Académique Documents
Professionnel Documents
Culture Documents
and
Imaging for Technicians
Diagnostic Radiology
and
Imaging for Technicians
AN Shastri
M.Sc. (Physics) Nagpur University, Maharashtra, India
B.E. (Electrical Communications Engineering)
Indian Institute of Science, Bengaluru, India
Fellow of the Institute of Engineers (India),
Kolkata West Bengal, India
A.N. Shastri
Acknowledgements
1. Introduction .................................................................1
2. Nature and Properties of X-rays ............................4
3. Production of X-rays ............................................... 10
4. X-ray Interaction with Matter .............................. 15
5. Total Radiographic System .................................. 21
6. X-ray Tubes .............................................................. 54
7. X-ray Generators ..................................................... 79
8. X-ray Examination Units ..................................... 125
9. X-ray Image and Beam Limiting Devices ....... 143
10. Radiographic Materials and Processing
Teachnique ............................................................. 160
11. Requirement of Good Radiograph ................... 171
12. Image Intensifiers and Related Systems ........ 178
13. Angiography Techniques and Systems ........... 217
14. Tomography ........................................................... 233
15. Radiation Protection ............................................ 257
16. Bone Densitometry ............................................... 279
17. Digital Radiography ............................................. 285
Index .......................................................................... 295
1 Introduction
HISTORICAL BACKGROUND
The day of 8th November 1895 will be remembered as most
important event in the history of Medical Imaging. On this very
day, a new invention was made by a physicist, Wilhem Conrad
Roentgen, from University of Wurzburg, Bavaria, Germany. He
saw with his own eyes, a faint flickering greenish illumination upon
a bit of cardboard, painted over with fluorescent material in
carefully darkened room. In that room a Crooks tube was simulated
internally by sparks from induction coil, but carefully covered by
a shield of black cardboard. In the darkness, his eyes were watching
luminous phenomena. The rays emerging from Crooks Tube
penetrated cardboard shield, fell upon luminescent screen, thus
revealing their existence and making visible in darkness.
Illumination was seen on fluorescent screen due to these invisible
rays, the line of shadow across it. The source of these rays was
Crooks Tube. These invisible rays were found to have a very high
penetrating power. These rays penetrated cardboard, wood, and
cloth with ease, they would pass through thick plank or book,
lightning the fluorescent screen placed on the other side. It was
also observed that denser materials such as metals were lesser
penetrable. Same experiment was tried with humans and it was
observed that flesh was transparent and bones were opaque. The
discoverer interposed his hands between the source of rays and
luminescent screen, saw the bones of his hand as a shadow on the
screen.
These rays later on were named after their inventor, Roentgen and
also called X-rays. The first official lecture by Dr. Conrad Roentgen
On new kind of Rays was delivered on 23rd January 1896 in
Wurzburg Germany. Dr. Roentgen was awarded the Nobel Prize
for Physics in 1901. This was the most important milestone in the
history of medical imaging.
Max Gebbert an instrument mechanic and medical equipment
specialist, recognized the significance of this discovery and
launched along with Dr. Conrad Roentgen, Reineger and Schall
the first diagnostic equipment. Later Siemens Medical Engineering
Group company was formed, which introduced new X-ray
diagnostic equipments and tubes.
Introduction 3
3 Production of X-rays
We have seen that when fast moving electrons collide with matter
X-rays are produced. The most efficient means of generating
X-rays is X-ray tube. In X-ray tube fast moving electrons, emitted
by filament, with kinetic energy depending upon the accelerating
potential between Anode and Cathode, are suddenly stopped at
the anode which is also called the target. After striking the target
material the kinetic energy of Electrons is converted to heat (99%)
and radiant energy (1%).
The accelerating potential has direct relationship with penetrating
properties of X-ray radiation, higher the voltage more is the
penetration. Normal operating voltage in a diagnostic
X-ray tube is 25 kV to 150 kV.
This range is divided in following ranges:
Range Organs in the region
25 to 40 kV Mammography
40 to 55 kV Periphery (Limbs)
57 to 90 kV Torso (Chest and Abdomen)
Above 90 kV Skull (High kV Technique)
The X-ray tube has two electrodes namely Anode (Target) and
Cathode enhoused in glass housing evacuated by vacuum.
Penetration
If the quantum, while passing through matter, does not interact
with electron of the atom in matter, it will leave unharmed without
any change in direction. This phenomena is called penetration.
Example 1: Material of low density such as wood is not rich in
electrons. Hence there will be no interaction and most of primary
X-ray photons will penetrate through wooden sheet, resulting into
high penetration.
Example 2: Material of high density such as metal is rich in
electrons. Hence interaction with electrons and most of the X-ray
photons will encounter resistance for passing through such matter
and hence low penetration.
Scattered Radiation
There are three different means by which X-ray quantum can be
scattered based on bonding energies of orbiting electrons in atom
of matter.
16 Diagnostic Radiology and Imaging for Technicians
Absorption
Transfer of the total energy of primary quantum into energy other than
electromagnetic energy is called absorption.
(a) Effects described earlier does not always take place in pure form.
In photoelectric effect an electron is ejected from K shell, and if
its place is refilled by electron from L shell, it produces K
quantum. This K quantum in turn may liberate electron from
M shell. Vacancies of L and M shell have to be filled by L or L
and M radiation which in turn may be absorbed by similar
process. Hence the energy of primary quantum is absorbed totally.
This is absorption within structure of an atom.
(b) As described in (a) if K and other secondary radiation escapes
the atomic structure and their energy is absorbed in neighboring
atoms, this also can be considered as absorption due to transfer
of the energy within restricted volume of matter.
Magnitude of Absorption: If the material has higher density, more
will be the number of atoms in unit volume and if the material has
higher atomic number Z, it denotes the number of electrons
surrounding nucleus. Hence heavy material comprises of more
number of electrons in unit volume than lighter material and if
primary quantum encounters such heavy material all energy is
absorbed. Hence absorption increases with atomic number Z of the
material. This property is used for filtering the unwanted X-ray radiation
or Shielding of X-ray radiation in undesired direction.
Since X-ray photons cannot be focused or their path cannot be
altered and they are harmful to human tissues, the only way to
control the X-ray radiation to the desired area is by using proper
shielding.
Film density (blackening of film) obtained depends upon total
quanta which reach the film and is termed as quantity of radiation
or intensity (Refer properties of X-rays). The absorption coefficient
is proportional to the atomic number Z. Higher value of Z more is
the absorption. Hence to achieve proper shielding, material such
as steel or lead is used.
For X-ray diagnosis we require energies more than 40 kV. Hence for
X-ray photons below 40 kV are called soft X-rays and they do not
contribute to latent image on X-ray film. (Except in Mammography
applications where detection of breast cancer is done. Since the
X-ray Interaction with Matter 19
Major Subassemblies
(A) X-ray generator
The X-ray generator has three major components namely high
tension transformer with or without high tension rectifiers, filament
transformer and control console. The high tension transformer is a
step up transformer to increase the voltage to desired value from
line voltage to be applied across X-ray tube. The filament
transformer is a step down transformer because the filament
voltage is around 6 volts at current of several amperes. These both
transformers are enhoused in one assembly called HT transformer
assembly. The control console selects the desired voltages for
Total Radiographic System 25
I. Routine Diagnostics
They are X-ray Viewing Box, Developing tanks, Safe light in dark
room, Cassettes, Intensifying screens, Lead aprons, Lead protection
screens, Chest stands, Vertical bucky wall stand, etc.
X-ray Viewing Box: This is used for viewing X-ray film in radiology
department, wards, ICU, operation theatres. They are incorporating
minimum two tube lights housed in MS housing powder coated,
fitted with white acrylic sheet to reduce glare and provide uniform
illumination. Roller clips are provided to hold the film firmly.
Developing Tanks: A manual film processing unit comprising
thermostatically temperature controlled tank for developing, fixing
and washing (1 each) for developing of films of all sizes. The casing
is of robust material of mirror finish stainless steel of 316 grade.
26 Diagnostic Radiology and Imaging for Technicians
It has single welded joint in the body height of tank and polished
to avoid corrosion. All welding joints are fold pressed welded to
avoid leakage of chemicals used.
Safe light: This is used in darkroom. It incorporates low wattage
bulb with unbreakable plastic red colored filter, housed in metal
housing powder coated.
Cassettes: It is a container having a cover which is transparent to
X-ray beam and opaque to light in which film is loaded for
radiography. The unexposed films are loaded in dark room, taken
to main radiology room for exposing and later brought back to
dark room for developing the films. They are made of aluminum
for light weight. Four corners are connected with nonmetallic
construction to give protection covers. Lead protection spray is
given on the inside rear flap of the cassette to eliminate fog effect
on the X-ray film. High grade foam material is pasted inside to
give film a uniform contact with intensifying screen. The
recommended sizes are 17 14, 15 12, 12 10, 10 8,
5 7.
Intensifying screens: It is a layer of suitable material used in direct
radiography to intensify the action of incident X-ray radiation up
on a radiation sensitive emulsion. Depending upon type of film
used the suitable compatible intensifying screen is pasted in the
cassette. As discussed earlier the material used is any one of the
following:
Calcium Tungstate, Luminous Salts of Rare Earths(Gadolinium
Oxisulphide, Lanthanum Oxibromide, Yttrium Oxisulphide).
These chemicals are deposited by sedimentation process on
Polyester layer.
Lead apron: Coat type aprons and hand gloves fabricated from
multiple leaded vinyl fabric having lead equivalence of minimum
0.5 mm lead is used by radiologist during radiological studies to
protect from soft X-rays due to scattered radiation. Apron covers
from shoulder to knees. It is light weight, durable and provided
with waterproof cloth lining stitched on vinyl fabric. It is approved
by controlling agency like AERB.
I. Lead protection screen: It is a major radiation protection devices
used for safe guarding the technician standing near the control
console behind the lead protection screen, so that unnecessary
X-ray exposure is avoided. As the name implies, it uses 2 mm lead
Total Radiographic System 27
MARKET REQUIREMENTS
The development of Radiological System depends upon the need
of the end-user. Hence any product before introduction in market
is subjected to market study, which covers overall requirements of
the end-user such as features, applications, etc. The equipment is
designed and developed based on these inputs. Prototype unit is
produced by manufacturer, kept under field trial in the hospital
for few months. Further modifications to suit end-users
28 Diagnostic Radiology and Imaging for Technicians
The X-ray film is kept in the mouth by patient and the X-ray source
(tube head) moves around the jaw and complete jaw is exposed.
The exposure parameters are 9 to 16 mA, 60 to 90 kV with exposure
timing of 5 to 25 seconds.
The X-ray tube head incorporates stationary anode X-ray tube with
focal spot dimensions of 0.5 0.5 mm. This equipment requires
separate room due to its large size and radiation hazards.
Portable
These equipments are used when radiologist is visiting patient,
railway or road accidents, military base hospitals located in border
area. Under these conditions the dismantled unit can be transported
by rail or road or helicopter or parachute dropped and assembled
at site. They can be energized with AC mains or battery or with
Diesel Generators. Hence such equipment should be compact, light
weight, and should be so designed that interconnections between
different modules are made with simple plug in connectors in short
time. The mechanical assembly of the unit should also be simple
without usage of special tools. As regards the power supply
requirements these equipments can be energized by 240 volts,
50 Hz, 1 phase, 5/15 amperes power. If this supply is not available
then it could be switched on with alternate power supply of DG of
the capacity of 1.5 to 5 KVA. Normally this DG set is available at
accident site.
Mobile X-ray
Since this equipment is moved from one location to another
frequently during the normal working schedule of the hospital it
should be
# Easily maneuverable on ramps, between beds in wards, lifts,
plaster rooms and operation theatres. Hence width, weight and
height of this equipment should not exceed certain limits.
# Equipments should be able to produce radiographs with good
diagnostic information at 60 to 100 mA and 40 to 100 kV, with
power rating of approximately 3.5 KVA. These equipments are
energized on power socket of 240 volts, 50 Hz, 1 phase, 5/15
amperes available on these locations. Since the output power is
limited, shorter exposure times with larger tube currents could not
be achieved, hence thicker body parts and moving organs like heart,
kidneys could not be diagnosed thus limiting the diagnosis to
location of fractures.
32 Diagnostic Radiology and Imaging for Technicians
Advantages
1. Small, compact, light weight units can be easily maneuvered
through hospitals.
2. Charging of capacitor does not require special line, only
charging time is a function of line resistance.
3. Shorter exposure time is possible for radiographs of chest, lungs,
and small body parts, heart, thus ensuring radiographs with
enough information for proper diagnosis. It is most suitable
for usage in ICU, NICU, wards, OT.
34 Diagnostic Radiology and Imaging for Technicians
Disadvantages
Since we have a power source as charged capacitor bank, the output
is limited to 30 to 50 mAs at 40 to 100 kV. Hence it is inadequate for
heavy body parts like spine, abdomen, etc. Hence as long as short
exposure times are used, capacitor charge is maintained this unit
is appropriate for use in ICU, NICU, wards, operation theatres.
Disadvantages
1. The weight of the unit is increased due to batteries which may
hamper the maneuverability.
2. Periodic charging of batteries is required.
3. Maintenance of batteries is required.
4. Batteries have limited working life, hence replacement cost is
to be taken into consideration.
Recently the High Frequency Multi-pulse X-ray generators have been
introduced in the market. They overcome all the above mentioned
disadvantages and have replaced both capacitor discharge and
battery powered X-ray units. These generators are covered under
chapter Modern X-ray Generators.
Now we discuss the stationary equipments which are not intended
to be moved.
Bucky Table. From figure 5.14, one can conclude that points A and
B in patient are exposed and cast a shadow on image plane
(Cassette) as A1, B1 in position 1 of cassette and A2, B2 in other
extreme position of the cassette. While as Point C does not cast a
shadow on the film loaded in cassette tray. This arrangement
ensures blurring of the patient organ beyond planigraphy plane.
Thus resulting information on the film cassette for correct
radiograph of the desired plane to locate the tumor in that plane.
Series of such planigraphy examinations are carried out with
different position of planigraphy plane, by adjusting layer height
adjustment, to assess the exact size and location of tumor in patients
body.
Modified version of planigraphy is Tomography. Planigraphy
examination is restricted to one plane while tomography is at
various angular projections due to movement of X-ray tube and
Image plane in arc. This subject is dealt in detail in chapter
Computer Tomography.
Applications:
A. GI Track studies with R/F tables,
B. Mobile C-Arm Image Intensifiers for Surgery in Orthopedics,
PCNL and URS procedures in urology, Pacemaker implantation
(Fig. 5.15).
C. Angiography Systems.
This subject is dealt in detail in chapter Image Intensifiers.
9. Angiography Systems
The word angio is a greek word meaning blood and graphy is to
measure the flow. Since the blood is translucent to X-ray photons,
contrast medium is added to blood, so that blood will become
opaque to X-rays. Thus angiography is visualization of blood
vessels by injecting contrast medium solution in bloodstream and
capture the flow on film, the diagnostically important phases of
Total Radiographic System 45
INFRASTRUCTURAL REQUIREMENTS
We have seen various types of radiological systems. Their
performance and final image quality can be guaranteed provided
proper infrastructure requirements are provided. If adequate
attention to infrastructure is not provided, it will result into
malfunctioning of the equipment and poor image quality. These
requirements are electric power, space, water connection for
darkroom, air conditioning, Humidity and Temperature control,
etc.
