University of Hail

Faculty of Applied Medical Sciences – Radiology department

‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

INTRODUCTION :
Medical imaging of the human body requires some form of energy to be able of
penetrating tissues such as X-ray .
X-rays are produced extranuclearly , this means that X-rays are produced in an
electrical device that accelerates electrons to high energy and then stopped them
abruptly in a target , (the target usually made of tungsten , molybdenum or
rhodium) , part of the kinetic energy of the electrons is converted to X-ray .

Objectives :
To verify the effect of spatial variation and heel effect on x-ray output
Theory
X-Ray Production, X-Ray Tube and Generators
X-rays are ionizing electromagnetic radiation that results from the conversion of
either the kinetic or potential energy carried by electrons into electromagnetic
radiation. In diagnostic radiology, x-ray beams are produced when highly
accelerated electrons boiling off the cathode thermionically are abruptly stopped
or collide with the anode , usually tungsten or molybdenum in case of
mammography unit, within x-ray tube. An X-ray tube (illustrated with a
simplified x-ray tube diagram below) insert contains the electron source and a
target within an evacuated glass or metal envelope that the cathode and the
anode (maintained at different potential).

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬
 University of Hail
Faculty of Applied Medical Sciences – Radiology department
‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

The x-ray tube is housed in a housing that provides it with shielding and also
contains coolant oil for anode cooling. The x-ray generator connects the anode
and cathode; it provides energy (voltage) for acceleration of the electron and
permits control of x-ray output through the selection (kVp, mAs, mA and time).
Also, the x-ray tube has window with collimator, for defining x-ray field size .
When the electrons are suddenly decelerated upon collision with an atomic
nucleus of the target metal in a CLOSE approach , these x-rays are commonly
called bremsstrahlung x-ray or " braking radiation " ,

If the bombarding electrons has sufficient energy , then the electrons can knock
the electron out of an inner shell of the target metal atom leaving a vacancy (
only if the energy of the incident electron is greater than the binding energy of
k-shell ) , then the electron from adjacent L-shell or nonadjacent shell will fills
the vacancy ( hole) and emitting x-ray photon with energy equal to the
difference between the binding energies of the two shells called characteristic
x-ray .

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬
 University of Hail
Faculty of Applied Medical Sciences – Radiology department
‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

so , braking radiation obviously has greater energy than characteristic x-ray .

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬
 University of Hail
Faculty of Applied Medical Sciences – Radiology department
‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

Heel Effect
It is generally accepted that an x-ray beam's intensity is not uniform throughout
its entirety. As x-radiation is emitted from the target area in a conical shape,
measurements have determined that the intensity in the direction of the anode
(AC) is lower (over and above the difference caused by the Inverse Square
Law) than the intensity in the direction of the cathode (AB). The fact that the
intensities vary in such a manner causes visible differences in the density
produced on the radiographs. This phenomenon is called heel effect and is
illustrated below.

NOTE:
A = 100-percent intensity
AB = consists of a slight increase over 100-percent intensity
and then a general decrease in intensity as B is approached
AC = consists of a considerable decrease in intensity as C is
approached

The decreased intensity at C results from emission which is

nearly parallel to the angled target where there is increasing absorption of the x-
ray photons by the target itself. This phenomenon is readily apparent in rotating
anode tubes because they utilize steeply angled anodes of generally 17 degrees
or less. Generally, the steeper the anode, the more severe or noticeable the heel
effect becomes.

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬
 University of Hail
Faculty of Applied Medical Sciences – Radiology department
‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

The effects of focus film distance on the visualization of heel effect are
illustrated below:

Figure G shows the film plane as having a shorter focus film distance than the
film plane in Figure H. Looking at Figure G, you can readily see that the x-ray
beam's involvement in exposing the film runs from C to B (the full cone of
radiation). Heel effect causes a greater decrease in x-ray beam intensity as one
travels from the central ray to the cathode (A to B).

As you look at Figure H, note that a long focus film distance is used which
results in the involvement of the x-ray beam at the film plane which does not
utilize the full cone of radiation (C to B). Hence, the extremities of the beam (C
and B) are not used in exposing the film. Because of this, heel effect is greatly
reduced.
For the heel effect, a 45cm x4cm square box with nine equal boxes was drawn
on the table and exposure measurement was taken at middle of each box with
the ion chamber. The light beam was set to cover the area of the square with its
center coinciding with square center.

Position 1 Position 2 Position 3

Position 4 Position 5 Position 6

Position 7 Position 8 Position 9

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬
 University of Hail
Faculty of Applied Medical Sciences – Radiology department
‫كلية العلوم الطبية التطبيقية – قسم األشعة التطبيقية‬

1 4 7

CATHODE
ANODE

2 5 8

3 6 9

Three clinical importance of this effect are :

i. Is useful in obtaining balanced densities radiograph of body part of
difference thickness. Thicker part placed at the cathode side,
ii. heel effect is less noticeable when larger focus-film distances are used
iii. for equal SID, heel effect will be less for smaller films

Student has to verify of the clinical importance of this phenomenon

experimentally and support his point of view with numbers and graphs .
I strongly recommend him to use supporting software's such as imagej ,
excel …. etc

Best wishes
Mamdouh Saud Al-Enezi
Mam-saud@hotmail.com

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‫ممدوح الوحداني – جامعة حائل – كلية العلوم الطبية التطبيقية‬