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Sponsored and
published by: Florida Department of Health

Produced by: The Center for Instructional Development and Services

Florida State University

For further infor-

mation, contact: James A. Futch
Environmental Administrator
Department of Health
Bureau of Radiation Control
Radiologic Technology Program
4052 Bald Cypress Way, Bin C21
Tallahassee, Florida 32399-1741

© State of Florida, Department of Health, 1998

The use of trademarks in this document is strictly for the purpose of clarity
and in no way should be considered an endorsement by the Department of
Education, Florida State University, or The Center for Instructional
Development and Services.

This publication was produced at a cost of $25 per copy to provide

information in compliance with Florida Statutes Chapter 468, Part IV, the
Radiologic Technologist Certification Act. The Department of Health
complies with state and federal nondiscrimination policies relating to race,
sex, age, and handicapping conditions.

DOH 5/0011000

State of Florida
Department of Health
December 1986

The Department of Health (DOH) is grateful to institutions and

publishers who have granted permission to include their copyrighted
materials in this study guide. In addition to sources noted in the text,
information and illustrations have been adapted or borrowed from the
following publications:

From Assisting in Radiology, by Janet Schnauze. 0 1984 by The

University of Texas at Austin. Used with permission.

From Basic Medical Techniques and Patient Care for Radiologic

Technologists, 2nd edition, by Lillian S. Torres and Carol Morrill Moore, o
1983 by J. B. Lippincott Company. Used with permission.

From Basic X-ray Operator Study Guide, 0 1983 by State of Florida,

Department of Health and Rehabilitative Services, Office of Radiation
Control. Used with permission.

From Emergency Medical Technician, by Betty G. Hirst and J. Jerome

Rohrbach, Jr. 0 1978 by Florida Department of State.

From Nursing Proceduresfor the Practical Nurse. 0 1972 by Ohio State

University, Instructional Materials Laboratory. Used with permission.

From Nursing Skills for Allied Health Services, by Lucille A. Wood and
Beverly J. Rambo. 0 1977 by The Regents of the University of California.
Used with permission.

Portions of this study guide have as their source the publication Medical
Service: Radiologic Technology, Departments of the Air Force, the Army,
and the Navy (Washington, D.C., 1974).

The Department gratefully acknowledges the efforts of the following

individuals who prepared many of the illustrations included in this study
guide: Gary L. Tomaszewski, formerly with DOH, Tallahassee; and Vala
Wagie, Broward Community College, Ft. Lauderdale.

The Department also thanks the following individuals who prepared the
first draft of the study guide: Gary L. Tomaszewski; Vala Wagie; Nancy
Delgado, formerly with the Center for Instructional Development and
Services (CIDS) at Florida State University (FSU); and Linda Cornelious,
CIDS, FSU. The Department thanks the following for their time and efforts
in reviewing the guide: Gary L. Tomaszewski, Richard Leverone, Vala
Wagie, Louise M. Tomaszewski, Janice Leifer, Susan Bridis, William
Passetti, Simon Growick, Mason Cox, Don Steiner, Danny Smock,
Roxanne McCarthy, Betsy Fulford, Marvin Patterson, Rusin Van Dyke,
and the entire staff of the Bureau of Radiation Control. DOH would also
like to express its appreciation to the applicants who reviewed the guide
and took the certification examination for a pilot study: Eileen Andreu,
Cheryl Bowie, Mary Bradshaw, Mary Cairns, Ladonna Greene, Mary
Guinan, Julie Hall, Michele Knisley, Geraldine

Labrecque, Mary Lamb, Sharon Lancaster, Diane Lutzen, Jane Muse,
Brenda Relstab, Brenda Reynolds, Catherine Richardson, Aimee Sallas,
and Susan Shephard.

Finally, the Department would like to acknowledge the project staff at the
Center for Instructional Development and Services of Florida State
University: Hyoja Lee, project manager and instructional designer; Frances
Brock and Peggy Barlow, editors; Susan Maxwell and Betty Willard, word
processors; Dan Haskin, graphic designer; Alice Fisher and Bob McCann,
proofreaders; Mary Sommer, illustrator; Roberta Carpenter, copyright
specialist; and Linda Cornelious, Young-Sun Yang, and Mike Lado,
graduate assistants.


Chapter 468, Florida Statutes, provides legal authority for the State
Radiologic Technologist certification program and Chapter 64E-3,
Florida Administrative Code, establishes necessary criteria and
procedures to carry out provisions of the statute.

The Radiologic Technologist Certification Act includes the following

declaration of policy:

It is declared to be the policy of the state that the health and safety of the
people must be protected against the harmful effects of excessive and
improper exposure to ionizing radiation. Such protection can in some
major measure be accomplished by requiring adequate training and
experience of persons who use radiation and radiation-emitting equipment
in each particular case under the specific direction of licensed
practitioners. It is the purpose of this part to establish standards of
education, training, and experience and to require the examination and
certification of users of radiation and radiationemitting equipment.

Well-trained radiographers and basic x-ray machine operators who at all

times fully utilize their expertise in the performance of their duties serve two
important purposes: 1) they provide the best possible x-ray film images for
the diagnosis of diseases and injuries; and (2) they minimize the
unnecessary radiation exposure of patients, operators, and others who are in
range of exposure by following appropriate safety precautions and

The Radiologic Technologist Certification Act is primarily concerned with

the reduction of radiation exposure by ensuring that radiologic procedures
are performed by personnel knowledgeable about safety precautions and
procedures. Exposure can also be reduced significantly if each procedure is
accomplished correctly the first time, thereby eliminating the added
exposure involved in retakes and the unnecessary exposure of vulnerable
body organs that results from poor body positioning.

The Radiologic Technologist Certification Act and rules provide:

a. A description of persons and the conditions under which they are

authorized to use radiation on human beings for medical purposes.

2. Requirements for admission to an examination.

3. Criteria for recertification and continuing education.

The Department of Health provides basic x- ray machine operator

examination applicants with a study guide to fulfill the study material
requirement of the Radiologic Technologist Certification Act. The study
guide is designed to impart a knowledge of (1) important safety
precautions and procedures for radiation protection, (2) x-ray

equipment operation and maintenance, (3) image production and evaluation,
(4) radiographic procedures and positioning, and (5) patient care and

Full understanding of the material in this manual, as indicated by

successfully passing the Basic X-Ray Machine Operator certification
examination, should qualify the applicant to safely operate x-ray equipment
while under the direct supervision of a licensed practitioner. Any person
who is interested in radiologic technology as a full-time profession or who
is required to operate x-ray equipment for sophisticated diagnostic
procedures must successfully complete the General Radiographer
examination and receive state certification as a General Radiographer.
Adapted from Basic X-Ray Operator Study Guide. Tallahassee, Fla.:
Department of Health and Rehabilitative Services, Sept. 1985. Used with

Table of Contents


Orientation to the Study Guide/ix

Unit 1: Radiation Protection/1

A: Introduction to X Rays/2
B: Biological Effects of Radiation/12
C: Protection of X-Ray Operators and Patients/21 D:
Radiation Monitoring/56

Unit 2: Equipment Operation and Maintenance/67

A: Electronics of X-Ray Generation and the Radiographic Tube/68

B: Identifying Equipment Failures/88
Unit 3: Image Production and Evaluation/101 A:

Selection of Technical Factors/102

B: Film Processing and Quality Control/126

Unit 4: Radiographic Procedures and Positioning/155

A: Positioning Terminology /156

B: General Procedural Considerations/167 C:
Positioning and Procedures/175
D: Foreign-Body Localization/257

Unit 5: Patient Care and Management/263

A: Verifying Patient Identification and the Radiographic

B: Transferring the Patient/271
C: Using Aseptic and Sterile Techniques/282 D:
Monitoring Vital Signs/289
E: Handling Emergency Situations/301 F:
Monitoring Medical Equipment/312


Answers to Practice Questions/355

Answers to the Posttest/367

User-Response Sheet/373

Orientation to the Study Guide

Purpose of the Guide

The Basic X-RayMachine Operator Study Guide is designed to help
applicants prepare for the certification examination required of basic xray
machine operators and to help them acquire the knowledge and skills
needed on the job. It is NOT the purpose of this guide to serve as the sole
source of instruction preparation for the certification examination. You,
the basic x-ray machine operator applicant, must acquire further training
or instruction in an organized program such as the one offered in the
Medical Assisting programs (HR 17-050300; MEA 0991) in community
colleges or in area vocational-technical centers. (NOTE: Some Medical
Assisting programs offer instruction for the basic x-ray machine
operator.) You can also obtain further instruction from licensed
physicians and from special training programs in hospitals and other
qualified training facilities.

