RADIATION

X-RAYS:
X-rays are a form of electromagnetic radiations like light, radio waves, and so on. They
have a wavelength of 10–0.01 nm. X-rays were discovered accidentally by Wilhelm Roentgen, a
German physicist. He found out that most of the materials allowed the new ray to pass through
and also left a shadow on a photographic plate. Since Roentgen’s days, x-rays have found very
widespread uses and are used across different fields such as radiology, geology, crystallography,
astronomy. In the field of radiology, x-rays are used in fluoroscopy, angiography, computed
tomography (CT). Today, many of the noninvasive surgeries are performed under x-ray guidance.

An x-ray machine consists of an x-ray tube, control unit and high voltage generator.

X-RAY TUBE CONSTRUCTION:

An x-ray tube consists of the following major parts. They are an anode, cathode, (focusing
cup with filament) and an evacuated glass tube (made of pyrex glass) to hold these parts together
(Figure 1).

Figure 1
 The cathode is the negative terminal that produces electrons that will be accelerated toward
the anode. The filament is heated by passing current, which generates electrons by a process of
thermionic emission.
The number of electrons produced is proportional to the current impressed upon it. The
filament is generally made from tungsten to withstand high temperatures. The electron produced
is focused by the focusing cup, which is maintained at the same negative potential as the cathode.
The glass enclosure in which the x-ray is generated is evacuated, so that the electrons do not
interact with other molecules and can also be controlled independently and precisely. The focusing
cup is maintained at a very high potential in order to accelerate the electrons produced by the
filament. The anode is the positive electrode and is bombarded by the fast-moving electron. A
tungsten target is fixed on the anode, which is generally made from copper, so that the heat
produced by the bombardment of the electron can be properly dissipated. The fast-moving
electrons knock out the electrons from the inner shells of the tungsten target. This process results
in generation of x-rays.

CATHODE:

The cathode in an x-ray tube consists of a filament and a focusing cup.

a-) The Filament:

The filament is the source of electrons within the x-ray tube. It is a coil of tungsten
wire about 2mm in diameter. It is mounted on two stiff wires that support it and carry the electric
current. The filament is heated by the flow of current and emits electrons at a rate proportional to
the temperature of the filament. The filament lays in a focusing cup with negatively charged
concave reflector.

b-) The Focusing Cup:

It has cylindrical metallic shape, which electrostatically focuses the electrons emitted by
the filament into a narrow beam directed at a small rectangular area on the anode called the focal
spot. The electrons move in this direction because they are repelled by the negatively charged
cathode and attracted to the positively charged anode. The x-ray tube is evacuated to prevent
collision of the moving electrons with gas molecules, which would significantly reduce their speed.
This also prevents oxidation.

ANODE:

The anode made of a tungsten target embedded in a copper stem. The purpose of the target
in an x-ray tube is to convert the kinetic energy of the electrons generated from the filament into
x-ray photons. In this process more than 99% of the electron kinetic energy converted to heat. The
target is made of tungsten, a material that has several characteristics of an ideal target material. It
has a high atomic number (Z = 74), high melting point (3700 C 0) and high thermal conductivity.
A target made of a high atomic number material is best because it is most efficient in producing x
rays. Due to the heat generated at the anode, the requirement for a target (anode) with a high
melting point is clear. Tungsten also has high thermal conductivity, thus dissipating heat into the
copper stem.

