9 Fe Gn a errata 6864 Cochran Road Solon, Ohio 44139 info@DITECnet.com (440) 519-1555 Fax (440) 519-1556 Presented by: DITEC, Inc. SIX-Time Winners of 24x7 Readers’ Choice Award Best Service Training Program or Aid - Diagnostic Imaging Maintenance Levels 1, I, IIL copyright DITEC, Inc. State of OH State Board of Career Colleges & Schools Reg # 94-05-1398 Diagnostic Imaging Technical Education Center, Inee ww Notes FUNDAMENTALS OF SERVICING DIAGNOSTIC IMAGING SYSTEMS INTRODUCTION In 1895, the first medical radiographs astounded the medical and scientific communities. Those early images were the result of a discovery of invisible rays that were able to create images of structures that were invisible to the naked eye. ‘The following is a list of diagnosed findings and applications that were performed in the first year following the discovery of x-rays: 1. Gallstones 2. Arteriosclerosis 3. Contrast injection for the first arteries 4. Chest film 5. Kidney stones 6. Iodine agent used as contrast 7. First execution of fluoroscopy 8, For the enhanced viewing of the stomach and intestines the contrast medium used was barium sulfate. The Fundamentals of Servicing Diagnostic Imaging Systems Level | course will introduce you to some of those methods. Specifically, you will be introduced to diagnostic X-ray techniques as well as Computed Tomography, Nuclear medicine, Ultrasound, Magnetic Resonance Imaging (MRI) and Filmless radiography. The main focus of this course will be on diagnostic Radiographic and Fluoroscopic x-ray imaging techniques. The course is designed to teach the new service professional the skills necessary to build an excellent foundation in the servicing of diagnostic x-ray imaging systems. It wil] provide in depth coverage of the different systems used in the radiology department. It must be realized that there is much more to the problem of creating diagnostic quality images than meets the eye. The nature of imaging, techniques requires that you have an understanding of the reasons behind the current choices if you are to understand the nature of diagnostic imaging as a goal. Fundamentals of Servicing 1 For Training Purposes Only ‘Diagnostic Imaping Systems. (© DITEC, Inew Notes COURSE OBJECTIVES: At the conclusion of this course, attendees will be able to: 1. Identify the various equipment in the radiology department and define their uses. 2. State and follow radiation safety procedures as they apply to all personnel in radiology. 3. Define x-rays and how they are produced and controlled. 4, Define the factors that affect the radiographic image quality and state how each affects the image 5. Define image receptor parameters and state how each affects radiographic quality. 6, Troubleshoot the normal radiographic/fuoroscopic system to the ‘major subassembly level. Fundamentals of Servicing 12 For Training Purposes Only Diagnostic Imaging Systems © DITEC, Incw Notes INTRODUCTION TO DIAGNOSTIC X-RAY IMAGING SYSTEMS INTRODUCTION This section will familiarize the service professional with the operation and purpose of the components found in the radiology depart- ment SECTION OBJECTIVES 1, Identify the components found in the various x-ray rooms. 2, State the purpose of the various components found in the x-ray rooms. 3, Describe the principle of mechanical tomography. 4. Descibe the principkes of computed radiography and digital radiography. 5. Describe the principte of computed tomography. Fundamentals of Servicing 2 For Training Purposes Only Diagnostic Imaging Systems ITEC, Ine& Notes RADIOGRAPHIC AND FLUOROSCOPIC IMAGING As an aid in diagnosis, x-rays provide two different methods of examination. One is known as Radiography, a permanent record of the x- ray image of the various parts of the body, The other method is known as Fluoroscopy, a visual study of the x-ray shadow as it appears on a moni- tor which enables the doctor to observe internal motion of the organs, Radiography, as stated above, presents us an image, which is a record of shadows of different parts, varying according to their respective densities and absorption of x-rays. It js from a highly skilled interpretation of the shadow images that a radiologist makes a diagnosis. X-ray examinations by fluoroscopy make it possible to study internal organs in motion, and therefore are vitally important in modern diagnosis. Fluoroscopic examination, for instance, is often used to observe the natural action of the heart, stomach, and gastrointestinal tract. Fundamentals of Servicing 22 For Training Purposes Only ‘Diagnostic Imaging Systems GHTEC, Ine& Notes RADIOGRAPHIC ROOMS “The most basic modem day radiography room consists of the following apparatus X-ray Control he x-ray control determines the length of exposure, KV, and mA which are critical in providing good radiographs. Included with the control are the overtable x-ray tube, high voltage transformer, and beam limiting device. Pedestal table ‘The function of a pedestal table is to position the patient. The table top is movable in four directions. Also built into the table is the cassette holder or Bucky to hold the image receptor. A grid may also be patt of the cas- sette holder. ‘hest Stand This wall mounted device contains a cassette holder and grid. It is used for radiographs while the patient is standing, ‘The preceding components are the minimum you will find in any radio- graphic room, Options such as tomography attachments may also be found. ‘The typical procedures performed with this equipment are: Chest, Extrem- ities, and Tomographic studies. Fundamentals of Servicing 23 For Training Purposes Only Diagnostic Imaging Systems ‘ITEC, IneFundamentals of Servicing Diagnostic Imaging Systems 24 Zz g BASIC RADIOGRAPHIC SYSTEM For Training Purposes Only ‘ITEC, IncNotes CONVENTIONAL MECHANICAL TOMOGRAPHY The figure below demonstrates the principle of tomography. As the x-ray tube and the image receptor are moved in opposite directions, the object at the top, closer to the x-ray tube, has apparent motion from left to right on the film. The object at the bottom has apparent motion from right to left on the receptor. Both objects will be blurred and not readily visible ‘on the image. The object in the middle has no apparent motion because its image remains in the center of theimage receptor. ‘Thus, this object will be in focus throughout the tomographic cut, as will be all objects in the same plane as the middle object. The thickness of the tomographic slice can be controlled by varying the arc of the x-ray tube and film cassette. The smaller the are, the thicker the slice. ‘The spatial location of the slice within the object can be determined by moving the subject in a vertical direction. <___________ TUBE Moron FOCAL PLANE IMAGE RECEPTOR Stee er MOTION PRINCIPLES OF TOMOGRAPHY Fundamentals of Servicing 25 For Training Purposes Only Diagnostic Imaging Systems MTEC, IneNotes RADIOGRAPHIC/FLUOROSCOPIC ROOMS The typical R/F room contains all the equipment used in a radiography room with the addition of the components used for fluoroscopy. X-ray Control ‘A fluoroscopic panel is added to control the fluoroscopic length of expo- sure, KV, and mA. Included with the control are the undertable x-ray tube and beam limiting device. Angulating Table To position the patient, the angulating table is able to be tilted and the tabletop is motorized. Also built into the table is the cassette holder or Bucky to hold the image receptor. Fluoroscopic Imaging Chain Fluoroscopic imaging chain includes the image intensifier, video camera, and video monitor. ‘After the object has been visualized, options that make it easier to make & permanent record of the study may be found in the room. These may include a spotfilm device, and/or a digital photospot to record the image. The procedures performed with this type of equipment are Gastrointestinal studies (upper and lower GD, spine studies (myelograms), and Renal/Urinary Tract studies (IVP/KUB). The procedures are typically performed by a radiologist and x-ray technologist Fundamentals of Servicing 26 For Training Purposes Only ‘Diagnostic Imaging Systems ITEC, IncNotes BASIC RADIOGRAPHIC/FLUOROSCOPIC SYSTEM Fundamentals of Servicing 27 For Training Purposes Only Diagnostic imaging Systems ‘@NTEC, IneNotes COMPUTED RADIOGRAPHY AND DIGITAL RADIOGRAPHY ‘The key to advancements in conventional radiology is in digitizing the images we normally put on film so they can be manipulated in an elec- tronic format and thus enhanced, ‘There are two means available to obtain Digital X-Rays from an other- wise conventional x-ray system. 