THE ESSENTIAL PHYSICS OF

MEDICAL IMAGING

SECOND EDITION

JERROLD~

BUSHBERG, PHD

Clinical Professor ofRadiology

University ofCalifOrnia, Davis
Sacramento, CalifOrnia

J. ANTHONY SEIBERT, PHD

Professor ofRadiology
University ofCalifOrnia, Davis
Sacramento, CalifOrnia

EDWIN M. LEIDHOLDT, JR., PHD

Associate Clinical Professor ofRadiology
University ofCalifOrnia, Davis
Sacramento, CalifOrnia

JOHN M. BOONE, PHD

Profissor ofRadiology
University ofCalifOrnia, Davis
Sacramento, CalifOrnia

4~ LIpPINCOTT WILLIAMS & WILKINS

A Wolters Kluwer Company Philadelphia Baltimore New York London Buenos Aires Hong Kong Sydney Tokyo

CONTENTS

Preface xv
Acknowledgments xvii
Foreword xix

SECTION I: BASIC CONCEPTS 1

Chapter 1:
1.1 1.2

Introduction to Medical Imaging 3

The Modalities 4
Image Properties 13
Radiation and the Atom 17

Chapter 2:
2.1 2.2

Radiation 17
Structure of the Atom 21
Interaction of Radiation with Matter 31

Chapter 3:
3.1 3.2 3.3 3.4 3.5

Particle Interactions 31
X- and Gamma Ray Interactions 37
Attenuation of X- and Gamma Rays 45
Absorption of Energy from X- and Gamma Rays 52
Imparted Energy, Equivalent Dose, and Effective Dose 56
Computers in Medical Imaging 61

Chapter 4:
4.1 4.2 4.3 4.4 4.5 4.6

Storage and Transfer of Data in Computers 61

Analog Data and Conversion between Analog and Digital Forms 66
Components and Operation of Computers 70
Performance of Computer Systems 78
Computer Software 79
Storage, Processing, and Display of Digital Images 82

SECTION II: DIAGNOSTIC RADIOLOGY 95

Chapter 5:
5.1

X-ray Production, X-ray Tubes, and Generators 97

Production of X-rays 97

viii
5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9

Contents

X-ray Tubes 102

X-ray Tube Insert, Tube Housing, Filtration, and Collimation 113
X-ray Generator Function and Components 116
X-ray Generator Circuit Designs 124
Timing the X-ray Exposure in Radiography 132
Factors Affecting X-ray Emission 135
Power Ratings and Heat Loading 137
X-ray Exposure Rating Charts 140
Screen-Film Radiography 145

Chapter 6:
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8

Projection Radiography 145

Basic Geometric Principles 146
The Screen-Film Cassette 148
Characteristics of Screens 149
Characteristics of Film 157
The Screen-Film System 163
Contrast and Dose in Radiography 164
Scattered Radiation in Projection Radiography 166
Film Processing 175

Chapter 7:
7.1 7.2 7.3 7.4 7.5 7.6 7.7

Film Exposure 175

The Film Processor 178
Processor Artifacts 181
Orher Considerations 183
Laser Cameras 184
Dry Processing 184
Processor Quality Assurance 186
Mammography 191

Chapter 8:
8.1 8.2 8.3 8.4 8.5 8.6 8.7

X-ray Tube Design 194

X-ray Generator and Phototimer System 204
Compression, Scattered Radiation, and Magnification 207
Screen-Film Cassettes and Film Processing 212
Ancillary Procedures 219
Radiation Dosimetry 222
Regulatory Requirements 224

Contents

ix

~Pter 9:
9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8

Fluoroscopy 231

Functionality 231
Fluoroscopic Imaging Chain Components 232
Peripheral Equipment 242
Fluoroscopy Modes of Operation 244
Automatic Brightness Control (ABC) 246
Image Quality 248
Fluoroscopy Suites 249
Radiation Dose 251
Image Quality 255