Development of the Guide

The certification examination for basic x-ray machine operators,
developed by the American Registry of Radiologic Technologists
(ARRT), is based upon tasks and content specifications identified by
ARRT. This study guide is based upon the same tasks and content
specifications. The practice and posttest questions, however, are not
identical to the certification examination questions. In order to prepare
yourself for the certification examination, YOU MUST
MATERIAL IN THIS GIDDE so that you can apply your knowledge
and skills to the different situations you will encounter. Hypothetical
situations posed in the examination differ from those provided in the

Components of the Guide

This study guide consists of five units: Radiation Protection, Equipment
Operation and Maintenance, Image Production and Evaluation,
Radiographic Procedures and Positioning, and Patient Care and
Management. Each unit is composed of several sections, in which you
will find the following components.
The Introduction tells you what each section covers and why it is
important for basic x-ray machine operator applicants to learn the
topics covered in that section.

The Objectives state what you should be able to do on a written test

after studying that section.

The Text contains information you need to know in order to achieve the
objectives. Definitions of technical terms are presented either in the text or
in the footnotes (terms defined in the footnotes are printed in bold face with
a footnote number). The text also includes illustrations to enhance the text.

The practice Questions allow you to see how well you have learned the
material. After completing the Practice Questions, check your answers with
the correct answers provided in the Answers to Practice Questions at the
back of this guide. If you miss questions, review those parts of the text that
cover the items missed. If you still have trouble understanding the material,
you need to seek further instruction.

The Posttest includes 140 multiple-choice items covering all five units:
items 1-40 on Unit 1, 41-55 on Unit II, 56-90 on Unit III, 91-100 on Unit V,
101-120 on the chest section of Unit IV, and 121-140 on the extremity
section of Unit IV. This posttest enables you to practice before you take the
140-item certification examination. Since you will be allowed three hours
for the certification examination, allow yourself three hours to complete this

After you have completed the posttest, check your answers in the Answers
to the Posttest at the back of this guide. If you made mistakes, review the
appropriate parts of the guide. If you still need explanation on the items
answered incorrectly, you should seek further instruction or training.

Remember, the items in the practice exercises and the posttest are not the
same test items that appear in the certification examination.

The Answer Keys to the practice questions and to the posttest are provided
at the back of this guide. For the purpose of clarification and review,
"Notes" are included in the answer keys.

In addition, a recommended number of study hours for each unit is indicated

on the unit cover page. This is only a suggested minimum number of study
hours, which is based on the results of a field test. You will have to study as
many hours as you need to in order to understand the material in the guide
thoroughly. (Be sure to include in your study the names and locations of
each bone of the chest and of the lower and upper extremities as shown in
diagrams in Unit IV.)

It is recommended that you read The Handbook for State Licensing
Examinees which candidates for the Basic X-ray Machine Operator
Examination that you will receive from the ARRT.


A: Introduction to X Rays/2
B: Biological Effects of Radiation/12

c: Protection of X-Ray Machine Operators and Patients/21 D:

Radiation Monitoring/56

Recommended study hours for Unit I: 24

Section A: Introduction to X Rays

The discovery of x rays has had a major impact in the field of medicine. With
the growing use and sophistication of radiographic procedures, the need for
well-trained operators has increased. The more knowledge about radiation that
you as an x-ray machine operator have, the greater your ability will be to
make proper job-related decisions. Such information will also help you to
minimize radiation exposure to the patient and yourself, while achieving an
optimum diagnostic radiograph.

In this section you will be introduced to the important properties of x rays.

You will learn what you need to know about the sources and types of
radiation, and you will find out how x rays interact with matter and how they
are produced. You will also learn terminology for the measurements used in


Upon completion of this section, you should be able to do the following on a

written test:
1. Identify the discoverer of x rays.

2. Describe the properties of x rays.

3. Describe the major sources of natural and man-made radiation.

4. Identify what can happen when x rays interact with matter.

5. Explain how x rays are produced.

6. Identify the major types of radiation.

b. Define "exposure," "absorbed dose," and "dose equivalent," and iden-

tify the unit of radiation measurement for each.

c. Given values of the absorbed dose, the quality factor, and the modi-
fying factors, calculate the dose equivalent.

2 I-A: Introduction toX Rays

Introduction to X Rays

Discovery of X Rays

In 1895, German physicist Wilhelm Konrad Roentgen was operating a vacuum

tube at high voltage when he noticed a glow coming from cardboard coated with
a chemical, several feet away from the tube. He realized that this glow, or
fluorescence, was caused by the invisible radiation leaving the vacuum tube.
Since the rays were new and without a name, they were called X (for unknown)
rays, and sometimes Roentgen rays, after their discoverer.

Properties of X Rays

X rays are a form of electromagnetic radiation* similar to gamma radiation.*

To understand how such radiation behaves, imagine a person throwing a stone
into a lake. The water moves in all directions away from the stone. Radiation
moves away from its source in a wavelike motion similar to the movement of the
water. Although x rays are the same type of radiation as radio, or visible light
waves, they have higher energy photons and a much shorter wavelength. For
example, the wavelengths used in television are approximately six feet, whereas
the average wavelength of medical x rays is about one-billionth of an inch.

Because x rays have such short wavelengths, they can penetrate matter, whereas
other types of electromagnetic radiation, such as visible light, are absorbed or
reflected. When x rays are produced, they travel in straight lines at an extremely
fast speed-186,000 miles per second, the speed of light. Although invisible, they
can cause certain substances to fluoresce, or glow. They produce an image on a
photographic film that can be made visible by processing. X rays are electrically
neutral; in other words, they are neither positive nor negative.

Some of the properties of x rays are listed below.

X rays:

•are a form of electromagnetic radiation like gamma radiation

•have higher-energy photons and shorter wavelength than visible light
•penetrate most forms of matter
NOTE: X rays do not readily penetrate certain dense materials such as lead.
• travel at the speed of light (186,000 miles per second)
• affect photographic film very much as light rays do

*electromagnetic radiation: the transmission of energy via photons* at the

speed of light
*photon: a very small bundle of electromagnetic energy
*gamma radiation: electromagnetic radiation spontaneously emitted from
radioactive materials

I: Radiation Protection 3
into•an make
electron and achemicals
certain positive electron (or(fluorescence)
emit light positron). The positron loses energy by
• can ionize matter, including living tissue it, producing two characterisic
ionization until it finds an electron and annihilates
NOTE: This photons.
property of x rays can produce biological changes and cause
damage to the human body.
• cannot be seen, heard, or felt
X-Ray Production • travel in a straight line from their source, though they may be de-
flected by atoms they meet
X rays
• used
obey for
thediagnostic purposes
inverse square are produced
law (This when fast-moving
law is discussed in Section electrons*
C of this
strike a positively charged target* (the anode) in the radiographic tube and
interact with the atoms of the target. Electrons are produced by heating a filament
cannot which
be reflected
is a coil of tungsten wire. When a high voltage is applied,
the negatively charged electrons are accelerated toward the positively charged
target. (According to a rule of physics, like charges repel and unlike charges
Ionizing Radiation and Its Sources
Radiation is the emission of radiant energy in the form of waves or particles.
When radiation interacts
The production of x rays with atoms, the atoms
in a radiographic tube are transformed
occurs into electrically
in three stages, as
charged particles,
illustrated called
in Figure ions. This conversion of atoms to ions is called
ionization. Since some forms of radiation ionize and some don't, the radiation
Stage as1. x-radiation)
The filamentthat
in aconverts atomstube
radiographic of materials
is heatedto
byions is calledcurrent,*
an electric ionizinga
radiation. process that causes the filament to emit electrons.

Ionizing radiation can be either natural (background) or man-made. Natural

Stage 2. Acomes from cosmic
high voltage radiation
is applied emitted
across by the sun and
the radiographic tubeother stars in the
to accelerate
outer space, electrons
radioactive materials
toward {uranium,
the target insidethorium,
the tube.etc.) in the earth, and
radionuclides* deposited in the human body by the food and liquid consumed.
Stage 3. As the high-speed electrons are rapidly decelerated by the target, x
rays are produced.
Sources of man-made radiation include radiographic and nuc1earmedicine
procedures, radioactive fallout from atomic- and nuc1earweapons testing,
and high-voltage electronic
Target devices.
Target (cathode, -) (anode, +)

Interaction of X Rays with Matter

When x rays enter an object, some of the x-ray photons interact with the object's
atoms and some do not. When they do, radiant energy is transferred from the x
rays to the atoms. This transfer of energy is called absorption. The remaining x-
ray photons, those that do not interact with atoms, travel in straight lines and can
produce an image on a film showing the size, shape, and internal composition of
the object. When the object is the human body, this image on a radiographic film
is used for diagnosis.