1. Computed Radiography (CR) 2. Digital Radiography (DR, or as PACS labels it, DX) Computed Radiography CR uses standard x-ray systems. There is only a change in the image receptor i.e. the cassette. A storage phosphor plate is placed in the X-ray cassette instead of a piece of film. There is no need to change existing X- Ray machines ‘The phosphor plate captures and “stores” the x-rays. The image is “developed” in a CR reader instead of a film processor, The CR reader extracts the information stored in the plate and produces a digital image. Fundamentals of Servicing 28 For Training Purposes Only Diagnostic Imaging Systems ‘@NTEC, IncDigital Radiogray In digital radiography, the X-Ray systems use what are called flat panel detectors instead of film. The detectors can be permanently affixed inside the imaging system. These DR detectors are electronic devices that directly capture x-rays, and produce a digital image. { \ Notes Fundamentals of Servicing 29 For Training Purposes Only Diagnostic Jmaging Systems ‘ITEC, Ineed Notes SPECIAL PROCEDURES ROOMS A special procedures room is a Radiographie/Fluoroscopic room that has been modified to perform Angiography (blood vessels) studies other than the heart X-ray Control Fluoroscopie panel and film changer panel are added to the x-ray control to determine the length of exposure, KY, and mA for each mode. Included with the control are the x-ray tube, high voltage transformer, and beam limiting device. C-arm ‘The x-ray tube and imaging chain are mounted on a c-arm configuration for positioning around the patient to obtain the proper view. Island Table To position the patient the table is movable in all directions plus it can rotate. Eluoroscopic Imaging Chain The fluoroscopic imaging chain includes the image intensifier and video camera which are mounted on the c-arm and the video monitor which is ceiling mounted. Afier the object has been visualized options that make it easicr to make a permanent record of the study may be found in the room. These may include a film changer, and/or a digital photospot to record the image. ‘The procedures are typically performed by a radiologist and an x-ray tech- nologist. Fundamentals of Servicing 210 For Training Purposes Only Diagnostic Imaging Systems ‘MTEC, IneNotes PATIENT ‘MONITORS MONITORS: IMAGE, BASIC SPECIAL PROCEDURES ROOM lw Fundamentals of Servicing 24) For Training Purposes Only Diagnostic Imaging Systems HEC, TneNotes CARDIAC CATH LABS ‘A Cardiac cath Jab is an R/F room that has been modified to perform cor- onary artery studies (blood vessels in the heart) and angioplasty studies. X-ray Control Fluoroscopic panel and cine film panel are added to control the length of exposure, KV, and mA for each mode. Cine camera frame rates range between 30 frames per second to 120 frames per second. Included with the control are the x-ray tube, high voltage transformer, and beam limiting device. arm The x-ray tube and imaging chain are mounted on a c-arm configuration for positioning around the patient to obtain the proper view, Island Table To position the patient, the table is movable in all rotate, irections as well as Fluoroscopic Imaging Chain The fluoroscopic imaging chain includes the image intensifier and video camera which are mounted on the ¢-arm and the video monitor which is ceiling mounted. ‘A cine film camera or digital cine will be used to make a permanent record of the study after the object has been visualized. ‘The procedures are typically performed by a cardiologist and a cardiovascular technologist. Fundamentals of Servicing 242 For Training Purposes Only Diagnostic Imaging Systems ‘@ITEC, tneNotes WOOU NOLLVZIWSLAHLVO DVIGUV OISVE SOLINON "ANAL ‘SHQLINOW ‘OVAL = “= ae = ar w For Training Purposes Only ITEC, inc 23 Diagnostic Imaging Systems Fundamentals of ServicingNotes COMPUTED TOMOGRAPHY Computed Tomography is a method of imaging the human body using x- rays by which the x-ray tube is rotated around the patient while the x-ray beam is measured and stored in a computer. This projected data is then reconstructed by the computer into a cross-sectional image. ‘The most striking difference of a CT image compared to x-ray is its view- ing angle in relation to the patient’s anatomy. Conventional x-ray portrays the anatomy as if you could see through the patient front to back or side to side. These views are called Anterior/Posterior and Lateral. In a CT image the viewing angle is as if the patient were cut in half and you could view the anatomy looking down the patient top to bot- tom as successive slices. This view is called a transverse slice or cross- section. Fundamentals of Servicing 24 For Training Purposes Only Diagnostic Imaging Systems ‘ITEC, IneNotes ray tube is rotated around the object. Each detector will provide a signal proportional to the x-ray intensities exiting the object. When these sig- nals are combined by the system computer, an image is generated which will display the object's internal characteristics within the slice. 6 ‘The following figure demonstrates the action of the CT system as the x- Motion of Tube X-Ray Tube \ Third Generation Ey / + Fan Beam ee, + Rotating Detector Array Motion of Detector ~ 77" Detector ‘Array Cae Motion of Tube Fourth Generation + Fan Beam ‘+ Stationary Cireular Detector Array Stationary Detector Array Fundamentals of Servicing 2s For Training Purposes Only Diagnostic Imaging Systems ITEC, inew Notes SUMMARY ‘The understanding of the purpose and operation of the various components found in the x-ray department is the foundation used for troubleshooting and calibration of the system. In this section we identified the components that are typically found in radiographic rooms, radiographie/fluoroscopic rooms, special procedures rooms and cardiac cath labs. We also stated the purpose of each component. In addition, we also covered the procedures that are performed and the personnel typically involved. Conventional tomography and computed tomography were also discussed. For Training Purposes Only Fundamentals of Servicing 216 Purposes Onl Diagnostic Imaging Systems[ S & Notes, TRODUCTION TO OTHER DIAGNOSTIC IMAGING TECHNIQUES INTRODUCTION “The methods of producing and recording diagnostic images of unseen structures within the human body has taken many interesting turns. The wide variety of diagnostic imaging techniques is staggering. The nature of imaging techniques and products requires that you have an understanding of the reasons behind the current choices if you are to understand the nature of diagnostic imaging as a whole. This section will introduce you to some of the more common imaging techniques. SECTION OBJECTIVES, 1. Describe the principle of nuclear medicine imaging techniques. 2. Describe the principle of ultrasound imaging techniques. 3, Describe the principle of magnetic resonance imaging techniques. Fundamentals of Servicing a4 For Training Purposes Only Diagnostic Imaging Systems ODITEC. IncNUCLEAR MEDICINE IMAGING Gamma Camera Nuclear Medicine involves the use of radioactive isotopes (radioisotopes) to prevent, diagnose, and treat disease. Very small amounts of radioactive materials are introduced into the body. Because they are attracted to spe- cific organs, bones or tissues, the emissions they produce can provide cra- cial information about a particular type of cancer or disease. Information gathered during a nuclear medicine technique is more comprehensive than other imaging procedures because it describes organ function, noi just structure. The result is that many diseases and cancers can be diagnosed much earlier. Because nuclear medicine procedures utilize very small doses of short lived isotopes (ones that only stay radioactive for a few hours or days), the amount of radiation received is generally less than or equal to that of an x- ray. ‘The gamma camera absorbs the gamma rays emanating from the patient. ‘When a gamma ray photon is absorbed by the camera, a flash of light is produced which is turned into an electric signal, which is eventually pro- ‘cessed to create an image on a CRT. ‘The digital image may be manipulated by any number of image processing techniques. The ability of these images to convey information about struc- ture and function makes nuclear imaging a valuable diagnostic tool. Fundamentals of Servicing 32 For Diagnostic Imaging Systems Notes ing Purposes Only ©DITEC, IneNotes Positron Emission Tomography Positron Emission Tomography (PET) is a nuclear medicine imaging tech- nique that produces a three dimensional image of functional processes in tg body, PET.is similar to Nuclear Medicine studies in that the patient is injected with radioactive isotopes, but the detectors are set in an array around the patient like CT. The radioactive isotopes in the patient emit positrons which are annihilated when they collide with electrons. This produces a pair of annibilation photons (similar to gamma rays) moving in exact opposite directions, These photons are picked up by the detectors and a map of their origin in the body can be plotted to give a view of a slice of the body. The patient is then moved farther into the detector and the next slice of the body may be imaged. These slices may be combined to give a three dimensional image of functions in the body. Fundamentals of Servicing 33 For Training Purposes Only Diagnostic Imaging Systems @DITEC, Inee Notes ULTRASOUND Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images from inside the human body through the use of high-frequency sound waves; generally between 2.5 to 10 MgHz. