning
In biopsy, knowing the exact location is only the first step. Now the tip of
the needle needs to be positioned at precisely this spot. For this, the
coordinates of the needle support are also transmitted to the computer.
The offset is computed and displayed. The needle support is operated
manually until the display reads zero. Each axis is adjusted until the final
position is reached. In real life, this is obviously done without the needle in
place. After positioning the needle support, the biopsy is performed.