SVBG-110010 Basic Infor About X-Rays and X-Ray Systems

Manual No.
: SVBG-110010
Revision: First edition
Basic information about X-rays

and X-ray systems
This manual is for professional service engineers.

It bears no relation to the usual operation.
Revision History
Revision Date Description of Changes
First edition Oct. 2011 First release

Introduction
Introduction
X-rays were discovered in 1895 by the German physicist Dr. W.C. Roentgen. While researching
cathode rays, he noticed that the fluorescent barium platinum cyanide material was glowing with
a blue color. Therefore, he reasoned that it must be from irradiation by invisible rays. He named
them X-rays and announced his discovery to the Medical Physics Society. Subsequently, the
German Society of Medical Physics named the rays Roentgen rays, in honor of the person that
discovered them.
It has been over 110 years since this discovery. Since then, X-rays have been utilized usefully in
a wide variety of areas. As you already know, its contribution has been immeasurable especially
in medical applications, where there has been increasing utilization of diagnostic radiography
methods and dramatic advancements to system technology in recent years, including
advancements in radiography systems, film, and intensifying screens.
To help trainees understand how X-rays are generated, X-rays characteristics, what technology
is involved, and other information, this text provides explanations in terms that are as easy to
understand as possible. We hope it will be helpful.
 Notice
 This training document is copyrighted by the Shimadzu Corporation.
It may not be reproduced either in whole or in part without the prior permission of
Shimadzu Corporation.
 The content of this training document is subject to change without notice. Every effort
has been made to ensure that the contents of this training document were correct at
the time of creation. However, if mistakes or omissions are discovered, it may not be
possible to correct them immediately.
 Screen shots and illustrations in this training document may differ from actual cases
and are included only as examples. In addition, illustrations may omit certain
information.
 Trademarks
 Company names and product names that appear in this training document are
trademarks or registered trademarks of their respective companies.
 The TM and  symbols are omitted in this document.
 2011 Shimadzu Corporation. All rights reserved.
SVBG-110010 Basic information about X-rays and X-ray systems i

Introduction
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ii Basic information about X-rays and X-ray systems SVBG-110010

Contents
Contents
Introduction i
1 Basic Information About X-Rays 1

1.1 X-Rays ...................................................................................................1
1.1.1 What Are X-Rays?.......................................................................................1
1.1.2 Electromagnetic Waves...............................................................................2
1.1.3 X-Rays Described as Particles....................................................................3
1.1.4 X-Ray Characteristics and Applications ......................................................3
1.2 How X-Rays Are Generated ...................................................................4
1.2.1 X-Rays Generation Mechanism ..................................................................4
1.2.2 X-Rays Generated by Kinetic Energy (Continuous X-Rays) .......................5
1.2.3 X-Rays Generated by Differences in Electron Excitation Levels
(Characteristic X-Rays) ...............................................................................6
1.3 Intensity and Quality of X-Rays ..............................................................7
1.3.1 X-Ray Dose.................................................................................................7
1.3.2 X-Ray Quality..............................................................................................7
1.3.3 Types of X-rays ...........................................................................................7
1.3.4 Electron Volts ..............................................................................................7
1.4 X-Ray Spectra ........................................................................................8
1.4.1 X-Ray Spectra Waveforms ..........................................................................8
1.4.2 Variations in Spectral Waveform Due to Changes in Parameters ...............9
1.4.3 Relationship Between X-Ray Spectral Waveform, Transmission, and X-Ray
Quality.......................................................................................................10
1.5 Mutual Interaction Between X-Rays and Substances........................... 10
1.5.1 Photoelectric Effect ...................................................................................10
1.5.2 Auger Effect .............................................................................................. 11
1.5.3 Compton Effect ......................................................................................... 11
1.5.4 Thomson Scattering ..................................................................................12
1.5.5 Formation of Electron Pairs.......................................................................12
1.6 X-Ray Absorption and Scattering ......................................................... 13
1.6.1 Linear Absorption Coefficient ....................................................................13
1.6.2 Mass Absorption Coefficient......................................................................14
1.6.3 Variation in Absorption Coefficient with Respect to Wavelength and
Elements ...................................................................................................14
1.6.4 Filters ........................................................................................................15
1.6.5 X-Ray Scattering .......................................................................................15
1.7 Mechanism of How X-Ray Generators Work........................................ 16
SVBG-110010 Basic information about X-rays and X-ray systems Contents-1

Contents
1.7.1 X-Ray Tube............................................................................................... 16

1.7.2 X-Ray Generator Unit ............................................................................... 18
1.7.3 Control System ......................................................................................... 19
1.8 X-Ray Dose Adjustment....................................................................... 19
1.8.1 Adjusting the X-Ray Dose......................................................................... 19
1.8.2 How X-Ray Photographs Are Affected ...................................................... 20
1.9 Effects and Elimination of Scattered Rays ........................................... 21
1.9.1 What Are Scattered Rays? ....................................................................... 21
1.9.2 Effect of Scattered Rays on Image Characteristics................................... 21
1.9.3 How to Eliminate Scattering...................................................................... 22
1.10 The Role of Intensifying Screens and Fluorescent Screens ................ 25
1.10.1 Intensifying Screens ................................................................................. 25
1.10.2 Cassettes.................................................................................................. 25
1.10.3 Fluorescent Screens................................................................................. 25
1.11 Specialized Radiography Methods....................................................... 26
2 Introduction to X-Rays 27
2.1 How X-Rays Are Generated ................................................................ 27
2.2 X-Ray Characteristics (Absorption and Transmittance) ....................... 28
2.3 X-Ray Images ...................................................................................... 30
2.4 Types of X-Ray Images ....................................................................... 32
2.4.1 Direct Radiography ................................................................................... 32
2.4.2 Indirect Radiography................................................................................. 34
2.4.3 X-Ray Television (XTV)............................................................................. 36
2.5 X-Ray Systems .................................................................................... 41
2.6 X-Ray Examinations ............................................................................ 46
2.6.1 Plain Radiography .................................................................................... 46
2.6.2 Contrast Radiography............................................................................... 47
2.6.3 Fluoroscopy .............................................................................................. 47
2.6.4 Tomography, Magnification Radiography, and Stereo Radiography.......... 48
2.7 Examples of Contrast Radiography ..................................................... 50
2.7.1 Gastrointestinal X-Ray Examination ......................................................... 50
2.7.2 Angiography ............................................................................................. 54
2.8 Interventional Radiology ...................................................................... 58
2.9 Damage X-Rays (Radiation) Can Cause to Humans........................... 59
2.9.1 Acute Symptoms....................................................................................... 59
2.9.2 Delayed Symptoms................................................................................... 60
2.9.3 Genetic Effects ......................................................................................... 60
2.9.4 Effects on Fetuses .................................................................................... 61
2.9.5 Manifestation of Disorders ........................................................................ 61
2.9.6 Everyday Radiation Exposures................................................................. 61
Contents-2 Basic information about X-rays and X-ray systems SVBG-110010

Contents
2.9.7 Avoiding Radiation Damage......................................................................62
3 Introduction to X-Ray Systems 63

3.1 Categories of X-Ray Systems .............................................................. 63
3.2 Portable X-Ray Systems ...................................................................... 64
3.3 Mobile X-Ray Systems ......................................................................... 64
3.4 General Radiography Systems ............................................................ 65
3.5 Gastrointestinal Diagnostic Systems .................................................... 66
3.5.1 Table-Side Operated R/F Table Systems ..................................................67
3.5.2 Remote-Operated R/F Table Systems ......................................................68
3.6 Cardiovascular Diagnostic Systems ..................................................... 70
3.7 Tomography Systems........................................................................... 71
3.8 Surgical Diagnostic Systems................................................................ 71
3.9 Diagnostic Mammography Systems ..................................................... 72
3.10 Group Examination Systems................................................................ 72
3.11 Pediatric Diagnostic Systems............................................................... 74
3.12 Diagnostic Urology and Gynecology Systems...................................... 75
3.13 Dental X-Ray Radiography Systems .................................................... 76
4 Overview of X-Ray Generators 77

4.1 Overview .............................................................................................. 77
4.2 Meaning and Definitions of Key Terminology ....................................... 78
4.2.1 Meaning and Units of Various Types of Dose Levels ................................78
4.2.2 Tube Voltage .............................................................................................78
4.2.3 Tube Current .............................................................................................78
4.2.4 Long-Term Rating......................................................................................78
4.2.5 Short-Term Rating .....................................................................................79
4.2.6 Maximum Nominal Power Supply .............................................................79
4.2.7 Exposure Time ..........................................................................................79
4.2.8 IGBT..........................................................................................................80
4.3 X-Ray High Voltage Generator ............................................................. 80
4.3.1 Transformer-Type X-Ray High Voltage Generators...................................80
4.3.2 Inverter-Type X-Ray High Voltage Generators ..........................................82
4.4 High Voltage Generators ...................................................................... 86
4.4.1 Rectified Tube Voltage Waveform .............................................................86
4.4.2 Voltage Transformer..................................................................................87
4.5 X-Ray Controller................................................................................... 88
4.5.1 X-Ray Tube Voltage Controller..................................................................88
4.5.2 X-Ray Tube Current Regulator..................................................................89