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (x-ray) is involved. Obstetric ultrasound refers to the specialized use of sound waves to visual- ize and thus determine the condition of a pregnant woman and her embryo or fetus. Ultrasound is also a useful way of examining many of the body's internal organs, including but not limited to the heari, liver, gallbladder, spleen, pancreas, kidneys and bladder. Because ultrasound images are cap- tured in real time, they can show movement of internal tissues and organs and enable physicians to see blood flow and heart valve functions. This can help to diagnose a variety of heart conditions and to assess damage after a heart attack or other illness. ‘Uluasound imaging is based on the same principles involved in the sonar used by bats, ships at sea and anglers with fish detectors. As the sound passes through the body, echoes are produced that can be used to identify how far away an object is, how large it is, its shape and its consistency (fluid, solid or mixed). ‘The ultrasound transducer functions as both a generator of sound (like a speaker) and a detector (like a microphone). When the transducer is pressed against the skin it directs inaudible, high-frequency sound waves into the body. As the sound echoes from the body’s fluids and tissues the transducer records the strength and character of the reflected waves. With Doppler ultrasound the microphone captures and records tiny changes in the sound wave's pitch and direction of the sound. These echoes are instantly mea- sured and displayed by a computer, which in turn creates a real-time picture ‘on the monitor. Fundamentals of Servicing 34 For Training Purposes Only Diagnostic Imaging Systems ‘@DITEC, IneNotes MAGNETIC RESONANCE IMAGING Magnetic Resonance Imaging (MRD), introduced in the early 1980s, uses a very powerful magnet and computer technology to get information from the water molecules in the body. Water molecules contain hydrogen atoms Within the magnetic field created by the MRI, the hydrogen atoms line up, allowing the hydrogen nuclei to act like tiny radios. An MRI sends radio waves (RF signals) and receives RF signals back from the nuclei. A com- puter then turns these signals into images with tremendous clarity. These images resemble CT images with the notable difference that no bone is vis ible in an MRI image due to the lack of hydrogen atoms in bone. MRI is particularly useful in studying the brain, spinal column, musculoskeletal system and blood vessels, MRI provides physicians a method of seeing your intemal body structures without using X-rays. This technology enables physicians to detect devel- coping diseases or abnormalities earlier. These images are of such amazing, clarity and detail that physicians are able to pinpoint brain lesions, identify problems of the spinal column and other organs and tissue masses, Fundamentals of Serv ‘Diagnostic Lmagin) 3S For Training Purposes Only @DITEC, IneNotes SUMMARY C22 This section introduced you to some of the most common diagnostic imaging modalities other than x-ray. We discussed various nuclear medi- cine imaging techniques, ultrasound imaging techniques, and magnetic resonance imaging techniques. The applications of each of these modali- ties was also discussed. If you had difficulty with any of these concepts, wwe suggest you review the material in this section Fundamentals of Servicing 36 For Training Purposes Only Diagnostic Imaging Systems ODITEC, IneNotes qe RADIATION SAFETY INTRODUCTION ‘This section will familiarize the service professional with the effects of ionizing radiation, detection and measurement, units of measure, and methods used to reduce exposure to ionizing radiation. SECTION OBJECTIVES 1. Discuss methods used for the detection of ionizing radiation, 2. Describe the operation of an ion chamber. 3. State the purpose of the film badge. 4, Discuss the methods used for reducing exposure to ionizing radiation. nd Fundamentals of Sesvicing an For Training Purposes Only Diagnostic Imaging Systems @DITEC, ineINTERACTION A service professional must fully understand the interaction that takes place when a beam of x-ray photons passes through matter. The term interaction is fairly simple; one force or body having a measurable effect on another forve or body. An x-ray beam consists of pure energy photons. Whether it be an x-ray film, air, or the living tissue of the patient being irradiated, an x-ray beam transfers its energy to the matter through which itis passing. Our normal senses cannot detect this transfer of energy as it involves x-ray photons, which are invisible. “They cannot be heard, or felt. It is not always immediately evident an interaction occurred without the use of specialized equipment to detect these incidents. In certain materials some, if not all, of the x-ray energy scems to di appear. This phenomenon is described using the term ‘Absorption’ - the process by which an x-ray photon transfers its energy to the medi- um through which it is passing. Some effects of this absorption pro- cess are: (1) chemical modifications, (2) electrical changes , and (3) biological changes in living tissue. ‘The process known as lonization (the removal or addition of an elec- tron from or to an atom) is the process which brings about these changes. Ionization leaves the atom with an overall positive or nega- tive charge. The ionization occurrence allows for the measurement of radiation. The detection and measurement of radiation is brought about by ionization and chemical changes. Indirect methods must be employed to detect the presence of x-ray radiation, as none of our five senses can do so. The ionization process is harmful, and in some cases deadly, to the living tissue. It is this ionization process which allows us to detect x-ray photons through the chemical and electrical changes it causes. ‘Chemical Changes The chemical changes caused by the ionization process ean be visualized through the use of x-ray film. As we know the ionization of silver bromide crystals caused them to turn black proportional to the amount of exposure. The amount of film blackening is directly related to the amount of radiation the film was exposed to. We ean equate the density of the film (o a quantity (dose) of radiation. One example of a total dose detector is a radiation film badge. This device is most ofien used to detect and measure occupational radiation exposures Diagnostic Imaging Systems Notes 42 For Training Purposes Only ‘©DITEC, IncNotes A radiation film badge is made up of a film packet inserted in a film holder (plastic or metal). Two pieces of film are in the film packet. This film packet has one piece of film which is double emulsion, the othe single emulsion. The film may contain x-ray sensitive emulsion only, or it may be x-rays, gamma rays, and beta particles sensitive. Films are available for detecting and measuring neutrons. The radiation badge film responds exactly as radiographic film to radiation. ‘The more it is exposed to radiation, the darker it gets. The amount of film density indicates the radiation dosage. Extremely controlled conditions by a central agency are used to insure accurate and consistent results when processing is carried out Electrical Changes ‘Also useful in detecting the presence of radiation are the electrical changes brought about by the ionization process. This is possible since the number of freed electrons from an x-ray beam will provide a large number of such electrons where there were essentially none before. ‘An example of an instrument that measures radiation dose, an ion chamber, is illustrated below. X-ray Photons) ae +4300 10 +700 VDC hy mN a > Signal Out ION CHAMBER ‘There is no reading on the meter if there is no ionization (no electrons being freed); consequently, there is no electron flow, even with application of a difference of potential across the chamber without radiation, A reading on the meter will occur with radiation, ionization will take place (electrons are being freed), and the application of a difference of potential will cause electron flow. Since more radiation causes more ionization, the rate of current flow would then reflect the amount of radiation striking the chamber. Calibration of the instrument can be done by using a known quantity of radiation. Fundamentals of Servicing 43 For Training Purposes Only Diagnostic imaging Systems ‘ITEC, IneNotes UNITS OF RADIATION Harmful consequences do occur with the ionizing of radiation to a living organism. This is due to the absorbed energy (dose) by the cells and tissues that form the organism. Chemical decomposition of the molecules present in the living celis is the result of absorbed energy (dose). Some measure of the amount of physiological damage that might be expected from a given quantity, or dose, may be attributed to the amount of ioniza- tion in the cells or tissues. Air, for certain practical reasons, is used in establishing a unit of measure. The number of ion pairs (or ionization) tak- ing place within the medium (air) of interest, would be the ideal basis for radiation-dose measurement. Roentgen ‘A Roentgen (R) is the amount of radiation that will produce one electrostatic unit of charge in 1 ce of air. Since one electrostatic unit of charge is equal to 2.083 x 10° electrons, one R causes 2.083 x 10° (2,083,000,000) ion pairs. Radiation Absorl ose (RAD) The type of absorbing material and the quality of radiation will vary the energy absorbed per R of exposure. The unit of absorbed dose equal to the absorption of 100 ergs of energy per gram of irradiated material is RAD. RAD Equivalent Man (REM) The absorbed dose in RADs multiplied by the relative biological < effectiveness of the radiation used on the particular biological system irra- diated is REM. ‘The energy range used for medical radiography, IR = 1 RAD = 1 REM. For all practical purposes the RAD and REM will be the same as the R. For occupations such as service professionals requiring exposure to ion- ized radiation on a regular basis, the following maximum accumulated dose should not be exceeded as recommended by radiation guides. The maximum average dose rate for external exposure, from X-rays or gamma rays, to the whole body, head and trunk, active blood-forming organs, gonads, and the lens of the eye should not exceed 5 REMs per year. The maximum permissible dose is generally higher when only a single postion of the body is exposed. For example, the average dose rate to the hands, forearms, feet