The most important is Electric Power. The electric power generated
in power plant is transmitted by transmission lines and distributed
to the locality with three phase step down transformer and made
Total Radiographic System 47
list which should be kept on round the clock for any emergency.
The switch over from mains to DG set should take place
automatically with the help of electronic circuitry so that process
oriented equipments will not have any interruption of power
supply. The DG set should have specifications as per BIS 4722. In
case the equipment requires voltage stabilizer or UPS (uninter-
rupted power supply) same should be provided in consultation
with vendor and should be planned along with installation of the
equipment.
Earthing
As per electrical rules, metallic components which do not form
part of the operating circuit of installations and equipments
operating at rated voltage above 1 kV, should be earthed if they
are likely to come into contact as a result of faults or arcing with
components which are at high voltage. There are 2 classifications
namely.
Protective Earthing
It is direct earthing of a conducting component of a machine or
installation which does not form a part of the operating circuit, in
order to protect a personnel from a dangerous voltage, under fault
conditions. For example Metal Housing of assembly such as Control
Console, X-ray Motor operated Table and X-ray tube shield.
System Earthing
It is the earthing of an installation of an installation component,
forming part of the operating circuit. For example earthing of the
high voltage windings of voltage transformers which can be
undertaken at the protective earthing device of their frames or
tanks.
Following steps must be taken.
1. All exposed metal parts of X-ray equipment should be properly
earthed.
2. Proper marking of earthing terminal of the equipment as per
BIS 2032 should be followed and the earthing conductor
terminated on equipment must have green color.
50 Diagnostic Radiology and Imaging for Technicians
Space Requirement
One should assess the amount of floor space required for the
equipment in terms of length, breadth, height, peripheral area, any
other equipments required in conjunction with the main equipment
and its space requirement, weight, etc. before finalizing on
equipment. One should also have specific plan for location of the
equipment, its layout for radiation protection. The vendors, if asked,
will provide the desired information in terms of prerequisites for
installation. After receiving this information one can arrive at a
conclusion whether all requirements have been taken into account
during planning at the proposed site. Many times the room requires
certain alterations and then civil work is involved.
Civil Work
Depending upon the check list and installation drawings given by
vendor the civil engineering department can suggest alterations
to suit the site plan. Since these equipments fall under radiation
equipments, Atomic Energy Regulatory Board (AERB), the
controlling authority in radiation protection in India, have issued
certain guidelines to be adhered failing which approval from AERB
would be a problem and the persons present during examination
52 Diagnostic Radiology and Imaging for Technicians
Fig. 5.17: Recommended layout plan for motor operated R/F system
Note:
1. Lead protection screen of 1.5 mm lead equivalence with viewing
window of lead glass with 1.5 mm lead equivalence.
2. Window or ventilator at a height of six feet from finished floor level.
3. Entrance door lead lined with 1 mm of lead sheet with proper
overlapping at all joints.
4. Wall of 9 thickness of brick and ceiling 15 cm of concrete at a height
of 3 meters from floor leel.
5. All interconnections between X-ray tube, console and table concealed.
Total Radiographic System 53
Water Connection
In order that the dark room should function trouble free, a
continuous water supply is required in dark room.
6 X-ray Tubes
Note: The apparent (effective) focal spot is smaller in size than actual
focal spot and depends on size of filament (a) and anode angle
Fig. 6.2: Line focus principle
56 Diagnostic Radiology and Imaging for Technicians
It can be seen that apparent focal spot, which decides the blur or
geometrical unsharpness, is much smaller than actual focal spot,
area on which the primary electrons from filament are striking. Hence
the actual focal spot determine the tube ratings and optical focal
spot determine the geometric unsharpness or image quality.
Table 6.1: Size of Image at different anode angles keeping FFD constant
Anode
We now discuss the design of Target of the X-ray tube. It is noticed
that higher the atomic number of the target material, better is the
efficiency of generation of X-rays. Moreover, since the heat generation
is about 99%, we require the target with higher melting point. Hence
the choice is Tungsten, which has atomic number as 74 and melting
point of 3600 degrees Kelvin.
There are two types of X-ray tubes namely Stationary Anode and Rotating
Anode type.
Stationary Anode X-ray Tube (Fig. 6.5): In this tube anode is
stationary. The Tungsten target material is made up of inch square
as an anode face at the center of the tube embedded in copper stem
so that heat generated can be transferred to the surroundings most
efficiently. The target of tungsten is subject to bombardment of stream
of electrons.
Cathode
The Cathode consists of pure tungsten filament wire (directly heated
cathode) in the form of coil of 1/8th inch in diameter and inch
long, set in cup shaped holder called Focusing Cup. Focusing
cup support extends outside the tube assembly for appropriate
connections of filament leads. The filament is heated to desired
The limitations of stationary anode X-ray tube arises from the melting
of tungsten forming the focal spot. If this small piece of tungsten
embedded in copper to form a stationary anode is replaced by a disc
of tungsten, free to rotate such that edge of the disc is placed opposite
to cathode, large loading per unit of focal area can be achieved.
These type of tubes are called Rotating Anode Tubes.
Rotating anode assembly: This consists of Target disc and rotor body.
Target Angle
It has bearing on rating of tube and field of coverage. Reduction in
target angle will reduce the optical focal spot size and increase tube
loading but will reduce the field size or cone of radiation. Hence one
must be prepared to sacrifice the field size coverage if the target
angle is reduced. We have already discussed the line focus principle
and Heel Effect. Smaller the target angle more predominant will be
Heel Effect.
Design of Filament
The filament is housed in filament cup made of nickel with
mechanical slots for exact placement of filament. The contour and
exact location of slots, size and placement of filament in cup, spacing
between anode and cathode will result in to the stream of electrons
and finally the area of bombardment on anode, thus eventually
determine the focal spot size. Filament is manufactured as spiral,
coiled coil winding of fine tungsten wire. The diameter of wire
forming spiral into cylindrical shape will give large surface area for
emission of electrons. The size (gauge) of wire, pitch and number of
X-ray Tubes 67
In Biangulix design the filaments are placed in one line so that there
are two focal tracks for F1 and F2 (Fig. 6.8B). This ensures lesser
wear and tear of the focal track, so that such tubes could be used for
higher loading (30/50 KW), for over couch radiography.
Effect of focusing cup: As discussed earlier the placement of filament
coil inside the cup has major effect on stream of electrons. (Figure
6.6). If it is deep inside the cup or almost above the filament cup the
electrical lines of force will not be parallel resulting in convergent or
divergent beam of electrons respectively, which is not desired. If the
filament cup is kept at negative potential with respect to filament,
focused electrical field is obtained giving narrow beam of electrons.
This technique is used in fine focus tubes. In case of grid controlled
tubes a negative voltage of the order of 2.4 kV is applied to the filament
cup. Due to presence of this negative voltage, electron cloud (space
charge) is formed near the filament cup. If a high positive voltage is
applied for required duration in terms of pulses, this will nullify the
negative voltage and allow the electrons to flow towards anode. The
exposure time is decided by the pulse width. This technique was
initially used in angiography equipments. But there is engineering
limitations to supply negative voltage to the cup. For this purpose
we required four wire connection (Common, small, large and grid)
and better insulation between grid and other three conductors. Since
these connections are made by High Tension cables, which are
subjected to mechanical stress due to positioning of the tube, these
cables were more failure prone and later withdrawn from the supply.
(for details refer chapter on X-ray generators).
Filament Characteristics
The filament characteristics for each focus is plotted indicating the
tube current on Y axis and filament current on X axis for different
voltages between anode and cathode. Higher the tube voltage more
number of electrons will be attracted towards anode overcoming
space charge resulting higher tube current. Hence in order to obtain
100 mA tube current at 40 kV, we require higher filament voltage as
that compared to the tube voltage of 100 kV (effect of space charge).
Hence for different tube voltages, the manufacturer of X-ray tubes
gives different curves in one chart. These characteristics are almost
parallel to Y axis if the filament current is higher. At such operating
point on the characteristics one has to be very careful not to exceed
the limits, otherwise tube filament may blow up resulting into major
breakdown which will turn out to be very costly. The cost of X-ray
tube is almost 30 % of the total cost of system.
Stator Windings
A two pole induction motor is incorporated for rotating the anode
using rotor as metal cylinder in tube insert and stator winding close
to glass envelope just outside. Stator serves a function of armature
coil of induction motor. It has two coils and hence three leads for
common (O) and winding I and winding II. The stator winding is
energized by power supply from control console.
Shield
The tube insert along with stator windings is assembled in housing
called shield. This housing provides shielding against radiation
and electrical high voltages applied to tube. It is made of aluminum
with internally lead lined from all sides for radiation protection
except ray port from where X-ray radiation is allowed to pass towards
patient. Hence location of focal spot with respect to ray port is
extremely important.
Both filaments are energized through secondary of filament
transformer with connection to cathode receptacle by three core high
tension cable. The three leads are common, large and small focus.
(In case of grid controlled tube the receptacle will have four terminals
one for the grid). The anode connection is made to anode receptacle.
In earlier days anode and cathode receptacles were having separate
72 Diagnostic Radiology and Imaging for Technicians
total anode heat storage capacity, the amount of heat units pumped
in with each examination and the cooling time between the pause.
For easier calculations one should refer to the tube characteristics.
If there is increase in radiographic parameters such as kV, mAs,
fluoroscopic mA and time, the anode heat capacity could be exceeded
resulting permanent damage to X-ray tube.
Filtration
The standards are set by ICRP and as per IEC 407 (1974) recommends
filtration should be more than or equal to
1.5 mm aluminum equivalent for tubes operating up to 70 kV (dental)
2.0 mm aluminum equivalent for tubes operating between 70 to
110 kV.
2.5 mm aluminum equivalent for tubes operating beyond 110 kV.
Hence X-ray tube units working up to 125 kV including shield should
have minimum total filtration of 2.5 mm Aluminum equivalent. In
case filtration offered by glass envelope and oil column is not
sufficient to reach this minimum value, additional filter is added at
X-ray shield ray port to obtain filtration > 2.5 mm aluminum
X-ray Tubes 75
Under such conditions either the glass to metal seal may crack
making tube gassy or anode will not rotate at desired speed
resulting in further damage to anode disc.
Housing or Shield
Oil plays important part in receiving the heat by convection from
tube insert to the shield. It is also used as insulating media. If the oil
is overheated then it may break down which will result in inferior
insulating properties of oil and flashing inside the shield. This arcing
may destroy the tube. This can be noticed by looking into the ray
port for the quality of oil. Due to Heel Effect cathode side of the tube
gets more X-ray radiation. This radiation when falls on cathode
socket, it ionizes the media, subjecting to insulation failure and
cracking of socket housing. Hence the socket is designed to withstand
higher voltage than rated voltage. This failure can be noticed by
noticing overheating of the socket terminal. In case of failure of socket,
it should be immediately replaced.
Filament: The major fault is opening of filament. This failure can be
due to excessive heating due to higher currents. Hence the design
and wiring of filament circuit is very important especially to cater to
mains voltage fluctuations. Normally a Voltage Stabilizer is
incorporated in filament circuit. This subject is dealt in detail in
control wiring in X-ray generator.
Another cause could be filament, in heated condition, is subjected to
vibrations caused by movement of tube head such as tilting of table
or planigraphy examination. Under these circumstances, the filament
vibrates and may short few turns resulting in offering different
resistance to power supply voltage which leads to excessive current
and opening the filament.
If the filament is boosted often, then tungsten evaporates and deposits
on glass wall. It reduces resistance of filament resulting in excessive
currents. Normally it is small focus filament is subjected to such
failures.
Hence care should be taken to avoid vibrations. If they are noticed,
immediate remedial measures should be adapted.
78 Diagnostic Radiology and Imaging for Technicians
for desired time. This appropriate supply is for (a) high tension voltage
across X-ray tube (b) filament voltage for emission of electrons to obtain
desired tube current and desired time for switching primary voltage for
desired time. The major parameters are KV, mA and seconds.
Major function of generator are:
(A) To protect X-ray tube from overloading.
(B) Warming up X-ray tube for radiographyAcceleration of
rotating anodeBoosting of filament voltage
(C) Selection of tube, focus and auxiliary equipment
(D) Setting parameters within tube limits by utilizing blocking
circuits.
(E) Responding signals from auxiliary equipment.
(F) Power supply.
In this case the X-rays are generated in positive half of ac cycle. But
when the tube conducts due to its internal impedance, the voltage
across X-ray tube is lower in absolute value as compared to voltage
in negative half cycle. Now let us say that we are using DSA-2
tube with maximum anode voltage of 100 kV. Thus if the positive
half of the cycle is generating 100 kV across the tube, then during
negative half of the cycle, since the tube does not conduct in
negative half, the voltage across tube will be higher than 100 kV. If
it is more than maximum inverse voltage, the tube will get
damaged. The electrons emitted by filament are attracted back to
filament during negative half cycle and due to high voltage they
acquire kinetic energy large enough to damage filament structure
which is not designed for this purpose. This phenomena is known
as Backfire.
In order to prevent backfire, modification in HT primary circuit is
carried out known as Inverse Voltage Suppressor Circuit. It
comprises of a rectifier and resistor connected in parallel introduced
in high tension primary circuit. The diode conducts in positive half
of cycle offering negligible resistance thus generating true ac voltage
across the primary winding of HT transformer. In the negative
half, the diode offers infinite resistance and resistance in parallel
to diode plays important role in feeding voltage to primary in such
a way that this negative voltage is lesser in amplitude than that in
the positive half. The value of resistor is chosen accordingly.
Although this circuit introduces distortion in primary circuit it is
acceptable than producing the negative high voltage and damaging
the tube.
Windings
The coils are wound on bobbin made of bakelite or plastic molded
material having good insulation properties. These windings are
also in stepped shape (Fig. 7.10). The layer close to core is having
maximum number of turns and the layer away from core is having
lesser number of turns so that insulation level is built up along
with voltage resulting outermost layer having highest voltage and
will be at a maximum distance from core.
The spacing between the core and bobbin and between winding
and sides of bobbin are not filled up with insulation. When
transformer is impregnated in oil, the oil column fills up this
spacing and offers better insulation. These coils are wound on high
X-ray Generators 93
2. FILAMENT TRANSFORMER
The filament transformer is a step down transformer with primary
energized with almost line voltage and the step down ratio depends
on the desired filament voltage on load decided by tube ratings.
Since the secondary voltage is low, but the current is high, a special
X-ray Generators 95
Since the X-ray tube is high voltage diode, certain precautions are
taken to safeguard its working such as 3 to 5 seconds warming up
time of filament from cold condition to maximum value. The time
required from switching over from fluoroscopy to radiography,
boosting time, is around 1 second (Fig. 7.14). Hence filament should
be kept in warmed up state, when the filament of tube is selected
so that, preparation time is reduced.