Contents
4.6 X-Ray Tube Units................................................................................. 91

4.6.1 Overview................................................................................................... 91
4.6.2 Definitions and Meaning of Key Terminology ............................................ 92
4.6.3 X-Ray Tube Function and Performance.................................................... 95
4.6.4 Allowable Load ......................................................................................... 96
4.6.5 Measurement Method and Allowable Tolerance for Focus Size................ 98
4.6.6 Service Life of X-Ray Tube Units .............................................................. 99
4.7 Adjustable X-Ray Collimator ................................................................ 99
4.7.1 Meaning of Key Terminology..................................................................... 99
4.7.2 Structure ................................................................................................. 100
4.7.3 Key Performance Desirable in Adjustable X-Ray Collimators ................. 101
4.7.4 Variations in X-Ray Quality Due to Mirrors.............................................. 102
4.7.5 Exposure Reference Lamp ..................................................................... 103
4.7.6 X-Ray Exposure Dose Reduction Filter .................................................. 103
4.7.7 Size of Irradiation Field and Scattered Rays........................................... 104
4.8 X-Ray High Voltage Cable with Plug.................................................. 105
4.8.1 Models .................................................................................................... 105
4.8.2 Key Performance Specifications ............................................................. 105
5 Image Receiving Device/System 107

5.1 X-Ray Image Intensifier (I.I.).............................................................. 108
5.1.1 Operating Principle of Image Intensifiers ................................................ 108
5.1.2 Conversion Factor of Image Intensifiers ................................................. 109
5.1.3 Degradation of I.I. Brightness ................................................................. 110
5.2 Flat Panel Detector .............................................................................112
5.2.1 Types of FPDs ........................................................................................ 112
5.2.2 Basic Structure of FPDs.......................................................................... 113
5.2.3 Structure and Function of Flat Panel Detectors ...................................... 113
5.2.4 Precautions for Handling Flat Panel Detectors ....................................... 114
5.3 Computed Radiography Systems .......................................................115
5.3.1 Imaging Plate (IP) ................................................................................... 115
5.3.2 Operating Principle of an Imaging Plate ................................................. 115
5.3.3 How Computed Radiography (CR) Forms Images ................................. 115
5.3.4 Repeated Use of IP (Recording / Reading / Deleting) ............................ 116
5.3.5 Dual-Side Reading Method..................................................................... 116
5.4 X-Ray TV Systems .............................................................................117
5.4.1 Meaning of Key Terminology................................................................... 117
5.4.2 Optical Lens System............................................................................... 119
5.4.3 Camera Tubes ........................................................................................ 120
5.4.4 Video Camera Scanning ......................................................................... 120
5.4.5 CCD........................................................................................................ 120
5.4.6 Composite Video Signal Waveforms....................................................... 122

Contents
5.5 Grids................................................................................................... 123

5.5.1 What Are Grids?......................................................................................123
5.5.2 Operating Principle and Structure ...........................................................123
5.5.3 Grid Standards ........................................................................................125
5.5.4 Geometric Performance ..........................................................................126
5.5.5 Physical Performance .............................................................................127
5.5.6 Performance-Related Maintenance Inspections .....................................128
5.5.7 Precautions for Use.................................................................................128
5.6 Cassettes ........................................................................................... 129
5.6.1 Structure..................................................................................................129
5.6.2 Performance ...........................................................................................130
5.6.3 Precautions for Use.................................................................................130
5.7 Photosensitive Materials (Film) for X-Ray Radiography ..................... 130
5.7.1 Overview .................................................................................................130
5.7.2 Structure and Types of Film ....................................................................131
5.7.3 General Characteristics of Film...............................................................133
5.8 Intensifying Screens ...........................................................................137
5.8.1 Overview .................................................................................................137
5.8.2 Function of Intensifying Screens .............................................................137
5.8.3 Structure of Intensifying Screens ............................................................137
5.8.4 Characteristics of Fluorescent Substances on Intensifying Screens .......138
5.8.5 Performance of Intensifying Screens ......................................................139
5.8.6 Meaning of Key Terminology ...................................................................140
5.8.7 Types of Intensifying Screens .................................................................141
5.8.8 Storage and Management of Intensifying Screens..................................143
6 Image Processor 145

6.1 Digital Radiography ............................................................................ 145
6.1.1 Overview .................................................................................................145
6.1.2 Configuration of Digital Radiography Systems........................................145
6.1.3 Digital Subtraction Angiography (DSA) ...................................................146
6.1.4 Characteristics of Digital Radiography ....................................................146
6.2 Image Processing .............................................................................. 147
6.2.1 Width.......................................................................................................147
6.2.2 Level .......................................................................................................147
6.2.3 Gamma Correction..................................................................................148
6.2.4 Integration ...............................................................................................148
6.2.5 Recursive Filter .......................................................................................149
6.2.6 Edge Enhancement (High-Frequency Enhancement Filter)....................150
6.2.7 Smoothing (Low-Frequency Enhancement Filter) ...................................151
6.2.8 Gamma Curve.........................................................................................152
6.2.9 Unsharp Masking ....................................................................................153

Contents
6.2.10 Contrast Correction................................................................................. 153

6.2.11 Examples of Actual Image Processing.................................................... 154
6.2.12 Artifact Correction ................................................................................... 155
7 Overview of X-Ray Systems 157

7.1 General Radiography Systems .......................................................... 157
7.1.1 Functionality............................................................................................ 157
7.1.2 System Configuration ............................................................................. 158
7.1.3 Direct Radiography Tables/Stands.......................................................... 158
7.1.4 Image Receiving Unit.............................................................................. 159
7.1.5 Indirect Radiography Unit ....................................................................... 160
7.1.6 Support Units .......................................................................................... 160
7.2 Gastrointestinal Diagnostic Systems (R/F Systems).......................... 164
7.2.1 System Configuration ............................................................................. 164
7.2.2 X-Ray R/F Tables.................................................................................... 165
7.3 Tomography Systems ........................................................................ 166
7.3.1 Operating Principle of Tomography......................................................... 167
7.3.2 Testing the Performance of Tomography Systems.................................. 167
7.4 Mobile X-Ray Systems ...................................................................... 168
7.4.1 Features ................................................................................................. 168
7.4.2 Basic Configuration................................................................................. 169
7.4.3 Safety ..................................................................................................... 171
7.4.4 Inspection ............................................................................................... 171
7.5 Surgical C-Arm X-Ray Systems......................................................... 172
7.5.1 Overview................................................................................................. 172
7.5.2 Functionality............................................................................................ 172
7.5.3 C-Arm Unit .............................................................................................. 172
7.5.4 X-Ray Generator Unit ............................................................................. 172
7.5.5 Collimators.............................................................................................. 173
7.5.6 X-Ray TV Imaging Systems.................................................................... 173
7.5.7 Exposure Dose Reduction Video Memory System ................................. 173
7.5.8 Safety Precautions.................................................................................. 173
7.6 Mammography Systems .................................................................... 174
7.6.1 Half-Value Layer ..................................................................................... 174
7.6.2 X-Ray Tube............................................................................................. 174
7.6.3 Collimator Mechanism ............................................................................ 176
7.6.4 Breast Compression Mechanism ............................................................ 176
7.6.5 AEC (Automatic Exposure Control) ........................................................ 178
7.6.6 Bucky Mechanism................................................................................... 178
7.6.7 Exposure Dose ....................................................................................... 178
7.6.8 Image Quality of Mammography Systems .............................................. 179
7.6.9 Other....................................................................................................... 181

1.1 X-Rays
1 Basic Information About X-Rays

This chapter describes some fundamental information regarding how X-rays are generated,
their characteristics, technology used, and so on, for those that are planning to be working with
medical X-ray systems. For Chapter 1, the following reference is used.
 Wikipedia, the free encyclopedia – X-ray, electronvolt
1.1 X-Rays
1.1.1 What Are X-Rays?
 In terms of physics, X-rays are a type of electromagnetic wave radiation with wavelengths
between 1 pm and 10 nm. (Radio waves and light waves are also types of electromagnetic
waves.)
 X-rays are known to function as particles with energy (photons).
 X-rays were discovered in late 1895 by Dr. Roentgen. Therefore, they are sometimes called
Roentgen rays. Its wavelength range (region where its energy can be obtained) partially
overlaps with gamma rays. The difference between X-rays and gamma rays is not the
wavelength, but rather, the mechanism that generates them. Rays generated by the transition
of orbital electrons are called X-rays, whereas rays generated by the transition of energy
levels within atomic nuclei are called gamma rays.
 The "X" in X-rays represents an unknown in mathematics and was so named by
Dr. Roentgen.
Fig. 1.1.1 Radiographic Image of a Hand Taken Fig. 1.1.2 Image Taken (First in Japan) by
by Dr. Roentgen on January 23, 1896. Genzo Shimadzu Jr. the Same Year
The areas of bones and a ring are (1896)
shown as dark areas.
SVBG-110010 Basic information about X-rays and X-ray systems 1