and ankles should not ‘exceed 75 REMs per year. & Fundamentals of Servicing 44 For Training Purposes Only Diagnostic Imaging Systems ODITEC, Ineed Notes Below are two examples of calculating the maximum permissible (accumulated) dose. Five (5) is the maximum dose rate per year, N is the age of the worker in years, and 18 is the age prior to which no occupa tional dose is allowed. Age 25 5(N-18) = 5(25-18) = 5(7) = 35 REMs Age 35 5(N-18) = 5(35-18) = 5(17) = 85 REMs Occupational dose is allowed only to persons over 18 years of age. The accumulated dose at any subsequent age should not exceed 5(N-18). Maximum exposure for a3 month period should not exceed 3 REMs as stated by radiation protection guidelines. Itis recommended that yearly radiation exposure to individuals in the general population shouild be held to one-tenth that of the service professional limits, This does not include exposure to natural radiation, medical or dental x-rays. Radiation dose for whole body exposure should not exceed .5 REMs per year, and partial body radiation dose should not exceed 7.5 REMs per year Fundamentals of Servicing 4s For Training Purposes Only Dingnostic Imaging Systems ODITEC, IneNotes EXPOSURE MEASUREMENTS @ inmate clearly understood before continuing with the detection and measurement of x-radiation are Total Dose and Dose Rate. ‘The total amount of radiation received, such as 10 R, with no indica- tion of the time during which it was received is Total dose. ‘The amount of radiation received per unit such as 10 R per hour (10 hr.) is Dose rate. ‘A dose rate of 10 R/min, for 6 minutes would result in a total dose of OR. REDUCING OCCUPATIONAL EXPOSURE, For reducing the amount of exposure to ionizing radiation there are three basic methods used. Time, Distance and Shielding. Time Decreasing the amount of time in which you are being exposed to x-rays will obviously reduce the amount of radiation received. Distance z Distance from the x-ray source is a highly effective method of reducing & the intensity of the x-ray beam. This can be expressed in the Inverse Square Law which states that the x- or gamma-radiation intensity from 2 point source varies inversely with the square of the distance from the source. Mathematically the inverse square law is: Intensity A / Intensity B = (Distance B)? / (Distance A)? ‘Where: Intensity A = intensity at original distance Intensity B = intensity at new distance Distance A = original distance Distance B = new distance By doubling the distance from the x-ray tube, the intensity of the beam can be reduced to one-fourth its original value. & Fundamentals of Servici 46 For Training Purposes Only Diagnostic Imaging Systems ‘ODITEC, IneNotes oe Shielding ‘The use of materials of various densities to limit, control, or modify the electromagnetic energy output of an x-ray tube is shielding. It is necessary to review certain facts about x-ray photon interaction with matter in order to understand the effects of shielding so that you can take advantage of it as a radiation protection tool. When x-ray photons travel through an absorber, the amount of reduction, or attenuation, is determined by three important factors: 1. The energy of the photons 2. The atomic mass of the shielding material. 3. The thickness of the shielding material. EFFECTS OF THE PHOTON ENERGY ‘The energy level of the photons is a factor that influences photon absorption or beam attenuation. An x-ray beam is more penetrating, regardless of the material used for shielding, at higher photon energy More penetration occurs when KV is increased since the photon energy also increases. ATOMIC MASS OF THE SHIELDING ‘A characteristic of an absorber which will determine its ability to eq absorb radiation is atomic density. The probability for photor/electron interaction taking place is greater when the atoms are more closely packed. Lead is an excellent shielding material, due to its high density, find is widely used in and around radiology departments. THICKNESS OF THE SHIELDING MATERIAL, The thickness of the shielding material is a factor which influences attenuation, More attenuation can be accomplished by simply adding more absorber material as long as photon energy and absorber density remain constant. If 9 inches of concrete is good, then 18 inches is better. & Fundamentals of Servicing ar For Training Purposes Only Diagnostic Imaging Systems ©DITEC, IneNotes c RADIATION PROTECTION GUIDELINES ‘The radiation protection guidelines are subject to constant modification aind revision. Tt is the service professional's responsibility to remain attentive to these changing guides. ‘The final responsibility for protecting both yourself and a patient from. needless exposure to radiation rests with you. Health physicists, radiologists, supervisors, and other personnel establish and maintain protective programs in the radiology department but without the constant efforts of the service professional, effective protection against ionizing radiation will not exist. Radiation prote sional. ion must be the concern of every service profes- PROTECTION FOR THE SERVICE PROFESSIONAL, Factors that are very important in radiation protection are good working habits, common sense, and proper respect for ionizing radia- tion. There is absolutely no reason for a service professional to even closely approach the maximum permissible dose with the present day knowledge and the vast amount of protective resources at your disposal. When proper precautions are practiced daily, the risk involved in being a service professional are minimal. Two categories are all that & are needed to Keep your exposure at @ minimum: 1. Those that protect you from the primary beam. Do not expose any part of your body to the primary beam; it's as simple as that. During an exposure you should never hold a patient, cassette, or in any other way subject yourself to primary radiation. 2. Those that protect you from secondary and scatter radiation. It is a simple matter to remain clear of the primary beam; somewhat more difficult to remain clear of scatter radiation. The radiation hazard to the service professional is perhaps greater with scatter radiation even though the intensity of scatter radiation is less than primary radiation (for a given technique), Scatter radiation can reach virtually all parts of the exposure room while the primary beam is restricted to an area which is much smaller by comparison, This is what make it more hazardous. Fundamentals of Servicin 48 For Training Purposes Only Diagnostic Imaging Systeras ODITEC, Ineww Notes ‘The following are some general rules to follow Protective Barrier When making an exposure, always remain behind a protective barrier. Protective barriers are designed so that the service professional will not be exposed to any radiation that has scattered only once. Radiation must scatter at least twice before it reaches you. Do not defeat the purpose of the protective barrier by Ieaning out from behind it to make an exposure. Distance Radiation intensity decreases as the distance from the source increases Exposure can be reduced by staying as far from the source as possible. Distance is then an effective means to reducing exposure. Where protective barriers are not available this is particularly important to remember. Protection During Fluoroscopy Wear a protective apron during fluoroscopy. When you are not needed, remiain bebind the protective barrier Film Badge Use ‘The radiation film badge generally should be worn on an area of the body expected to receive the highest exposure, such as the chest. To deicrmine local exposure, occasionally it may be advisable to wear an additional film badge. A wrist badge worn by a radiologist during fluoroscopy to check exposure to that area is a good example. A radiation film badge should not be carried in a pocket, or behind any obstruction; as these can affect the density reading of the film. When undergoing diagnostic or therapeutic x-ray exposure themselves, the service professional should avoid receiving a direct exposure of x-rays while wearing the film badge. X-ray exposure in those instances should not be included in the occupational dose. Direct exposures will also make it difficult to obtain a correct density reading. Film badges should be protected against direct sunlight, to prevent thermal sensitization and possible light leaks in the wrapping paper. Film badges should be stored in a radiation-free area along with a control film badge (This control badge must have the same tracking numbers). The film control badge is a necessary item in the processing and evaluation of the radiation film badge; this allows the laboratory responsible for processing to take into account such factors as back- ‘ground radiation, temperature variations, etc., that would otherwise be recorded as an occupational exposure. An investigation may be conducted when an overexposure ii ona film to determine if the exposure was accidental or if it was the result of a deliberate act or carelessness. Some common causes of Fundamentals of Servicing 49 For Training Purposes Only Diagnostic Imaging Systems @DITEC, Ine& Notes excessive exposure are improper storage, direct exposure to the prima- ry beam, improper use of shielding, poor radiation safety habits or a damaged film packet. Misleading reports and a waste of time and money in unnecessary investigations are the result of the improper use of a radiation film badge. Programs have been designed relating to the radiation film badge, used for detecting accidental exposure to