Chapter 10:
10.1 10.2 10.3 10.4 10.5 10.6 10.7

Contrast 255
Spatial Resolution 263
Noise 273
Detective Quantum Efficiency (DQE) 283
Sampling and Aliasing in Digital Images 283
Contrast-Detail Curves 287
Receiver Operating Characteristics Curves 288
Digital Radiography 293

Chapter 11:
11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10

Computed Radiography 293

Charged-Coupled Devices (CCDs) 297
Flat Panel Detectors 300
Digital Mammography 304
Digital versus Analog Processes 307
Implementation 307
Patient Dose Considerations 308
Hard Copy versus Soft Copy Display 308
Digital Image Processing 309
Contrast versus Spatial Resolution in Digital Imaging 315
Adjuncts to Radiology 317

Chapter 12:
12.1 12.2 12.3 12.4

Geometric Tomography 317

Digital Tomosynthesis 320
Temporal Subtraction 321
Dual-Energy Subtraction 323

Contents

Chapter 13:
13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9

Computed Tomography 327

Basic Principles 327 Geometry and Historical Development 331 Detectors and Detector Arrays 339 Details of Acquisition 342 Tomographic Reconstruction 346 Digital Image Display 358 Radiation Dose 362 Image Quality 367 Artifacts 369 Nuclear Magnetic Resonance 373

Chapter 14:
14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9

Magnetization Properties 373 Generation and Detection of the Magnetic Resonance Signal 381 Pulse Sequences 391 Spin Echo 391 Inversion Recovery 399 Gradient Recalled Echo 403 Signal from Flow 408 Perfusion and Diffusion Contrast 409 Magnetization Transfer Contrast 411 Magnetic Resonance Imaging (MRI) 415

Chapter 15:
15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8

Localization of the MR Signal 415 k-space Data Acquisition and Image Reconstruction 426 Three-Dimensional Fourier Transform Image Acquisition 438 Image Characteristics 439 Angiography and Magnetization Transfer Contrast 442 Artifacts 447 Instrumentation 458 Safety and Bioeffects 465 Ultrasound 469

Chapter 16:
16.1 16.2

Characteristics of Sound 470 Interactions of Ultrasound with Matter 476

Contents

xi

16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11

Transducers 483
Beam Properties 490
Image Data Acquisition 501
Two-Dimensional Image Display and Storage 510
Miscellaneous Issues 516
Image Quality and Artifacts 524
Doppler Ultrasound 531
System Performance and Quality Assurance 544
Acoustic Power and Bioeffects 548
Computer Networks, PACS, and Teleradiology 555

Chapter 17:
17.1 17.2

Computer Networks 555

PACS and Teleradiology 565

, SECTION III: NUCLEAR MEDICINE 587

Chapter 18:
18.1 18.2 Radioactivity and Nuclear Transformation 589

Radionuclide Decay Terms and Relationships 589

Nuclear Transformation 593
Radionuclide Production and Radiopharmaceuticals 603

Chapter 19:
19.1 19.2 19.3

Radionuclide Production 603

Radiopharmaceuticals 617
Regulatory Issues 624
Radiation Detection and Measurement 627

Chapter 20:
20.1 20.2 20.3 20.4 20.5 20.6 20.7

Types of Detectors 627

Gas-Filled Detectors 632
Scintillation Detectors 636
Semiconductor Detectors 641
Pulse Height Spectroscopy 644
Non-Imaging Detector Applications 654
Counting Statistics 661
Nuclear Imaging-The Scintillation Camera 669

Chapter 21:
21.1 21.2

Planar Nuclear Imaging: The Anger Scintillation Camera 670

Computers in Nuclear Imaging 695

xii

Contents

Chapter 22:

Nuclear Imaging-Emission Tomography 703

22.1 Single Photon Emission Computed Tomography (SPECT) 704 22.2 Positron Emission Tomography (PET) 719

SECTION IV: RADIATION PROTECTION, DOSIMETRY, AND

BIOLOGY 737

Chapter 23:
23.1 23.2 23.3 23.4 23.5

Radiation Protection 739

Sources of Exposure to Ionizing Radiation 739 Personnel Dosimetry 747 Radiation Detection Equipment in Radiation Safety 753 Radiation Protection and Exposure Control 755 Regulatory Agencies and Radiation Exposure Limits 788
Radiation Dosimetry of the Patient 795