1.1.2 Electromagnetic Waves

Electromagnetic waves are formed from variations (undulations) in the electric field and
magnetic field of a given space (see Fig. 1.1.3).
By means of mutual electro-magnetic induction, electric and magnetic fields generate each
other, generating a vibration of the space itself. This periodic fluctuation of the electromagnetic
field causes transverse waves to propagate through the surrounding space. As a type of energy
radiation phenomenon, these waves are sometimes called electromagnetic radiation.
For example, if a stone is thrown in pond, waves are generated, which propagate out from that
point. This example illustrates that the medium, which is the water, does not propagate, but only
the wave of energy propagates. This wave action is illustrated as a sine wave in Fig. 1.1.4 and
has characteristics that relate to wave length, frequency, and velocity.
Wavelength refers to the distance between any point on the wave and a corresponding point on
the next wave with identical vibrational change. Frequency refers to the number of waves that
appear during a unit of time (1 second).
The following expresses the relationship between frequency and wavelength.
 (frequency) = C (speed of light) /  (wavelength)
Fig. 1.1.3 Electromagnetic Waves
Fig. 1.1.5 Electromagnetic Wave Types and

Fig. 1.1.4 Sine Wave
Their Wavelengths
As shown in Fig. 1.1.5, there are many different types of electromagnetic waves, but differences
in their characteristics are primarily determined by their wavelength.
There are some characteristics in common with all electromagnetic waves, such as their
propagation speed, which is about 3  108 m/s (the speed of light).
Since the range of electromagnetic wavelengths is extremely broad, a variety of units are used
to express wavelength.
 Radio waves ……… cm, m, km

 Visible light, ultraviolet rays ………  (10-6 m), nm (10-9 m), Å (10-10 m)
 X-rays, gamma rays ……… nm (10-9 m), Å (10-10 m), pm (10-12 m)
 Medical X-ray wavelengths are about 0.1 to 10 Å.
 X-rays for medical treatments or industrial application are about 0.001 to 0.1 Å.
 Visible light wavelengths range from 400 to 700 nm.
2 Basic information about X-rays and X-ray systems SVBG-110010

1.1 X-Rays
1.1.3 X-Rays Described as Particles

Particles have the characteristic of being individually countable. Light particles are called
photons.
Normal light functions using photons, which have an energy level proportional to their frequency.
This principle also applies to all other electromagnetic waves. This means that shorter
wavelengths with higher frequencies, such as X-rays, have a much higher energy level.
Furthermore, there is a wide range of wavelengths among electromagnetic waves referred to as
X-rays. In general, X-rays with shorter wavelengths, and consequently higher energies, are
called hard X-rays, whereas X-rays with longer wavelengths are called soft X-rays. Each
photon has a photon energy that is inversely proportional to its wavelength. This relationship
(between photon images and wave motion images) is shown below.
E (photon energy in keV) = 12.4 /  (wavelength in Å)
1.1.4 X-Ray Characteristics and Applications

When an X-ray hits a substance, various reactions can occur, but in general, X-rays have the
following characteristics.
 Strong ability to pass through substances
Though radio waves and light waves are part of the same electromagnetic wave spectrum,
when they hit a substance, some of the waves may pass through the substance, but most are
reflected away. In contrast, X-rays have the characteristic of most rays passing through
substances. Therefore, X-rays have a strong transmission effect, which is the most important
characteristic of X-rays. This characteristic is utilized for applications such as diagnostic
medicine and nondestructive inspection.
 Generates visible or ultraviolet light when they hit fluorescent substances

X-rays have been called invisible light, but they generate visible fluorescent light if they hit a
fluorescent substance (such as calcium tungstate, barium sulfide, and other sulfide compounds
of rare earth elements, such as cadmium, lanthanum, and yttrium). This characteristic is utilized
for applications such as diagnostic fluoroscopy and radiography intensifying screens.
 Reacts with photographic film to create latent images

Just as with visible light, X-rays create a latent image when exposed to photographic film.
This characteristic is utilized to obtain X-ray photographs of breasts, hands, finger bones, and
teeth with non-screen film.
 Causes changes in biological tissue

X-rays can damage healthy tissue, cause leukemia or other cancers, or affect reproductive
glands, however, sensitivity to X-rays differs for healthy tissue and cancerous tissue or other foci,
so these differences can also be used for medical treatment.
 Other
 Chemical effects (such as inducing precipitation in solutions, altering substance color, or
hardening plastics)
 Ionic effects (When ionizing radiation pass through a substance, the radiation energy
can knock out electrons from their atomic orbits. As a result, atoms are
separated into cations and electrons. This is called the ionization effect.)
 X-ray diffraction (phenomenon of X-rays being diffracted by crystal lattices that is used to
analyze crystalline structures of substances)

1.2 How X-Rays Are Generated

1.2.1 X-Rays Generation Mechanism
X-Rays
Filament
Target
Electrons
High Voltage
Fig. 1.2.1 X-Ray Generation
X-rays are normally generated by using a configuration illustrated in Fig. 1.2.1 to generate
extremely high-speed electrons in a vacuum, which are collided against an anode (target).
However, only about 1 % of the total power consumed for acceleration voltage (X-ray tube
voltage) and the flow of electrons (X-ray tube current) is converted to X-rays. This means that
99 % of the power used for the electron beam ends up heating the anticathode metal mass.
Consequently, cooling is very important.
 = 1.1  10-9
ZV
: Generation efficiency
Z: Atomic number of target material (where, W = 74 and Mo = 42, etc.)
V: Tube voltage
Example: Assuming a tungsten target and 100 kV tube voltage
Z = 74, V = 100 kV = 105,  = 1.1  10-9  74  105 = 0.81 (%)
Consequently, to improve generation efficiency, the target should be made of a heavy element.
In addition, the maximum X-ray levels obtainable from an X-ray tube are also determined by the
melting point and thermal conductivity of the target element. Normally, X-ray tube targets are
made of Cr, Fe, Co, Cu, Mo, Ag, or W. The most common targets are made of tungsten, due to
its high atomic number and superior heat resistance (melting point of 3400 C), and are cooled
with water or oil to dissipate heat away from the target.
X-ray tubes used for mammography use molybdenum targets, which generate higher intensities
of characteristic X-rays at energy levels compromised by contrast and radiation exposure.

1.2.2 X-Rays Generated by Kinetic Energy (Continuous X-Rays)

When electrons are suddenly decelerated by the anticathode or their direction of motion is
changed by an electric field or they are otherwise accelerated, they emit X-rays. These X-rays
are called Bremsstrahlung X-rays. Since Bremsstrahlung X-rays don't emit specific spectra,
they are also referred to as white X-rays (continuous X-rays).
Instruments using this method to generate X-rays are equipped with an X-ray tube, synchrotron
radiation source.
-
Electron e
Fig. 1.2.2 Continuous X-Rays
Electronucleus
When the path of an electron is bent by the

Electron
Coulomb field of the nucleus, a braking effect acts
Beam on the electron. The difference in energy resulting
from this braking effect is emitted as X-rays.
Continuous
X-Rays
X-Ray Intensity
Fig. 1.2.3 Spectrum of Continuous X-Rays

Since the degree of braking varies, the
wavelengths of emitted X-rays vary as well.
(The amount of energy lost by the incident
electron varies depending on how close it passes
by the nucleus.)
Consequently, it emits a continuous distribution of
wavelengths, which is called continuous X-rays.
Wavelength
Shortest Wavelength
Therefore, the intensity of continuous X-rays can be calculated as follows.
I  i  V2  Z
: Symbol that indicates proportionality

V: Tube voltage
i: Tube current
Z: Atomic number Tungsten W 74
Molybdenum Mo 42
Chromium Cr 24
Consequently, to obtain a high intensity of continuous X-rays, given a constant voltage and
current, a target made of a heavy element should be used.