Both cathode and anode lie within an evacuated glass envelope or tube. This glass envelope
is immersed in an electrical insulating material usually oil, which lie within an electrically
grounded metal housing (metal case) called the head of the x-ray machine. Thus the oil is used to
reduce the heat and to isolate the metal case from the high voltage. The design of metal case allows
the x ray to pass from a small window on the tube only.
There are two types of the anode, a stationary and a rotating anode. The rotating anode has
a longer life than the stationary anode, as the area exposed to the electrons varies continuously.
X-RAY GENERATION:

There are two different types of spectra (Figure 2) generated when x-rays are produced by
the electron beam generated from the filament and bombard the anode. Most of the kinetic energy
of the electron beam goes into heating the target, a small number of incident electron produces x-
ray by giving up their kinetic energy in the following processes:
a) - The general radiation or Bremsstrahlung “Braking” spectrum, which is a
continuous radiation.
b)- The characteristic radiation, which is a discrete spectrum.
 Figure 2
Bremsstrahlung spectrum:
When the fast-moving electron produced by the cathode moves very close to the nucleus
of the tungsten atom, and strongly deflected in its path by the attraction of the nucleus as illustrated
in Figure 3, the electron decelerates and the loss of energy is emitted as radiation. This spectrum
is referred as the Bremsstrahlung spectrum.

Figure 3
 X-rays produced by the energy of the Bremsstrahlung interaction may have energy in the
range of 0 to max energy of the incident electron.

Characteristic spectrum (Discrete):

The second type of radiation spectrum (Figure 4) results from the interaction of incident
electron with an electron orbit within the tungsten structure, which called the characteristic
radiation. The fast-moving electrons could eject the electron from the k-shell or L shell (inner
shell) of the tungsten atom. Since this shell is unstable due to the ejection of the electron, the
vacancy is filled by an electron from the outer shell. This is accompanied by the release of x-ray
energy.

Figure 4 production of characteristic radiation

 The energy and wavelength of the electron are dependent on the binding energy of the
electron whose position is filled. Thus the bombarding electron must have energy of more than the
energy of the ejected electron (electron shell).
In the x-ray machine the x-rays of low energy are blocked by special filters and would not
become a part from the useful x-ray beam.

FACTORS CONTROLLING THE X-RAY BEAM

The x-ray beam emitted from an x-ray tube may be modified by altering the exposure time,
tube current “mA” and tube voltage “kVp”. Where selecting values of all these factors depends
mainly on the body of the patient (fat or thin).
X ray is an invisible light, which is able to penetrate, ionize and may be scattered, passed
or absorbed in the penetrated medium. This invisible light has the following properties

a-) FLUORESCENCE:
Some metallic salts of crystalline form (for example zinc-cadmium sulfide or cadmium
iodide) emit visible light if irradiated. Fluorescence describes the fact that light is emitted only
during irradiation. This can be used in intensifying screen (usually the film is fixed between two
papers of intensifying screen), where the end result in this case is a hardcopy of the image or can
be used in image intensifier (I.I) for continuous imaging.

b-) PHOTOGRAPHIC EFFECT:

X ray is found to be blacken photographic film; this property is utilized in film badge
dosimeter, which should be carried (worn) for monitoring the x ray dose received by radiographer
and radiologist in x ray department.

c-) PENETRATION:
X rays are able to penetrate materials which depend on their atomic number and density;
these materials include tissue which is called soft tissue and bone which is known as hard tissue.
Based on that x ray can be used with high penetrating power or little penetrating power, which are
known as hard x ray and soft x ray respectively. Penetration and absorption play an important role
to produce image with good contrast for the inner structure of the human body, while scattered
radiation fogs the image.
d-) CHEMICAL EFFECT:
If a beam of x ray irradiates a matter, interaction will occur and produce chemical changes
due to the absorbed energy. For example (ionization chamber) X-ray energy will ionize the gas
(air), this energy converted in kinetic energy of electrons, which cause them to move resulting in
current (Ic). This chemical change is the base on which the radiation dose meter is designed. An
examples of such dose meters is:
* Pen dose meter
e-) BIOLOGICAL EFFECT:
X ray as ionizing radiation can affect living cells. Most of the damages are resulted of
biochemical reaction, which are triggered by the ionization ability of the penetrating radiation. In
the cell liquid “about 70% water” short living toxic substances are produced. It may destroy the
cell (indirect damage).
If the safe level is exceeded then radiation will cause:
• Somatic damage.
• Late Somatic damage.