X rays interact with matter in basically three different ways: photoelectric

interaction, Compton interaction, and pair production. In photoelectric
interaction, the x-ray photon transfers all of its energy to the electron when they
interact. If that energy is sufficient to release the electron from its atomic orbit,
the atom is ionized. In Compton interaction, the photon transfers only a part of
its energy to the electron when they interact. The rest of the photon's energy is
radiated as a lower-energy photon, which travels in a different direction, causing
scatter radiation. Therefore, Compton interaction is also called Compton scatter.
In pair production, the photon changes all its energy

*radionuclide: a radioactive nuclide

4 I-A: Introduction to X Rays

trols the filament temperature of the radiographic tube: the higher the rn A, the
greater the electron emission. Consequently, by varying the rnA, we can vary the
quantity of x rays. (The relationship between exposure time and rnA is discussed
in Section C of this unit.)

In stage 2, the acceleration of the electrons controls the quality-that is, the
penetrating power-of the x rays. The higher the voltage, the greater the speed of
the electrons. The greater the speed, the higher the energy range of the photons.
The higher the energy range of the photons, the greater the penetrating power of
the x rays. In other words, by varying the peak kilovoltage (k Vp), we can vary
the quality of the x rays.

In the third stage, the rapid deceleration of the electrons produces the x rays.

Types of Radiation

As the electrons interact with the atoms of the target, photons of various energies
emerge from the target. Most of these photons are directed toward the object
being radiographed, and a few of them are not. Those photons directed toward the
object are called primary radiation, and those which are not are called leakage
radiation. The primary radiation is then divided into remnant and attenuated
radiation. The primary photons that pass through the object being radiographed
and reach the film are the useful x-ray beam, and they are called remnant radia-
tion. The primary photons that interact with atoms of the object are called
attenuated radiation (see Figure I-A-2). When it interacts with the object, the
attenuated radiation is divided into scatter radiation and absorption. Since scatter
radiation and leakage radiation are not useful for radiographic procedures, they
are categorized as secondary radiation. These different types of radiation can be
depicted as follows:


Figure I-A-l
Production of X-Radiation Inside a Radio-
graphic Tube

In stage 1, the number of electrons produced provides a means of controlling

the quantity of x rays. The number of milliamperes (rn A) con-

*electron: a tiny, negatively charged particle that revolves in orbit around

the nucleus of an atom
*target: a block or disc made of tungsten, which has a high melting point,
and high heat conductivity
*current: a movement of electric charges from one place to another. Its
strength is measured in am peres.

I: Radiation Protection 5


tube Remnant
radiation (useful x-ray beam)

Figure I-A-2
Types of Radiation

6 I-A: Introduction to X Rays

Units and Quantities

Roentgen (R}-Unit of Exposure. It is difficult to measure the amount of energy

carried by an x-ray beam because it travels through the air. Therefore, an indirect
form of measurement is used, as follows: The amount of ionization in a specified
amount of air surrounding a point of interest is proportional to the energy carried
by the beam at that point. To measure the amount of energy carried by the x-ray
beam, therefore, you measure the amount of ionization that x-ray beam produces
in that specified amount of air. This amount of ionization is called exposure, and
the unit used to measure exposure is the roentgen (known as R).
One roentgen represents the amount of exposure necessary to produce 1
electrostatic unit of ions or 1 charge (+ or -) per 0.001293 gram of air. An equally
important and commonly used unit is the milliroentgen (rn R), which is 1/1000 of
a roentgen.

The exposure rate is the number of roentgens produced by the x-ray machine per
second, per minute, or per hour. In other words, it is the intensity of radiation.
Exposure rate can be expressed, for example, as R/min (roentgens per minute) or
R/hr (roentgens per hour).

Rad-Unit of Absorbed Dose (D). The absorbed dose of radiation, known as D, is

the amount of energy absorbed by a substance or object. A rad refers to a unit of
the absorbed dose. A rad is 100 ergs deposited per gram of substance. As the
amount of exposure (R) increases, so does the absorbed dose (D). The higher the
quantity of the absorbed dose in the human body, the greater the chance of
biological damage occurring.

Rem-Unit of Dose Equivalent (10 . The dose equivalent, known as H, takes into
account the fact that the biological effects of ionizing radiation on human body
tissue are dependent not only on the absorbed dose, but also on other factors. The
rem is the unit used to measure dose equivalent.

The quality factor (Q) takes into account the different degrees of biological
effect that can result following exposure to the same absorbed dose of different
types of radiation. The quality factor for diagnostic x rays is 1, for neutrons 10,
and for alpha 20. This means that neutrons can cause ten times more damage
than diagnostic x rays.

The modifying factor (N) is the product of all other factors. For practical
purposes, N is assigned a value of 1 for all irradiations by external sources.

The dose equivalent (H) is the product of the absorbed dose (D), the quality
factor (Q), and any other necessary modifying factors (N). Since the quality
factor (Q) of diagnostic x rays is 1, and an absorbed dose (D) of 50 rads has been
received, the dose equivalent (in rems) is calculated as follows:

H = 50 rads x 1 x 1
H = 50 rems

I: Radiation Protection 7
Another example: If an x-ray machine operator exposed to an x-ray beam
received an absorbed dose of 200 rads, the dose equivalent for this operator is
200 rems because

H = 200 x 1 x 1
H = 200 rems

The following table lists the ionizing radiation quantities with their units of
measure, the media, and the effects measured.

exposure roentgen (R) air ionization of

absorbed dose (D) rad any object amount of energy

absorbed by the

dose equivalent (H) rem human body biological effects


X rays are a form of electromagnetic radiation (like gamma radiation) that can
penetrate and ionize matter, including human tissue. Ionizing radiation has both
natural and man-made sources. X rays, a type of ionizing radiation, are
produced when electrons are made to strike a positively charged target in the
radiographic tube and to interact with the atoms of the target. Radiation can be
categorized into two main types: primary radiation and secondary radiation.
Primary radiation is the useful x-ray beam, and secondary radiation consists of
leakage and scatter radiation. Three units of measurement are used in
determining the amount of ionizing radiation: roentgen for radiation exposure,
rad for absorbed dose, and rem for dose equivalent.

Complete the Practice Questions beginning on the following page.

8 I-A: Introduction to X Rays

Practice Questions (I-A)


Each of the questions or incomplete statements is followed by four suggested

answers or completions. Circle the one (a, b, c, or d) which is best in each case.

1. Who discovered x rays?

d. Curie
e. Rothernburg
f. Roentgen
g. Ohms

2. Which of the following is not a property of x rays?

h. They are electromagnetic in nature like gamma radiation.

i. They have a shorter wavelength and higher-energy photon than
visible light.
j. They produce biological changes.
k. They penetrate any object.

l. Which basic property of x rays can cause damage to the human


m. They can be refracted from the line of travel.

n. They ionize matter.
o. They are absorbed uniformly.
p. They cannot be seen, heard, or felt.

q. Which of the following causes the harmful effects of radiation on the

human body?

r. ionization
s. photons
t. deflection
u. refraction

5. Which of the following describes ionizing radiation?

v. the conversion of atoms to electrically charged particles

w. the collision of a filament with a specific target
x. the straight-path travel of x rays
y. radiographic fallout from nuclear-weapons testing

I: Radiation Protection 9
6. Which of the following are sources of natural radiation?

z. outer space
aa. the earth
bb. food

cc. 1 and 2 only

dd. 2 and 3 only
ee. 1 and 3 only
ff. 1, 2, and 3

gg. Which of the following does not represent a source of man-made

hh. nuclear medicine
ii. radiographic procedures
jj. food and drink
kk. nuclear-weapons testing

ll. When x rays interact with matter, all of the following can happen

mm.The radiant energy is absorbed in the matter.

nn. X-ray photons are transformed into ions.
oo. X-ray photons penetrate the matter and travel in a straight line.
pp. X-ray photons produce an image of the matter on a radiograhic

9. All of the following describe steps in x-ray production EXCEPT:

qq. Tungsten is melted to produce electrons.

rr. The heated filament produces electrons.
ss. When electrons strike a target, sudden deceleration occurs.
tt. Rapidly decelerated electrons produce x rays.