Rotating anode tube is normally twin foci, and only one filament
at a time is used depending on applications and requirement of
end user (geometric and movement unsharpness). Hence there are
two types of filament heating namely Standby and Fluoroscopic
heating.
Standby heating serves as warm up and it is below the threshold
of emission. Filament temperature is too low to liberate electrons
even if maximum kV is applied to tube. Filament is heated to such
a level that when this level is exceeded, it will start emitting
electrons. Hence it is ensured that filament is warmed up and
energizing of tube in cold condition is avoided. If the fluoroscopic
examination is to be performed, the filament is heated for higher
temperature above that of threshold of emission (Fig. 7.15).
After application of desired fluoroscopic kV, electrons are
accelerated towards anode resulting in fluoroscopic current, which
can be varied depending on brightness desired on fluorescent
screen. Since the requirement of fluoroscopic current is not more
than 4 mA in twin focus tube normally small focus is used for this
examination for obtaining minimum geometric blurring.
During fluoroscopic examination if the radiologist discovers some
X-ray Generators 101
6. FILAMENT CIRCUIT
The filament of X-ray is energized through the filament
transformer. In case of single tank generator, due to proximity of
filament transformer with X-ray tube, direct connection is made,
but in case of dual focus tube used for higher power output system,
connection is made through high voltage cable. In a table below
radiography is performed on large focus.
102 Diagnostic Radiology and Imaging for Technicians
voltage for filament, thus reducing tube current. This further results
in lesser load on mains and increase in tube voltage. Hence
stabilization of tube voltage is not achieved which in turn may
affect the image quality.
Introducing additional pumping voltage during exposure to
encounter the drop in voltage during exposure overcomes
used for preheating and basic heating. The large focus is kept at
standby heating and small focus is kept at preheating voltages.
The voltage for radiography is kept at higher value around 220
volts for boosting. These voltages vary as per length of HT cables.
These voltages are fed to filaments through transformers T3/T4,
relay contacts and filament dropping resistors. For fluoroscopy T3
is energized through resistor R fluo. When fluoroscopic relay is on
and the relay contacts are opened up. T4 is energized through
resistor RLF for basic heating. Relay fr is not energized and supply
to T3/T4 is made through normally closed contact of relay fr.
During boosting stage relay fr is energized and the normally closed
contacts of fr open and normally open contacts close. As per
selection of focus small or large, transformer T3 or T4 is energized.
Stabilized power supply to filament gives constant potential to
filament enabling the fixed number of electrons emitted from
filament. Now the anode voltage variation is from 40 to 125 kV.
This results in different tube currents at different voltage settings
due to space charge cloud near filament. In order to overcome this,
a variable resistor is introduced in series with filament resistor
called Space charge resistor, whose value is minimum at lowest kV
and maximum at highest kV, thus ensuring the filament primary
current to be constant. Since it is difficult to achieve resistor values
for all kV steps the kV steps are grouped together for some steps
such as 40 to 55 kV resistor value Space Charge Resistor SR1, 57 to
66 kV resistor value Space Charge Resistor SR2 and so on.
Techniques
Isowatt Technique
If the power given to X-ray tube is constant throughout the kV
range, then this technique is known as ISOWATT technique. It is
used in single pulse mobile units, wherein as the kV value increases
the tube current decreases in the same order to maintain the same
power.
Example: 50 mA@50 kV, 44 mA@56 kV, 37 mA@67 kV, 31 mA@81
kV, 25 mA@100 kV
Register Technique
The tube current is kept constant during the exposure for different
values of kV. In order to preselect quantity of X-ray or mAs value,
106 Diagnostic Radiology and Imaging for Technicians
8. TIMER
It is a device which controls duration of HT supply to X-ray tube.
There are two basic methods of switching X-ray generator ON and
OFF. Each one has its advantages, but major difference is in method
of switching or connecting high voltage to X-ray tube. These are
Primary switching and Secondary switching depending on the
location of switching mechanism. In primary switching, generator
switches the HT primary voltage On and Off applied to X-ray tube
112 Diagnostic Radiology and Imaging for Technicians
Primary Switching
In this case the operating voltages are line voltages. Operating
devices at these low voltages are much cheaper and safer to service.
Since the power handling is in KW, the current rating is very high
of the order of 200 to 300 Amperes depending on the transformer
ratio. Hence the stepwise switching is adopted. Stepwise switching
HT primary by means of Pre-contact through a damping resistor
(Fig. 7.22).
One set of contacts are extended and second set is normal contacts.
The extended contacts close earlier and open later than normal
contacts so that voltage applied to HT transformer primary through
resistor and will have smaller amplitude due to drop in resistor.
When the normal contacts close full voltage will be applied to HT
primary. It is advised that switching on and off of these contacts
should be carried out at zero crossing of ac cycle. Since the voltage
at zero crossing is minimum, there is no current drawn and arcing
at contacts do not take place during breaking or making of contacts.
Thus it ensures that there are no surges and this method enhances
the life of contacts. This is also called synchronous switching. In
this case the exposure timings are multiples of 10 milliseconds for
50 Hz supply frequency.
There are various devices used to switch HT primary such as
electromagnetic contactors (power relays), thyratrons, silicon
controlled rectifiers (SCR).
Electromagnetic contactors: The coil of the relay or contactor is
energized with required voltage allowing plunger to move,
enabling the spring loaded contacts to change their position against
spring tension. (Normally open contacts close and normally closed
contacts open). When voltage to coil is removed the reverse action
takes place due to spring tension and contacts are brought back to
their original state. The coil is rated in voltage or ampere-turns. If
power supplied is below their rating, contacts bounce while closing.
This is known as chattering of relay. This results in inconsistent
working and charring or pitting of contacts. In order to avoid
chattering, circuit design incorporates resistors in series to limit
the current and capacitors in parallel of the coil. In order to enhance
life of switching mechanism, contacts should be checked, cleaned
from carbon deposits by conducting regular maintenance. Most of
the conventional X-ray generators use electromagnetic contactors
for switching of exposure.
Thyratrons: They are gas filled triodes and are used as electronic
switches. Once the triode conducts, due to ionization of gas inside
glass envelope, it offers minimum dynamic impedance and acts as
short between anode and cathode. Thus grid looses control after it
starts conducting. The only way to switch off triode is by removing
the anode to cathode voltage. This device is now replaced by SCR
because of its inherent drawbacks such as large size, high cost, low
life, high power consumption and high maintenance.
Secondary Switching
In secondary switching the HT transformer is energized and HT
secondary voltage is rectified and fed to X-ray tube. There are two
methods of secondary switching namely with grid controlled tube
and use of constant potential generator.
X-ray Generators 115
Interrogation Time
It is the time required for generator to react to given impulse and
is calculated as time interval between triggering of exposure to
start of exposure. This time depends on phase in time for zero
phasing 10 milliseconds, the delay in pick up of relay system or
switching mechanism. In the conventional X-ray generators using
electromagnetic contactors it was of the order of 50 milliseconds
and has special importance in serial exposure technique called
Serialography.
The three terminals of the stator coil brought out on the anode side
are marked as I, II, O. The control circuit must ensure that, between
O and II terminals 220V-5.0 A is present at the time of starting and
50V-1.2 A after 0.8 seconds. The time 0.8 seconds is minimum time
required to gain maximum speed as specified by manufacturer.
This delay is incorporated in designing the rotating anode circuit
and it is normally kept more than 1.0 second. The values indicated
here will change from design of the tube stator windings and may
vary for different tubes.
Compactness
The conventional X-ray generator directly processes the power line
voltage and feeds the same to transformer with line frequency of
50 Hz. In HF generator the high voltage is fed with a considerably
high frequency up to 14 kHz. Voltage is proportional to product of
frequency, number of turns, cross-sectional area of the core. If the
frequency is increased the cross-sectional area can be decreased in
same proportion. This is given by formula as follows.
Voltage U = (4.14). (f). (A). (N)
Where f = frequency
A = Cross-sectional area
N = Number of turns
This drastically reduces transformer core size and windings
resulting in compact construction and lower weight. Thus this
technology has major advantage in saving space in stationary units
and easy mobility in mobile units.
X-ray
8 Examination Units
1. Dental X-ray
Features and use: X-ray unit for intra oral radiography, organ
program preferred, single tank generator mounted on spring
counterpoised articulated arm, complete system wall mounted or
on mobile column base could be maneuvered around dental chair
with locking facility for mobile base, supplied with exposure release
switch and dental cone.
Specifications:
Single tank 1.2 KW X-ray generator with
Radiographic output: 70 kV @ 7 mA
Exposure time: 0.03 to 3.2 seconds
Stationary anode X-ray tube with focal spot of 0.8 m 0.8 mm
(IEC 336)
Rotation of tube head: 270 degrees in vertical and 360 degrees in
horizontal plane
Exposure release switch: Two step switch with coiled cable with
3 m length.
Total filtration : > 2 mm Al.
Source image distance (SID): 200 mm
Mains supply: 190 to 260 volts, 1 phase, 50 Hz, 0.9 ohms
Accessories:
Beam limiting device: 20 cm cone
Safety standards: BIS 13709 or equivalent
2. Orthopantograph
Features and use: Stationary X-ray unit for ortho radial tomography
of the whole jaw region incorporating single tank X-ray generator.
Motor operated movement of tube head as per geometry of the
jaw.
Specifications:
Single tank multi pulse 3 KW X-ray generator with
Radiographic output:
Radiographic kV : 60-90 kV
Radiographic mA : 9-16 mA
Exposure time: 5 to 25 seconds
Exposure release switch: Two step switch with coiled cable with
3 m length
128 Diagnostic Radiology and Imaging for Technicians
3. Portable Equipment
Features and use: It is an equipment intended to be moved from one
location to another while used or between period of use while being
carried by one or two persons. Portable X-ray is an equipment
which can be dismantled in various subassemblies and carried in
any transportable vehicle to the destination and assembled to take
radiograph. These are used when radiologist is visiting patient,
railway or road accidents, military base hospitals located in border
area. Under these conditions the dismantled unit can be transported
by rail or road or helicopter or parachute dropped and assembled
at site.
Specifications
mAs range: 0.12 to 150
Exposure time: 0.1 to 5 seconds
Stationary anode X-ray tube with focal spot of 1.8 1.8 mm
Rotation of tube head : 270 degrees in vertical and 360
degrees in horizontal plane
Exposure release switch : Two step switch with coiled cable
with 3 m length
Power supply : 190 to 260 volts, 1 phase, 50 Hz, 0.9
ohms mains or battery or DG set
Number of modules : Maximum 3 namely stand, control
console and X-ray tube head
Interconnections between modules preferably plug in type to save
time.
Total weight : not more than 25 kg.
Safety standards: BIS 7620 Part III or AERB safety code or
equivalent.
4. Mobile Equipment
Features and use: It is an equipment intended to be moved from one
location to another while supported by its own wheels without
dismantling. It should be able to reach the patient in ward, OT,
ICU, enter in standard lift and narrow passages. The parking of
tube head during transportation from one ward to another, should
facilitate easy mobility preferably at lower height, ensuring safety
when moving around corners, negotiating bends, and ramps. The
output of the generator should not affect due to mains voltage
fluctuations preferably incorporating high frequency multi-pulse
technique. The tube head should be compact, single tank to
maneuver for under coach position below patients bed or under
operation table.
Specifications
Single tank X-ray generator with
Radiographic output of 2.5 KW (preferably multi-pulse)
Kv range 40 to 100 kV incorporating Stationary anode X-ray tube
Tube current mA range from 15 to 60 mA
mAs range from 0.3 to 200 mAs
Exposure time from 20 ms to 5 seconds
Parameter display: Digital display of kV and mAs
Exposure release: Two step switch with coiled cable with 3 m length
Rotation of tube head: Along the axis 180 degrees/15 degrees
Collimator: Light beam type (Halogen lamp with automatic switch
off preferred)
FFD: 40 to 190 cm
Cassette box: To accommodate at least 8 cassettes.
Dimensions: 60 150 140 cm (W H L)
Weight: 130 kg
Mains supply: 195 to 265 volts, single phase, 50 Hz, @ mains
resistance 0.6 ohms.
Safety standards: BIS 7620 Part III or AERB safety code or
equivalent.
skull, peripheries and spine. Bucky Table with floating table top
(both longitudinal and transverse movements) with electro-
magnetic brakes enables patient shifting and positioning easier.
Floor to ceiling column stand, incorporating twin focus rotating
anode X-ray tube on cross arm, powered by 10 to 24 KW two-pulse
generator and chest stand completes the radiographic system.
Bucky is a device for supporting and imparting motion to X-ray
grid.
Specifications
Bucky table with floating table top:
Table height 75 cm from floor; Table top dimensions 240 75 cm
Table top travel: Longitudinal +/ 55 cm
Transverse +/ 12 cm
Table top film distance 6.5 cm
Bucky travel longitudinal +/ 20 cm
Grid 10:1, 40 lines per cm
Cassette tray to accommodate 5" 7" to 14" 17" cassettes
Floor to ceiling Column stand: Fully counterbalanced
Focus floor distance:17cm (min), 180 cm (max)
Travel: Horizontal 290 cm, Transverse 83 cm,
Tube arm swivel 0 to 180 degrees,
Tube head swivel 0 to 205 degrees
Chest stand: Wall or floor mounted, Cassette tray height adjustable
with vertical movement approximately 2" with facility to lock
cassette compatible for 5" 7" to 14" 17" size.
Vertical bucky wall stand: Wall or floor mounted, cassette tray height
adjustable with vertical movement approximately 54 to 165 cm
with facility to lock cassette compatible for 5" 7" to 14" 17" size.
Additionally it incorporates Bucky with the grid, with self centering
plate marked for cassette and measuring position. It is used for
taking Radiographs for chest, spine with catapult bucky using
cassettes upto 14"17". Handgrips are provided for patient support.
HT cables: 1 pair of length 8 m each with sleevings and angles
X-ray tube: DRA-1, 125/20/40
132 Diagnostic Radiology and Imaging for Technicians
X-Ray generator:
Examination units 3 3
Safety standards: BIS 7620 Part III or AERB safety code or equivalent
5. Hand Operated Equipment for Radiography/Fluoroscopy
Features and use: Diagnostic unit for health centers, general and
cottage hospitals. These units are used for conventional fluoroscopy
and radiography for standing, sitting, or recumbent patients for
over table, under table and teleradiography. It consists of hand
operated multi position radio transparent table with fluorescent
screen assembly and cassette parking facility (SFD), floor to ceiling
stand, chest stand. HT cables (in case of Rotating anode tube).
X-ray tube, and 24 KW generator.
Specifications:
Hand operated table: Multi position table with SFD.
Table parking at 90 (vertical), 75, 30, O (horizontal), and 12
(trendelenberg) degrees.
Table top height: 80 cm; Table top dimensions: Length 194 cm,
width 60 cm
Tube screen distance 90 cm
Spot Film Device grid 6/40 (FFD = 70 cm)
Light beam collimator
X-ray Examination Units 133
Vertical bucky wall stand: Wall or floor mounted, cassette tray height
adjustable with vertical movement approximately 54 to 165 cm
with facility to lock cassette compatible for 5" 7" to 14" 17" size.