radia- tion, for the proper medical treatment to be given should a service pro- fessional be exposed. In order for the film badge dosimetry program to be effective, service professionals must wear the film badge when appropriate and take any and all measures to insure the success of the program. PROTECTION FOR OTHERS No one should be allowed in the exposure room during the examination if not absolutely necessary. Sometimes it is necessary for others to remain in the room. Parents may be needed to hold the film, to hold the child, or merely to be present to assist the technologist in getting the child's cooperation. Hf possible, they should remain in the contro! booth during exposures. Parents must wear a protective apron and gloves if needed to hold the film or child. (Pregnant women should not be allowed to hold a film or child during exposure.) Fundamentals of Servicing 410 For Training Purposes Only Diagnostic Imaging Systems ODITEC, IncNotes ae SUMMARY In this section we discussed the effects of ionizing radiation in terms of the chemical, biological, and electrical changes that occur. We also discussed methods used for the detection and measurement of ionizing radiation. They were the operation of an ion chamber, the purpose and use of the film badge, and methods for reducing exposure to ionizing radiation. Radiation Safety is the responsibility of everyone from the technologist to the service professional. If you do not feel confident in your knowledge of radiation safety, we recommend that you review this section. & ing an For Training Purposes Only ‘@DITEC, Ine Fundamentals of Serv Diagnostic Imaging SystemsNotes ce BASIC ANATOMY INTRODUCTION ‘A basic understanding of anatomy is essential if you are to understand the problems and challenges of diagnostic x-ray imaging. This section will introduce you to the basics of human anatomy. SECTION OBJECTIVES 1. Identify the major bones of the skeletal system. 2. Describe the respiratory system. 3. Describe the circulatory system. Fundamentals of Servicing st For Trsining Ryrposes Only Diagnostic lazing Systems ‘BBrrec, inece we Notes ‘THE SKELETAL SYSTEM ‘The skeletal system is comprised of the bones and the strong ligamentory band which holds them together. The 20 bones, which form the structural network of the body also serve to protect and support the delicate internal organs such as the brain, the heart and the lungs. (Refer to the figure on the following pages) ‘The 12 paired Ribs which form the Rib cage arise on either side of each of the 12 Thoracic Vertebrae. ‘The shoulder blades, the Scapulae, are connected to the Rib Cage by two collar bones, the Clavicles. From the Scapulae hang the bones of the upper extremities; the upper arm (Humerus), the forearm (Ulna and Radius) and the bones of the Hand. At the lower end of the Spine, in the Sacral Section, are attached the ‘two large flat bones which meet in front to form the Pelvis. The Pelvis provides a base for the attachment of the bones of the lower extremities; the upper leg (Femur), the knee-cap (Patella), the lower Jeg (Tibia and Fibula) and the bones of the Foot. Set at the top of the first cervical vertebra, is the Skull, consisting of the several bones which make up the Cranial Cavity and the bones of the Face. The Spinal Cord enters the Cranial Cavity through an opening at the base of the Skull, the Foramen Magnum. Fundamentals of Servicing sa For rinngRuroses Only Diagaosc Imaging RHE iNotes _ Fundamentals of Servicing 33 For Training Pynposes Only Diagnostic Imaging Systems ITEC, IncNotes ‘The spine or vertebral column is the central system of a group of, articulated blocks, the Vertebrae, set one upon the other to form the pillar which supports the trunk and the head, and protects the spinal ‘cord which is inside the vertebral canal. The vertebral column is divided into the Cervical, Thoracic, Lumbar, Sacral and Coccyx. Fundamentals of Serving sa For TaningRyposes Only ngnweIaging Systems "OBrrEC Ine& ‘THE RESPIRATORY SYSTEM. ‘The Respiratory System consists of the Larynx, Trachea, Bronchi and Lungs. Its function is to bring air into contact with the blood, in order that the oxygen of the air can be absorbed into the blood, and the carbon-dioxide, which is a waste-product of the body, can be blown off. Alveoti Bronchus Bronchioles Air enters Trachea alveoli Pulmonary, arteries superior vena cava’ oxygen airfuston “The Trachea is about four inches long. Like the Larynx, its walls are made firm by rigid cartilage rings. The Trachea divides into the two main branches, the Bronchi, serving the right and left Lungs. Inside the Lungs, the Bronchi divide again and again, branching like the limbs of a tree. The succeedingly smaller branches extend out into the lung fields, carrying oxygen into minute air sacs, the Alveoli, where the actual exchange of gases between the air and the blood takes place. ‘These alveolar air sacs are extremely minute and each lung contains millions of such sacs. The walls of these sacs consist of a very thin and delicate membrane surrounded by a network of minute blood vessels. ‘The blood coming from the heart is rich in carbon-dioxide and poor in oxygen. In the alveolar sacs carbon-dioxide is removed from the blood and a fresh supply of oxygen is picked up. The blood now rich in oxygen is returned to the heart, from which itis distributed to all parts. of the body. ‘The air- and blood-filled lungs have a sponge-like, elastic consistency. ‘They are enclosed within the thoracic cavity above the Diaphragm. The Diaphragm is a large flat muscle which separates this cavity from the abdomen. ‘The contraction and expansion of the lungs, and the resulting movement of air, is accomplished by the contraction and relaxation of the muscles of the chest walls and the Diaphragm. Notes Alveott network Fundamentals of Servicing 55 For Training Bysposes Only Diagnostic Imaging Systems 'DITEC, Inc‘THE CIRCULATORY SYSTEM ‘The blood, which carties nutriment and oxygen to all the tissues of the body and carries waste products away from the tissues, is pumped by the Heart through a closed system of tubes comprised of the Arteries, the Capillaries and the Veins. ‘The Arteries carry blood away from the heart to the minute network of fine vessels, the Capillaries, in each of the organs and tissues. After flowing through these Capillaries, the blood is collected in the Veins, and returned (o the heart. ‘There are about 5 quarts of blood in the average adult. ‘The Heart is a hollow muscle, divided into four chamber receiving chambers, the Atria, and two ejecting chamber Ventricles. The blood returning to the Heart enters via two main veins (the Superior and Inferior Vena Cavae) into the right atrium. Tt then flows into the right ventricle from which it is pumped out into the lungs, via the main Pulmonary Artery. After flowing through the capillaries of the lungs, the oxygenated blood retums, via the Pulmonary Veins, to the left side of the heart, entering the left atrium. From the left atrium, the blood flows into the left ventricle which is the major muscle mass of the heart. ‘The blood is ejected from the left ventricle under pressure, into the main artery of the body, the Aorta. The direction of flow through the chambers of the heart is controlled by four valves: the Tricuspid Valve, between the right atrium and vyeniticle; the Pulmonary Valve at the base of the main Pulmonary ‘Artery; the Mitral Valve between the left atrium and ventricle; and the Aortic Valve at the base of the Aorta. Pulmonary artery Pulmonary, f Ee Left ati ight Bortic valve trum : Mitral valve Tricuspid valve ‘ AN ‘hae on Ves verde [ae BEL — scx Inferior Myocardium vena cava, Fundamentals of Servicing 56 For Training Py Diagnostic Imaging Systems Notes poses Only ITEC, IneNotes SUMMARY In this section we discussed the major bones of the skeletal system, the respiratory system, and the circulatory system, A basic understanding of human anatomy is important for the service professional. If you had any difficulty with the material in this section, we suggest you review it. Fundamentals of Servicing $7 For Training Ryrposes Only Diagnostic Imaging Systems ‘OSMTEC, neNotes qe i: COMMON RADIOGRAPHIC/FLUOROSCOPIC TERMINOLOGY INTRODUCTION In this section emphasis will be placed on the terminology of anatomy that is of particular significance in radiographic practice. Common radiographic and fluoroscopic procedures will also be described. SECTION OBJECTIVES 1, Discuss the terminology used in anatomical reference. 