10. To control the quantity of x rays, what should you adjust?

uu. kilovoltage at peak

vv. milliamperes
xx. filament

11. To control the quality of x rays, what should you adjust?

yy. peak kilovoltage

zz. milliamperes

ccc.Which of the following is the useful x-ray beam that contributes to the
formation of the radiographic image?

ddd.scatter radiation
eee.remnant radiation
fff. absorbed radiation
ggg.leakage radiation

1 I-A: Introduction to X Rays

hhh.Which of the following is dispersed in all directions by the object
being radiographed?

iii. scatter radiation

jjj. remnant radiation
kkk.absorbed radiation
lll. leakage radiation

14. Which of the following describes exposure?

mmm.the degree to which atoms are ionized

nnn.the amount of collision that occurs after ionization
ooo.the degree to which electrons are neutralized through
diagnostic x rays
ppp.the amount of ionization that occurs in a specified volume of air

15. What is the unit for measuring exposure in air?

rrr. rad
sss. rem
ttt. quality factor

16. What is the unit for measuring the absorbed dose?

xxx.quality factor

17. What is the unit that takes into account the biological effects?

yyy.quality factor

18. Dose equivalent is the product of all of the following EXCEPT:

cccc.absorbed dose
dddd.quality factor
eeee.ionizing factor
ffff.modifying factor

gggg.When the absorbed dose is 100, the quality factor is 2, and the
modifying factor is 1, what is the dose equivalent?

hhhh.50 rems
iiii. 100 rems
jjjj. 200 rems
kkkk.400 rems

Now check your answers with the correct ones provided in the Answers to
Practice Questions (I-A) at the back of this Guide.

I: Radiation Protection 1
Section B: Biological Effects of Radiation


In Section A, we discussed the fact that x rays ionize when they interact with
atoms. Human body tissues are composed of atoms. Therefore, when x rays
penetrate body tissue, ionization occurs. This ionization can result in molecular
change, which can cause cellular damage. Cellular damage can result in the
abnormal functioning or the loss of cells, which may result in organic damage.
When organic damage occurs, biological effects of radiation, such as cataracts or
leukemia, appear in the living organism. In other words, biological effects occur
at three levels: molecular, cellular, and organic.

This section deals with the effects of radiation at these three levels and in the two
categories, genetic and somatic.


Upon completion of this section, you should able to do the following on a

written test:

llll. Describe the three levels at which biological effects of radiation


2. Identify the most radiosensitive cells.

3. Identify three characteristics of DNA.

mmmm.Identify the genetic and somatic effects of radiation.

nnnn.Identify the three types of the acute radiation syndrome.

oooo.Identify four types of long-term somatic effects of radiation on the

human body.

7. Describe the linear and sigmoid dose-response curves.

12 I-B: Biological Effects of Radiation

Biological Effects of Radiation

The Cells and Their Radiosensitivity

The human body is composed of various types of cells that perform many
different functions. Every mature human cell is highly specialized, having a
specific function to perform. The cell's specialized function is determined by the
structure of the cell's molecules. Most of these cells can be damaged by ionizing
radiation, because ionization can change the structure and chemical balance of
the cell's constituent molecules. This molecular change, then, changes the cellular

Different types of cells can be exposed to different amounts of radiation before

damage occurs, since the degree of their radiosensitivity differs. The lower the
cells' degree of specialization and the faster their division, the greater their

Immature cells, which are nonspecialized and which undergo rapid cell
division, are more radiosensitive than mature cells, which are specialized in
function and which divide slowly or have ceased to divide.

Lymphocytes (white blood cells) are among the most radiosensitive of the
blood cells. Female and male reproductive cells (ova and spermatogonia) are
very radiosensitive. The cells that become the linings and covers of body organs
(epithelial cells) have moderately high sensitivity. Muscle and nerve cells, which
are highly specialized and do not divide, have low sensitivity.

Three Levels of Biological Effects

The biological effects of radiation occur at three levels: the molecular, the
cellular, and the organic.

Molecular Effects of Radiation. Damage to the human body caused by

ionizing radiation begins with damage at the molecular level. A couple of
theories attempt to explain how biological damage occurs: the direct-hit theory
and the indirect-hit theory. These refer to the way radiation interacts with a cell
at the molecular level.

Cells are composed mainly of water and biologic macromolecules such as DNA
(deoxyribonucleic acid) which, as the genetically active part of the genes,
transmits the hereditary pattern. So, when ionizing radiation interacts with a cell,
the radiation interacts directly with macromolecules such as DNA or with water.
When the interaction occurs directly with DNA, the resulting ions may break a
chemical bond and change the DN A molecular structure. This is called the
direct-hit theory because the damage to the DNA molecules occurs directly.

When the radiation interacts with water and ionizes it, water molecules break
down into ions and free radicals. These free radicals can then cause damage to
biologic macromolecules such as DNA. This is called the indirect-hit theory
because the damage to the DNA molecules takes place indirectly.

I: Radiation Protection 1
Cellular Effects of Radiation. The effects of radiation at the cellular level can
result in the following:

• instant death, when a dose of about 100,000 rads is absorbed in a

period of a few minutes
• reproductive death (the cell loses its reproductive capacity), when a
dose of about 100 to 1000 rads is absorbed
• genetic death (the cell dies after a few divisions), even when a small
dose of radiation is absorbed
NOTE: Genetic death is also called mitotte= death.
• interference with cellular function, permanently or temporarily
• chromosome breakage, when ionizing radiation interacts directly with a
DNA macromolecule
Organic Effects of Radiation. The cellular effects of radiation can result in
organic damage, causing problems such as cataracts and leukemia. The degree
of damage generally depends upon the following:

• the quantity of ionizing radiation

• the ionizing ability of the radiation
• the body part exposed to radiation (because some body parts are more
radiosensitive than others)
• the amount of body area exposed to radiation

Two Categories of Biological Effects

The biological effects of ionizing radiation can be considered in two

categories: genetic effects and somatic effects.

Genetic Effects. Molecular damage to DNA molecules in the sperm or ova can
cause biological damage in offspring. Though these effects may not show up for
years or for generations after the exposure is received, they may be passed on
from one generation to another. Because the radiation dose at the gonads (ovaries
and testes-where egg and sperm, respectively, are manufactured and stored) is
genetically significant, it is called the genetically significant dose (GSD).
Gonadal shielding (discussed in the next section) is important to minimize the
amount of radiation received by the male or female gonads.

NOTE: Symptoms of genetic effects are also called genetic dose indicators.

Somatic Effects. Forms of biological damage that affect the individual but that
are not passed on to the offspring are called somatic effects. These effects can be
either short-term or long-term depending upon the length of time between the
exposure and the appearance of symptoms of the damage.

NOTE: Symptoms of somatic effects are also called somatic dose


*mitotic: a type of cell-division process

1 I-B: Biological Effects of Radiation

Short-term somatic effects are relatively severe and begin a short time after a
person has received a large amount of radiation over his or her body within a
short period of time. These injurious effects, also known as the acute
radiation syndrome, occur in four stages:

pppp.The initial stage, which begins within 48 hours after radiation expo -
sure, includes nausea, fatigue, loss of appetite, and other symptoms.

qqqq.The latent stage occurs next and lasts about a week. During this
latent period, the early symptoms disappear and the person feels
better. However, changes are taking place within the blood-forming
and other organs; symptoms of these changes will not show up until
the next stage.

rrrr.During the manifest illness stage the patient exhibits fever, infec -
tion, diarrhea, hemorrhage, nausea, vomiting, disorientation, shock,
and other symptoms resulting from the damage. Death may follow
these symptoms.

ssss.If the dose was not lethal, body tissue starts to heal and the
recovery stage begins. Full recovery may take many weeks.

There are three types of acute radiation syndrome in most mammals: central
nervous system syndrome, gastrointestinal syndrome, and hema topoietic

• Central nervous system (CNS) syndrome will occur after very

high doses, exceeding several thousand rems. Death, occurring
within hours after exposure, is apparently due to the breakdown
of the neurological and cardiovascular systems.

• Gastrointestinal syndrome will occur at lower doses, but at doses

usually above 600 rems. Death, occurring within 15 to 30 days, is as -
sociated with the destruction of the gastrointestinal linings.