1.2.3 X-Rays Generated by Differences in Electron Excitation

Levels (Characteristic X-Rays)
As an example, assume a copper, molybdenum, tungsten, or other such anticathode (target) is
irradiated with a beam of accelerated electrons (at about 30 keV), which knocks an orbiting
electron out of an atom's K-shell. This causes an orbital electron from the L or M shell, located
farther from the nucleus, to move in (transition) to fill the hole left in the K-shell. The
electromagnetic waves emitted by this transition process are X-rays (characteristic X-rays).
The X-ray's wavelength is determined by the difference in potential energy between these
orbitals. Therefore, characteristic X-rays are not emitted with just any sort of wavelengths.
Instruments that generate X-rays using methods describe above contain X-ray tubes. (In
particular, X-ray tubes used for devices called analyzer tubes and for mammography utilize
characteristic X-rays.)
-
Electron e
Fig. 1.2.4 Characteristic X-Rays
Hole
Electronucleus When an electron flies in and knocks out an

Electron electron from an inner shell, another electron
Beam
moves from the outer shell to fill the resulting
hole.
Characteristic
X-Rays
Incident Electron
Fig. 1.2.5 Model of an Element and How
Characteristic X-Rays Are Emitted
This emits an X-ray with an energy equal to the
N-Shell difference in energy levels of the electron
M-Shell orbitals.
L-Shell
(from energy of outer shell electron to inner
K-Shell
shell electron)
Fig. 1.2.6 Spectrum of Characteristic X-Rays

X-Ray Intensity
These are called characteristic X-rays and are

normally emitted as a discrete spectrum.
Characteristic X-rays emitted due to transitions
from L to K shells result in K-alpha emission
lines, whereas transitions from M to K shells
result in K-beta lines. Similarly, there are also
L-alpha, L-beta, and other emission lines.
The K-alpha line for molybdenum (Mo) appears
at about 0.75 Å (equivalent to about 20 kV).
Short Long Wavelength
This is the type of X-ray used for
mammography.
In addition, the constituents of unknown
substances can be identified by measuring the
characteristic X-rays they emit. – X-ray analysis
The intensity I of characteristic X-rays is determined experimentally based on the following

proportionality.
I I (V - V0)n
Where,
: Symbol that indicates proportionality V: Tube voltage I: Tube current
n: Constant related to tube voltage
If V is 2 to 3 times V0, then n  2. If V > 3V0, then n  1.

1.3 Intensity and Quality of X-Rays
V0: Excitation voltage

Excitation voltage is the minimum acceleration voltage required to eject an electron bound
to the target element when high speed electrons are collided into the target.
This is a substance-specific value, which is 69.3 kV for tungsten (W), 20.0 kV for
molybdenum (Mo), and 5.98 kV for chromium (Cr).
1.3 Intensity and Quality of X-Rays

Measurements using counter tubes usually involve counting the number of X-ray photons
entering the counter window per unit time and using that number, in other words the count rate,
to indicate X-ray intensity. However, it is important to note that this indicates X-ray intensity level
in terms of the number of photons per unit time, rather than the energy level of the photons. The
difference the photon energy level (wavelength) makes is not in intensity, but in X-ray quality
(ability to penetrate and so on).
1.3.1 X-Ray Dose

X-ray dose is the product of X-ray intensity and irradiation time. It is the factor that determines
how dark the film becomes.
1.3.2 X-Ray Quality

Quality is determined by the X-ray wavelengths. Shorter wavelengths are referred to as hard
X-rays (high transmission ability), whereas longer wavelengths are referred to as soft X-rays
(low transmission ability). In other words, quality serves as criteria for judging the capacity to
pass through substances (or the degree of absorption).
1.3.3 Types of X-rays

 Ultrasoft X-rays
X-rays near the UV range with extremely low energy levels of about a few dozen electron volts
 Soft X-rays
X-rays with low transmission capacity due to low energy levels of about 0.1 to 2 keV
 X-rays
Typical X-rays with about 2 to 20 keV (a portion is sometimes included with soft or hard
X-rays)
 Hard X-rays
X-rays with high transmission capacity due to high energy levels of about 20 to 100 keV
These X-rays have more particle-like characteristics than wave-like characteristics.
1.3.4 Electron Volts

An electron volt (symbol eV; also sometimes electronvolt) is a unit of energy. It is also used as a
unit of mass for elemental particles.
A joule is often inconvenient for expressing energy levels of electrons since it is too big as a unit.
Therefore, electronvolts are commonly used as a unit.
 Symbol: eV
 Definition: The energy equivalent to accelerating one electron with an
electric potential of one volt
 Converted to SI units: 1.60217733(49)  10-19 J

1.4 X-Ray Spectra

Also referred to as X-ray energy spectra, X-ray spectra show the distribution of X-ray intensity
(number of photons) at respective X-ray energy levels (photon energy). There are two types of
X-ray spectra - continuous and characteristic X-ray spectra. Fig. 1.4.1 shows an X-ray spectrum
that combines both continuous and discrete line spectra. The continuous portion represents
continuous (or white) X-rays, whereas the vertical lines represent characteristic X-rays.
Characteristic X-rays are called "characteristic" because the wavelengths of their line spectra
indicate (characterize) what the target material is made of.
1.4.1 X-Ray Spectra Waveforms

X-Ray Intensity
Fig. 1.4.1 Spectrum of All X-Rays

Characteristic X-Rays
This is a combined spectrum of characteristic and continuous

X-rays. The intensity of characteristic X-rays with respect to
continuous X-rays depends on the material.
Continuous X-Rays
Wavelength
X-Ray Intensity
Fig. 1.4.2 Spectrum of Continuous X-Rays
Continuous X-rays appear when some of the kinetic energy of

electrons that collide with a target is converted to X-ray photons.
(This is called braking radiation.)
This generates a continuous distribution of X-ray wavelengths,
from short to long, as shown to the left.
Wavelength
Shortest Wavelength
If X-rays are generated by accelerating electrons using a constant voltage, the short wavelength
end of the continuous X-ray spectrum will show a clear minimum wavelength cut-off point.
The shortest X-rays appear when all of the kinetic energy of electrons that collide with the
target is converted to X-ray photons. Therefore, the shortest wavelength is only affected by the
applied voltage, regardless of the type of target material.
The relationship between the shortest wavelength m and electron acceleration voltage V is as
follows.
eV = hm = hc/m m = hc/eV
Where, e: Electron charge (1.6  10-19 C) h: Planck constant (6.61  10-34 Js)
c: Speed of light (3  108 m/s) m: X-ray frequency
Therefore, the relationship between V (kV) and m (Å) is,
m = 12.4/V

1.4 X-Ray Spectra
1.4.2 Variations in Spectral Waveform Due to Changes in

Parameters
Fig. 1.4.3 Differences in Spectra Depending on

Characteristic
Materials (Given Identical Applied Voltage)
X-Rays
Since the shortest wavelengths are only affected by

the applied voltage, it does not matter what type of
Intensity
target substance is used.
X-ray intensity is proportional to the atomic number,

where tungsten has the largest among W, Mo, and Cr.
In addition, characteristic X-rays from molybdenum
appear with more intensity than from other materials.
Continuous X-Rays
Wavelength
Fig. 1.4.4 Voltage and X-Ray Spectra

Target: Tungsten
Given a tungsten target and constant current, this

figure shows the change in intensity distribution in
Intensity
response to varying the voltage from 20 to 50 kV.

The higher the kV setting, the higher the dosage level
and the more the shorter wavelength components
(with higher transmission ability). (The radiation quality
becomes harder.)
Wavelength
X-Ray Intensity
mA is increased with Fig. 1.4.5 Current and X-Ray Spectra

kV kept constant
Only the dose level increases from Fig. 1.4.4. The

X-ray quality does not change.
High mA
Low mA
X-Ray Quality Hard Soft
This figure shows that,

 The maximum intensity point in continuous X-ray intensity distributions appears near the
wavelength 1.5 times the shortest wavelength.
 Intensity of continuous X-rays increases with increasing acceleration voltage V of thermal
electrons. In addition, it is related to current and the atomic number of the target metal as well.

1.4.3 Relationship Between X-Ray Spectral Waveform,

Transmission, and X-Ray Quality
X-Ray Intensity
Fig. 1.4.6 Relationship Between Spectral

Waveform, Transmission, and X-Ray
Quality
Wavelength
Shortest Wavelength
Wavelength Short  Long

Speed of Electron Fast  Slow
Transmission High  Low
X-Ray Quality Hard  Soft
1.5 Mutual Interaction Between X-Rays and

Substances
1.5.1 Photoelectric Effect
(Characteristic
Fig. 1.5.1 Diagram of Photoelectric
X-Rays) Effect
(Auger Electron)
If an X-ray photon hits an orbital
electron and its energy is captured
Photoelectric
Effect by the orbital electron, the X-ray
disappears at that point and the
(Photoelectron)
orbital electron gains kinetic energy
and is ejected from the atom. This is
called the photoelectric effect and
the ejected orbital electron is called a
photoelectron.
This is described by the following equation, where E is the kinetic energy of the photoelectron,
h is the energy of the X-ray photon, and W is the bond energy between the orbital electron and
atomic nucleus.
E = h - W
Where, h: Planck constant (6.61  10-34 Js) and : X-ray frequency
Photoelectrons are repeatedly ionized within a substance and excited (sometimes becoming
Bremsstrahlung X-rays), whereas the vast majority are consumed as heat energy. As a result,
incident X-rays are truly absorbed within the substance.
The probability of a photoelectric effect occurring is greater the lower the electron's shell, which
means K-shell electrons have the highest probability. If the bond energy of the K-shell electron
is Wk, then h must be greater than Wk for the K-shell photoelectric effect to occur. The instant
h exceeds Wk, photoelectric absorption increases dramatically. This phenomenon is called
selective absorption and the corresponding energy value is called the absorption edge. There is
one K-absorption edge and three L-absorption edges. (See Section 1.6.3.)
The probability of a photoelectric effect occurring not only depends on the electron orbital, it also
varies depending on the atomic number of the substance and the X-ray photon energy. In other
words, the atomic absorption coefficient is proportional to Z4 (where the electron absorption
coefficient is Z3). In addition, for a photon energy of h and wavelength , the coefficient