In addition to the medical diagnosis, the knowledge of these properties (effects) has led to
two new applications of x ray in medical area are:

• Radiation therapy.
• Radiation protection.
FLUOROSCOPY:
It is a continuous radiation used for imaging internal organs in order to examine,
diagnose, treat these organs, and many of the noninvasive surgeries are performed under x-ray
guidance providing a new “eye” to the surgeons.
The image intensifier allowed intensification of the light emitted by the input phosphor; it
could be safely and effectively used to produce a system that could generate and detect x-rays and
also produce images fit enough for human consumption using a series of lens and camera to display
the image on a TV or it can be recorded on a film.
 CONTRAST EXAMINATION
Barium and iodinated compounds are used as an aid for imaging internal organs this is due
to their high atomic numbers and high densities compared with soft tissue. When contrast
compound fills the kidney or when barium fills the colon, these internal organs are readily
visualized on the radiograph.
INTERACTIONS OF X RAYS WITH MATTER
The intensity of an x-ray beam is reduced by interaction with the matter it encounters.
This attenuation results from interactions of individual photons in the beam with atoms in the
absorber. The x-ray photons are either absorbed or scattered out of the beam. In absorption,
photons ionize absorber atoms and convert their energy into kinetic energy of the absorber
electrons. In scattering, photons are ejected (change the direction) out of the primary beam.
Photons in an x-ray beam interact with the object primarily by Compton scattering, in
which case the scattered photon may strike the film and degrade the radiographic image by causing
film fog, or photoelectric absorption. Relatively few photons undergo coherent scattering within
the object or pass through the object without interacting and expose the film. In x-ray beam there
are three means of beam attenuation: (1) coherent scattering, (2) Compton scattering and
photoelectric absorption (3).
COHERENT SCATTERING:
Coherent scattering (also known as classical, elastic, or Thompson scattering) may occur
when a low-energy incident photon passes near an outer electron of an atom (which has a low
binding energy). The incident photon interacts with the electron by causing it to become
momentarily excited at the same frequency as the incoming photon (Figure 1).

Figure (1)
 The net result of classical scattering is a change in direction of x-ray without a change
in its energy. There is no energy transfer and therefore no ionization. Most classically scattered x-
ray are scattered in the forward direction.
COMPTON SCATTERING:
In Figure (2) Compton scattering occurs when a photon interacts with an outer orbital
electron. In this interaction the incident photon collides with an outer electron, which receives
kinetic energy and recoils from the point of impact. The path of the incident photon is deflected
by its interaction and is scattered from the site of the collision. The energy of the scattered photon
equals the energy of the incident photon minus the sum of the kinetic energy gained by the recoil
electron and its binding energy. Scattered photons continue on their new paths, causing further
ionizations. Similarly, the recoil electrons also give up their energy by ionizing other atoms.

Figure (2)

The probability of a Compton interaction is directly proportional to the electron density

of the absorber. The number of electrons in bone (5.55 x 1023/cc) is greater than in soft tissue (3.34
x 1023/cc); therefore the probability of Compton scattering is correspondingly greater in bone than
in tissue. Compton interaction is disadvantageous because it causes nonspecific film darkening.
Scattered photons darken the film while carrying no useful information because their paths are
altered. Both Coherent and Compton scattering are of no useful diagnostic information,
Backscatter radiation is an example of such scattered radiation.

PHOTOELECTRIC ABSORPTION
 Photoelectric absorption is critical in diagnostic imaging. This process occurs when an
incident photon collides (interact) with an inner electron in an atom of the absorbing medium as
shown in Figure (3). At this point the incident photon ceases to exist. The electron is ejected from
its shell and becomes a recoil electron (photoelectron). The kinetic energy imparted to the recoil
electron is equal to the energy of the incident photon minus that used to overcome the binding
energy of the electron. The absorbing atom is now ionized because it has lost an electron. In the
case of atoms with low atomic numbers (e.g., those in most biologic molecules), the binding energy
is small. As a result the recoil electron acquires most of the energy of the incident photon. An atom
that has participated in a photoelectric interaction is ionized as a result of the loss of an electron.
Recoil electrons ejected during photoelectric absorption travel only short distances in the absorber
before they give up their energy through secondary ionizations.

