Thomographic Equipment

In this chapter we shall consider more apparatus which is intended for a particular radiographic porpose, that is topographic. In order to employ effectively the spesalizedsometimes highly spesialized-equipment which is designed for tomography, radiographers should understand the processes which they are to control. Because of this, we are opening this chapter with a necessary theoretical discussion.

THEORY OF TOMOGRAPHY
Everyday life makes us familiar with the fact that when a photograph is taken the aspect of the subject which is nearer the camera and the film is the aspect recorded. However, this is not true of a radiograph. In the same antero-posterior projection of the abdomen, for example, there may be visualized the pubic bones, gan in the tranverse colon, gas opaque stone in the biliary tract, the renal outlines and the vertebral bodies. If our photographic analogy were applicable to the radiograph , among the structures listed we should see probably only the last two, since they are posteriorly situated in the body and were nearest to the film when the exposure was made. In fact a radiograph present a composite image whic includes any number of structures in the line of primary X-ray beam. Tomography is a procedure which allows us to record on radiograph only selected structures, free from the superimposed shadows of other organ an tissue. The advantages of this in producing clearer visualization are immediately obvious : for example, the gall bladder may be separated from intesinal gas ; the lung hila distinguished in the pulmonary vasculature ; the large cranial bones prevented from overshadowing the minute architecture of the inner ear. To understand this we should consider the patient as number of anatomical layers. At any one time tomography makes a single layer sharp on a film, while the layers above and below it are indistinguishable because their detail is blurred. This blurring is motional unsharpness : it is produced by movement of the X-ray tube and film during the exposure.

Figure II.I depicts a patient in whom two anatomical tructures. Y and A, are situated in line with each other. The X-ray tube is T and on the film placed beneath the patient the shadow of Y is recorded at X and the shadow of A at B. As we face the diagram, B is seen to lie to the right of X which happens to be at the centre of the film. In Fig.II.2, the X-ray tube has moved to T; The film too has moved in a similiar excursion but in the opposite direction. The image of A at B has chan ged places and is now in another situation altogether, to the left of X. FigureII.3 is a combination of the previous two diagram and summarizes the position, as we can now summarizes the position , as we can now summarize it in words. (i) (ii) (iii) (iv) (v) (vi) (vii) During exposure of the film, the focus of the X-ray tube moves in a straight line between T and T. The film move in a parallel straight line in the opposite direction. The X-ray tube, the fulcrum and the film do not alter their relative position in any way. The X-ray tube, fulcrum and the film do not alter their relative positions in any way. Therefore the projection of Y in the film is theoretically as sharp as on an ordinary radiography. This is true not only of Y but of other points in the same horizaontal plane. Structures (for example A) which are not in the same plane as Y-they may be either above or below it are recorded as a blur because the tube focus and the flm are moving in their respect.

If we content ourselves for the moment with the above simple statment of the condition of tomography, we can at once appreciate a few of the requirment of apparatus disigned to perform it. Such apparatus must have:

a) A means of moving the X-ray tube in a controlled direction; b) A means of linking the X-ray tube to the Bucky tray, so that a film placed in the latter will be simultaneosly driven an equal excursion in the opposite direction; c) A means of altering the height of the fulcrum or turning point of the movement, so that different anatomical levels in the patient may be examind at will; d) Mechanical stability, to prevent unsharpness arising in the fulcrum plane as the result of tube or cassete vibration.

The thicness of the tomographic section

So far we have considered-an have used diagrams to show-a fulcrum point at Y : we have said that the theory must be true also of other points in the same horizontal plane as Y. However, in practice the plane which is recorded on the radiograph will have definite dimension ; that is, it will have a certain thicness and is not survacebut a section or layer sharp. This is because there is lower limit to the sharpness perceivable by the eye. The accepts as sharp an image which in fact contains a small element of blur an even if the blur were reduced the eye could not recognize any improvement. We can therefore say that within certain strict limits, details which are slightly above an below Y we sharply recorded on the film even though they are not exactly in the fulcrum plane: in theory blur is present but it is accetable because it is not perceivable. Once we have understood that tomography is concerned with a layer, rather than a plane, we are bound to ask ourselves about the dimension of this layer. Is the section which appers sharp on the radiograph a thick, or a thin strip ?

In Fig. II.4 there is again depicted the movement of an X-ray tube and film about a fulcrum at Y. Let us suppose that in the LINE CD (or for thatmatter in EF, since the two are equal), we have the maximum amount of movement which can be present without the eye perceiving that the image is blurred. Then it follows that the whole of the shaded section in the figure will appear sharp.

In Fig. II.5 the only change made is a wider swing of the X-ray tube. CD and EF again define the maximum permissible blur. This time,however, these lines are seen to come much nearer to the fulcrum and the shaded in-focus section narrower. In Fig. II.6 the focus-fokus-film distance has been decreased relative to Fig. II.4 but the movement of the X-ray tube is the same. Again CD and EF represent the iimits of acceptable blur. The shaded layer is narrower than it was in the first instance-altought not so narrow as it is in Fig. II.5 In Fig. II.7 we have to consider two separete tomographic section. The first examination is made with the fulcrum at Y near to the film. The second cutis taken with the fulcrum at Y, much further removed from the film. The in -focus layer has been shadded in the diagram in each case and we can see that in the second circumstance it is narrower than in the first.