1.5 Mutual Interaction Between X-Rays and Substances
increases proportionally to (1/h)3 or 3.

Once a photoelectric effect occurs, the ejected orbital electron leaves a hole. To fill this hole, an
electron from an outer shell moves (transitions) to the inner shell, which generates a
characteristic X-ray or Auger electron. Since characteristic X-rays generated from substances
with high atomic numbers have higher energy levels, they have a higher probability of escaping
from the substance. In this case, the photoelectric absorption is h - W. However, if any
characteristic X-ray energy is absorbed, then (h - W) + W = h.
1.5.2 Auger Effect

When the electron orbital hole left after a photoelectric effect occurs is filled by another orbital
electron, the surplus energy is emitted as a characteristic X-ray, but in some cases a process
can occur where instead the surplus energy is absorbed by an orbital electron, consuming the
energy through the work performed to eject that electron from the atom and as kinetic energy of
the ejected electron.
This process is called the Auger effect and the ejected electron an Auger electron. For example,
assume a hole in the K-orbital affects two L-electrons, one which transitions to fill the hole and
the other ejected from the atom as an Auger electron. This is called a KLL process, resulting in
an Auger electron with a kinetic energy of Ek - 2EL. In addition, there are many other
combinations possible as well, such as KLM and LMM processes.
The probability of an Auger effect occurring depends on the substance atomic number, where
the lower the atomic number of the substance, the higher the probability. Most Auger electrons
are absorbed within the substance.
1.5.3 Compton Effect
Fig. 1.5.2 Diagram of Compton Scattering

(Coherent
Scattered Rays)
and Thomson Scattering
Thomson Scattering
Coherent When an X-ray photon collides with an orbital
Scattering
electron, part of the photon energy is
(Recoil Electron) transferred to the orbital electron, which
changes the direction of the photon and
causes it to scatter. The electron that receives
the energy obtains kinetic energy, which
ejects it from its orbital. Such electrons are
Compton Effect
called recoil electrons or Compton electrons
and the scattered photons are called
(Compton
Scattered Rays)
Compton scattered rays.
Given a scattering angle  and scattered photon energy E, they can be related as follows.
1 (1-cos)
h' = h E= h
1 + (1-cos) 1 + (1-cos)
where,  = h/m0C2 = h[MeV]/0.51 [m0C2: Static energy of electron]

This means that, based on the conservation of energy, h' + E = h. Since energy is conserved
under conditions that ignore the bond energy of orbital electrons, it occurs mainly at outer shell
orbitals, but can even occur with inner shell orbital electrons if a high energy photon interacts
with a low atomic number substance.
Since the energy of Compton scattered rays is decreases from h to h', their wavelength
becomes longer. Given a change in wavelength length of , then the following equation
applies.
 = h(1-cos ) / m0C2 = 2.43(1-cos ) [pm]

At a scattering angle of  = 0, h' = h and E = 0. The recoil electron energy is maximum and
scattered photon energy minimum at  = 180. h/m0C2 = 2.43 [pm] is constant, regardless of
X-ray energy, and is called the Compton wavelength.
The kinetic energy of the recoil electron is absorbed within the substance, in the same manner
as for photoelectrons, but scattered photons have a high probability of escaping from the
substance. Therefore, it is safe to assume the true absorption due to the Compton effect is
transferred to the recoil electron.
The probability of a Compton effect (atomic absorption coefficient) occurring is proportional to Z.
Put another way, it is proportional to the number of electrons per unit mass. Therefore, it varies
more with the substance's density than its atomic number. The probability of the Compton effect
occurring is the greatest at medium photon energy levels of 0.5 to 5 MeV. Therefore, it is less
important at high and low energy levels. In terms of angle distribution, the greater the photon
energy, the greater the tendency of Compton scattered rays to scatter forward (in the same
direction as incident X-rays). (Recoil electrons are not emitted backwards.) Compton scattering
is sometimes called quantum scattering, incoherent scattering, or other terms as well.
1.5.4 Thomson Scattering

Outer orbital electrons are forced by incident X-rays to vibrate at frequency , which results in
these vibrating electrons serving as a wave source for radiating electromagnetic waves within a
given space. Since the radiated electromagnetic waves have the same frequency as incident
X-rays, the scattering process causes no change in wavelength, but only a change in direction.
This is called Thomson scattering. Thomson scattering treats X-rays as electromagnetic waves,
according to classical theory, where other electrons are considered independent individual
electrons. Therefore, since no classical scattering, coherent scattering, or exchange of energy
is involved, it is sometimes called elastic scattering. In contrast, the scattering process that
considers scattered electrons as an electron swarm bound to an atom is called Rayleigh
scattering, which is important for substances with high atomic numbers. In either case,
Thomson scattering is prominent when substances with relatively high atomic number are
irradiated with low energy X-rays, which can be mostly ignored for the range of X-rays used
in medical applications. (It is safe to primarily be concerned only with Compton
scattering.)
1.5.5 Formation of Electron Pairs

Fig. 1.5.3 Diagram of Electron Pair Formation
(Negative
Electron)
When incident X-rays with over 1.02 MeV

Electron Pair (Annihilation energy pass near an atomic nucleus, they are
Formed Gamma affected by a strong coulomb field, which
Rays)
annihilates the X-ray photons and creates a
positive-negative electron pair. This
(Positive phenomenon is called electron pair
Electron) formation.
Since, based on the principle of relativity, an electron with a rest mass m0 has an energy
equivalent to E = m0C2 = 0.51 MeV, an energy of at least 1.02 MeV is required to form positive
and negative electrons. Therefore, electron pair formation can never occur at photon energies
less than1.02 MeV. In other words, they never occur with X-rays in the diagnostic range.
Any surplus energy (h - 1.02) MeV beyond the photon energy h is consumed by kinetic
energy of the positive and negative electrons (T+ and T-).
(T+ + T-) = h - 1.02 [MeV]
The kinetic energies T+ and T- transferred to the positive-negative electrons are absorbed within

1.6 X-Ray Absorption and Scattering
the substance by the electrons causing ionization and excitation as they move within the
substance. The highest probability of energy distribution between T+ and T- is half and half, but
can range from zero to h - 1.02.
The probability of an electron pair formation increases proportionally with the substance atomic
number and photon energy and, given a constant photon energy, the atomic absorption
coefficient is proportional to the atomic number Z2.
Once the kinetic energy of the positive electron is consumed, it bonds with the negative electron
again and their electron masses form two 0.51 MeV gamma rays that radiate out in opposite
directions, annihilating the negative electron. This is called annihilation. Since there is a high
probability of the two gamma rays escaping the substance, the energy absorbed from electron
pair formation is effectively (h - 1.02) MeV.
Though the electron pair formation occurs at the nucleus, it can have the effect of emitting a total
of three electrons in the region of orbital electrons – the positive-negative electrons formed, plus
an orbital electron. This is called triplet formation, which requires a minimum photon energy of
4m0C2(2.04 MeV).

1.6.1 Linear Absorption Coefficient
Elastic/Inelastic Scattered X-Rays

Fluorescent X-Rays
(Characteristic X-Rays)
Primary X-Rays Transmitted Primary X-Rays Fig. 1.6.1 Conversion of X-Ray
Energy
Beta Rays
Heat
As X-rays pass through a substance, they are converted to a variety of other energies, whereas
only a portion of the rays pass straight through (Fig. 1.6.1). The proportion of X-rays absorbed
while passing through 1 centimeter of a substance is called the linear absorption coefficient.
Fig. 1.6.2 X-Ray Absorption
For monochromatic X-rays, assuming dI is the decrease in intensity I as it travels d cm through

a substance  cm from the surface (Fig. 1.6.2), then
-Id = Id
If integrated, taking into consideration boundary conditions, then
I = I0 e-
Where,
: Linear absorption coefficient : Sample thickness I0: Incident intensity

1.6.2 Mass Absorption Coefficient

 varies depending on the atomic number of constituent elements in a substance, but it also
varies in proportion to density. Therefore,  divided by density (/) is often used. Using the ratio
/, the equation in 1.6.1 can be rewritten as,
I = I0 e-(/)
where / is referred to as the mass absorption coefficient. / is expressed as the attenuation
per gram of substance. Mass absorption coefficients are unique to each substance, where each
substance has a given value at a given incident X-ray wavelength.
The mass absorption coefficients are given by the sum of the true absorption coefficient and
scattering absorption coefficient.
In reality, energy from recoil electrons and electron pairs generated due to photoelectric and
Compton effects are absorbed within the substance. Therefore, the true absorption coefficient is
given by the sum of the absorption coefficients for the photoelectric and Compton effects and
electron couple formation (/, a/, and /, respectively). Note that even for scattering
processes, such as Compton scattering, the corresponding X-rays leave the X-ray beam, so
they effectively contribute to attenuation. Assuming this scattering is s/, the mass absorption
coefficient / is calculated as follows.
/ = / + a/ + / + s/
1.6.3 Variation in Absorption Coefficient with Respect to