Figure (3)
As a consequence, all the energy of incident photons that undergo photoelectric
interaction is deposited in the patient. Although this is beneficial in producing high-quality
radiographs, because no scattered radiation fogs the film, it is potentially deleterious (harmful) for
patients because of increased radiation absorption. The frequency of photoelectric interaction is
directly proportional with the third power of the atomic number of the absorber. For example,
because the effective atomic number of compact bone (Z = 13.8) is greater than that of soft tissue
(Z = 7.4), the probability that a photon will be absorbed by photoelectric interaction in bone is
approximately 6.5 times greater than in an equal thickness of soft tissue. This difference in the
absorption makes the production of a radiographic image possible.

DIFFERENTIAL ABSORPTION:
 The importance of photoelectric absorption and Compton scattering in diagnostic
radiography relates to differences in the way photons are absorbed by various anatomic structures.
The number of photoelectric and Compton interactions is greater in hard tissues than in soft tissues.
As a consequence, the photons in the beam exit the patient are more after passing through soft
tissue than through hard tissue. Thus while the incident beam, the beam striking the patient, is
spatially homogenous, the remnant beam, the beam that exits the patient, is spatially
heterogeneous. This remnant beam strikes the image receptor (film), resulting in greater exposure
of the film behind soft tissue than behind hard tissues. this is differential exposure of the film that
allows a radiograph to reveal the morphology of bone, and soft tissues.
The photoelectric absorption of x-ray results in bright areas of a radiograph such as those
corresponding to bone; while other x-ray penetrate the body and transmitted with no inter action
whatever, these result in dark areas of a radiograph, which means that an x-ray image results from
the difference between those x-ray absorbed photoelectrically and those not absorbed at all.
Based on these interactions of x rays with matter and according to the physical properties
of the x-ray, some special techniques are developed and applied in other different field of medical
area. Examples of such techniques are mentioned in the following paragraph.

ANGIOGRAPHY:
A digital angiographic system consists of an x-ray tube, an image intensifier-based
detector, a video camera to record the image and a computer to process the acquired image. The
system is similar to fluoroscopy except that it is primarily used to visualize blood vessels using a
contrast as shown in Figure (4). The x-ray tube must have big focal spot to prevent tube loading
due to constant generation of x-ray. It must also provide a constant output over time.

The computer controls the whole imaging chain and also performs digital subtraction
angiography (DSA) on the images obtained. The computer controls the x-ray technique so that
uniform exposure is obtained across all images.
 Figure (4) Digital subtraction angiography (a) image without contrast material (b)
image with contrast material (c) the difference image.

The computer obtains the first set of images without the injection of contrast and stores
them as a mask image. Subsequent images obtained under the injection of contrast are stored and
subtracted from the mask image to obtain the image with the vessel alone.