2. Discuss the terminology used in radiographic positioning. w Fundamentals of Servicing or For Training Purposes Only Diagnostic Imaging Systems @DITEC, IneNotes eq TERMINOLOGY USED IN ANATOMICAL REFERENCE ‘To avoid misunderstanding in describing the location of anatomical structures, a standard body position is used as a point of reference. ‘This generally accepted standard body position, called the anatomical position, is assumed when the body stands erect, arms hanging at the Sides, and palms of the hands turned forward. When using any terms described below, one must visualize the body in this anatomical position Anterior and posterior ‘Anterior, or ventral, refer to the front of the body; posterior, or dorsal, to the back. These terms may also be used to indicate relative positions within the body. For the hands, however, palmar is used instead of anterior. In describing the feet, plantar refers to the sole and dorsal to the upper surface. In describing the anterior surface of the forearm and hand, the term volar is used Medial and lateral Medial refers to the structures located nearer the midline of the body; Jateral to those nearer the side. For example, the tibia is medial to the fibula, and the fibula is lateral to the tibia. These terms may also be used 10 identify surfaces of various structures. For example, the thumb and little finger are located on the lateral and: medial aspects of the: hand, respectively & ‘Superior and inferior Superior refers to a position above a point of reference; inferior refers, to a position below a point of reference. For example, the thoracic vertebrae are superior to the lumbar vertebrae and inferior to the cervical vertebrae. Cephalad and caudad Cephalad and caudad are terms used in describing the direction of the x-ray beam when the x-ray tube is angulated. For example, cephalad ‘means the x-ray tube is pointing toward the head, and caudad means the x-ray tube is pointing toward the feet. Proximal and distal Proximal means nearer the attachment of the limb or nearest the point of origin. Distal refers to remote from attachment or furthest from the point of origin. For example, the shoulder joint is in the proximal arm and the elbow joint in the distal arm. Fundamentals of Servicing 62 For Training Purposes Only Diagnostic Imaging Systems DITEC, IncNotes e TERMINOLOGY USED IN RADIOGRAPHIC POSITIONING ‘A radiograph may be referred to by many different names. For ‘example, it may be referred to by the name of the originator, the structures being imaged, the anatomical surface in contact with the film, or the anatomical surfaces indicating the entrance and exit of the central ray. This lack of uniform terminology has made it difficult to testablish a standard nomenclature. The terms presented below are acceptable because each conveys an exact and specific meaning. View ‘A view of a particular part can be described as how the film “sees” the part being irradiated. For example, in a posterior to anterior (PA) projection of the chest, the film is on the anterior aspect of the chest ‘and “views” the chest from the anterior to posterior. Therefore, a PA. projection of the chest is an anterior to posterior view (sometimes called an anterior view). Projection Projection refers to the path of the central ray. For example, in a PA projection of the chest, the central ray enters the posterior aspect of the chest and exits from the anterior aspect. In comparing the definitions of view and projection, it must be noted that they are exact opposites, In fact, the terms are often used interchangeably, which can lead to confusion. e& Pe Position Position describes the position of the patient. For example, most routine chest radiographs are performed with the patient in the upright position using a PA projection, Some other positions are supine, prone, etc. In addition, radiographs named after the originator are commonly referred to as positions, such as Water's position. Many technologists do not prefer to use the terms view, position, and projection according to the previous descriptions. They prefer to use the terms interchangeably. For example, in referring to a PA chest it could be referred to as a PA view, PA position, or PA projection. This is also true of radiographs referred to by the originator’s name, such as the Water's, which could be Water’s view, Water's position, or. ‘Water's projection & Fundamentals of Servicing 63 For Training Purposes Only ‘Diagnostic Imaging Systems ODITEC. ineNotes terior to Posterior and Pt to-Anterior ‘Anterior to Posterior (AP) indicates that the central ray entered the anterior surface of the part being irradiated and emerged from the posterior surface. Posterior to Anterior (PA) indicates that the central ray entered the posterior surface of the area being irradiated and emerged from the anterior surface, Lateral and Medial ‘The term lateral describes a side view of the part being irradiated, The central ray may pass from the lateral to the medial aspect of the part (the normal procedure for upper extremities), from the medial to the lateral surfaces (the riormal procedure for the lower extremities), or from the lateral to the lateral surfaces (the normal procedure for the trunk and skull). Lateral views of the trunk and skull are described as right lateral or left lateral, depending on which side is being placed closest to the film Anterior-Posterior (AP) Posterior-Anterior (PA) SH ren Left Lateral Right Lateral Fundamentals of Servicing od For Training Purposes Only Diagnostic Imaging Systems ©DITEC, IneNotes ‘Obliques The term oblique (or semi-lateral) describes a view made with the part ‘at an angle other than the AP, PA, or lateral angles (0° and 90°) to the film of with the central ray directed obliquely. in a true oblique position the partis rotated 45°. Four distinctly different oblique views can be performed. For obliques of the trunk and skull, the part in contact with the film indicates the name of the oblique. The four obliques of the trunk and skull are listed and illustrated below: 1. Right posterior oblique (RPO) 2. Right anterior oblique (RAO) 3. Lelt posterior oblique (LPO) 4, Left anterior oblique (LAO) Fundamentals of Servicing 6s For Training Purposes Only Diagnostic Imaging Systems @DITEC, IncNotes ec SUMMARY In this section we discussed the terminology used by the technologist in describing the location of various structures of the body using the anatomical position as a reference. We also discussed the terminology used in radiographic positioning and common radiographic and fluoroscopic procedures. If you do not feel confident with this ‘material, we Fecommend that you review this section. Fundamentals of Servicing 66 For Training Purposes Only Diagnostic Imaging Systems ODITEC, Inew Notes BASIC RADIOGRAPHIC PHYSICS INTRODUCTION This section will introduce the service professional to basic radiographic physics. This will include discussions on what x-rays are, how they are produced, x-ray beam characteristics, and the properties of x-rays. SECTION OBJECTIVES 1, Define what x-rays are. 2. Describe how x-rays are produced. 3, Describe the x-ray beam in terms of quantity and quality. 4. Describe Bremsstrahlung radiation. 5. Describe characteristic radiation. 6. Discuss how KV, mA, and Time affect the x-ray beam in terms of quantity and quality. 7. Define ionization. 8. Describe the Photoelectric and Compton effects. Fundamentals of Servicing Te For Training Purposes Only Diagnostic Imaging Systems ©DITEC, IncLd Notes HISTORY OF X-RAYS ‘X-rays were discovered on November 8, 1895 by Wilhelm Konrad Roentgen, a professor at the Royal University of Wurzburg in Germany. Roentgen hed been performing experiments with a Hittorf-Crookes tube, The tube was essentially a primitive vacuum tube consisting of an evacuated pear-shaped glass envelope with two electrodes. It was used to study the effects of cathode rays (streams of accelerated electrons in evacuated tubes). Although many scientists had studied the properties of cathode rays, Roentgen discovered an effect that the others had missed. Namely, that a surface coated with barium platinocyanide placed outside the Hittorf-Crookes tube would emit light (fluoresce), even when it was shielded from the direct visible and ultraviolet light of the tube. He noted that an invisible radiation passed through various materials and fluoresced the screen. So he named these new unknown radiation x-rays to indicate their ‘unknown nature, Upon further investigation he noticed these x-rays hhad a penetrating power that varied with the composition of the absorbing material, even the bones in his hand cast shadows when placed between the tube and the screen. This discovery gave an instant application to medical diagnosis. In a very short time (2-3 weeks), with very crade eguipment, Roentgen had established many of the properties x-rays possess that are still accepted today. Word of this discovery spread throughout the scientific and medical communities. Many applications of these new x-rays were found. Fundamentals of Servicing 12 For Training Purposes Only Diagnostic Imaging Systems ‘©DITEC, IneSd Notes BASIC X-RAY CONCEPTS What are X-rays? X-rays are defined as electromagnetic radiation of short wavelength high frequency). They are sometimes described as having a wave-like nature or a parliculate nature. The description using wave-like nature is generally used to relate the frequency of the x-ray to an energy level as shown on the electromagnetic spectrum illustrated on the following page. As the frequency of the x-ray increases, so does the energy level. The description using the particulate nature is generally used when discussing the interactiofis of x-ray with matter. These particles are referred to as x-ray photons, which are simply bundles of pure energy having no mass or polatity. ‘THE ELECTROMAGNETIC SPECTRUM ‘The electromagnetic spectrum is made up of various types of eleetro- magnetic radiation, such as light, TV, radio, gamma, and x-rays. These are all forms of electromagnetic radiation, the only difference between them is their frequency, and hence their energy level. Gamma rays and x-rays frequencies overlap and occupy some of the same space in the electromagnetic spectrum; this is because the only difference between them is their method of production. Gamma rays are produced through a muclear yield and x-rays are produced through electron interaction with matter. Conventional x-ray and CT uses energy in the 10'7 to 109 range of frequencies. MRI uses radio frequency energy in the 10° to 108 range. The human body absorbs all energy in the 108 to 10"7 range. Fundamentals of Servicing 73 For Training Purposes Only Diagnostic Imaging Systems ©DITEC, Inece Energy (KeV) 108 Frequency Wavelength (Herz) (meters) 1022. 