• Hematopoietic syndrome, also known as bone-marrow syndrome,

will occur at even lower doses, but at doses greater than 100 rems.
Death may occur because of damage to the blood-forming organs.

Long-term somatic effects appear after months or years have elapsed

following exposure. There are generally four types of long-term somatic
effects: cataractogenesis, life-span shortening, carcinogenesis, and
embryological effects.

• Cataractogenesis is the formation of a cataract on the lens of the eye.

Radiation causes the normally transparent lens to become opaque,
that is, to develop a cataract. The result may be a loss of vision.
Human evidence for radiation cataractogenesis is derived pri marily
from a relatively small number of workers inadvertently ex posed to
large doses of radiation to the eye, from patients exposed to
therapeutic radiation, and from Japanese atomic-bomb survivors.

• Life~ shortening occurs when the average life span is shortened

because of radiation received. Several studies have been made of the
longevity of radiologists (physicians who specialize in radiology),
and although all the statistics do not agree, there seems to be some

I: Radiation Protection 1
dence of life-span shortening. This effect has been confined mainly to
those who practiced during the early years of x-ray use, when
occupational exposure among radiologists was much higher than
today •
• Carcinogenesis, the production of cancer, is a greater risk
following radiation exposure. Such cancers as leukemia (of the
blood) and breast cancer can be caused by radiation. Evidence
indicating that radiation is a carcinogen comes from radium-dial
painters who in gested radioactive material, early radiologists and
dentists, and uranium miners •

• Embryological effects are the effects of radiation on the embryo

or fetus during its development. These effects vary in severity
during each of the three major periods, or trimesters, of
gestation. As the pregnancy progresses, radiosensitivity
The most severe effects occur during the first trimester. Exposure to x-
radiation during the first six weeks often causes death or abnormalities.
Between the second and sixth week of the first trimester, during
organogenesis (when major organs are developing), the fetus is
extremely susceptible to radiation-caused abnormalities.

Radiation sensitivity decreases during the second and third trimes ters.
Even at these stages, however, abnormalities and disorders can result
from radiation exposure.

Dose-Response Curves. Also known as dose-effect curves, these graphic

representations show what can happen to cells in response to certain
dosages of radiation. Two types of dose-response curves are the linear and
sigmoid curves (see Figures I-B-l and I-B-2). The linear
curve indicates that the biological response to radiation is directly pro -
portional to the dose received; the greater the dose, the greater the
biological effects. The sigmoid curve indicates that there is a threshold at
which a biological response to radiation first occurs, and a plateau at
which the maximum biological effects level off.

w w
(j (j)
z z
2 2
f f
a: a:


Figure I-B-l Figure 1-B-2

Linear Dose-Response Curve Sigmoid Dose-Response

1 I-B: Biological E ffects of Radiation

Different types of cells have different degrees of radiosensitivity. The most
radiosensitive cells include the blood-forming cells and the reproductive cells.

Ionizing radiation can result in biological damage to the human body at the
molecular, cellular, and organic levels. The damage can be either genetic or
somatic. Genetic effects damage the offspring of an individual exposed to
radiation, whereas somatic effects damage only the individual exposed.

Generally short-term somatic effects, known as acute radiation syndrome, are of

three types: central nervous system syndrome, gastrointestinal syndrome, and
hematopoietic syndrome. Long-term somatic effects, which appear long after
exposure, consist of cataractogenesis, life-span shortening, carcinogenesis, and
embryological effects.

Complete the Practice Questions beginning on the following page.

I: Radiation Protection 1
Practice Questions (I-B)


Each of the questions or incomplete statements is followed by four sug gested

answers or completions. Circle the one (a, b, c, or d) which is best in each

tttt. Biological damage caused by ionizing radiation begins at

which level?

uuuu.biological level
vvvv.molecular level
wwww. cellular level level

2. Which of the following are most radiosensitive, in general?

yyyy.blood-forming cells
zzzz.nerve cells
aaaaa. reproductive cells
bbbbb. muscle cells

ccccc. 1 and 3 only

ddddd. 1 and 4 only
eeeee. 2 and 3 only
fffff.1, 2, and 4 only

3. Which of the following is not a characteristic of DNA?

ggggg. It is the genetically active part of the genes.

hhhhh. It transmits the heredity pattern.
iiiii.It breaks down into ions when interacting with water.
jjjjj.It is the biologic macromolecules in cells.

kkkkk. The cellular effects of radiation can result in all of the

following EXCEPT: damage
mmmmm. molecular effects
nnnnn. genetic death
ooooo. reproductive death

5. All of the following affect the degree of organic damage EXCEPT:

ppppp. the quantity of ionizing radiation

qqqqq. the ionizing ability of the radiation
rrrrr.the gender of the person exposed to radiation
sssss.the body part exposed to radiation

1 I-B: Biological Effects of Radiation

6. Which of the following best describes genetic effects?

ttttt.They affect only the patient's DNA.

uuuuu.They mayor may not show up for generations after radiation
vvvvv.They become noticeable only in the implantation stage.
wwwww.They promote the risk of cancer.

7. What is the radiation dose received by the gonads called?

xxxxx.ionizing radiation
yyyyy.genetically significant dose
zzzzz.somatically significant dose
aaaaaa.gonadal dose

bbbbbb.Which of the following is not a symptom of short-term

somatic effects?


gggggg.Acute radiation syndrome includes all of the following

types EXCEPT:

hhhhhh.central nervous system syndrome

iiiiii.bone-marrow syndrome
jjjjjj.cataractogenesis syndrome
kkkkkk.gastrointestinal syndrome

10. Which of the following best describes long-term somatic effects?

llllll.short-term adverse effects on animals

mmmmmm.adverse effects on individuals and their offspring
nnnnnn.adverse effects on an individual that appear long after exposure
oooooo.long-term adverse effects on a patient's offspring

11. Which of the following are long-term somatic effects?

pppppp.lif e-span shortening


ssssss.1 and 2 only

tttttt.2 and 3 only
uuuuuu.1 and 3 only
vvvvvv.1, 2, and 3

wwwwww.The fetus is most sensitive to x-radiation during which period

of a pregnancy?

xxxxxx.first three months (first trimester)

yyyyyy.second three months (second trimester)
zzzzzz.last three months (third trimester)
aaaaaaa.last month

I: Radiation Protection 1
bbbbbbb.A dose-response curve is a graph representing which of
the following?

ccccccc.the potential damage to cells when they respond to different

doses of radiation
ddddddd.the probable damage to DNA molecules once they become
eeeeeee.the interaction between DNA and other structures
fffffff.a damaged DNA molecule

14. Which of the following describes the linear curve?

ggggggg.There are a threshold and a plateau in the curve.

hhhhhhh.The biological response to radiation occurs within a short period
of time.
iiiiiii.The biological response to radiation is not directly proportional to
the absorbed dose.
jjjjjjj.The biological response to radiation is greater if the absorbed dose
is greater.

Now check your answers with the correct ones provided in the Answers to
Practice Questions (I-B) in the back of this Guide.

20 I-B: Biological Effects of Radiation

Section C: Protection of X-Ray Machine Operators and Patients


As discussed in Section A, people are exposed to both natural and manmade

radiation. Among the various sources of radiation exposure to the public,
radiographic procedures are considered the largest single source of man-made
radiation. Since secondary radiation (scatter and leakage radiation) produced
during a radiographic exposure can be harmful to both patients and x-ray
machine operators, you should employ all methods and devices to minimize
secondary radiation. Effective measures include keeping the exposure time short;
maintaining a considerable distance from the radiographic tube; using shielding
devices, a collimator, and filter; selecting appropriate exposure factors; and using
appropriate radiographic accessories.

This section focuses on how these factors can reduce secondary radiation and
how you can protect patients and yourself during radiographic procedures.


Upon completion of this section, you should be able to do the following on a

written test:

1. Identify three basic radiation protection measures.

kkkkkkk.Explain the inverse square law and compute radiation intensity

(or exposure rate), using the formula for the inverse square law.

lllllll.Identify shielding accessories and primary and secondary protective


4. Identify means for protecting patients from overexposure.

5. Describe beam restriction (collimation) and filtration.

mmmmmmm.Identify the types of patients and the body parts requiring

gonadal shielding.

nnnnnnn.Identify and explain the three primary exposure factors: kVp,

rnA, and time.

ooooooo.Explain radiographic accessories-radiographic film, film holders,

intensifying screens, grids, autotimer, and immobilization devicesin
terms of their roles in patient protection.

ppppppp.Explain why pediatric patients especially must be protected

from ionizing radiation.

qqqqqqq.Explain the 10-day rule and the reason female patients of child-
bearing age must be protected from radiation.