Wavelength and Elements
The absorption coefficient of elements is a function of the wavelength of incident rays and
atomic number of the absorbing material and so on. For a given element, if the absorption edge
is ignored, the longer the wavelength (i.e. soft X-rays), the higher the absorption coefficient,
whereas the shorter the wavelength (i.e. hard X-rays), the lower the absorption coefficient, as
shown in Fig. 1.6.3, making it easier for X-rays to pass through a substance. The point where
the mass absorption coefficient stops changing in a discontinuous manner is called the
absorption edge.
L1 Absorption Edge
Mass Absorption Coefficient
L11 Absorption Edge

L111 Absorption Edge
Fig. 1.6.3 Variation in Absorption

Coefficient with Respect to
Wavelength (Platinum)
K Absorption
Edge
Wavelength (A)
This type of discontinuity in the change in mass absorption coefficient occurs due to the energy
of the incident X-ray exceeding the electron bond energy, which is used to eject an electron from
a shell (by photoelectric effect). The corresponding discontinuities determine the shell from
which an electron is ejected, referred to as the K-absorption edge, L-absorption edge, and so on.
When this occurs, an electron from a different orbital moves down to fill the vacated position,
which generates an X-ray. The areas between respective absorption edges are similarly
described by the following relationship.
/ = 3Z3, where
: Constant : Wavelength Z: Atomic number

In general, for a given wavelength and ignoring absorption edges, the heavier the element, the
greater the absorption coefficient and the more difficult it is for X-rays to pass through the
substance.

1.6.4 Filters
Substances that utilize absorption edges to provide monochromatic X-rays are called filters.
Filters used in X-ray diffraction have a mass absorption coefficient larger than the K-beta line,
but smaller than the K-alpha line (K-beta filter). Consequently, K-beta filters are made of a
substance with a K absorption edge wavelength between both K-alpha and K-beta incident
wavelengths. In other words, something with an atomic number one or two smaller than the
atomic number of the target element.
Absorption
Mass Absorption Coefficient
Edge of Ni
Intensity
Fig. 1.6.4 Comparison of Cu X-Ray

Spectra (b) With and (a)
Without Using a Ni Filter
(Dotted line indicates
mass absorption profile of
Ni)
(a) Without a K-Beta Filter (b) With an Ni Filter
1.6.5 X-Ray Scattering

When X-rays enter a substance, primary X-rays are absorbed or scattered as shown in Fig.
1.6.1. Scattered X-rays are called secondary X-rays and reemit the following.
(1) X-rays with the same wavelength as primary X-rays (elastic scattering, coherent scattering,
and Thomson scattering)
(2) X-rays with slightly longer wavelengths than primary X-rays (inelastic scattering, incoherent
scattering, and Compton scattering)
(3) Fluorescent X-rays (characteristic X-rays resulting from photoelectric effect)
The above scattering is caused by electrons, rather than the atomic nucleus.
It is incoherent scattering that does not indicate diffraction phenomena and, since scattered rays
are radiated in all directions, scattering contributes to background intensity levels in X-ray
diffraction.
Fluorescent X-rays are used to analyze elements by utilizing a monochromating crystal and
diffraction phenomena.

1.7 Mechanism of How X-Ray Generators Work

When electrons moving at a high speed collide with the target, the electron movement is
obstructed, resulting in some of its energy being converted to X-rays. For this to occur, the
following are required.
 Electrons are generated. (A filament in the X-ray tube is heated to generate free
electrons.)
 The X-ray tube is kept at high vacuum levels (10(-5 to -8) mmHg).
 Electrons are accelerated to high speeds. (A high voltage direct current is applied.)
 The substance used to stop the high speed electrons (anode / target) should have a high
melting point. In general, they are made of tungsten or molybdenum.
X-ray generators are devices that are designed to provide these four requirements (mechanism)
to efficiently and safely emit X-rays. X-ray generators comprise an X-ray high voltage generator,
X-ray tube unit, collimator, and high voltage cables.
1.7.1 X-Ray Tube

Target
Glass Housing (Tungsten) Filament
Cathode
Anode
Focusing Cup
Electron Flow
X-Rays
Body
Fig. 1.7.1 Internal Structure of X-Ray Tube
A fixed anode tube consists of a cathode (-) that emits electrons and an anode (+) that stops
them, sealed in a vacuum tube. These are configured as shown in Fig. 1.7.1.
When the cathode filament in the X-ray tube is heated by passing current through it, thermal
electrons are emitted from the filament surface, then when high voltage current is applied, with
the filament as the cathode and the copper rod as the anode, the thermal electrons flow to the
anode. This flow of electrons is called a cathode ray, which collides with the tungsten plate on
the surface of the anode, converting part of its energy to X-rays. The actual surface area where
electrons impact the target is called the real focus. The size of the real focus as viewed down
the center axis of the cone beam is called the effective focus. Since the effective focus is often
simply called the focus, the effective focus size is widely used to refer to the focus size of
an X-ray tube.
X-rays can be generated by applying several tens of thousands of volts across the electrodes,
but this results in extremely poor generation efficiency, converting only 1 % of the energy to
X-rays and the remaining more than 99 % to thermal energy.
Target Metal such as

Filament X-Ray
W, Mo, etc.
Electron
Beam
Tens to Hundreds of kV
Fig. 1.7.2 Principle of How X-Rays Are Generated

1.7 Mechanism of How X-Ray Generators Work
In reality, this heat could cause melting at the focal point, so the anode is normally cooled with
water or oil. This type of X-ray tube is called a fixed anode tube.
In contrast, in some X-ray tubes, the anode is rotated to better dissipate the heat and reduce the
effective focal point size, as shown in Fig. 1.7.4. This type of X-ray tube is called a rotating
anode tube.
Copal Ring
Target
Target Bearings (bonded steel alloy Bulb (Glass)
Glass Bulb and glass)
Electron X-Ray
Beam
Focusing Focus Focal Anode Shaft Coil Used to Rotate

Stem Cup
Cathode
Track
Anode Rotor
Target
Filament
Sleeve
Fig. 1.7.3 Rotating Anode X-Ray Tube Fig. 1.7.4 Rotating Anode X-Ray Tube (Structure)
(Cross Section)
Anode Cathode
Target
Target Angle 
Width of Real
Real Focus Focus
Filament Electrons Length of
B
Real
Focus
Length
L
Target Angle  Length of
Real Focus
L Width of Width
Width of Real
Focus Effective Length of
Center Beam Effective
Length of B Focus
b Focus
Effective Focus
l
l
Width of (A)
Effective Effective Center of Center of X-Rays
Focus Focus X-Rays
b
Fig. 1.7.5 Size of Focus Fig. 1.7.6 Size of Focus
(For a Fixed Anode Tube) (For a Rotating Anode Tube)
The size of the tungsten plate used for the focus is rectangular, as shown in Fig. 1.7.5, but if
viewed from the direction from which X-rays are actually emitted (above), it appears as a square
(A). This is referred to as the effective focus. The focus as viewed from the side, it is called the
real focus.
Since X-ray images are a type of projected silhouette image, a smaller focus is desirable to
minimize blurring and degradation of image quality.
Fig. 1.7.7 Penumbra Blurring Due to Focus

F: Focus spot, H: Penumbra blur
Assuming f is the left edge of the focus spot F and

f' is the right edge, X-rays emitted from point f
Object
project part of the object (point o) onto point h and
X-rays emitted from point f' project it onto point h'.
Since the given positions on the object are
projected to different points of the image, this
Image Surface
results in penumbra blurring. It also illustrates
how reducing the focus size will reduce the
amount of penumbra blurring.

1.7.2 X-Ray Generator Unit

The heart of the X-ray generator unit is the X-ray tube and the high voltage generator used to
accelerate generated electrons to high speeds. These require a controller to control the dose,
X-ray quality, and other aspects, and various peripheral equipment depending on its intended
application. X-ray system components and equipment are indicated in Fig. 1.7.1, whereas Fig.
1.7.8 shows an overview of the key components of the X-ray generator unit.
Primary Voltage Transformer

High Voltage Filament Voltage Transformer
Generator Rectifier
Capacitor
Shock-Resistant Cable
X-Ray High High Voltage
Voltage High Voltage Cable Guides
Cables
Generator High Voltage Switch
Controller
Control
Switch Box
X-Ray System
Generator Unit Low Voltage Conductor
X-Ray Tube
Tube Housing
X-Ray Tube
Cooling Mechanism
Unit
X-Ray System Shock-Resistant Cable
Support
R/F Table
Radiography Table
X-Ray
Treatment Table
Equipment
X-Ray Shielding Barrier
Door Safety System
Danger Signage
Other
Table 1.7.1 X-Ray System Components and Equipment
Power Supply
X-Ray Tube
Rectifier Controller
High Voltage
X-Ray Transformer
Fig. 1.7.8 Key Components of an X-Ray Generator Unit
X-ray generators are classified into major categories according to generation method and
purpose, as follows.
Types Power Supply Waveforms Features
Self-rectifying 1-phase Low price, compact size
More expensive than
Half-wave
1 or 3-phase self-rectifying, but enables
rectifying
Rectifier Type
continuous operation
Full-wave Enables achieving large current,
1 or 3-phase
rectifying but most expensive
Commonly used in indirect
Capacitor 1 or 3-phase
applications
Smoother waveforms than
3-phase full-wave rectified units,
Inverter 1 or 3-phase
even with a 1-phase power supply.
Currently the most popular type
Table 1.7.2 X-Ray Generator Types