Chapter 24:
24.1 24.2

X-ray Dosimetry 800 Radiopharmaceutical Dosimetry: The MIRD Method 805

Radiation Biology 813

Chapter 25:
25.1 25.2 25.3 25.4 25.5 25.6 25.7

Interaction of Radiation with Tissue 814

Cellular Radiobiology 818
Response of Organ Systems to Radiation 827
Acute Radiation Syndrome 831
Radiation-Induced Carcinogenesis 838
Hereditary Effects of Radiation Exposure 851
Radiation Effects In Utero 853

SECTION V: APPENDICES 863

Appendix A:
A.l A.2 A.3

Fundamental Principles of Physics 865

Physical Laws, Quantities, and Units 865

Classical Physics 867
Electricity and Magnetism 868
Physical Constants, Preftxes, Geometry, Conversion Factors, and
Radiologic Data 883

Appendix B:
B.l 8.2

Physical Constants, Prefixes, and Geometry 883

Conversion Factors 884

Contents

xiii

8.3

Radiological Data for Elements 1 through 100 885 Mass Attenuation Coefficients and Spectra Data Tables 887

Appendix C:
C1 C2 C3 C4 C5 C6 C7

Mass Attenuation Coefficients for Selected Elements 887 Mass Attenuation Coefficients for Selected Compounds 889 Mass Energy Attenuation Coefficients for Selected Detector Compounds 890 Mammography Spectra: Mo/Mo 891 Mammography Spectra: Mo/Rh 893 Mammography Spectra: RhfRh 895 General Diagnostic Spectra: W/Al 897 Radiopharmaceutical Characteristics and Dosimetry 899

Appendix D:

0.1 Route of administration, localization, clinical utility, and other characteristics of commonly used radiopharmaceuticals 900

D.2 Typical administered adult activity, highest organ dose, gonadal dose, and adult effective dose for commonly used radiopharmaceuricals 908 D.3 Effective doses per unit activity administered to patients age 15, 10, 5, and 1 year for commonly used diagnostic radiopharmaceuticals 910

0.4 Absorbed dose estimates

Appendix E:
Subject Index 915

to the embryo/fetus per unit activity administered to the mother for commonly used radiopharmaceuticals 911

Internet Resources 913

PREFACE TO THE
SECOND EDITION

The Erst edition of this text was developed from the extensive syllabus we had created for a radiology resident board review course that has been taught annually at the University of California Davis since 1984. Although the topics were, in broad terms, the same as in the course syllabus, the book itself was written de novo. Since the Erst edition of this book was completed in 1993, there have been many important advances in medical imaging technol ogy. Consequently, in this second edition, most of the chapters have been completely rewrit ten, although the organization of the text into four main sections remains unchanged. In addition, new chapters have been added. An Introduction to Medical Imaging begins this new edition as Chapter 1. In the Diagnostic Radiology section, chapters on Film Processing, Digi tal RadioKraphy, and Computer Networks, PACS, and Teleradiography have been added. In recognition of the increased sophistication and complexity in some modalities, the chapters on MRI and nuclear imaging have been split into two chapters each, in an attempt to break the material into smaller and more digestible parts. Considerable effort was also spent on integrating the discussion and assuring consistent terminology between the different chap ters. The ImaKe Quality chapter was expanded to provide additional details on this impor tant topic. In addition, a more extensive set of reference data is provided in this edition. The appendices have been expanded to include the fundamental principles of physics, physical constants and conversion factors, elemental data, mass attenuation coefficients, x-ray spec tra, and radiopharmaceutical characteristics and dosimetry. Web sites of professional soci eties, governmental organizations and other entities that may be of interest to the medical imaging community are also provided. The Eeld of radiology is in a protracted state of transition regarding the usage of units. Although the 51 unit system has been officially adopted by most radiology and scientif-1c journals, it is hard to avoid the use of the roentgen and rem. Our ionization chambers still read out in milliroentgen of exposure (not milligray of air kerma), and our monthly mm badge reports are still conveyed in millirem (not millisievens). The U.S. Government has been slow to adopt 51 units. Consequently, while we have adopted 51 units throughout most of the text, we felt compelled to discuss (and use where appropriate) the older units in con texts where they are still used. Furthermore, antiquated quantities such as the effective dose equivalent are still used by the U.S. Nuclear Regulatory Commission, although the rest of the world uses effective dose. We have received many comments over the years from instructors, residents, and other stlldents who made use of the Erst edition, and we have tried to respond to these comments by making appropriate changes in the book. Our intention with this book is to take the novice reader from the introduction of a topic, all the way through a relatively thorough description of it. If we try to do this using too few words we may lose many readers; if we use too many words we may bore others. We did our best to walk this fine line, but if you are in the latter group, we encourage you to readjezster.