Additionally it incorporates Bucky, with the grid with self centering
plate marked for cassette and measuring position. It is used for
taking Radiographs for chest, spine with catapult bucky using
cassettes upto 14" 17". Handgrips are provided for patient
support.
HT cables:1 pair of length 8 m each with sleevings and angles.
X-ray tube: DRA-1, 125/20/40
Safety standards: BIS 7620 Part III or AERB safety code or equivalent
7. Image Intensifier Television Equipments
(A) For GI Studies
Features and use: GI track studies with R/F tables, and angiography
systems. With Automatic gain control, circular blanking, last image
hold, image reversal for both horizontally and vertically.
Specifications:
Nominal entrance field 230 mm,
Useful field 215 mm
1st zoom 170 mm
2nd zoom 130 mm
Output window diameter 25 mm
X-ray Examination Units 137
Weight of assembly 30 kg
Power supply 27 V DC/0.6 A
CCD camera: interline transfer
CCD sensor size: 752 582 pixels
Video output: 1 volt pp composite video
Video standard: 625 lines interlaced (CCIR) 50 Hz
9. Mammography Equipment
Features and use: It is used for detecting breast tumors by using soft
radiation. Unit constitute of mammography stand provided for
mammography in standing, sitting position with compression
device and biopsy attachment.
Specifications:
X-ray generator: Mono tank multi pulse high frequency 4 KW
Radiographic Ratings:
Radiographic kV 25 to 35 kV(steps of 1 kV)
mAs range : 2 to 560 mAs (mAs mode)
Dual focus X-ray tube: P40Mo, Rotating anode at 8400 rpm
Heat units: 1500,000.
Focal spot dimensions : 0.15/0.3 (IEC 336)
Magnification factor: 1.5 or 1.8
Stand with motorized height adjustment 650 to 1350 mm from floor
to object
Swivel angle: + 135 to 180 degrees
Motorized rotation of swivel arm, isocentric
Source image distance (SID): 65 cm
Film format: 18 24 or 24 30 cm
Reciprocating grid: Pb 4/27
Compression force 200N maximum
Accessories:
Compression Plate: 18 24 cm
Object Table: 24 30 cm
Spot compression plate
Axilla compression plate
Biopsy attachment with Shadow Cross
X-ray Examination Units 139
2. Warranty
It means that vendor will repair the equipment for a specified time
at no cost to the purchaser. Normally the warranty period starts
from date of acceptance by end user. Since the vendor wants a
satisfied customer to add to his list for future sale of his equipments,
he may extend free service for period more than warranty. But if
customer is non cooperative he may not extend this period. One of
the major problem arises, when end user is not satisfied with the
performance of the equipment. This arises due to poor performance
140 Diagnostic Radiology and Imaging for Technicians
3. Delivery Period
Purchaser should plan out when the delivery should be made by
vendor, based on point 1. Delays in delivery will cause idle
manpower in the radiology department and unnecessary incurring
higher cost without revenue.
4. Methods of Payment
Normally vendor demands certain percentage of payment as
advance at the time of booking the order. Purchaser will make the
remaining payment after the completion of installation, inspection
and handing over the equipment to end user. Sometimes the
purchaser holds back some percentage of payment for performance
guarantee during warranty period and releases this payment after
warranty period is completed without any major breakdown. In
case major breakdown takes place the warranty period is extended.
X-ray Examination Units 141
5. Service Contract
Any biomedical equipment should have preventive maintenance
performed at periodic intervals to avoid trouble free working of
the unit. Well maintained unit lasts longer. In addition if the
equipment has been modified in factory after it was installed, these
changes should be incorporated in the equipment.
Since the staff in biomedical department is limited both in number
and skills, there is normal practice to enter into the service contracts
with the vendor on specific equipment, especially if it is high value
equipment when high cost spares which are normally not available
in market are involved. But first hand repairs in case of emergency
should be carried out by biomedical department to make the unit
working, so that the workload in department should not suffer. It
is therefore necessary for the biomedical engineer to know the
functioning of the unit. Sufficient training to biomedical staff should
be given by representative of vendor to cater to these emergency
problems. After their training, staff can inform the vendor the exact
fault, so that engineer from vendor can bring the required spare
parts, tools, test and measuring instruments to make the unit
working to the satisfaction of operating staff.
These maintenance contracts are applicable after warranty period.
There are two types of service contracts namely Annual
Maintenance Contract (AMC) involving labor only and
Comprehensive Maintenance Contract (CMC) involving labor and
parts. Purchaser is free to decide on which contract is to be finalized,
depending on the failures and their, costs involved during warranty
period. If the equipment is failure prone, with high value spares
one should consider CMC. The vendor has their policy regarding
the value of respective contracts. Biomedical engineer should opine
based on the nature of equipment, his assessment regarding the
type of contract to be finalized. As a general rule the AMC will cost
between 3 to 5% of the value of the equipment in first year of the
contract and it will be increased as per inflation rate for subsequent
years. The percentage for CMC may vary between 6 to 12%.
Minimum Service Requirements for Radiology Equipment:
In addition to routine maintenance items such as lubrication,
cleaning, wire rope for counterweights inspection, adjustments and
settings, following items should be checked periodically to ensure
trouble free performance of the equipment.
142 Diagnostic Radiology and Imaging for Technicians
room with only one light. If the light source is small such as candle
light and is located away from the object which is very closer to
wall, then the shadow boundaries are sharp. In this example we
have assumed large source object distance resulting into parallel
rays from source, smaller source size and small object image plane
distance. Now instead of candle we take a normal tube light
(increasing source size), then we observe that shadow is blurred at
boundaries. If the distance between source and object is reduced
we get more blurring. The blurring is further increased if object
image plane distance is increased. This phenomena is called
Penumbra or Geometrical blurring. Thus in order to reduce penumbra
steps such as reduction in size of source to minimum possible,
increase in source object distance, reduction in object image plane
distance should be taken. But there are engineering limitations for
these steps.
I. Focal spot: We know that smaller the focal spot higher is the
resolution. But with smaller focal spot more heat is generated
per square area on anode which demands higher heat storage
capacity of anode.
II. Source image plane distance: It is not practical to achieve
very large SID due to limitations in size of examination room.
Larger SID means the power of generator should be high
(Inverse square Law). The large focus is used to reduce
movement unsharpness by increasing mA and reducing time
for the selected mAs. As large focus would increase geometric
blurring, the SID is increased to compensate geometric
blurring. Hence, normally for the chest stand radiograph, the
SID is 1.5 m and for over couch radiograph, it is around 1 m.
III. Object image plane distance: More this distance more is the
enlargement. Hence, minimum possible distance should be
kept. But it has limitations such as table top thickness,
requirement of grid, location of cassette in bucky tray, etc. In
order to overcome table top thickness now-a-days table tops
are manufactured with plastic with reinforced carbon which
are very thin as compared to wooden table tops manufactured
earlier and they have better radio transparency i.e. lesser
absorption coefficient.
We will now discuss how the X-ray image is obtained.
X-ray Image and Beam Limiting Devices 145
1. Fluoroscopy
There are three major applications of fluorescence property of
X-ray radiation namely conventional fluoroscopy with zinc
cadmium sulphide fluorescent screen, image intensifier technology
and intensifying screens. The intensifying screens find their
applications in direct radiography and will be dealt later.
Conventional Fluoroscopy
In order to obtain image of penetrated object (organ of the patient)
during examination, a fluorescent screen is placed in the path of
X-rays after the object and image thus obtained gives preliminary
diagnosis (refer Fig 5.1). When X-rays impinge on fluorescent
screen, light is given out by zinc cadmium sulphide crystals. The
degree of brightness is related to quantity of X-ray photons
(proportional to tube current) striking the fluorescent screen and
degree of penetration or quality of radiation which is related to
the accelerating potential between anode and cathode. If a object
is introduced between source of radiation and fluorescent screen,
the object absorbs certain amount of radiation depending on the
absorption coefficient of the object which in turn depends on
thickness, density and atomic number of the object. There will be
variation of absorption for adjacent areas in body under
examination, which brings proportionally the difference in
brightness of screen. Darker areas are seen as shadows cast by radi-
opaque substance having more density, thickness and atomic
number and brighter areas are obtained when X-ray beam is
encountered by radio transparent substance having lesser density,
thickness and atomic number. This leads to diagnosis by screening
of patient for lung fields or gastrointestinal track.
Since X-rays are harmful to human tissues, especially eye, viewing
of fluoroscopic image poses certain restrictions such as limited time
for diagnosis, filtration and complete darkness while viewing in
order to adapt eye to minute details of image. Hence, viewing is
done in complete darkness and viewer has to get himself adopted
to the darkness. Moreover due to harmful nature of radiation, a
lead glass is used for filtering extraradiation penetrating the screen,
and eyes of viewer are protected.
146 Diagnostic Radiology and Imaging for Technicians
2. Image Intensifier
The basic working of this device will be dealt in separate chapter.
The input screen of image intensifier tube is coated with cesium
iodide crystals, which are smaller than that used in conventional
fluoroscopic screen. These crystals convert incident photons in to
light, obtaining high resolution image.
Resolution is resolving capacity of the image and is expressed in
line pairs per unit length, for example line pair/mm. Normally a
fixture is made with radiopaque substance like metal wires equi
spaced at the dimensions of diameter of wire. Resolution
measurement is carried out with this test pattern so that the radi-
opaque wires will cast a shadow on image plane and spacing
between the wires made of plastic radio transparent material will
allow the radiation to pass through. This test pattern is placed
directly between patient and image plane, near the image plane,
and its image is obtained. In case of image intensifier the pattern is
placed at the input screen and viewed at output screen.
X-ray Image and Beam Limiting Devices 147
The light photons fall on the photo cathode which converts light
image in to electrons. Electrons are accelerated towards the anode,
focused and aligned by electron lens system. The voltage applied
to the lens system vary from 80 to 12000 volts. The focusing of
electrons by electric lens system produce a fluorescent image on
the output screen which is several times brighter than that
produced on input screen. The image obtained is reversed.
Generally the input screen is 15 to 25 cm in diameter and output
screen is 15 to 25 mm in diameter. Thus the information available
on input screen of 25 cm diameter is concentrated on 25 mm
diameter of output screen. The area reduction factor is square of
the ratio of two diameters. In our example it will be 100. Hence,
the image on output screen is 100 times brighter than that at input
screen. This image is scanned by television camera and transmitted
to television monitor for suitable viewing.
Advantages
Much brighter image as compared to conventional fluoroscopy.
Multiple viewing of image simultaneously, facility used in
teaching hospitals.
No dark room adaptation because examination is conducted
in normal room light.
Complete cooperation from patients leading to reduction in time
of examination thus reducing radiation hazards.
Due to brighter image, substantial reduction in energy
requirement to tube, reducing radiation hazards.
Hence low dose required to get the better information.
Image can be recorded on VCR for documentation purpose.
Image can be enlarged by ZOOM technique.
This technique can be expanded to indirect radiography by
using radiographic cameras, serial film changers and cine
radiography exposures (Angiography technique).
3. Radiography
When photographic film is subjected to X-ray radiation, it becomes
black after processing. The amount of blackening depends on total
number of photons interacting with film which is proportional to
148 Diagnostic Radiology and Imaging for Technicians
the product of tube current and exposure time provided the tube
voltage is constant. If the voltage (kV) is increased while mAs is
constant, the photographic emulsion will be more blackened
because penetrative power of beam is increased and more number
of photons will reach film. Thus blackening depends on tube
voltage. When an object is placed between tube and photographic
emulsion, it absorbs certain amount of radiation. The radiation thus
weakened by absorption, blacken the film to lesser extent with
respect to surroundings resulting in brighter area after processing
the film. Hence the bright area is called shadow while dark area are called
bright spots because more radiation has fallen on them. This is exactly
opposite to fluoroscopy. The correct image should have high degree
of contrast and sharpness in order to achieve good resolution,
contrast and sharpness influence each other for the human eye.
Contrast: There are two types of contrast namely subjective and
objective.
The subjective contrast is dependent on eye of the observer and
ability to distinguish contrast varies from person to person. The
objective contrast is actual difference of densities or difference
between black and white, suitably measured by instrument such
as photometer. There are number of measures which can be
implemented to obtain optimum contrast such as radiation quality
(kV), quantity (mAs), scattered radiation filtration, radiographic
materials and processing techniques. Hardness of radiation
depends on penetrating power (kV value). Soft to medium
radiation result in images which give more contrast and hard
radiation give more details. Hard X-rays along with high kV films
give advantages like larger source object distance, lower radiation
dose, shorter exposure time which in turn reduces dynamic
blurring, lower energy load (mA) on tube in high kV technique,
the components of higher atomic number absorb fewer X-rays than
at low (Conventional) tube voltages. Hence the absorption in soft
tissues is to lesser extent.
Example: In chest radiography at 120 kV, ribs are more transparent
and lungs can be seen better.
Radiation quantity: X-ray film has very little exposure latitude. It
must reproduce slight differences in intensity within the gray scale
leaving the object with maximum amount of contrast. Hence slight
X-ray Image and Beam Limiting Devices 149
Compression Device
There are two types of these devices namely compression cone
and compression band. Their purpose is to displace body fat in the
vicinity of the region of interest to be exposed so that the radi-
opaqueness or density of the organ under examination is
considerably reduced enabling the lesser dose to be given to the
patient and reducing scattered radiation. These devices are used
in abdominal examinations. It also ensures that object is stationary
during exposure to reduce motion artifacts.
Compression Cone
This device is made of lead cone with aperture of 85 115 mm
enclosed in ABS housing. Cone is pressed against abdomen to
displace body fat and fluids. During examination conducted with
spot film device.
Compression Band
This device is made of cloth band fixed to side rails of examination
table and the tension on the band can be altered as desired. As the
band is tightened over belly of the patient, it displaces the fat from
region of interest and reduces radiopaqueness which in turn
reduces scattered radiation.
Grids
We have covered path of the X-ray beam up to patient. Even after
using the beam limiting devices as mentioned above, it is observed
that the scattered radiation is not fully eliminated. The other source
of scattered radiation is patients body and table top which cannot
be avoided. In order to filter scattered radiation from these sources
a Scattered Radiation Grid is used. Grid prevents most of the
scatter produced in patients body and table top reaching image
plane (Film in case of radiography and screen in case of
fluoroscopy). The grid consists of vertically arranged radiopaque
thin strips, preferably made of tungsten or lead, separated by radio
transparent material such as plastic or aluminum. The strips of
lead absorb the scattered radiation as well as primary radiation.
The absorption depends on following factors.
1. Composition of radiopaque material (Atomic number)
2. Height of radiopaque strips
152 Diagnostic Radiology and Imaging for Technicians
As a general rule 12:1 and 16:1 linear parallel grids for distance of
1.5 m are used with tube voltage more than 100 kV for vertical
chest stand, while as 8:1 focused grid is used for over couch bucky
radiography for distance of 1.1 m.