MAMMOGRAPHY:
An example of soft tissue radiography is mammography that is radiographic
examination of the breast, where the breast cancer is the leading cause of cancer death in women.
Normal breast cancer consists of different principal types of tissue. Conventional radiographic
technique is useless for imaging the breast that is due to:
*)- The similarity of the mass density
*)- The effective atomic number for soft tissue components of the breast.
Therefore x-ray mammography requires a low kVp technique. As kVp technique is
reduced, however the penetrability of the x-ray beam is also reduced, which in turn requires an
increase in the mAs. If kVp is too low, inordinately high mAs may be required, and this could be
unacceptable because of the increased patient dose. Technique factors of kVp are taken in
consideration, which are employed as an effective compromise between the increasing the dose at
low kVp rang and reduced the image quality at high kVp range. The incident radiation must be
very low energy. Thus the x-ray tube is operated at voltage below 28 kV. They have typically
anode (target) of molybdenum (Z = 42), in contrast to tungsten (Z = 74) target of conventional x-
ray machine. In addition to that compression is of particular importance in mammography and
should be employed there. Some advantages resulting from the use of vigorous compression as
follow:
- A compressed breast is of more uniform thickness.
- Tissues near the chest wall are less apt to be underexposed and tissues near
the nipple are less apt to be overexposed. By using vigorous compression, all object
structures are brought closer to the image plane and focal spot blur of image is reduced
caused by motion.
- Absorption unsharpness, radiation dose and scattered radiation are all
reduced.
All dedicated mammographic x-ray machine have a built in stiff compression device that
is parallel with the surface of the image receptor (film).
Breast compression produces a greatly improved image by increasing contrast,
spreading tissue structure and minimizing the distance between the breast tissue and the image
receptor.
COMPUTED TOMOGRAPHY:
The fluoroscopy and angiography discussed so far produce a planar projection image,
which is a shadow of the part of the body under x-rays. The image may also contain other
organs/structures that impede the ability to make a clear diagnosis. In such cases, a slice through
the patient would provide an unimpeded view of the organ of interest. The system that produces
this virtual slice is called the CT “there are 4 generation of the CT scan”. It uses the x-ray source
to produce selectional or slice images. The radiographic film is replaced by detectors “very
sensitive crystals”. When the tube rotate around the patient the detectors receive the x-ray beam
through the patient and measured its intensity then convert this into digital form to produce
penetration and attenuation profile of region being examined, which are stored and can be
manipulated by computer. The computer calculate the absorption at point on matrix, which is
called pixel “points”, where the area being imaged by each pixel has definite volume depending
on the thickness of the tomographic slice this is voxel “the thickness of the slice is usually between
1.5mm – 6mm or 10mm” as shown in Figure (5). This numeric information is converted into gray
scale, which represents different tissue densities, this allowing a visual image to be generated.

Figure (5)
The normal x-ray systems studied so far produce a shadow or projection of the object on
a 2D plane and, hence, the 3D depth information is permanently lost. CT solves that problem by
acquiring x-ray images all around the object. A computer then processes these images to produce
a map of the original object using a process called reconstruction.
SURGICAL X-RAY:
Surgical x-ray is another technique used in operation rooms and C- arm is an example of
this technique, where many of the noninvasive surgeries are performed under x-ray guidance such
as kidney stone destruction, foreign body localization and orthopedics surgery.
RADIATION THERAPY:
X ray can affect living cells, which may lead to sickness such as cancer, this type of damage
can be treated by exposing these cancer cells with x-radiation using different x-ray doses, where
the application range of the energy depends on the effect depth. Radiation can be divided as follow:
(5-60) kv for surface
(15-60) kv for medium depth
(80-250) kv for deep tissue.
Energies up to 400 kV were used before, which is higher than the power of the conventional
x-ray machine (40 kV to 125~150 kV).
RADIATION PROTECTION:
 In order to limit the effect of ionizing radiation on the human body, exposure limits have
been established for contact with radiation, based on international findings. The limits are intended
to prevent the risk of radiation damage leading to sickness be coming. They form the basis for
measures in radiation protection.
The radiation protection subdivides rooms, in which work is carried out with radiation, into
radiation protective zones. In control area doses can be between 15 mSV up to a maximum of 50
mSV per year. Persons working in these areas are subject to continuous medical supervision. To
prevent risk of radiation, two steps should be taken in consideration:
• X-ray room must be covered with material of high density, which is able to absorb
the radiation (usually the lead is used due to its properties high density and high atomic number).
• The radiographer or radiologist should wear protective clothing manufactured from
material containing lead (apron).These persons must carry out measurements of their personal dose
using techniques as shown in Figure (6):
1- Pen dosimeter 2- Film badge.

Figure (6)