I: Radiation Protection 21
Protection of X-Ray Machine Operators (I-C-l)

As a basic x-ray machine operator, you will be exposed to radiation

from several sources:

• radiation from accidental exposure to the primary x-ray beam-when,

for example, you hold a patient
• scatter radiation from patients
• scatter radiation from other surfaces, such as walls, floor, and x-ray
• leakage radiation from the radiographic tube

Three Basic Protection Measures

The radiation exposure you receive as a result of your occupation is called

occupational exposure. You can minimize occupational exposure by
practicing basic radiation protection measures. These measures involve time,
distance, and shielding accessories.

Time. Keep the time of exposure as short as possible. The quantity of

radiat ion received by an individual is directly related to the amount of
exposure time. If the exposure time is doubled, the dose is doubled. By the
same accounting, cutting the time in half will cause the exposure to be
reduced by 50 percent.
Distance. Maintain a considerable distance between yourself and the
radiographic tube, the source of radiation. As the distance from the source of
the x-ray beam increases, the intensity of the radiation (also called exposure
rate) beam decreases. Thus, the greater the distance, the smaller the radiation
intensity. If the distance is doubled, the intensity is decreased to 1/4 the
original exposure. A distance in creased by three times will reduce the
radiation intensity to 1/9 the original exposure. This relationship is known as
the inverse square law, which states that the radiation intensity is inversely
proportional to the square of the distance. The formula is

Where: 11 is the exposure at the original distance 12

is the exposure at the new distance

Dl is the original distance from the radiographic source D2

is the new distance from the radiographic source

2 I-C: Protection of X-Ray Machine Operators and Patients

For example, if an x-ray machine operator receives an exposure of 100 R/hr
at a distance of 20 inches, the exposure rate (radiation intensity) at a
distance of 40 inches is 25 R/hr, because:

100 R/hr
= (40)2
x (20)2

100 R/hr 4
x 1
(Invert and
100 R/hr x = 25 R/hr
As Figure I-C-1 and this example show, when the original distance (0 1) is
doubled (0 2), the radiation is spread over an area four times larger, but the
exposure rate, or radiation intensity, is reduced, to 1/4 of the original


Figure l-C-l
Inverse Square Law

NOTE:The distance from the source of radiation to the film is called target
to rum distance (TFO), source to image detector (SID), or focal r u m
distance (FFD). These three terms are used interchangeably.

I: Radiation Protection 23
c. Radiation Protection Sbiel@!g
Methods Accessories. Use protective shielding routinely. Shielding refers
to radiopaque* materials inserted between the source of radiation and the
In addition to
individual. those protective
Shielding measures
accessories forprotective
such as which the barriers,
x-ray machine operator
aprons, and
is responsible,
gloves protection
are generally madeis afforded
of lead. both operator and patient through built-
in features wherever an x-ray machine is in use.
While activating radiographic equipment, you should stand behind the
protective lead
Radiographic barrier
Room or wear
Design . Aaradiographic
protective lead
roomapron or gloves,
and the aspa
adjoining shown
in Figure
rooms are I-C-2.
designed in such a way that the placement of the x-ray machine
will direct as little radiation as possible toward the adjoining areas (see
Figure I-C-3).


Pigure I-C-2
Protecting Yourself from Radiation Using

Reproduced by permission from: Statkiewicz, M. A., and Ritenour, E. R.: Radiation

Protection for Student Radiographers, Denver, 1983, Multi-Media Publishing Co.;
copyrighted by the C. V. Mosby Co., St. Louis.

NOTE: The National Council on Radiation Protection and Measurements

(NCRP) recommends that the thickness of the lead in shielding accessories
be as follows:

lead aprons .5 mm Pb (lead or equivalent) .

lead gloves 25 m m Pb (lead or equivalent) .
Bucky slot cover 25 mm Pb (lead or equivalent)

NOTE: The Bucky tray receives the cassette during radiographic procedures.
The slot (see Figure I-C-3) has a protective cover to minimize the radiation
that would otherwise be directed through this opening.

*radiopaque: having the capacity to absorb (rather than transmit) a

relatively large amount of the x rays passing through

24 I-C: Protection of X-Ray Machine Operators and Patients


tube ----

Figure I-C-3
Examples of Radiographic Room and Protective

Reproduced by permission from: Bushong, Stewart C.: Radiologic Science for

Technologists, ed. 3, St. Louis, 1984, The C. V. Mosby Co.

Primary Protective Barriers . When a chest radiographic unit is placed on a

wall and a patient stands in front of the unit, the primary beam is directed to
the patient's chest, and thus toward the wall. Lead-bonded wall covering is
used on these walls to eliminate the passage of radia tion into an adjoining
room. This lead-bonded wall is designated as a primary protective barrier
because it is designed to protect areas from primary radiation.

Secondary Protective Barriers . Barriers designed to shield areas from

secondary radiation are called secondary protective barriers. The lead used
in secondary barriers is thinner than that used in primary protec tive barriers.
However, most common building materials such as con crete sufficiently
absorb and reduce secondary radiation to an accept able level. Most control
booths are secondary protective barriers.

NOTE: Following are some NCRP specifications for protective barriers:

I: Radiation Protection 25
primary barrier 1.5 mm Pb (1/16 inch lead) .75
secondary barrier mm Pb (1/32 inch lead)
lead glass in
control booth control 1.5 mm Pb (1/16 inch lead)
panel (behind
barrier) 1. 5 m m Pb (1/16 inch lead)


The basic measures that the x-ray machine operator can take to protect against
occupational exposure to radiation involve three factors: time, distance, and
shielding. Even with the proper exposure time, TFD, shielding accessories, and
protective barriers, you and other persons can be exposed to radiation
unnecessarily if you are not careful.

The following state what you should and should not do when making an

• Stand behind the protective barrier.

• Wear protective lead apron and gloves.

• Never stand in the primary beam.

• Never allow a pregnant female to hold the patient, since she may be
exposed to radiation and the embryo or fetus may be damaged.

• When another person restrains the patient during an exposure, have

that person wear protective lead apron and gloves and never allow
that person to stand in the primary beam.

• Make sure to remove all unnecessary persons from the area where
they can be exposed to radiation.

• Never hold the patient or touch accessories during exposure.

• Keep the time of exposure as short as possible.

• Keep as great a distance as possible between you and the source of


Before continuing to Patient Protection, complete the Practice Questions

beginning on the following page.

26 I-C: Protection of X-Ray Machine Operators and Patients

Practice Questions (I~-1)


Each of the questions or incomplete statements is followed by four suggested

answers or completions. Circle the one (a, b, c, or d) which is best is in each

rrrrrrr.All of the following are basic radiation protection measures for

operators EXCEPT:

sssssss.Keep exposure time as short as possible.

ttttttt.Keep the distance between yourself and the radiographic tube as
great as possible.
uuuuuuu.Use only a safelight.
vvvvvvv.Use shielding accessories routinely.

wwwwwww.To minimize your occupational exposure, how should you

keep the distance between you and the x-ray table?