Initially parallel grids were introduced, but soon they were taken
over by focused grids (Table 9.1). It is extremely important to use
the focused grids in such a way that the correct side of the grid
faces the X-ray tube. When using focused grid the direction of strips
is marked by a line on the side of the grid facing the tube with a
symbol of tube. If it is inserted in opposite direction, or not in the
center of the cone formed by primary beam, the primary rays will
Table 9.1: Tolerance of focus grid
be filtered and cut-off will result (Figures 9.5 and 9.6). Hence, while
using focused grid direction, focal distance and centering is very
important.
If the grid is kept stationary it is called stationary grid. In this case
the radiopaque strips will cast shadow on the film because some
amount of primary radiation will get filtered by these strips. In
order to avoid these shadows, the grid is kept moving at a fixed
speed. There are two ways to move the grid.
(a) Oscillating with damped oscillations achieved by release of
magnetic lock against leaf spring. This results in damped
oscillations which may die out after 2 seconds. Hence, this
procedure is used in cheaper equipments.
(b) Catpult Bucky mechanism was introduced by two scientists
Potter and Bucky. In this case grid is kept moving by drive
mechanism with dc electric motor and cylindrical cam to
operate micro switches to initiate the X-ray exposure after the
grid has achieved required speed (Figs 9.7 and 9.8).
Effect of Decentering
As the SID is increased we get more parallel rays resulting lesser
% loss. The amount of % loss increases if the distance from grid
center increased for a grid of same ratio and if the grid with higher
ratio is used for the same distance from center.
Other devices which contribute to Radiographic Image
(A) Cassette
They are made of aluminum for light weight and easy handling.
Four corners are connected with non metallic construction to give
protective cover. Soft push button locking arrangement with
stainless steel springs for cover is incorporated and suitable lead
protection is given on the rear side of the cassette to eliminate fog
effect on film. High grade foam material is pasted inside to give
the film a uniform contact with intensifying screen. They are also
provided with indicator indicating if they are loaded with film.
They are manufactured in several sizes to suit the film sizes. The
intensifying screens are pasted to inner walls on both sides upper
and lower of cassette and cassettes with intensifying screens should
not be exposed to direct light. These cassettes require periodical
checking with exposure of wire mesh as an object and have average
life span of 3 years. They should meet BIS 6991 standards.
Radiographic Materials
10 and Processing Technique
1. Developer Solution
2. Washing with water
3. Fixer solution
4. Water
BEFORE EXPOSURE
Select cassette as per requirement, size of the film, with or
without screen.
Select box of films which meets the requirement.
Close the door of dark room, switch off lamps, load the film in
cassette in dry area.
Once the film is taken out of the packet, close the packet carefully
so that it will not allow any light leakage for exposing other films
in packet. Normally films are individually packed in paper
wrapping inside film package.
EXPOSURE
The loaded cassette in dark room, transport it to radiology room
either through lead lined pass box or otherwise and place in cassette
tray provided in equipment. Use lead letters for patient ID and
date. Take care that thinner wall points towards tube. Select
radiographic exposure parameters on control console and position
the patient.
Expose: Remove lead letters after the exposure.
AFTER EXPOSURE
(a) Dry Section
Prepare film hanger, switch off light, and close the door. Open the
cassette, lift the film and close the cassette. Load the film on hanger
and take the film to wet section.
After the developing time is over, lift the film hanger from
developer tank and transfer it to rinsing bath. Wash the film in
running water for at least 30 seconds. In case if the running water
is not available, keep the film in water tray for 1 minute. Transfer
film hanger after rinsing to fixer bath. Time required for fixing is
normally double of developing time. Set this time on timer. Now
we can switch on the safe light after immersing the film in fixer.
After fixing time is over shift the film to final washing for 30
minutes.
Drying of film in film dryer or normal drying at room temperature.
After film is dried documentation should be completed before film
is sent to radiologist for his final opinion.
Requirement of
11
Good Radiograph
(b) 15% decrease in mAs value for thinner patient per cm.
(c) 1.5 cm thickness difference for lung radiographs instead of 1 cm.
(d) For wet plaster cast exposure 3 times normal and dry cast 2
times normal.
(e) For FFD apply inverse square law:
Distance factor = square of ratio of desired FFD over old FFD.
(f) Increase in kV for the same object:
(I) 60 to 70 kV range reduce mAs value to half
70 to 60 kV range increase mAs value twice
(II) Voltages below 60 kV, mAs factor must be divided or
multiplied by factor 3 for voltage change of 10 kV.
During this procedure, the tube current is kept constant but
tube voltage is increased from 60 kV to 90 kV (Fig. 11.1). Hence
energy of each electron is increased from 60 to 90 kV. Hence
Emax moves from 60 to 90 kV by shifting line V1 to V2 and
three more triangles of full energy have gained.
Area abc = (fbd) = (abc + aef + aec + ecd)
The general rule is derived from the fact that there is exponential
decay of intensity as the radiation passes through media and change
in tube current is linearly proportional to density of exposure.
Hence based on these factors optimum exposure tables are devised
considering following:
1. Object and positioning
2. Object thickness
3. Film focus distance (FFD) in cm (Table 11.1)
4. Screen
5. Grid
6. Type of X-ray generator
These exposure tables are merely guide to obtain optimum results
which depend on power line quality, film processing and
chemicals.
Hence Point System is generated, representing the exposure data.
The points are logarithmic function of different factors so that
calculation of exposure value are simplified by addition or
subtraction. In most modern generators, kV or mAs values are in
logarithmic scale to compensate or overcome the exponential decay
in intensity.
1. FFD:
Table 11.1: FFD values
2. Screen
Rare earth high speed= 7
Rare earth universal = 3
Rare earth detail or high speed standard = 0
Universal = + 2
High definition = + 3
176 Diagnostic Radiology and Imaging for Technicians
3. Generator
DC/ Multi-pulse/12 Pulse= 0
6 Pulse = + 1
2 Pulse = + 3
4. Grid
Without grid = 6
8/40 grid = 2
10/40 grid = 1
12/40 grid = 0
5. Object thickness
Each cm more = +1
Each cm less = 1
Example: Kidney a.p. : Exposure parameters (66 kV/50 mAs)
= (12 + 16) points = 28 points
Now we increase kV to 70 kV = 13 points; Then mAs will be
15 points = 40 mAs
Hence new exposure parameters will be 70 kV/40 mAs.
Please note that in this example we have not altered other variables
such as FFD, generator, screen, grid, object thickness, etc. If these
are altered corresponding correction should be applied.
Now in this case if patient has 3 cm more thickness than average
patient then exposure points will be increased by 2 points on kV
and 1 point on mAs which means we can select 73 kV/63 mAs.
If the generator is six-pulse instead of two-pulse then we should
reduce two point that means either we can reduce mAs to 25 from
40 mAs or decrease kV further to 60 kV. Reduction in mAs is
preferred because the kidney has motion unsharpness. By
increasing kV one should also explore if the selected grid is capable
enough to filter scattered radiation. If not one should change the
grid with higher ratio and subsequently correct the exposure
parameters to achieve the same points (Table 11.2).
Requirement of Good Radiograph 177
Points kV mAs
0 40 1
1 41 1.25
2 42 1.6
3 44 2
4 46 2.5
5 48 3.2
6 50 4
7 52 5
8 55 6.3
9 57 8
10 60 10
11 63 12.5
12 66 16
13 70 20
14 73 25
15 77 32
16 81 40
17 85 50
18 90 63
19 96 80
20 102 100
21 109 125
22 117 160
23 125 200
24 133 250
25 141 320
26 150 400
178 Diagnostic Radiology and Imaging for Technicians
Image Intensifiers
12 and Related Systems
Few years back, radiologist was seen wearing red goggles and
moving from one room to another in radiology department. Those
wearing red goggles were conducting fluoroscopic examinations
in the darkened room which was main work load of radiologist,
who used to perform fluoroscopy of lungs to diagnose tuberculosis
or bronchitis or GI track studies for intestinal disorder.
In 1940, Dr Manoel de Abreue a Brazilian radiologist, applied photo
fluoroscopy technique for mass examination of lungs. Photo
fluoroscopy is photography of image on fluorescent screen. This
procedure was first performed with normal lens camera and 35 mm
film, followed by usage of mirror camera made by M/s Odelca
with 70 or 100 mm films. Recently this procedure is taken over by
indirect radiography or image intensifier radiography.
In principle, this technique is similar to one devised by Dr. Abreue,
except the fluorescent screen is replaced by the output screen of
Image intensifier and normal camera is replaced the video camera.
The image intensifier has replaced the conventional fluorescent
screen in many developed countries, due to the relative advantages
and applications.
Light Distributor
The image obtained on output screen as inverted image, can be
seen in various planes (directions) with the help of tandem optics
and mirror system, thus ensuring that image intensity is not
reduced. The light distributor is in two versions:
(a) Three channel for video camera, spot camera and cine camera or
(b) Two channel for any of the two of above mentioned in
point (a).
Video Camera
It converts the light image to electronic image, which scans the
input target of video camera and displays the electronic image on
television screen. Hence, the original X-ray beam undergoes
following changes.
Change Location/Device
X-ray to light Image intensifier input screen
Light to electrons Image intensifier input screen
Electrons to light Image intensifier output screen
Light to electrons Video camera
Electrons to visible image Television monitor
180 Diagnostic Radiology and Imaging for Technicians
Electronic Lenses
The accelerating voltage is 25 kV for anode and 90 V, 360 V and
4 kV for focusing electrodes. The electron optics with these lenses
invert and reduce the image and acceleration of electrons by 25 kV
produces a fluorescent image on the output screen which is several
thousand times brighter than that produced at input screen.
Output Screen
The output screen is composed of zinc cadmium sulphide covered
with thin aluminum foil to prevent back scattering from output
screen from interfering with the photo cathode. The dimensions
are around 25 mm diameter of output screen.
(a) Visualization
(b) Coupling systems
(c) TV camera
(d) TV monitor
(e) Automatic dose regulation
(f) Recording.
Visualization
There are two methods. Mirror optic and television viewing system.
Mirror optic system: This system is cheaper than television viewing
system due to its simple design. But since only one person can
view the image it has not become popular. The size of output screen
is around 25 mm. Image formed on output screen should be
converted large enough for viewing. This enlargement of the image
can be accomplished through a system constituting mirrors and
lenses as shown in Figure 12.5, without loss of brightness. The image
quality at the viewer depends upon quality of lenses and mirrors.
Objective Lens
It converts light emitted from output phosphor of image intensifier
tube into parallel beam so that light distributor or beam splitter
can be inserted in the parallel beam. In the absence of parallel beam,
since the beam is divergent beam, beam splitter will cast a shadow
on the pick up tube. The purpose of beam splitter is to reflect the
parallel light rays in the direction of recording systems such as
photo camera or cine camera without disturbing the main beam
Image Intensifiers and Related Systems 189
Camera Lens
It is tandem with objective lens, hence, the system is called tandem
lens system. It focuses the light on the target or input plate of
television picture tube. Since the light transmission is carried out
through tandem optics, the tandem optics should be handled with
utmost care especially when the lens system is kept cleaned for
dust.
As in other optical systems, amount of light transmitted from the
periphery of lens is not the same as that at center or axis of lens.
190 Diagnostic Radiology and Imaging for Technicians
VIDEO CAMERA
Video camera converts the image projected on input screen into
video signal. As the technology advanced, new pick up devices
with better features were introduced in the market. These can be
classified in two types namely vacuum tube type and charged
coupled devices (CCD) type. Vacuum tube type cameras are recently
taken over by digital cameras in certain applications.
charge. Excess electrons are then returned to the photo multiplier where
an electric charge is developed and amplified to become a composite video
signal output.
The orthicon tube is composed of an optical face plate on which
photo cathode is deposited. Each point on photo cathode emits
electrons proportional to the amount of light focused on to that
point from tandem lens system. Electrons emitted by photo cathode,
proportional to light photons, are collected on target which is
composed of thin piece of glass having low forward electrical
resistance and high lateral electrical resistance.
A very thin wire mesh is placed on anode side of target. Electrons
pass through this thin mesh. Electrons emitted by photo cathode
reach the target, and result in secondary electron emission and are
collected on wire mesh which develop positive charge on glass
target corresponding to light image on photo cathode. Higher the
light intensity, greater is the space charge on corresponding point
on glass target.
This image is scanned by an electron beam produced by electron
gun. This is decelerated to almost zero velocity before electron
scanning beam strikes the target, thus elimination production of
secondary electrons. When scanning beam hits a point on target,
electrons neutralize the positive space charge. After equilibrium,
the excessive electrons are deflected back as return beam towards
electron gun, strike the photo multiplier, which increase their
number. Current from photo multiplier is fed to amplifier and then
is converted to composite video signal.
direction (side by side). Hence, all four coils move electron beam
over the target area in repetitive scanning motion. Scanning starts
in upper left hand corner and ends up in lower right hand corner.
This scanning produce a trace called Raster. The scanning speed is
33 milliseconds for standard 525 lines TV system.
Image from the object, i.e. light photons is focused on target with
the help of optical lens system. Target consists of three layers.
(a) Glass faceplate for maintaining vacuum.
(b) Signal plate made up of transparent film of graphite located
on inner surface of faceplate. A positive bias of 80 V is given to
signal plate. It is known as signal plate because it transmits video
signal.
(c) Vidicon target is a thin film of photoconductive material.
Antimony tri sulfite is used for vidicon and lead monoxide is used
for Plumbicon. It is applied to electrically conductive base layer
of zinc oxide signal plate. When light quanta impinge on the
semiconductor layer, it alters resistance according to
illumination due to internal photoelectric effect. The change in
resistance of photoconductive layers is due to free electrons
being generated in the layer, by light quanta absorbed and this
alters conductivity. The transparent metallic signal plate and
free surface of the semiconductor layer represent a capacitance
whose dielectric is formed by semiconductor layer. The
equivalent circuit of a single storage element is represented by
parallel connection of capacitor Cs and photoresistor Rs. The
value of Rs is determined by the illumination E present at that
point. When a signal plate voltage Ua is applied, each storage
capacitor Cs charges. When a photoelectric storage layer is
illuminated, the resistor Rs of each storage element changes in
accordance with magnitude of illumination E (Fig. 12.11).
The storage capacitor Cs then discharges to varying degrees via
Rs during the time between scanning of electron beam.
Since every storage element capacitor is periodically scanned by
electron beam, the current pulse produced is proportional to the
capacitor discharge provided that free surface of the target is held
by electron beam close to cathode potential. The current pulse
produce negative voltage pulses also known as video signal at
external resistor Ra.
Image Intensifiers and Related Systems 195
CCD CAMERA
It is a device that measures light and coverts this information into
picture signal. The incident light photons are focused on to a sensor
with the help of lens system. The sensor converts the incident light
into an electric charge. This analog information is converted into
digital form by A/D converter and saved in proper file format.
The standard sensor technology for this type of device is Charged
Coupled Device (CCD). The CCD is a collection of tiny light
sensitive diodes which convert incident light photons into electrons.