xvi

Preface to the Second Edition

We are deeply grateful to that part of the radiology community who embraced our first effort. This second edition was inspired both by the successes and the shortcomings of the first edition. We are also grateful to those who provided suggestions for improvement and we hope that they will be pleased with this new edition.
Jerrold T Bushberg j. Anthony Seibert Edwin M. Leidholdt, Jr. John M. Boone

ACKNOWLEDGMENTS

During the production of this work, several individuals generously gave their time and exper tise. First, we would like to thank L. Stephen Graham, Ph.D., University of California, Los Angeles, and Mark W Groch, Ph.D., Northwestern University, who provided valuable insight in detailed reviews of the chapters on nuclear medicine imaging. We also thank Michael Buonocore, M.D., Ph.D., University of California, Davis, who reviewed the chap ters on MRI, and Fred Mettler, M.D., University of New Mexico, who provided valuable contributions to the chapter on radiation biology. Raymond Tanner, Ph.D., University of Tennessee, Memphis, provided a useful critique and recommended changes in several chap ters of the First Edition, which were incorporated into this effort. Virgil Cooper, Ph.D., Uni versity of California, Los Angeles, provided thoughtful commentary on x-ray imaging and a fresh young perspective for gauging our efforts. We are also appreciative of the comments of Stewart Bushong, Ph.D., Baylor College of Medicine, especially regarding film processing. Walter Huda, Ph.D., SUNY Upstate Medical University, provided very helpful discussions on many topics. The expertise of Mel Tecotzky, Ph.D., in x-ray phosphors enhanced our discussion of this topic. Skip Kennedy, M.S., Uni versity of California, Davis, provided technical insight regarding computer networks and PACS. The efforts of Fernando Herrera, UCD Illustration Services, brought to life some of the illustrations used in several chapters. In addition, we would like to acknowledge the superb administrative support of Lorraine Smith and Patrice Wilbur, whose patience and attention to detail are greatly appreciated. We are grateful for the contributions that these individuals have made towards the development of this book. We are also indebted to many other scientists whose work in this field predates our own and whose contributions served as the foundation of many of the con cepts developed in this book.

]. T.B.
].A.S. E.M.L. ].M.B.

FOREWORD

Can medical physics be interesting and exciting? Personally, I find most physics textbooks dry, confusing, and a useful cure for my insomnia. This book is different. Dr. Bushberg and his colleagues have been teaching residents as well as an international review course in radiation physics, protection, dosimetry, and biology for almost two decades. They know what works, what does not, and how to present information clearly. A particularly strong point of this book is that it covers all areas of diagnostic imaging. A number of current texts cover only one area of physics and the residents often purchase several texts by different authors in order to have a complete grasp of the subject matter. Of course, medical imagers are more at home with pictures rather than text and formulas. Most authors of other physics books have not grasped this concept. The nearly 600 exquisite illustrations contained in this substantially revised second edition will make this book a favorite of the medical imaging community. Fred A. Mettler Jr., M.D. Professor and Chair Department ofRadiology University ofNew Mexico Albuquerque, New Mexico