3. What is the inverse square law?

bbbbbbbb.kVp is inversely proportional to the square of rnA.

cccccccc.rnA is inversely proportional to the square of kVp.
dddddddd.Exposure time is inversely proportional to the square of the
eeeeeeee.Intensity of radiation is inversely proportional to the square
of the TFD.
ffffffff.If the length of exposure time is increased from 5 to 10 seconds, the
amount of exposure will do what?

gggggggg.double the same

kkkkkkkk.If you receive an exposure of 100 R/hr at a distance of 50 inches,

how much will you receive if the distance is decreased to 25 inches?

llllllll.400 R/hr
mmmmmmmm.200 R/hr
nnnnnnnn.50 R/hr
oooooooo.25 R/hr

I: Radiation Protection 27
pppppppp.If the exposure rate is 90 R/hr at a distance of 20 inches from
the source of radiation, what will be the exposure rate at a new dis-
tance of 60 inches?

qqqqqqqq.10 R/hr
rrrrrrrr.25 R/hr
ssssssss.50 R/hr
tttttttt.200 R/hr

uuuuuuuu.When the exposure rate exceeds 5 mR/hr, which of the

following should you wear?

vvvvvvvv.white gown
wwwwwwww.rubber gloves
xxxxxxxx.lead apron
yyyyyyyy.a lot

zzzzzzzz.What is the NCRP recommended thickness for the

lead in protective gloves?

aaaaaaaaa.0.25 mm
bbbbbbbbb.0.5 mm
ccccccccc.2.5 mm
ddddddddd.5.0 mm

eeeeeeeee.Which of the following is required to reduce exposure to the

waiting room directly behind the upright chest unit?

fffffffff.first barrier
ggggggggg.primary barrier
hhhhhhhhh.secondary barrier
iiiiiiiii.scatter barrier

jjjjjjjjj.What is the recommended thickness of the lead in a primary pro-

tective barrier?

kkkkkkkkk.1/4 inch
lllllllll.1/8 inch
mmmmmmmmm.1/16 inch
nnnnnnnnn.1/32 inch

ooooooooo.To minimize your occupational exposure, you should do all

of the following EXCEPT:

ppppppppp.hold the patient during the exposure

qqqqqqqqq.stand behind the lead barrier while activating x-ray
rrrrrrrrr.stand outside of the primary beam
sssssssss.wear lead apron and lead gloves

Now check your answers with the correct ones provided in the Answers to
Practice Questions U-C-l) at the back of this Guide.

2 I-C: Protection of X-Ray Machine Operators and Patients

Patient Protection
Collimators. (J-C-2) is the best device for restricting the primary beam.
A collimator
The collimator is attached to the tube housing of the x-ray ma chine. It has
two sets of lead shutters that can be adjusted to restrict the size of the
radiation field to no larger than the film size (see Figure I-C-5).

The overexposure of the patient to radiation during a radiographic

Anode (+) examination
can be reduced by several means: by preparing and positioning
focal spot the patient
properly, by restricting the primary beam (collimation), by using a filter in front
of the radiographic tube opening, by providing gonadal shields, by selecting
appropriate exposure factors, and by using radiographic accessories.

Patient Preparation and Positioning

Patient preparation requires having the patient remove clothing or

other items that might interfere with the examination and instructing the patient in
how to breathe correctly. Patient positioning requires ensuring that the parts of
the body to be radiographed are clearly visible, centered in the field of the
radiograph, and immobilized during the exposure. To prevent the patient from
moving voluntarily, you may need to use an immobilization device. Failure to do
procedures correctly can mean having to repeat the radiograph. A needless repeat
gives the patient an additional 100 percent radiation exposure.

NOTE: This topic is discussed in more detail in Unit!y.

Beam Restriction

In order to minimize secondary radiation, the primary x-ray beam should be

limited to the body part being radiographed, and the radiation field size (size of
the beam or size of the field exposed) should never be larger than the film. 1be
smaller the field size, the smaller the amount of scatter radiation there will be.

Diaphragms, 2Yli~ and Cones. Nonadjustable diaphragms, cylinders, and

cones--early devices used to restrict the area of the primary beam-no longer
meet the State of Florida's legal requirements for restriction of the primary
beam (see Figure I-C-4).

Simple lead
with aperture
Cone SIde view Cylinder
TISide view
of cone of cylinder

Figure 1-C-4
Nonadjustable Beam Restriction Devices:
Diaphragm, Cylinder, and Cone

I: Radiation Protection 2
X-ray tube

Radiation field
(light source projectio
on film)

Film carrier

Figure I-C-S
Exterior (A) and Interior (B) of Collimator

A: Courtesy Machlett Labs, Inc., Stamford, Connecticut.

B: Reproduced by permission from: Statkiewicz, M. A., and Ritenour, E. R.: Radiation

Protection for Student Radiographers, Denver, 1983, Multi-Media Publishing Co.;
copyrighted by the C. V. Mosby Co., St. Louis.

One set of shutters is adjusted to reduce the amount of off-focus radia tion
coming from the primary beam and exiting from the radiographic tube
housing. The other set of shutters is adjusted to confine the radio graphic
beam to the body part radiographed. For protection against exposure, the
surface of the patient's skin should be at least 15 centi meters below the
collimator. Most x-ray machines manufactured be fore August 1974 had
manually adjusted collimators. By manually adjusting the collimator, an x-
ray machine operator can use a radiation field smaller than the size of the
cassette, thus reducing unnecessary radiation to the patient.

3 I-C: Protection of X-Ray Machine Operators and Patients

Since 1974, the federal government has required that every radiographic
machine have a positive beam limitation (PBL) device. The PBL device
automatically adjusts the collimator so that the radiation field size is
no larger than the film. Figure I-C-6 shows a properly collimated radiographic
beam, which minimizes scattered radiation, and an improperly collimated
radiographic beam, which results in extra scattered radiation.

Figure I-C-S
Proper (A) and Improper (B) Collimation

Reproduced by permission from: Statkiewicz, M. A., and Ritenour, E. R.: Radiation

Protection for Student Radiographers, Denver, 1983, Multi-Media Publishing Co.;
copyrighted by The C. V. Mosby Co., St. Louis.

Collimators are equipped with a light and mirror assembly, known as the light
localizer, which projects a light field through the collimator opening onto the
patient's body and shows the size and location of the x-ray beam. Because the
light localizer enables the machine operator to see the actual location of the x-
ray beam prior to making the exposure, the operator can project the light
source onto the film and accurately place the radiation field (see Figure I-C-


Filtration reduces radiation exposure to the patient's skin by absorbing

lower energy photons (or soft radiation). A metal (usually aluminum) filter
placed in front of the radiographic tube opening (see Figure I-C-5)
accomplishes this purpose. An x-ray beam includes many low-energy xray
photons that contribute nothing to the formation of the radiographic image
because they have insufficient energy to penetrate the patient and reach the
film. These photons increase the patient's radiation exposure, nevertheless,
because the skin absorbs the radiation. Removing these low-energy x rays
decreases the dose that the patient

I: Radiation Protection 31
receives. Tbe NCRP recommends 2.5 millimeters of aluminum
equivalent filtration.

In most new radiographic equipment, the necessary amount of filtration is

installed and requires no operator adjustment. Older models may have a
"filter wheel, tI requiring the operator to manually adjust the filtration prior to
making an exposure.

NOTE: In addition, x-ray machines must allow no appreciable radiation

leakage outside the primary beam. A radiation physicist decides the filtration's
effectiveness and leakage radiation during machine inspection. If the amount
of filtration is reduced, the patient's exposure rate will be increased.

Shielding for Patients

Gonadal Shields. A gonadal shield is a radiopaque material placed between

the x-ray source and the gonads (female ovaries or male testes) to reduce the
radiation dose. Its main purpose is to protect the gonads from exposure to the
primary x-ray beam when the gonads are within range of the properly
collimated beam. Gonadal shielding should be used in addition to and not
instead of proper beam limitation for all patients-adults and children-with
reproductive potential.

Techniques for testicular shielding are better established than for ovarian
shielding. The anatomical location of the testes is such that covering them
with a shield usually does not obscure needed clinical information. On the
other hand, the location of the ovaries often interferes with the visualization
of other structures.

Two basic kinds of gonadal shields are available today: the shadow
shield and the contact shield.

The shadow shield, a device made of radiopaque material, is suspended

from the radiographic tube. The operator may move the shield in and out of
the light field, so that it casts a shadow on the patient. The shield should be
positioned over the gonadal region (see Figure I-C-7).

Figure 1-C-7
Shadow Shield
Courtesy Nuclear ASSOCiates, Carle Place, New York.

3 I-C: Protection of X-Ray Machine Operators and Patients

The contact shield, also made of radiopaque material (usually containing
lead), is placed directly on the patient. The most common kind is the flat
contact sbield. These shields are pieces of lead-impregnated rubber in various
shapes. A contact shield is placed on the patient above the gonads. Since flat
contact shields are difficult to secure in place, they are best suited to
recumbent projections and to anteroposterior (AP) or posteroanterior (P A)
views (these terms are defined in Unit IV).

Another type of contact shield is the shaped contact shield. These radiopaque
shields surround the testes. Shaped contact shields are contained within
various carriers such as disposable or washable athletic supporters and
jockey-style briefs. The carrier, which has a pouch into which the shield is
inserted, is designed to hold the shield comfortably in position over the
scrotum and penis, whether the patient is recumbent or upright. Since the
patient can put on this garment by himself, effective shielding can be
provided with a minimum of embarrassment to the patient (see Figure I-C-8).