1.8 X-Ray Dose Adjustment
1.7.3 Control System

The control system is the system that includes the various adjustment devices and switches for
setting the tube voltage (kVp), tube current (mA), the timer (sec), and so on, used to control the
X-ray system. The table where the gauges, switches, buttons, and other controls are centralized
for convenient operation is called the control panel, which is the control system for the X-ray
generator.
1.8 X-Ray Dose Adjustment

1.8.1 Adjusting the X-Ray Dose
To obtain easy to read X-ray photographs with appropriate darkness level, the X-ray dose must
be adjusted according to the area being radiographed or diagnostic objectives.
There are four parameters used to adjust the X-ray level – tube voltage, tube current, time, and
distance.
 Tube Voltage (kVp)
Shorter X-ray wavelengths, which are referred to as hard X-rays, have a higher capacity to pass
through objects. Therefore, varying the tube voltage changes the proportional X-ray
transmission level, where images obtained with higher voltage settings have lower contrast of
the object than with lower voltage (Fig. 1.8.1).
Low Voltage High Voltage
Object
Transmission X-rays
X-Ray
Images
Fig. 1.8.1 Tube Voltage (kVp) Effect 1
Weak X-Rays (25 kV) X-Ray Exposure Level
Medium X-Rays (40 kV) Object
Level of Transmission
Somewhat Strong X-Rays X-Rays
(60 kV)
Aluminum
Copper
Paper
Wood
Brass
Lead
PVC
Iron
Fig. 1.8.2 Tube Voltage (kVp) Effect 2 Fig. 1.8.3 Relationship Between X-Ray
Exposure Level, Object
Thickness, and X-Ray
Transmission Level

 Tube Current (mA) and Time (sec)

The factors used to adjust X-ray dose are current (mA) and time (sec). Put another way, current
(mA)  time (sec) = cumulative X-ray dose (mAs). This means that if the current is doubled, half
the exposure time is needed to achieve the same X-ray dose level.
 Distance
Just as with light from a light fixture (visible light), varying the distance from the X-ray focus
surface to the object changes the X-ray exposure level. That effect is same as with visible light,
which is inversely proportional to the distance squared. In other words, doubling the distance
reduces X-ray dose to 1/4 the previous level. This is the rule of squared distance. In this case,
since the X-ray quality was not changed, the contrast remains unchanged.
1.8.2 How X-Ray Photographs Are Affected

As noted above, X-ray quality is not related to tube current, time, or distance, but rather is
determined only by tube voltage. Table 1.8.1 shows a simplified summary of how different X-ray
tube voltage levels affect the quality of generated X-rays, their transmission level, and their
general effects on X-ray photographs.
X-Ray Tube Voltage High Voltage Low Voltage

X-ray quality X-rays with short wavelengths X-rays with long wavelengths
X-Ray Source
(energy) (hard X-rays) (soft X-rays)

Half-value layer* Thick Thin
Transmission Strong Weak
Scattered rays Many Few

Grayscale levels Soft gradient Sharp gradient
Effect on X-Ray
Photographs
(contrast) (low contrast) (high contrast)

Exposure latitude Broad Narrow
Sharpness Worse Better
Graininess Worse Better

Table 1.8.1 Tube Voltage and X-Ray Quality
* Half-value layer: One method of expressing X-ray transmission ability, the half-value layer (HVL) is the thickness of
the object penetrated by one half of the X-rays. Aluminum is normally used for some objects.

1.9 Effects and Elimination of Scattered Rays

1.9.1 What Are Scattered Rays?
Scattered rays refer to the phenomena of X-rays scattering in all directions due to interaction
with the substance they are penetrating.
This scattering even occurs with X-rays freshly generated form the anode as they pass through
the X-ray tube wall, then they also scatter as they pass through an object (patient). Scattering
also occurs from reflecting off of film, cassettes, objects behind the cassette, or anything else in
its path.
X-rays before passing through an object are often called primary X-rays, whereas scattered rays
are called secondary X-rays, which generally have longer wavelengths than primary X-rays and
lower transmission ability. Generation of scattering is also related to tube voltage and the
thickness of the object being penetrated, where the higher the tube voltage or the thicker the
object, the more scattered rays are generated.
1.9.2 Effect of Scattered Rays on Image Characteristics

Fig. 1.9.1 shows how scattered rays are generated.
Collimator
Fat Fat
Air
Fat Air Fat
Projected image formed by primary

X-rays (sharp silhouette)
Film Blurring due to scattering

Beam of Primary X-Rays
Scattering inside the object
Beam of Primary X-Rays
Off-Focus X-Rays
Scattering that occurs inside the object
Fogging due to scattering

(The number of dots represent the amount
of fogging.)
Fig. 1.9.1 Status of Scattering Fig. 1.9.2 Effect of Scattered Rays on Film
Suppose differences in darkness levels (contrast levels) in regions A, B, and C were obtained
from the primary X-ray beam just generated from the focus. Scattering amplifies the darkness
level (and fogging) at each of the regions A, B, and C. However, the change in darkness due to
scattering is not uniform, but rather there is less amplification in dark regions (B) and a greater
change in darkness in medium (A) and low (C) darkness regions. Therefore, it gives the
resulting image the appearance of lower contrast.
Fig. 1.9.2 shows an enlargement of part of Fig. 1.9.1, which shows that the original projection
obtained from primary X-rays has blurred and just those areas have lower sharpness.

1.9.3 How to Eliminate Scattering

One common method of eliminating scattering effects while maintaining sufficient tube voltage
necessary to obtain adequate darkness and contrast is to use a shielding cone or multi-aperture
collimators.
 Shielding Cones and Multi-Aperture Collimators

These can help restrict the primary X-ray beam to only the target area being exposed and
significantly suppress not only off-focus X-rays, but also the occurrence of scattering within the
object. They are also important in terms of reducing radiation exposure levels.
Shielding cones are conical tubes made of leaded glass or high atomic number metal, which are
used by attaching them to the front of the X-ray tube. However, because the conical shape must
be varied depending on the exposure distance and area, they can be tedious to use. Currently,
they are mostly used for specialized radiography (such as mammography and dental
radiography). In plain radiography, multi-aperture collimators are commonly used.
Multi-aperture collimators consist of multiple apertures combined in layered stack to function
collectively, as shown in Fig. 1.9.3. This configuration offers the benefit of being easier to
determine the irradiation field than with shielding cones and it also rather reliably eliminates
off-focus X-rays.
Multi-Aperture Collimator
Shielding Cone X-Ray Tube
Shielding
Cone
Multi-Aperture
Collimator
X-Ray Beam
Fig. 1.9.3 Shielding Cone and Multi-Aperture Collimator

 Grid or Blende
1) Grid Structure and Effect
The most effective way to eliminate scattering is using a grid, which is placed between the
object and cassette (see Fig. 1.9.5).
Lead Foil
Protective Shielding Plate
Incident X-Rays
(Aluminum Plate)
(Bakelite Plate)
Spacers
Scattered Rays Center Line
Grid
Flat Grid Cassette
Fig. 1.9.4 Structure of Grid Fig. 1.9.5 Diagram of Grid Operating Principle and
Usage
The grid consists of an evenly spaced grid of lead foil of uniform thickness and height, as shown
in Fig. 1.9.4, filled with a spacer material between the foil that transmits X-rays easily (such as
aluminum or Bakelite).
The principle of how the grid works is illustrated in Fig. 1.9.5, where scattered rays are readily
absorbed by the lead foil walls, allowing only an extremely small amount of scattered rays to
reach the film.
2) Grid Ratio and Grid Density

Typical grid foil is 0.05 mm thickness and 2.5 mm height, with 0.35 mm spacers, but there are
many other configurations as well. Each grid configuration has different characteristics, which
allows using different grids for different radiography conditions or objectives.
Foil Height
Grid Ratio = Grid Density = Number of Lead Foil Strips (line pairs/cm)
Spacer Thickness
A larger grid ratio means more scattered rays can be eliminated. However, the grid density level
has minimal relation to the efficiency of eliminating scattered rays, but closer spacing of foil lines
can reduce the coarser striping effects from lead foil shadowing on images, which can make
reading the images more difficult. Therefore, finer stripe configurations, with grid densities of 40
lines per cm or more have been introduced recently.