10-4 108 108 GAMMA RAYS 1043 10” 10-72 108 10° 10-1 102 10"8 40-0 10" 109 10! 0% 108 10'5 107 10" 10 10" 105 10” 104 10" 103 10° 102 10° - 10" 10° 100 10° 101 108 TELEVISION a 5 FM RADIO. 10 AM RADIO. 108 ELECTROMAGNETIC SPECTRUM Famdamentas of Servicing 74 For Training Pu Diagnostic Imaging Systems ° Notes poses Only DITEC, IncNotes c SIMPLIFIED X-RAY PRODUCTION X-rays are produced when accelerated electrons undergo a loss of energy during their interaction with matter, Since the electrons are given kinetic energy when they are accelerated, they must give up this energy when they are decelerated; about 99% of this energy is in the form of heat and only 1% in the form of x-rays. ‘There are three conditions that must be met for the production of x-rays, as illustrated in the figure below: ANODE CATHODE © eens A source of electrons is provided by heating a tungsten filament with an electric current, causing it to emit electrons through thermionic emission. As the filament current is varied, filament temperature is varied. This varies the amount of electrons available to be accelerated, which ultimately affects the quantity of x-rays produced. Acceleration Accelerating the electrons is accomplished by applying a large negative potential to the cathode of the x-ray tube. This negative potential pushes ‘or repels the electrons toward the anode. In the same instant a large positive potential, which pulls or attracts the electrons, is applied to the anode. This pushing and pulling action of the cathode and anode respectively is how the electrons are accelerated. The greater the potential applied to the tube elements, the greater the acceleration and thus the higher the kinetic energy. The higher the kinetic energy level a particular electron possesses when it interacts with the target material ihe more it is decelerated, and therefore it must give up more energy in the form of higher energy x-rays. The greater tube potentials not only produce higher quality x-rays (more penetrating ability), but also produce a higher quantity (number) of x-rays. w Fundamentals of Servicing 7s For Training Purposes Only Diagnostic Imaging Systems ODITEC, Ine& Notes Target ‘A target in which the kinetic energy of the accelerated electrons is converted into x-rays is also needed. The material used for the target ‘will be discussed later in the course. CONTROL OF X-RAY PRODUCTION ‘The x-ray beam is described in terms of quantity and quality. This is illustrated in the figure below: QUANTITY NUMBER OF X-RAY PHOTONS. : QUALITY ‘occa LOWER FREQUENCY HIGHER FREQUENCY LOWER ENERGY HIGHER ENERGY LONGER WAVELENGTH SHORTER WAVELENGTH LESS PENETRATING MORE PENETRATING SOFT RADIATION HARD RADIATION ‘Quantity refers to the intensity or amount of x-rays being produced. Quality Quality refers to the penetrating ability of the x-rays being produced. Fundamentals of Servicing 76 For Training Purposes Only Diagnostic imaging Systems ©DITEC, Ine.S & w Notes ‘The following figure illustrates that the quality and quantity of the %-Tays being produced are controlled by three major factors. QUANTITY ELECTRON ELECTRON ENERGY ] TIME QUALITY Electron Energy ‘The greater the kinetic energy of the electrons, the greater the quantity and quality of the x-rays produced. Number of Electrons ‘The greater the number of electrons being accelerated the greater the quantity of x-rays being produced. This has no effect on the quality of the x-rays being produced. ‘Time ‘he longer the potential is across the tube, the greater the quantity of x-tays produced. Time has no affect the quality of x-rays being produced, Pundamentals of Servicing 7 For Training Purposes Only Diagnostic Imaging Systems ODITEC, IneNotes X-RAY PRODUCTION X-rays are produced when an accelerated electron interacts with the atomic structure of the target material. There are two ways in which the electron can interact with the atomic structure: Radiative interactions and Collisional interactions. Radiative Interactions Radiative interaction occurs when an electron (which is negatively charged) approaches the nucleus (which is positively charged); it may be deflected from its original direction by the attractive force of the nucleus. The change of direction causes deceleration of the electron, or a loss of some of its kinetic energy. The cnergy lost by the electron is given off as an x-ray photon. This process is referred to as a radiative interaction of an electron with matter. The radiation produced by this type of interaction is called Bremsstrahlung (German for braking radiation), general radiation, or white radiation. The energy of the resultant photon depends upon: (1) the original kinetic energy of the electron, (2) how close the electron comes to the nucleus and (3) the charge of the nucleus. An electron, as well as being decelerated near the nucleus, may collide with the nucleus. In this case the electron loses all its energy, which is given off as an x-ray photon, The energy of the photon would be equal to that of the electron. The figure below shows an interaction of this type. If the electron shown possessed 100 KeV of energy, the resultant x-ray photon would also have 100 KeV of energy. ‘The wavy line represents the X-ray photon. COLLISION WITH NUCLEUS Fundamentals of Servicing 78 For Training Purposes Only Diagnostic Imaging Systems ‘©DITEC, IncThe following figure shows two separate radiative interactions. The two electrons, EI and E2, have been deflected from their original direc- tion by the attractive force of the nucleus. NOTE: Electron E1, which passed closer to the nucleus, had its original direction deflected more than electron E2. If the original kinetic energy of both electrons had been equal, photon A would have more energy than photon B because of the greater deceleration of electron El Since in this type of interaction the electron loses only a portion of its kinetic energy, it may have one or more interactions with other atoms before expending all its energy. In this manner it could produce several photons with various energies. Notes Fundamentals of Servicing 19 ©DITEC, Ine| “The following figure shows how two electrons might interact with more than one atom to produce photons with a wide range of energies. ‘Assume two electrons, E] and E2, entering the illustration from the left each possess 100 KeV of kinetic energy. The first interaction of El results in it losing 10 KeV of energy which is given off as a 10 KeV photon, E1 continues (its energy now reduced to 90 KeV) to interact With another atom and this time loses 30 KeV of energy, which is given off as 30 KeV photon, E1 now has 60 KeV of energy remaining and it interacts once again when it loses 55 KeV of energy given off as a 5 KeV photon, EZ has interacted with two atoms and lost 15 and 80 KeV respectively, given off as 15 and 80 KeV photons. Five photons with energies of 10, 15, 30, 55, and 80 KeV were generat- ed by the actions of two electrons. If millions of electrons interacted with millions of atoms in this manner, one could see the wide range of photon energies that could be generated. 10KeV Photon ‘58 KeV Photon 2 nit Oe BE a G) EXO MULTIPLE RADIATIVE INTERACTIONS. Notes Fundamentals of Servicing 7-10 For Training Purposes Only Diagnostic Imaging Systems ©DITEC, IneNotes A beam of Bremsstrahlung radiation shows a continuous energy range from a very low energy to the maximum energy possessed by the electrons, The energy spectrum produced by 100 KeV electrons in is illustrated below \ \ \ \_BREMSSTRAHLUNG. W of X-RAY PHOTONS \ RADIATION QUANTITY 2 4 O10 Kev, QUALITY BREMSSTRAHLUNG. RADIATION SPECTRUM Fundamentals of Servicing 7A For Training Purposes Only Diagnostic Imaging Systems ©DITEC, IneNotes ]~ . Golisonutneraciions The discussion to this point has demonstrated how x-rays are generated when electrons interact with the nucleus of an atom. X-rays are also generated when electrons interact with tightly bound oxbitel electrons. ‘This is called Collisional interaction of an electron with matter and produces Characteristic or line radiation. In this interaction, an approaching electron has a collision with a tightly bound orbital electron such as an electron in the K shell of an atom of tungsten, AS a result of the collision, the K electron is ejected from its shell and energy is absorbed by the atom equal to the binding energy of the shell, The atom is left in an excited state or with an excess of energy and an electron vacancy in a shell. Immediately after excitation, the atom returns to a normal state by emitting the energy it has absorbed in the form of x-ray photons. Another electron, such as from the L shell, fills the vacancy. Since the potential energy of an clectron in the L sheli is higher than that of one in the K shell, the L electron loses energy in the transition. The energy lost is equal fo the difference in the binding energies of the K and L shell and is given off as an x-ray photon. ao e Pee) ‘ ELECTRON oa.) od oa % Although a photon has been emitted, the process is not yet completed because there is now a vacancy in the L shell, and the atom still has an excess of energy. This vacancy is also immediately filled by another electron, such as one from the’M shell, and another photon is emitted equal to the energy of the difference of the transition. This chain reaction continues with a photon