Figure I-C-l
Shaped Contact Shields
Courtesy Nuclear ASSOCiates. Carle Place, New York.

Shields for Other Radiosensitive O r g a .nOther

s organs in the body besides
the gonads are particularly radiosensitive. Two of these are the eyes and the
thyroid. The eyes can be protected by glasses that have been impregnated
with lead or by eye cups that fit over the eyes during some procedures. The
thyroid can be protected by a device called the thyroid collar. The collar,
made of a lead-impregnated material, fits around the neck.

Regular use of these shields should be implemented for an effective shielding

program. Any patient who undergoes radiographic examinations on a regular
basis should have some sort of shielding to protect his or her body from
unnecessary exposure to radiation.

Other techniques for exposure reduction are related to technical factors,
which fall into two groups: exposure factors and radiographic accessories.

I: Radiation Protection 3

o o o o
Three Prim~ ~ure Faetors. The factors that control
Signalthe quantity and
quality {ienetra ting power) o·f the radiation produced
-tight are called primary

The three primary factors are kilovoltage

exposure factors. These factors affect how much radiation will reach the film
and how energetic the radiation will be to penetrate the patient and reach the
film. peak (kVp), milliamperage
t (m
Major Minor mA Exposure timer
A), and exposure
kVp selector time (s),
kVp selector selector selector Exposure
• The kUoyoltage peak (kVp) is the energy of the electron beam inside

the radiographic tube at its peak value. The Line
amount of kVp selected
affects radiation exposure by determining the energy of the x-ray
photons, which in turn determines the penetrating
control knob
power of the x-ray
beam. That is, the amount of kVp selected determines the amount of
force that will be used to accelerate the electrons from the filament to
the target. With a higher kVp, the force with which the electrons
strike the target will be greater. The greater the force, the more
penetrating the energy of the x rays will be. In other words, the higher
the kVp, the higher the quality of the beam.
• The amount of mi11iamperage (rnA)selected controls the rate at
which electrons are emitted from the heated filament. The higher the
rnA, the hotter the filament and the more electrons emitted.
Therefore, the amount of rnA selected controls the quantity of radia-
tion produced.

• The length of exposure time (s) selected also affects the quantity of
radiation. The longer the exposure time, the higher the quantity of
radiation produced. The combination of these two exposure factors,
exposure time and rnA, is known as milliamperes per second
With all other factors remaining constant, an increase in the TFD will result
in a decrease in the quantity of x rays striking the film, while a decrease in
the TFD will result in an increase in quantity. As discussed in the previous
section, this is the principle of the inverse square law.
Selection of Exposure Factors. Since each patient is different in size and
condition and since different body parts are of different sizes, the operator
must be able to adjust exposure factors on the machine to produce the
appropriate radiographic beam for every situation. In accomplishing this
purpose, you should use the three basic controls (kVp, rnA, and exposure
time) on the x-ray machine control panel (see Figure I-C-9).

NOTE: Since distance is standardized for each radiographic examination,

Summar you usually do not adjust distance to alter radiographic exposure.
To set the kVp, use the kVp selector knob or buttons on the control panel, To
select the appropriate kVp, take into consideration how much penetration the
body part being radiographed requires. For example, the femur is much
heavier than the bones of the hand; therefore, the kVp required to radiograph
the femur is higher than that required for the hand.

To select the appropriate rnA, adjust the rnA control knob or buttons for the
particular radiographic examination, as shown on the technique chart you are
using. (The use of technique charts is discussed in Unit m .) By doubling the
rnA, you double the amount of x rays produced.

34 I-C: Protection of X-Ray Machine Operators and Patients

kVp meter mA meter switch

Figure I-C-S
The X-ray Control Panel

Since a high kVp produces a more penetrating x-ray beam and a high mAs
produces more radiation, a combination of higher kVp and lower mAs
reduces the patient's radiation dose. For the proper selection of these
exposure factors, use the standardized technique charts.
To determine bow long x-ray production will take place, set the timer on the
control panel. Through the selection of time and rnA (rnAs), you can control the
quantity of x rays, and you can select the fastest time possible without changing
the quantity.
For example:

• If you use 100 rnA for 1 second, you are using 100 mAs, because 100
rnA x 1 second = 100 mAs.
• If you use 200 rnA for 1/2 second, you are still using 100 mAs, be-
cause 200 rnA x 1/2 second = 100 mAs.

To protect patients from overexposure to radiation, you should do the

• Instruct patients to remove clothing and jewelry before the exposures and
to breathe properly and remain immobile during the exposures.

I: Radiation Protection 35
• Use aeoUimator to restrict the beam to the area to be radiographed.
(Remember, the smaller the field size, the less scatter radiation

• Adjust filter.

• Use gonadal shields over male and female reproductive organs

prior to taking radiographs, when indicated.

• Place protective shields (protective lenses, eye cups, or thyroid col-

lars) over radiosensitive organs when repeated examinations or high
dosage levels are required.

• Select the appropriate kVp and rn As, using technique charts. Gener-
ally, a combination of higher kVp and lower mAs reduces the patient's
radiation dose.

Before continuing to study about radiographic accessories, complete the

Practice Questions beginning on the following page.

3 I-C: Protection of X-Ray Machine Operators and Patients

Praetiee Questions Which
vvvvvvvvvv. (I-C-2)of the following is a device that projects a light
field through the collimator to enable the machine operator to see
the actual location of the x-ray beam before the exposure?

wwwwwwwwww. an aluminum filter

Direetions xxxxxxxxxx. a radiographic tube window
yyyyyyyyyy. a set of shutters
Each of the questionsa or
light localizer statements is followed by four suggested
answers or completions. Circle the one (a, b, c, or d) which is best in each
7. What is the main purpose of filtering an x-ray beam?

ttttttttt.All to reduce provide
of the following radiationprotection
exposure to patient's
from radiation EXCEPT:
bbbbbbbbbbb. to reduce radiation exposure to
patient's gonads (beam restriction)
ccccccccccc. to increase the quality of radiation
8. Onxxxxxxxxx.shielding
which to increase
of the following the gonadal
should quantityshields
of radiation
be used?

yyyyyyyyy.The pregnantandpatients only
the x-ray machine operator receive
fffffffffff. allradiation
unnecessary female patients
exposure from which of the following?
ggggggggggg. all male patients
zzzzzzzzz.a all patients
limited with reproductive
radiographic examinationpotential
aaaaaaaaaa.a repeat radiographic examination due to technical error
9. Which of the following would you use for male patients?
or carelessness
bbbbbbbbbb.beam limitation and filtration techniques used when
making exposureshield
jjjjjjjjjjj. flat high-quality
cccccccccc.a contact shieldradiograph produced on the first exposure
kkkkkkkkkkk. shaped contact shield
lllllllllll. lead x-ray
dddddddddd.The shieldbeam should be collimated so that which of the
following is true?
10. Which of the following does not require special shielding?
eeeeeeeeee.The radiation field size is larger than the film holder.
mmmmmmmmmmm. beam is restricted
the eyesto the body part being radiographed.
nnnnnnnnnnn. the
gggggggggg.The thyroid
beam is no larger than the film.
ooooooooooo. the gonads
hhhhhhhhhh.1 the 2femur
iiiiiiiiii.1 and 3 only
11. Alljjjjjjjjjj.2
of the following are primary exposure factors EXCEPT:
and 3 only
kkkkkkkkkk.1, 2, and 3
qqqqqqqqqqq. kVp
rrrrrrrrrrr. does
rnA an automatic collimator allow the x-ray machine
operator to do? shielding
ttttttttttt. exposure time
mmmmmmmmmm.use a film holder larger than the radiation field
uuuuuuuuuuu. When you theincrease
amounttheof kVp
radiation produced
and then forthe
decrease a mAs
accordingly, what happensexamination
specific radiographic to skin exposure?
oooooooooo.remove the low-energy photons of x rays
vvvvvvvvvvv. It isthe film accurately and consistently
wwwwwwwwwww. It is decreased.
qqqqqqqqqq.An It is unchanged.
improperly collimated radiographic beam will do
which of the following? It is multiplied.

rrrrrrrrrr.minimize scattered radiation

ssssssssss.result in extra scattered radiation
tttttttttt.limit the beam to the area of radiation
uuuuuuuuuu.reduce the amount of absorbed radiation

I: Radiation Protection I-C: Protection of X-Ray Machine Operators and Patients 37