Each photo diode or photo site is sensitive to light. Brighter the
light, greater is the charge that accumulates at the site. The number
of photo sites on a CCD (pixels) determine its maximum resolution.
Next step is to measure charge of each cell in image. The charge is
actually transported across the chip and read in one corner of the
array. The analog to digital converter (ADC) converts each pixel value
into digital value. The photo site measures total intensity of light
striking its surface. It cannot distinguish different colors of light
from one another. (monochromatic). It is easy to process this
information, than the complicated circuitry adapted in
photographic cameras for different colors. In order to get colored
image, special filters are used (endoscopy application) to separate
light into three colors, red, green and blue. All colors in the visible
spectrum can be created by combining these colors. The higher
Image Intensifiers and Related Systems 197
quality of CCD camera use three CCD chips each with different
filter. The beam splitter sends the same light information to all the
three sensors, so that each sensor gets identical information of
image. After overlaying red, blue, green images one can get full
color picture. This type of camera has advantage that it can record
each of the three colors at each pixel location.
Output, storage and compression
MONITOR
The purpose of television monitor is to display radiographic image
in visual picture format with the help of synchronized signals
generated by television camera connected to monitor with coaxial
cable. The radiologist views more intensively than viewer in
broadcast TV. He also goes nearer to the television screen. Hence,
these monitors are installed on trolley or ceiling suspension. In the
large set up more than one monitor is used, one in the examination
room and other in specialist room or teaching hall. They are
connected in parallel. These monitors are furnished with automatic
brightness control to suit the ambient light.
Television monitors for this application are different as compared
to commercially available ones. They are with 17" diagonal Cathode
Image Intensifiers and Related Systems 201
This system is simple to operate and has low cost. But it has major
disadvantage of poor reaction time due to heating or cooling of
filament of tube. For patient with smaller structure, X-ray image is
noisy due to small mA requirement at high kV across tube. Hence,
this technique is not used for cineangiography due to its low
response time.
Pulse width automatic system: This system controls the exposure
time and is used in pulsed fluoroscopy using video disc or electronic
video storage system. In this system both kV and mA are kept
constant and are pre-selected prior to viewing or recording and
pulse width is varied as per requirement of comparator circuit.
This system offers minimum exposure time for fixed ideal kV and
high constant mA resulting in reduction in motion unsharpness.
This technique is widely used in applications with cine and photo
camera especially with secondary switching. This system is costly,
complex and more service breakdowns are noticed if not
maintained properly.
Combined System
It primarily controls mA till maximum permissible mA is reached
and then kV is automatically increased to maintain desired
brightness of image. This is called milli amperage automatic
system with kilo voltage override.
Figure 12.16, indicates that screen brightness with image intensifier
TV link is multifold as compared to that with conventional
fluoroscopy with fluorescent screen for the same dose rate.
Example: For dose rate at 100 micro roentgens per second the
brightness achieved with image intensifier TV chain is 10 cd per
sq m while as at the same dose rate it, is 0.007 cd per sq m with
conventional fluorescent screen.
The Figure 12.17, indicate that resolution is three fold for image
intensifier vidicon tube as against conventional fluoroscopy. In
order to get same resolution with conventional fluoroscopy with
fluorescent screen one has to give very large amount of radiation
dose.
RECORDING
While performing fluoroscopy with image intensifier, one
visualizes the event, but if permanent records are required to be
206 Diagnostic Radiology and Imaging for Technicians
achieved with this technique is around 4 line pairs per mm. But
the disadvantages are as follows:
(I) Due to time delay of 1 second, event recorded on film is an
event that occurred after last event during fluoroscopy
1 second earlier.
(II) Bringing of cassette in radiographic area at high speed will
introduce vibrations in SFD and affect the image resolution,
if these vibrations are not reduced either by appropriate
cushioning effect or larger time delay.
(III) Cost: Since the SFD is considered conventional technology
with cassette movement, the relative cost is much lesser
against spot film camera. But due to constant wear and tear
of moving parts, SFD requires frequent maintenance and is
failure prone. Hence, strict preventive maintenance schedules
have to be observed from date of installation failing which
the end user has to pay heavy repair charges. There is a need
of replacement of cassettes and intensifying screens due to
their continuous use and subsequent damages due to
mishandling. They have average life span of two years after
which the intensifying screens fade and give lesser light
output. The replacement cost of intensifying screen is very
high. Moreover the running cost of films used in SFD is very
high, as compared to those in photo camera. Hence, if we
calculate the costs for a period of seven years, it will be seen
that the photo cameras are much economical as compared to
SFD. With the introduction of Automatic Dose Control, one
can expose the patient to much lesser degree as compared
with exposures from SFD. However, due to initial cost of
investment being low and the workload also low, SFD is
acceptable in smaller hospitals such as district hospitals and
teaching institutions. Another reason for its acceptance is the
technology is simple and hence appreciated by end user.
Cine Camera
Cine camera records light from output screen of image intensifier
through beam splitter (Fig. 12.8). The radiation is triggered with
210 Diagnostic Radiology and Imaging for Technicians
Video Recording
This is achieved by video tape recorder.
It is also known as magnetic picture recording and is a counterpart of
audio tape recording. Video signals are stored in magnetic tape
along its length. The tape consists of plastic base material coated
with magnetic oxide. It is fed past recording head, video signals
are stored in magnetized oxide particles. Playback is possible
without any development or processing.
The common problems associated with this device are:
1. Accumulation of oxide coat on magnetic head from video tape
2. Slippage of drive belt.
Advantages: Video signal is easily available for viewing. Simulta-
neous video and cine recordings are possible. With the help of video
recording one can immediately assess the usefulness of recorded
event. The output of television camera is ideally suited for this
device. During recording, the boosting of required radiation over
normal frequency, providing better quality video tape recording
without noise.
Earlier Developments:
(A) In 1898 Paulsen developed Telegraph-phone for recording
telegraphic messages and later speech on thin steel wire as
magnetic media.
(B) In 1930 M/s AEG developed Magneto phone using iron
oxide powder as storage material applied to base consisting
paper or plastic.
(C) In 1953 M/s RCA developed video tape recorder at a speed of
6 m/sec longitudinal recording with fixed recording/
reproducing head. It was not found suitable due to its high
speed.
tape so that the drum moves along the tape diagonally. Each tape
head records or plays one diagonal band on every pass. The helical
scanning system allows the VCR to fit in more information on
length of tape and tape can move at reasonable speed past recording
heads.
Basic requirements of VCR are as follows:
VCR has to wrap up video tape against the rotating head, when
it plays or records.
VCR needs to read and encode linear audio and control tracks
on the same tape.
VCR should move the tape at right speed and it should detect
the end of the tape.
While recording VCR should move the tape past erase head to
get rid of previously recorded data.
Tape Movement
When tape is inserted in VCR, pin releases and opens plastic guard
located at bottom of cassette so that tape is exposed. VCR also inserts
pin into cassette to unlock the spools. Two movable arms pull the
tape out of cassette to fit it around rotating drum as well as other
heads and rollers that tape must pass. The pinch roller and inertia
roller press the tape into audio head, the control head and erase
head. The tape is also spooled between small light and light sensor.
Since the beginning and end part of tape are clear without any
magnetic material, VCR senses from light reflected from shining
surface of the tape and stops tape movement.
The control track indicates to VCR, the recording of mode such as
Standard Play (SP), Long Play (LP) or Extended Play (EP) and gets
tape head to line up with diagonal tracks correctly. It also ensures
the speed of the tape. Due to its continuous usage there is a
possibility that tape is stretched. In that case VCR may have to
increase its speed for correct video playing. The movement of
recording head and magnetic tape requires exact adjustment for
maintaining synchronization during replay. The resolution of
player depends on quality of magnetic tape and gap in recording
head. For higher bandwidth of video signal, smaller should be the
gap in recording/play head and smaller should be crystals in
214 Diagnostic Radiology and Imaging for Technicians
DVD PLAYERS
DVD is a short form of Digital Video Discs. They include following:
(a) Up to 133 minutes of high resolution video in letter-box or PAN-
SCAN format with 720 dots resolution; Video compression ratio
of 40:1 using Moving Picture Experts Group (MPEG)
compression.
(b) Soundtrack using 5:1 channel Dolby Digital Sound.
DVD can store 7 times more data than CD because pits and tracks
are much smaller in size. DVD format does not waste space on
error correction.
Multi-Layer Storage
DVD can have maximum 4 layers, two on each side. The laser beam
can focus on desired layer through the earlier layer. However, the
capacity of disc does not increase with number of layers because
then the pits are little longer on both layers than in single layer.
This enable to suppress interference.
Normally DVD is 1.2 mm thick. In order to focus separately on the
first or second layer, the first layer uses semitransparent gold
coating and the second layer uses opaque aluminum mirror. The
laser beam can focus on gold layer or it can pass through gold
layer and focus on aluminum layer. Each layer is injection molded
plastic impressed with billions of tiny bumps. Layer of gold or
aluminum is sprayed on to the bumps to create the reflective
coating. After all these layers are made, they are coated with
lacquer, squeezed together and the disc is cured under infrared
light. Labeling is done on non-readable area. Each layer has spiral
track. Track circles from inside to outside of disc. The elongated
bumps are 320 nm wide, 400 nm long, 120 nm high; separation of
track is 740 nm.
Recording on DVD is done with 24 frames per second speed. MPEG
encoder creates the compressed file, analyses each frame and
encodes. Each frame can be encoded in three ways as follows:
Image Intensifiers and Related Systems 215
Upgradation of System
Due to economic considerations the end user may buy a simple
R/F equipment with SFD. Later the end user would prefer to
upgrade the system to image intensifier television system. This is
also known as retrofitting. Manufacturers offer retrofit package,
to incorporate this change. In case if only the image intensifier needs
to be changed to the recent model, depending on the technology
involved the circuitry need to be changed along with mechanical
modifications.
Angiography Techniques and Systems 217
Angiography
13 Techniques and Systems
1. Magnification
In order to minimize magnification, image plane should be as close
to the object as possible. But as we had seen scattered radiation
plays important role in image quality and in order to filter out the
scattered radiation the use of grid is mandatory. This increases the
object film distance leading to certain amount of magnification.
However, one can locate the cut film changer or image intensifier
as close to the object as possible permitted by engineering
mechanical design of system. In case of peripheral angiography the
cut film changer is kept below the table at a minimum distance
from lower end of table top and in case of cerebral angiography, the
cut film changer is kept close to skull area with X-ray tube as over
couch. While as in cardioangiography the image intensifier is almost
touching the chest of patient in over couch position and X-ray tube
is under couch. The image intensifier is moved in circular motion
forming an arc and away from patient with linear movement in
order to get different projections such as LAO (left anterior oblique),
RAO (right anterior oblique), the focus table top distance is
220 Diagnostic Radiology and Imaging for Technicians
Exposure Requirements
We notice that the requirement of exposure will vary depending
on the recording system used, object motion, type of intensifying
screen used with cut film changer, type of lens (focal length) used
in optical system of tandem optics, and image intensifier mode
(9, 6, 4.5 or Zoom). In case of cine camera we refer to exposure
per frame. It is observed that less radiation exposure and shorter
exposure times are required for exposures made with image
intensifier system. Although the resolution is inferior with image
intensifier system as compared to film changers, the loss of
resolution is compensated by advantage of shorter exposure time
to overcome dynamic blurring.
For example: Cut film changer at 6 exposures per second, radiation
dose requirement is 800 R for calcium tungstate screen, 400 R
for rare earth relative speed 2 screen and 200 R for rare earth
relative speed 4 screen.
9 6 4.5 image intensifier
Photo spot camera f = 11 f = 8 lens opening
For 9 100 R 50 R
For 6 220 R 120 R
For 4.5 500 R 250 R
35 mm cine camera with f = 4 lens opening
For 9 13 R
For 6 30 R
For 4.5 50 R
Equipment Requirements
The equipment should be so designed that it facilitates the operator
to fully control the procedure with easy access to all control
parameters and adjustments, so that operator can concentrate
towards patient. This is extremely important because angiography
procedure is performed with incision given to patient. We have
discussed the angiography applications for peripheral, cerebral and
cardioangiography and how they differ. If an equipment is
designed for all these applications, it will be so complicated and
turn out to be very big and costly. Moreover due to sensitive nature
of the procedure for cardioangiography, this equipment requires
special installation in CATH LAB, which can be treated as an
operation theater. Hence, there are two types of equipment designs
available commercially in the market namely, for universal
angiography (Fig. 13.1) and cardioangiography.
Fig. 13.2: Combined angiography of abdomen and both legs with puck
film change and telescopic table with additional facility of automatic
shifting of table top
Angiography Techniques and Systems 225
1. C-Arm, 2. X-ray tube, 3. Image intensifier, 4. Light distributor with video camera,
5. Cine camera, 6. Floor to ceiling column stand incorporating C-Arm, 7. Collimator,
8. Patient table, 9. Carbon reinforced plastic table top with linear movement.
Film stationary time: During this period, one must take into
consideration the inherent time delays of film changer to X-ray
generator interface and phase in time required for X-ray generator
depending on type of timer used in X-ray generator.
Definitions
Zero time: Interval between electrical command from the film
changer to start of exposure by triggering timer.
Phase in time: Time required for actual start of radiation from time
of triggering of exposure, also known as interrogation time. Both
zero time for film changer and phase-in time for X-ray generator
are fixed, once we choose the device. Hence, the actual maximum
time available for exposure can be determined for particular film
rate. In the example of 5 FPS each film cycle time is 200 ms. The
film stationary time is 40% or 80 ms and if zero time and phase-in
time is around 30 ms, the exposure time will be 50 ms.
Referring to angiographic ratings of X-ray tube focal spot used,
one can determine whether this exposure time is sufficient or not.
If required the exposure rate should be changed. This is called
maximum permissible exposure time (Fig. 13.4).
Angiographic Injectors
Since we are imaging vital organs such as heart or brain, it is very
important that we take all safety precautions while giving contrast
Design Aspects
Each injector basically consists of following components:
1. Electromechanical motor driven screw.
2. Controls for parameter settings.
Angiography Techniques and Systems 231
3. Safety device.
4. Mobile stand.
1. Electromechanical motor driven screw: It is the main part of the
injector which transforms electrical energy into mechanical energy
by pushing or pulling the plunger of an injection syringe to achieve
injection of contrast media into patients blood stream.
2. Controls for parameter settings: Operators control panel is designed
to operate switches for start, stop, forward, reverse, fill, etc. as well
as motor speed selection to determine pressure, volume per second
and rate rise.
3. Safety devices: It includes following:
(a) Automatic circuitry to detect the rate of injection by sensing
speed of motor and comparing pressure and volume per second
set by operator. It terminates the injection and malfunctioning is
indicated on panel.