given off for each electron transition until the atom has no shell vacancies and again is in a normal state. (The vacancy in the last shell is filled by a free electron) & Fundamentals of Servicing m2 For Training Purposes Only Dingnostic Imaging Systems ‘©DITEC, IneNotes ‘The following figure shows an atom of tungsten with only K, L, and M shells demonstrated. The binding energy of tungsten K, L, and M shells are 69.5, 12, and 2 KeV, respectively. In the left illustration, the impinging electron has collided with and ejected a K electron from its shell and both electrons are seen leaving the vicinity of the atom. In the right illustration, as the electron transitions take place, two photons are emitted with energies 57.5 KeV (the difference in binding energies of the Land K shells) and 10 KeV (the difference in binding energies of the Land M shells). S7SKeV 10KeV COLLISIONAL INTERACTIONS When a K shell electron is ejected, the vacancy need not be filled from the L shell. It can be filled from any shell with a higher potential energy level or even from outside the atom. In any case, the emitted photon is always equal to the difference in the binding energies of the shell from which the electron was ejected and the shell that filled the vacancy. This will account for the amount of energy initially absorbed by the atom. The maximum energy of a photon cannot be greater than the binding enerey of the K shell of the atom under consideration, or in the case of tungsten 69.5 KeV. Fundamentals of Serv m ing 743 For Training Purposes Only ‘Diagnostic Imaging ODITEC, IneNotes In order for characteristic radiation to be generated at all an electron ist be ejected from its shell. The energy required to remove an electron from its shell is equal to or greaier than the binding energy of the shell. Since the binding energy of tungstens K shell is 69.5, it would require an electron with at least 69.5 Ke of energy to eject the K electron and therefore generate useful characteristic radiation from tungsten. It should be noted at this time that 12 KeV of electron energy would eject an L electron from tungsten, thereby producing characteristic radiation, However, this radiation’s maximum energy would be 10 KeV, which is not considered useful in radiology. The Figure below shows tungstens characteristic radiation superimposed over the continuous x-ray spectrum of tungstens Bremsstrahlung radiation, L SHELL K SHELL # of XRAY PHOTONS. 2 «400 «6 80100 Kev X-Ray Spectrum Fundamentals of Servicing a4 For Training Purposes Only Diagnostic Imaging Systems optNotes ec CHARACTERISTICS OF THE X-RAY BEAM. Quantity The x-ray beam is generally described in terms of quantity and quality. Quantity refers to the amount or number of x-ray photons being produced and it is controlled by three factors: 1. KV - As the tube potential is increased, the electrons receive additional kinetic energy. This added kinetic energy increases the amount of radiation produced through both Bremsstrahlung and characteristic interactions. 2, mA (tube current) - The mA refers to the amount of electrons ‘crossing the gap between the anode and the cathode. By increasing the amount of electrons being accelerated, the quantity of radiation produced increases proportionally. The mA is increased by increasing the amount of current to the filaments. This in tum increases the filament temperature causing the filaments to emit more electrons. 3. Time - The longer the potential (KV) is applied across the tube (Le. producing radiation) the greater the amount of radiation produced. Increasing the time the x-ray tube is energized provides a proportional increase in the quantity of radiation produced. QUANTITY kv mA, TIME QUALITY w Fundamentals of Servicing For Training Purposes Only Diagnostic Imaging Systems ODITEC, Ine& Notes Quality Ghuality refers to the penetrating ability of the x-ray beam. A high quality beam means itis more penetrating. The x-ray beam is Sometimes described as being hard or soft, A hard beam means it is a high quality, more penetrating beam. A soft beam means itis @ low quality, less penetrating beam. Since quality refers to the penetrating ability of the x-ray beam, and the Kinetic energy of the electrons which produced the x-rays determines the penetrating ability, varying the kinetic energy will vary the quality of the beam. This is accomplished by changing the tube potential (KV). In conclusion, the quantity of radiation produced is affected by KV, mA, and time. The quality of radiation produced is only affected by KV. Fundamentals of Servicing 7.16 For Training Purposes Only Diagnostic Imaging Systems @DITEC. IneNotes eq ‘THE PROPERTIES OF X-RAYS IONIZATION Tonization can be defined as any process which results in the removal ‘or addition of an orbital electron from or to an atom, thereby leaving the atom with an overall positive or negative charge. Ionization can ‘occur when an electron is struck by a photon, at which time an energy transfer will take place. Although it is technically possible for this energy transfer to take place in the nucleus, the chances of a photon reaching that vicinity is extremely remote. After an ionizing event ‘occurs, the remaining particles are called a pair of ions (in the case of eleciron removal). The parent atom (minus an electron) has an overall positive charge and is known as a positive ion. The ejected electron has a negative charge. This process of ionization is illustrated below The two types of ionization that most generally occur in the diagnostic radiation energy range are the Photoelectric effect and the Compton effect. Photen ton & a ree oo (@} Sots IONIZATION lw Fundamental of Servicing a For Training Purposes Onl ‘Diagnostic Iniging Systems SODITEC, Ie,Notes Photoelectric Effect ‘The photoelectric effect is an all-or-none energy exchange in that the jphoton imparts all of its energy to the electron and simply vanishes. The ejected electron, called a photoelectron, departs with all the inherent energy of the photon and can cause secondary ionization due to its increased kinetic energy. In the meantime, as the excited atom returns 10 the normal state, it quickly attracts another electron to fill the ‘Yacant “hole”, and radiation is emitted. ‘The energy of the radiation, and the sequence of events that causes the radiation, are much the same as the replenishment of an electron. shell vacancy created by the ejection of an electron collision as explained earlier. The photoelectric effect normally occurs with photon energies up to 100 KeV. SOFT XRAY Wn, — rae = © 3 55 (mS 9) 7 (© 7 7 Diagnostic Imaging Systems @DITEC, IneNotes Compton Effect Compton effect, also referred to as modified or incoherent scattering, is the result of a partial transfer of energy from an x-ray photon to an orbital electron. In this ease, the photon strikes a glancing blow to the tlectron and ejects it from orbit, Although considerably weakened in energy (longer wavelength), the photon will continue on. While the ‘now “soft” photon will eventually disappear via a final photoelectric effect, the ejected electron can, as in the previous case, continue on to cause another, or secondary ionization of a nearby atom. In contrast to the photoelectric effect, the Compton effect is predominant with highly energetic x-rays or in the 100 KeV to 10 MeV cnergy range. XRAY 1 ny, may Fundamentals of Servicing 7:39 For Training Purposes Only ‘Diagnostic Imaging Systems ‘©DITEC, IncNotes PENETRATION, ABSORPTION, AND SCATTER When an x-ray photon enters the subject, it will go through one or more of the following processes: Penetration refers to the unimpeded passage of the photon through matter ‘Absorption refers to the complete annihilation of the photon in matter. Tris generally associated with the photoelectric effect. Scatter refers to the photos which are traveling in a different direction than the primary beam. It is generally associated with the Compton effect _— ABSORBED SCATTER PENETRATE INTERACTIONS OF X-RAYS WITH MATTER. Fundamentals of Servicing 7.20 For Training Purposes Onl} ‘Diagnostic Imaging Systems eon : ©DITEC, IneNotes ef SUMMARY In this section we discussed what x-rays are, how they are produced, how they are controlled and how they interact with matter. The service professional must have a thorough understanding of basic radiographic physics in order to be able efficiently service image quality problems. We suggest a review of this section if you are not confident in your understanding. bw damental of Servicing 7a For Training Purposes On Diagnostic liaging Systems SOIC. Inetw Notes AN OVERVIEW OF THE BASIC RADIOGRAPHIC SYSTEM INTRODUCTION ‘This section will familiarize the service professional with the purpose of the numerous components which make up the basic radiographic system, and their location in the overall system, To accomplish this, we have divided the basic radiographic system into three major areas: X-ray Production and Control, Aerial Image Formation and Image Receptor. SECTION OBJECTIVES 1. State the purpose of each of the components in the basic radiographic system. 2. State the location of each component in the basic radiographic system (e.g.which of the three areas). Fundamentals of Servicing 84 For Training Purposes Only Diagnostic Imaging Systems @DITEC. ineNotes | CONTROL, XRAY PRODUCTION AND CONTROL IMAGE | fo] 9] (G] fe RECEPTOR AISI | re iG} allo PROCESSING aya la} Gj |G} |S a |) ae 5||6 Ke} BASIC RADIOGRAPHIC SYSTEM. Fundamental of Servicing 82 For Training Purposes Only ODES, ne Diagnostic Imaging Systems