From the feregoing observation we can now accept certain conclusions. (i) A tomographic plane is in fact a layer of some definite thickness. (ii) The thickness of the layer is not a constantin all circumstances. (iii) Increasing the angle of tube-swing decreases the thickness of the layer is again decreased. (iv) At shorter focus-film distance the thickness of the layer is again decreased. (v) When the distance between the layer and the film is great, the layer thinner than when it is near to rhe film. In practice both (iv) and (v) above may be disregarded as methods of controlling the thickness of the tomographic layer. Altering the distance between the selected layer and the film result in only small variation and the use of a short anode-film ditance in order to obtain a thinner cut would imply some loss of fine detail owing to increased geometric blur. We find,therefore , that satisfactory apparatus for tomographic includes a means of altering the angle throught which the X-ray tube moves, so that by extending or diminishing its excursing the requirments of particular examination. The ability to alter the thickness the layer which froms a sharp image is advantageos radiographically simply because there is not uniformity between the dimensions of different body structures. The thinner the layer which is sharp the more selective tomography becomes. It is un-necessary an not helpful for it to be highly selective in examination of the lung, for example; this is partly because the pulmonary lesion sought are not likely to be less than milimetres in extent and partly because contrast

diminishes with decreasing thickness of layer. In the inner ear, on the other hand, the structures to visualized are very small. It is necessry to able to look at a number of section placed not more than 2 mm apart;eah section is conseqeuntly required to be a very thin slice. We may notice at this point that profesional jargon sometimes refers to the layer which is sharp as acut: we say in tomography that we are intending to take a cut at a certain level to show certain structure. It is a useful short-hand but phrase should not employed without caution. A radiographer once explaining tomography to a student in the presence of a patient in the word and waited in a condition of understandable nerveous tension for the touch of the knife. The student may well ask what is the thickness of a layer in any particular tomographic examination. Its thickness is difficult to specify because there is no absolute standard for the measurement of sharpness : we cannot precisely define a boundary for the amount for blur which makes in image either sharp or unsharp. However, for practical porposes one may assume a certain limit and this enables asessment of layer thickness to be made. It varies-depending upon the sophistication of the apparatus and the operating condition-from a thicness of about 7mm down to0.7 mm.manufacturers publication about their equipment may include estimates of layer thicness in different circumstances and the student is advised to have a look at these: a knowledge of the layer thicness likely to be obtained in a particular set of condition is helpful in making the fullest use of specialized and costly machinery.

The tomographic movement

Movement is fundamental to tomography and we must now consider the effets inherent in it . The plane of movement ,its direction ,its speed and the length of the tube trajectory all influence the results obtained. THE PLANE OF MOVEMENT When earlier we said tomography requerid the x-ray and film to move equally in similar planes of opposite direction ,we depicted these planes as being parallel and harizontal. This is the simplest tomographic arrangement,though it is not the only one possibel .we will consider it a litte further in the section below . HARIZONTAL PLANES Figure II.8 illustrates movement of the x-ray tube and film in harizontal planes .the student should notice that at the extremities of travel the x-ray tube is rotated on its axis in order to obtain correct beam direction. Nevertheles the vertical heigt of the anode above the film represented by the line AF remains the same . it is evident

that the lines AAA (focal spot of the x-ray tube) and FFF ( film) are both parallel and harizontal. Let us now consider what is happening at the fulcrum Y. From thediagram it is tempting to imagine that the distance YF change ,being greater at the extremities of travel than when the tube is vertically above the film : this would imply alteration in the fulcrum-film (object film ) distance and consequently a blurring of the image due to inconstant magnification. In the same way the distance between the anode (A) and the fulcrum (Y) appear to alter. However, we should not be deceived by the appearance of the lines drawn through Y in the diagram. A harizontal plane through Y is always the same vertical distance above the film .the object plane is parallel to the film plane (image plane) and this is an esential condition to corret tomograpyh. Arcuate planes Although horizontal plane are easier to achieve mechanically ,tomograpyh has been described with apparatus which moves the x-ray tube and the film thougrh acrcs of circles.this is depectidin fig.II.9. it is obvious that in these circumstances the vertical distance between the fulcrum plane (through Y) and the film ( F2FF1) does in fact change,as also does the anode-film distance.We might expect from this an alteration in image manification .howefer , although the actual heights vary,certain ratios do not .we can say that AF/AY ,A1 F1/A1 Y and A2F2/A2Y are all equal .putting this in word,the ratio of anode film distance to anode fulcrum distance remains the same through tube and film travel .this constancy implies a constancy of image magnification and therefore no loss of sharp-ness from this cause is present.the student should note that though the films plane of movement is arcuate,the plane of the film it self is horizontal and reamains parallel to the selected tomographic plane. It is possibel that the student will meet apparatus which relies on a combination of the two movements described: the x-ray tube travel in an arc ,while the flim is moved on one horizontal line .in such equipment there is a theoretical failure . while anode film and fulcrum distance visibly and demonstrably vary, the fulcrum film distance does not . the important ratios are not constant and consequetly neither is the degree of magnification present in the image: the image is bound to be unsharp to some extent. However ,it is to be admitted that such equipment undoubtedly works.one may suppose that it does so because the human eye is not an accurate recording instrument and accepts as being sharp unsharpnesses within certain limits.