(b) Electrical safety: Syringe are electrically isolated to protect
against electrical shock hazards. Since the patient is undergoing
angiography, electrical devices such as ECG leads are connected
to patients body and are sometimes inserted near the heart or in
the heart. This may cause fibrillation. The leakage currents should
not exceed 10 mA for electrically sensitive patients. A grounding
connection in wall receptacle are found to be at different potential
with respect to other which cannot be accepted in cardiac applic-
ations where patient is subjected to angiographic examination. A
grounding system that allows all equipments in examination room
to the same potential is called equipotential ground. This is
recommended as an additional ground network. The power
distribution system in special angiography room should have
separate grounding lead that is separate from conventional
grounding. This special ground lead is connected to structural
grounding. Neutral lead which is current carrying conductor
should not be used as grounding conductor. Neutral lead should
not be grounded in room and should not be connected to
equipment. As per electricity rules separate non-current carrying
conductor should always be used to connect equipment to ground.
It should have higher cross section than main current carrying
conductors.
232 Diagnostic Radiology and Imaging for Technicians
14 Tomography
ZONOGRAPHY
In this case the planigraphy angle is very small around 5 degrees.
The sharpness of image obtained is from specific zone. It contributes
to the planigraphic sharpness of thicker objects (kidney). The spatial
relationship of the region of interest to the surrounding body tissues
is maintained, as though these tissues will form unsharp
radiographic image. Modified version of planigraphy is
tomography. Planigraphy examination is restricted to one plane
while tomography is at various angular projections due to
movement of X-ray tube and image plane in arc.
Tomography 237
COMPUTER TOMOGRAPHY
In conventional radiography, the part of body under examination
is exposed to primary radiation and absorption image is recorded
on film or seen on screen. However due to superimposition of
several organs of different absorption coefficient, the image is not
very informative for the region of interest. In order to overcome
this disadvantage, tomography units were developed as discussed
earlier. But these units were very difficult to operate and maintain.
In the year 1967, Godfrey Haunsfield of EMI Ltd. introduced first
clinically useful Computer Tomography Unit. It was used for
diagnosing brain tumor and was known as Head Scanner. The first
CT scanner was commercially introduced in market in 1973.
The name computer tomography implies that it analyses the
tomographic image of patients body with the help of computer.
The image is obtained by exposing smallest cross-sectional area of
patient called Slice, by collimating the beam which scans the body
linearly from various directions. The image is developed from
multiple measurements of X-ray absorption coefficients and is
computed. These images or slices are in transverse or oblique plane
to the long axis of body and hence this technique is called
computerized axial tomography or CAT.
Principle of CT Scanner
The simplest CT scanner constitute of X-ray tube and detector
assembly, which are mechanically coupled and aligned with each
238 Diagnostic Radiology and Imaging for Technicians
other. The X-ray tube along with detector assembly form a scanning
system, which moves around the patient in circular motion. After
completion of each rotation or scan, the system moves linearly with
a fixed predetermined distance. At each scan, the detector system
records the different measurements based on different absorption
values, which are converted to electrical signals by electronic
circuitry and fed to computer. After calculations a tomogram of
that slice or scan is displayed on monitor screen and also is recorded
on magnetic media or film. The image computed from this unit is
usually formed from very small rectangular image elements in the
form of matrix such as 256 256 or 512 512 etc. Higher the number
better is the resolution. CT units can differentiate between
attenuation values of various tissues of body. Hence, contrast media
is not commonly used.
Initially the CT unit was developed for head and neck region and
was called as head scanner. This was used for cerebral hemorrhage
or accidental injuries in head and neck region. Due to its
applications, the focal spot of X-ray tube was very small. Later the
whole body CT Scanners were introduced for the scanning of
complete body.
Thus CT Scanning is a noninvasive radiographic technique, that
involves the reconstruction of a tomographic plane of body (slice),
from a large number of collected X-ray absorption measurements
taken during a scan around body.
X-ray Generator
The high frequency, multi-pulse, high voltage X-ray generator in
single tank construction (reder Fig. 7.11) to eliminate high tension
cables supplies electrical power to X-ray tube, which usually is
high speed rotating anode type and is capable of withstanding the
high heat load generated during rapid multiple slice acquisition.
Tomography 239
Scanning Gantry
The gantry houses the X-ray tube, detectors, collimators and
rotational circuitry. In some scanners it also houses compact X-ray
generator. X-ray tube used is high power, rapid rotating anode at
high speed tube with small focal spot dimensions to overcome
geometric blurring. The anode of tube is made of rhenium,
tungsten, molybdenum and carbon material (RTMC Anode). There
are various types of detectors used namely.
Sodium iodide crystals with photo multipliers
Calcium fluoride crystals with photo multipliers
Xenon gas detectors
Solid state detectors
Xenon gas detectors are commonly used. They produce current
(output signal) when incoming radiation ionizes xenon atoms. This
signal is proportional to intensity of radiation. Detector array is
used to indicate the number of detectors. It is associated with
scanning motion and geometry of scanner. In case of pencil beam
coupled with single detector, X-ray tube and detector are
mechanically coupled and move together as a unit.
Solid state detectors contain cesium iodide or calcium tungstate
crystals that produce light when subjected to ionizing radiation.
Silicon photodiodes convert this light into an electrical signal.
Collimators located near X-ray tube and detector end are aligned
so that the scattered radiation is minimized and X-ray beam is
properly defined for scanning.
In the modern CT scanners, the X-ray beam is collimated to form
shape called Fan Beam and set of detectors forming an arc of circle,
are placed in the pathway of X-ray beam. They both are
mechanically coupled and rotate together as a unit. In some units
only the tube rotates in 360 degrees while as the detectors are fixed
along the arc and are stationary. Gantry assembly can be tilted for
oblique view.
Computer Console
The computer console controls the operation of the complete CT
system, processes the image, reconstructs and stores the images.
The capability of computer supplied with the equipment
determines the specifications of equipment. More mathematical
calculations are calculated with larger matrix rapidly by larger
computer and having larger storage facility. The image
reconstruction is performed by taking large number of
measurements made by exposing the object with finely collimated
X-ray beam and measuring intensity of the beam after it emerges
through the patient. One can measure the intensity of beam
emerging from the object by projecting the collimated beam
through the object under examination at different angles. The
reconstruction of object will be more accurate, if number of
measurements are large. In order to reconstruct the image the
amount of energy absorbed per unit volume must be calculated.
The quality of reconstructed image depends on following factors:
X- ray source
Efficiency of detectors
Number and speed of measurements
Methods of reconstruction (algorithm)
X-ray generator characteristic
Geometry of measuring system.
The image can be viewed on monitor. Modern systems flicker free,
14 inch 1249 line monitor for displaying images. During a CT scan
the table moves the patient into gantry, X-ray tube along with the
detectors rotate around the patient. As the X-rays pass through
the patient to the detectors, the computer acquires and processes
the data to form an image. The computer also controls the X-rays,
gantry movements and image display and storage.
Tomography 241
Generations of CT scanners
Over the years, CT technology has advanced from first generation
(Fig. 14.5 A) introduced in early 1970 to fourth generation
(Fig. 14.5 D) developed in late 1980. Today only third (Fig. 14.5 C)
and fourth generation CT systems are used. With this advancement
in the movements of X-ray tube/detector system, the slice scan
time in first generation of few minutes in head scan unit in first
generation has come down to less than a second for the whole
body in third and fourth generation scanners.
First Generation
Third Generation
Fourth Generation
Applications of CT Scanner
(a) Conventional CT scanner: Diagnosis of spine, head injuries, brain
scan, intracranial tumors, blood clot in brain, cerebral ventricles,
soft tissue lesions, gastrointestinal lesions, abdominal and pelvic
malignancies, 3D reconstruction of bones etc.
(b) Spiral CT scanner: In addition to above normal scanning
techniques, special applications which can be performed by spiral
CT scanner are:
Spiral CT technique is more effective in breath hold studies
like thorax or abdomen where scanning large volume in short
time is important
Effective contrast flow studies
CT angiography
CT vascular endoscopy.
(c) MDCT Scanner: MDCT advances have especially been
pronounced in CT angiographic applications in evaluation of the
vascular system. Large scale availability, excellent spatial and
temporal resolution and comparatively low costs have established
and cemented the role of CT in angiographic studies. CT
angiography requires the use of 3D reconstruction techniques for
extracting volumetric information and display of information
produced from acquisition of large datasets. MDCT is commonly
indicated in evaluation of hepatobiliary pathology with the main
objective being the capability of newer scanners to obtain
multiphase datasets, i.e. timed arterial and portal venous phases
accurately. The study indication dictates whether dual or triple
phase scanning is required. Multiphase study is commonly
required in evaluation of cirrhotic livers for detection of focal
hepatic lesions as well as evaluation of the arterial, portal and
hepatic venous anatomy. CT volumetry is routinely performed in
cirrhotic patients posted for liver transplants as well as donor liver
evaluation. Helical CT scanners have produced high quality non-
contrast and contrast images of the retroperitoneum
which historically have always been an extremely difficult
anatomical region to evaluate. Pancreas, kidneys and the urinary
collecting system are easily identifiable, evaluated with excellent
246 Diagnostic Radiology and Imaging for Technicians
Accessories of CT Scanner
1. Automatic voltage regulator
2. Automatic film processor
3. Laser camera.
DEVELOPMENT OF IMAGE
It should be noted that there is requirement of finite number of
X-ray photons to reach image plane to get informative image.
Patient will be subjected to higher dose if the resolution desired is
high. As we had seen earlier, the density of anatomical structure
under examination will determine absorption of X-ray radiation.
This absorption can be determined by measurement of intensity
of radiation emerging out of patients anatomical structure.
Matrix is defined in mathematics as an array of numbers arranged
in rows and columns. Each number of matrix is called element of
matrix. Size of matrix depends on the demand of resolution or
contrast. There are two terms which are mentioned quite often
namely,
(a) VOXEL which is volume element, and
(b) PIXEL which is picture element
Pixel is representation of anatomical voxels in reconstructed image.
Each pixel is identified as to its exact location of matrix. The most
commonly used matrix are 256 256 or 512 512 or 1024 1024.
In order to increase resolution of image, finer matrix with more
number of pixels should be developed with finer X-ray beam. Since
for better resolution, we require higher dose to get better signal to
noise ratio, there should be choice of matrix given to end user to
select type of matrix required, depending on anatomical part under
examination.
The measured signals occurring are coded in a suitable form and
transferred into computer. Since the digital computer can directly
process discrete values, the radiation profile is split in each case
into few measured values. Hence, for each picture several
projections are required.
Control unit coordinates the functioning of the equipment,
X-ray generator and measured value acquisition electronics.
Computer calculates from measured data, distribution of
absorption values corresponding to examined object slice. Strongly
absorbing region of the object is assigned high value and weakly
absorbing one low value. Each absorption value describes the
average absorbing capability of a block-shaped element of the object
slice, to which value is assigned. The object slice can be imagined
as composition of many blocks. The array of numbers obtained,
Tomography 249
Image Reconstruction
We now go back to the properties of X-rays. They are attenuated
while passing through the matter. The amount of absorption
depends upon density of the medium through which they pass.
Higher the atomic number of medium greater is the absorption of
X-rays. It is given by following formula:
I = (Io) e x
where, I is the intensity of the radiation at a distance x when
incident beam is passed through the medium having absorption
coefficient as and Io is the incident intensity. As explained in this
equation, there will be exponential decay of X-ray energy as the
beam passes through the medium. In order to determine the
distribution of absorption coefficients in one slice, the slice is radiated
from different directions as shown in Fig. 14.9. For simplification
we assume that slice is subdivided in 4 fields with each field having
constant absorption coefficient . (1, 2, 3, 4). The measured value
of intensity I gives sum of 1+ 2 (Fig. 14.9 A).
If more measurements are carried out as shown in Fig. 14.9 B, the
four unknown absorption coefficients 1, 2, 3, 4 can be
calculated from sums as follows:
It is assumed that 1 = 6, 2 = 2, 3 = 2 and 4 = 2. Then
for I1, 1 + 2 = 8; For I2, 3 + 4 = 4; For I3, 2 + 4 = 4; For I4, 1
+ 3 = 8; For I5, 1+ 4 = 8.
Each measured value obtained with CT scanner supplies a linear
equation with unknown values of absorption coefficient of the
object under examination. The number of equations are quite large.
Hence, there are various methods adopted for displaying values
of attenuation coefficients for each pixel.
252 Diagnostic Radiology and Imaging for Technicians
15 Radiation Protection
Protection Procedures
Radiation hazards on mankind are classified in two ways namely,
somatic and genetic effects. Somatic effects affect life span of the
individual subject to radiation. This results in cancer of skin,
reduction in blood count, loss of fertility, loss of eye sight,
shortening of life span. It is related to injuries of cells in blood and
bone marrow. Genetic effect affects life of future generation. This
related to injuries to gonads, offsprings are abnormal.
If a controlled X-ray beam is directed towards body, the amount of
quanta which will interact with atoms of body mass will result in
biological effects. Each interaction will transfer energy to several
atoms with absorption of quantum energy into the atoms of
material of larger density resulting in heating effect. The energy
absorbed can be expressed in joules per kg, which has led to the
concept of radiation dose.
Measurement of Dose
Unit of dose = Roentgen Absorbed Dose = RAD
1 RAD = 0.01 joules per kg
260 Diagnostic Radiology and Imaging for Technicians
Measurement of Dose
As discussed earlier in interaction with matter, this process is
accompanied with liberation of electrons and this type of radiation
is called ionizing radiation. Since it is difficult to measure the
degree of absorbed energy in human tissue, the easiest way to get
a quantitative assessment of radiation is the measurement of
ionization in air and it is called ion dose given by formula:
Ion dose J = c/kg = coulombs per kilogram.
Refer Fig. 15.1. The ionization chamber current Ic is constant if
tube voltage and current is kept constant. But the dose increases
since it is measured as total number of electrons produced during
the exposure time. Hence, for dose measuring circuit, integrator is
used.
The ion dose unit in use is roentgen (R).
Definition as per according to ICRU
1 roentgen = 0.000258 Coulomb per kg
Ion Dose Rate: It describes how many ions are produced in one kg
per unit time.
J = C / (kg sec)
= mR/second
Refer Fig. 15.2. The chamber current Ic is proportional to the total
amount of produced electrons in a unit of time. Therefore, we
incorporate proportional amplifier, dose rate will be proportional
to chamber current.
Radiation Protection 261
Dose Equivalent H
The biological effects of various ionizing radiation depend upon:
(a) Type and quality of radiation.
(b) Irradiation conditions.
Hence, equal energy absorption of different type of ionizing
radiations will produce different biological effects. The dose
equivalent is product of energy dose D and coefficient q. Therefore,
dose equivalent H = q D
where value of q is unity for X-ray, gamma rays and beta radiation
where, value of q is 10 for fast neutrons, protons and alpha radiation
where, value of q is 20 for heavy nucleus.
Local Dose
It is the absorbed dose for soft tissue measured at a specific area.
Radiation Protection 263
One can define half value layers for different kV potentials and
media.
Table 15.4 indicates that as we lower the energy (KeV), then the
wavelength increases resulting in decrease of value of half value
layer in that medium. We also note that at 125 KeV, the thickness is
0.28 mm of lead will reduce half value. Hence, lead is preferred as
better shielding material or filtration of X-ray beam.
Table 15.4: Half value layer
They are:
(a) Protection plate
(b) X-ray ray guard
(c) Metal plate
(d) Double slot collimator for under couch tube.
(a) Protection plate at SFD: This is manufactured from lead sheet
sandwiched between the two layers of plywood so that X-ray
radiation will not leak to the X-ray cassette which is loaded with
unexposed film in parking area. This plate is located at rear side of
the SFD, towards table top, with a slot of 35 35 cm (Fig. 15.8).
(b) X-ray ray guard: X-ray ray guard is manufactured with lead
rubber, having a lead equivalent of 0.5 mm Pb with multiple
overlapping flaps. It is heavy but flexible so that desird position of
patient is adjusted by radiographer during examination. The
physical position of ray guard can be changed with the position of
table (horizontal or vertical); for details refer to Fig. 15.9.
(c) Metal plate: Metal plate at the base of table is made up of thick
mild steel which serves two purposes namely radiation protection
from scattered radiation from floor and radiation leakage from
under couch tube. Additionally it gives mechanical strength to the
table assembly and improvement in esthetics. This is also called
ornamental cover.
(d) Double slot collimator for under couch tube: Under couch X-ray
tube is furnished with lead cone, additional filters and double slot
collimator to collimate the X-ray beam.
7. X-ray Generator: It is now clearly understood that, the lesser
amount of soft radiation generated, it is preferred. This has direct
relationship with the waveform of voltage applied across X-ray
tube. Smaller the ripple less is softer radiation. Hence, the choice
of high power X-ray generator with low ripple will reduce exposure
time. Reduction in exposure time will reduce the interaction time
between X-ray radiation and human tissue which will reduce the
radiation hazards. Modern generators work with electronic
switching using solid state circuits. The automatic dose rate control
(ADR) is easily compatible with these generators due to its
electronic switching timers. X-ray systems with ADR facility will
give the required dose to patient and reduce radiation hazards.
These modern X-ray generators are provided with fluoroscopic
timer. This has now become mandatory as per AERB. Since
fluoroscopy is an examination, which has no control on duration
of time, as in case of radiography procedure, there is a possibility
that radiologist will continue fluoroscopy and subject himself as
well as patient for radiation hazards. The incorporation of
fluoroscopic timer will sound an alarm after 5 minutes of
fluoroscopy examination.
Radiation Protection 273
11. Dark Room Adaptation Goggles: Their usage will reduce the
fluoroscopic examination time.
12. Cones: Radiographic cones used should be long enough to filter
the soft radiation. They are generally made of zinc or brass. In case
of dental radiography, the radiographic cone should be used with
lead diaphragm, such that diameter of X-ray field on the skin does
not exceed 6 cm. This will protect eyes of the patient. If eyes are
unnecessary exposed to radiation, cataract may develop.
13. Focus Film Distance (FFD): The FFD should not be too small
as the dose increases inversely to the square of distance. Therefore,
radiation to patient is considerably higher than at conventional
distance of 70 cm for under couch tube, since we have limitation of
distance due to geometry and design considerations of X-ray table.
In horizontal position table height should not exceed 80 cm to
ensure easy patient entry and in under couch tube should not touch
flooring. But in case of over couch, the normal FFD should be 1.1
to 1.2 m. This is limited by room height and design of floor to ceiling
column stand. In case of radiographic exposure with chest stand,
this distance should be at least 1.5 m, limiting factor will be room
dimensions.
14. Protective Screens (Mobile Protective Barrier): They are
manufactured in two designs namely, fixed and mobile. Fixed ones
are used for placement of X-ray generator console behind the
screen, so that during exposure radiation worker stands behind
this protective screen away from the radiation zone. They are
manufactured with lead lining, so that radiation leakage behind
the screen is avoided. Since radiation worker wants to observe the
patient during examination, a lead glass window is provided in
the center of the screen (Fig. 15.10). These screens come in two
executions (a) two fold, (b) three fold. Depending upon the room
plan the type could be selected.
The mobile protective screens are provided for radiologist to use
during fluoroscopy examinations. During this examination
radiologist sits on elevated chair to view lead glass fluorescent
screen assembly and is very close to patient, hence, in radiation
zone. For radiation protection from scattered radiation from floor,
a mobile protection screen is used which can be removed and kept
Radiation Protection 275
Fig. 15.10: Three fold protection screen with lead glass window
GENERAL RULES
1. Only persons required for radiographic examinations should
be present in X-ray examination room.
2. Radiation worker should stand behind protective screen during
radiography exposure.
3. Proximity of patient: Medical staff should take extra-precautions
while attending to infants because they may be required to hold
the patient in radiation zone. They should wear all protective
clothing as described above. Alternatively infant cradle which
can be attached to the table only when required could be used.
Duty of Radiologist
1. Radiologist must weigh the necessity of diagnostic X-ray
examination against risks due to radiation.
2. Information should be obtained from patient about previous
radiation examinations, type of exposures and details about part
of body exposed before starting the examination. The answers
given by patient should be recorded on case paper for future
reference.
3. Pregnant women should not be exposed to X-ray examination
of pelvis.
4. Attempts to reduce radiation burden should be made.
Dose Monitoring
As guidelines set by ICRP, in India the controlling authority is
Atomic Energy Commission, Directorate of Radiation Protection
(DRP), Bhabha Atomic Research Center. They have set down
mandatory standards for manufacturer of X-ray equipment and
end user (Radiation Worker).
Every manufacturer must get AERB approval of design and
development of product for radiation safety standards, before
launching the product in market. Team of testing engineers from
AERB inspect the equipment at vendors premises and after
conducting radiation measurements suggest amendments to
improve the radiation leakage if required. After implementation
of same, the clearance for manufacture with complete description
of system is issued by controlling authority. The controlling
authority can carry out surprise inspection during manufacturing
process and if discrepancy is found the certification is withdrawn.
Every purchasing authority should insist that vendor should
furnish the AERB certificate. AERB also issues the recommended
Radiation Protection 277
Installation Requirements
In order to ensure adequate radiation protection, compliance to
building and installation plan of radiographic system
recommended by AERB is essential. This protection is not only for
278 Diagnostic Radiology and Imaging for Technicians
16 Bone Densitometry
It has been noticed that, with receding of age the bone mineral
density is reduced, resulting into the possibility of fractures of
wrists, elbow, spine or femur. Bone Mineral Density (BMD) has
become the complete bone assessment tool ever devised. This
diagnostic tool is used to determine osteoperis or osteoporosis
developed in aging patient. Generally, as age of the patient is
around 50 in male subjects and in female subjects after menopause,
the BMD starts decaying. The amount of decay depends upon the
age.
As the age increases the BMD reduces at a faster rate (Figs 16.1
and 16.2).
The green area indicates that BMD is within tolerable limits. Yellow
area indicates osteoperis means reduction in BMD but still
acceptable limits (on border) and red indicates osteoporosis, which
means that BMD level is alarmingly low and patient is susceptible
to fracture of bone.
The most susceptible bones during fall are elbow, femur and spine.
In case of elbow fracture the tendency of patient is to take support
of hand during fall. The patient can be treated with plaster cast or
sling in local area. Patient can perform other tasks with certain
limitations. But if the fracture is in vertebral column (L1-L4) region
or at femur neck the patient has to lie down in bed till corrective
measures like orthopedic surgery are performed. This means that
patient will be immobile for some time till the fracture heals.
If the patient BMD is known in advance, the patient is administered
required quantity of calcium and other drugs to prevent further
decay, thus avoiding the possibility of fractures. The three curves
A, B, C, indicate the decay of BMD over the age in different patients.
The statistical data is arrived with screening of different patients.
When a whole body scan is taken with BMD equipment, the BMD
is calculated for different parts of body as indicated above in
Fig. 16.1. Hence, patients with low bone density, and vertebral
fracture are at high risk.
It is well-established that existence of a previous vertebral fracture
increases the risk of subsequent fracture. Irrespective of patients
BMD, previous fracture increases risk significantly. Additionally,
it is well-established that risk for future fractures is increased for
patient with low BMD.
with medium BMD and an existing one vertebral fracture has twice
the risk for subsequent fractures compared to a patient with low
BMD and no fracture. (Fig. 16.3).
Configuration
K edge filter
Rare earth filter for elimination of continuous calibration
Constant potential X-ray Generator
Simultaneous dual focus beam
Patient positioning table
Under couch X-ray tube head utilizing stationary anode tube
and Over couch detector system both coupled together for
continuous movement in longitudinal direction at a low speed
to scan the patient from head to toe, thus completing whole
body scan.
Laser Beam for patient positioning with output power of less
than 1 MW,
Wavelength = 635 nm
284 Diagnostic Radiology and Imaging for Technicians
Beam aperture = 4 1 mm
Aspect ratio = 4:1
Divergence 28 degrees
Current drain = 105 mA
Input voltage = 4-6 volts DC
Safety = Class II
Computer
Laser printer.
Digital Radiography 285
17 Digital Radiography
DETECTORS
There are many types of detectors marketed by different companies
and they are similar in size, appearance and applications but have
differences in the image capturing technology incorporated, which
in turn decide the image quality. There are three distinguishing
technologies incorporated namely, CCD Camera Technology (uses
gadolinium oxy-sulfide as X-ray scintillator with lens optics and
CCD Camera), Flat PanelIndirect (uses cesium iodide as X-ray
scintillator with a-Si: H photodiode and Thin Film Transistors (TFT)
screen), Flat panelDirect uses a-Se as X-ray Photoconductor,
Storage Capacitor and a-S: H Thin Film Transistors (TFT) screen.
We will now discuss their relative advantages and disadvantages.
Digital Radiography 287
Flat-panel Technology
This technology have two types of detectors namely direct
conversion type and or indirect conversion type.
Advantages of DR System
To The Hospital
1. Negligible repeat examinations, increased room use and
reduced cost.
2. Higher productivity resulting in large number of patients in day.
3. Improved patient care.
4. Eliminates the need of conventional film processing, thus
reduced load on purchase department for frequent ordering of
dark room chemicals.
To The Radiologist
1. Rapid, good quality images, easy transmission, display, archive
and retrieve.
2. Capture and convert X-ray image into digital format within
seconds of exposure enabling technician to preview each image
prior to completion of examination procedure.
3. Enhance work flow through distribution of diagnostic images.
Digital image can be transmitted electronically via reading on
monitor or printing or storage.
4. Adjustment of electronic image at workstation (as well as
hardcopy), by radiologist for optimum information of the
desired anatomy.
5. Images can be communicated to other location for second opinion.
6. Image data on workstations, printer or in archives is identical
and does not get affected due to multiple viewing or storage
modalities.
Index 295
Index
A Basic circuits 80
Basic dual field image intensifier
Absorbed dose 262 186
Absorption 6, 18 Basic heating 100
Absorption value scale of CT Basic radiographic system 36, 129
scanner 249 Battery powered unit 34
Age dose 260 Beam direction 172
Air conditioning 53 Beam limiting device 149, 171, 269
Ampex system 212 Biangulix filaments 68
Analog to digital converter 196 Blanking 202
Analytical method 253 Blocking circuit 110
Angiographic injectors 229 Body section radiography equip-
Angiography 217 ment 138
Angiography systems 44 Body section radiography unit 42
Anode 58, 76 Bone densitometer unit 282
Applications of CT scanner 245 Bone densitometry 279
Area reduction factor 184 Boosting 67
Armstrong units 5 Brachial angiography 218
Attenuation 6 Brems strahlung 4, 11, 12
Auto transformer 102 Bright spots 148
Automatic circuitry 231 Bucky table with floating table top
Automatic dose rate control 204 131
Automatic exposure control 116
Automatic film processor 165 C
Automatic gain control 198
Automatic programming tech- Camera control unit 198, 199
nique 122 Camera lens 189
Average gradient 161 Capacitor discharge unit 33
Cardioangiography 218, 225
Cassettes 26, 156
B
Catapult bucky 133
Back projection method 253 Catapult bucky assembly 155
Backfire 81, 99 Catapult bucky mechanism 155
Base-plus-fog density 161 Cathode 58
296 Diagnostic Radiology and Imaging for Technicians
F G
Falling load technique 106, 111 Generations of CT scanners 241
Fan beam 239 Genetic effect 259
Fiberoptic system 187, 188 Geometrical blurring 67, 144
Filament 77 Glass envelope 70
Filament characteristics 70 Glass faceplate 194
Filament circuit 101, 103 Grid controlled tube 115
Filament control by triac 108 Grids 151
298 Diagnostic Radiology and Imaging for Technicians
M N
Magnetic voltage stabilizer 104 Nonionizing radiations 257
Magnification 219 Normal values for tungsten 14
Mains compensation 48, 119
Mains compensation circuit 120 O
Mains resistance 48, 90
Mammography equipment 138 Object image plane distance 144
Mammography units 45 Objective lens 188
Manual dark room processing 166 On load voltage 88
mA-Ri correction 89 Optical focal spot 55
Market requirements 27 Optical zoom 197
Maximum permissible dose levels Orthicon tube 192
263 Orthopantograph 29, 127
Maximum permissible exposure Output screen 183
time 229 Overcouch radiography 268
MDCT scanner 245 Overload protection 109
Measurement of dose 260
Metal plate 271 P
Methods of calculating BMD 281
Minification factor 184 PAG4 222
Mirror optic system 186 Pantix filaments 68
Mobile C-arm image intensifier Parallel grid 152
137 Patient table 239
Mobile equipment 129 Penetration 15
Mobile protective barrier 274 Penumbra 144
Mobile stand 232 Peripheral angiography 218
Mobile units 126 Persistence 195
Mobile X-ray 31 Phase in time 229
Modern X-ray generators 121 Photo cathode 182
Modular designs 123 Photo spot cameras 208
Monitor 200
Photoconductivity 190
Monochrome television monitor
Photoelectric effect 17
tube 201
Photoemission 190
Motor operated equipment for
radiography and fluoroscopy Photographic film 7
40, 134 Pinhole camera 66
Motor operated table 134 Planigraphy 42, 138, 233, 234
Multidirectional blurring 236 Planigraphy angle 234, 235
Multi-directional computer tomo- Planigraphy arm 234
graphy 244 Planigraphy principle 234
Multi-layer storage 214 Plumbicon 194
Multiple field image intensifiers Portable equipment 128
185 Portable X-ray 31
Multiplier 119 Portable/mobile X-ray 30
300 Diagnostic Radiology and Imaging for Technicians
R S
Radiation dose 259 Safe light 26
Radiation hazard 257 Scanning gantry 239
Radiation injury 260 Scattered radiation 5, 15, 149
Radiation protection 8, 257, 259, Scattered radiation grid 151
273 Screen structure mottle 157
Radiation quantity 148 Secondary switching 83, 114
Radiation sickness 8, 257 Selection of DR system 291
Radio transparent substance 145 Selenium rectifiers 95
Radiographic cone 149 Semiconductor radiation receiver
Radiographic image 7 118
Radiographic lead apron 273 Serial film changer 226
Radiographic materials and Serialography 116
processing technique 160 Service contract 141
Radiography 7, 147 Shield 71
Index 301