3) Grid Types
 Parallel Grids ·········· Foil strips are arranged in a parallel configuration, a typical one being
the Lysholm Blende grid (see Fig. 1.9.4).
 Focus Grid·············· All foil strips are tilted to point toward the X-ray tube (see Fig. 1.9.5),
where the grid is positioned so its focus is aligned with the X-ray tube
focus.
 Cross Grid ·············· Layering two grids at perpendicular orientations is called cross grids,
which offer the benefit of doubling the scattering elimination rate.
 High Voltage Bucky ·· Developed for short exposures from less than 0.2 or 0.3 seconds,
down to 0.02 seconds, this oscillates the previously described high
density grid, from side to side, a few centimeters (in a direction
perpendicular to stripes) to reduce striping. It has become an essential
tool for high voltage short exposures used in chest X-rays.
 Image Characteristics and X-Ray Level

Using a grid helps reduce scatter fogging and obtain sharp images, but using a grid can require
2 to 7 times higher X-ray levels than without a grid, for the following reasons.
 In general, film is darkened not only by primary X-rays, but also by scattered rays. Therefore,
to achieve adequate darkness, extra X-rays must be emitted to compensate for the X-rays
filtered out by the grid.
 Primary X-rays are also blocked by the lead foil.
In general, the larger the grid ratio, the greater the additional X-rays required. Therefore, using a
grid with a higher than necessary grid ratio can result in increasing the radiation exposure to the
patient.

1.10 The Role of Intensifying Screens and Fluorescent Screens
1.10 The Role of Intensifying Screens and

Fluorescent Screens
1.10.1 Intensifying Screens
As described above, since X-rays have an extremely high transmission ability, only about 1 % is
absorbed by the film.
Consequently, if an X-ray photograph is obtained using enough X-rays to prevent movement
blurring (as short an exposure as possible), the sensitivity and contrast both will be extremely
inadequate. To compensate for this shortcoming, shorter radiography times can be achieved by
sandwiching the film between two intensifying screens. An intensifying screen is paper (or
synthetic polymer) coated with a fluorescent substance that, when exposed to X-rays,
generates a fluorescent wavelength spectrum that matches the photosensitivity characteristics
of the X-ray film (such as calcium tungstate). In this case, the fluorescent intensifying screens
serve to increase the energy hitting the film and effectively amplify the darkening effect with a
lower level of X-rays.
Intensifying screens are used in pairs, for the front and back.
1.10.2 Cassettes
Cassettes are made of material with low X-ray absorption, such as aluminum or Bakelite sheets,
and generally have the following performance characteristics.
 Extremely flat to facilitate complete contact between the intensifying screen and film
 Light weight and sturdy
 Completely blocks out all light
 Made of materials with minimal X-ray absorption
 Low dimensional variability
1.10.3 Fluorescent Screens

Fluorescent screens consist of the same type of paper (or Bakelite) as used for intensifying
screens, but coated with fluorescent substances used for applications such as fluoroscopic
diagnostics and indirect radiography.
The fluorescent substance is silver-activated zinc-cadmium sulfide (ZnCdS:Ag). Some with rare
earth minerals are now being used as well.
To increase sensitivity, it is necessary that the fluorescent wavelength range emitted from the
fluorescent screen matches the wavelength sensitivity profile of the isochromatic film used for
indirect radiography.

1.11 Specialized Radiography Methods

In addition to plain radiography, some other radiography methods actually used in X-ray
systems are indicated in Table 1.11.1 below.
Name Purpose
Contrast Radiography Improve contrast of organ images.
Indirect Radiography Reduce film size or improve productivity.
Tomography Determine depth of affected areas.
Kymography Measure pulsation amplitude of the heart or other
areas or analyze change over time.
Polisography Identify affected areas by measuring peristalsis.
High Voltage Radiography Identify foci behind bone shadow.
Magnification Radiography Identify more detail.
Spot Radiography Radiography of optimal position during fluoroscopy
Stereography Identify affected area.
Angiography Investigate condition of blood vessels using high
speed radiography.
Mammography Identify irregularities in mammary glands.
Double Contrast Radiography Identify irregularities in the stomach lining (early
detection of cancers).
Color-X-Ray Radiography Improve identification of irregularities using color.
Table 1.11.1 Specialized Radiography Methods

2 Introduction to X-Rays
This chapter is intended as a brief explanation of diagnostic X-ray systems, X-ray images, X-ray
examinations, and other basic introductory information for people newly assigned to medical
service or sales positions.
(It is ideally suited as a first step toward learning about X-ray equipment.)

1895 Dr. Wilhelm Conrad Roentgen (1845 to 1923) discovered X-rays.
Named X-rays to mean unknown rays.
First Nobel laureate in physics
X-rays are sometimes also called Roentgen rays in honor of the discoverer.
1896 Genzo Shimadzu (Shimadzu founder) was first in Japan to successfully generate
X-rays.
1911 Shimadzu's X-ray device, Japan's first practical device, was delivered to Otsu Branch
of Japanese Red Cross Society.
Though called X-rays in academic and official contexts, they are commonly called Roentgen in
Japan.
(In a hospital, they say "taking Roentgen images" rather than "taking X-ray images."
X-Ray Tube: An electron tube used to generate X-rays, consisting of an anode and cathode
sealed in a glass vacuum housing.
Filament (cathode) Flow of electrons (tube current)

Target (anode)
Tube Voltage (kV)

Tube Current (mA)
X-Rays
High voltage
(tube voltage)
When the filament, a part of the cathode, is heated to high temperatures and a high voltage
(20 kV to 150 kV) is applied between the cathode and anode, tube current flows so that
electrons collide with the target, a part of the anode, which then radiates X-rays.
The surface the electrons impact (surface where X-rays are generated) is called the focus.

2.2 X-Ray Characteristics (Absorption and

Transmittance)
X-rays move in a straight line and cannot be bent with a lens or other such device.
X-rays pass through objects.
X-rays pass through objects, but not all of the rays.
Some things X-rays pass through easily (low absorption).
Some things readily absorb X-rays (low transmittance).
Object
X-Rays Absorption Transmittance
When X-rays are absorbed Light generation (fluorescent substances)

in an object, they cause Photosensitivity (film emulsion)
ionization and excitation Secondary X-rays (scattered rays)
Bodily effects Genetic effects
Shorter life expectancy
Damages to cells Cancer cells···· Treatment
Normal cells···· Side effects
Disabilities
If something has high X-ray absorption, If something has low X-ray absorption,
it means it means
Atomic number is: Large Small
Density is: High Low
In other words, heavy densely packed In other words, light airy things
items
Thickness is: Thick Thin
X-ray quality is: Soft Hard
Voltage level is: Low High
Wavelengths are: Long Short

2.2 X-Ray Characteristics (Absorption and Transmittance)
Primary Constituents of Humans
Element Atomic Number

Hydrogen (H) 1
Carbon (C) 6
Nitrogen (N) 7
Oxygen (O) 8
Phosphorus (P) 15
Chlorine (Cl) 17
Calcium (Ca) 20
Iron (Fe) 26
Iodine (I) 53
Reference:
Barium (Ba) 56
Density of Human Tissue
Tissue Density Effective Atomic Number X-Ray Absorption X-Ray Transmission

Bone 1.9 11.6 High Low
Cartilage 1.09
Muscle 1.04 7.4
Soft Tissue 1 Medium Medium
Water 1 7.4
Fat 0.94 6.3
Lungs 0.32
Air 0.0013 Low High
Since X-ray photographs are used to view differences in X-ray absorption, obviously, the bones are most
visible due to their high absorption difference.

2.3 X-Ray Images

When a human is exposed to X-rays,
Fluorescent substances Film

(luminescent) (photosensitive)
Human
White
Bone
Gray
X-Rays Muscles, etc.
Black
Air (lungs)
X-rays with image information. X-rays change to visible light. Records an

Differences in transmission X-rays Visible image appears here. optical image.
are converted to an image.
 In reality, bones are surrounded by muscle, for example, so a white bone appears within the
gray image of the muscle.
Fluorescent substances Film

(luminescent) (photosensitive)
Muscle Gray
X-Rays Bone + muscle White
Muscle Gray
Muscle Bone
 A video camera is often used instead of film to create the images on a CRT screen.
 Transmission X-rays are often projected directly onto photosensitive film as well. However,
film only absorbs an extremely small amount of X-rays, so sensitivity is poor and high levels
of X-rays are required. This use is limited to special applications, such as dental X-rays.

2.3 X-Ray Images
 Contrast Media
Since there is only slight difference in absorption between muscle, fat, water, and other areas, it
can be difficult to distinguish between them. Therefore, a contrast medium is used to create a
difference in absorption.
For the stomach and

surrounding muscle, etc.
X-Rays
Barium within the stomach
For blood vessels and

surrounding muscle, etc.
X-Rays
Iodine within the blood vessels

2.4 Types of X-Ray Images

2.4.1 Direct Radiography
Actual Size Image on Film
Film
X-Rays
Intensifying Screen
Light
Direct radiography is far more common and probably what would be used if you undergo an
X-ray examination at a typical hospital.
 Intensifying Screen
Film is also sensitive to X-rays, but the sensitivity level is extremely poor.
Therefore, a highly sensitive (high X-ray absorption) fluorescent substance is illuminated to
expose the film with light.
An intensifying screen is a board-like substrate coated with this fluorescent substance.
This intensifying screen is placed in close contact with the film.

 Cassette
The film and intensifying screen are inserted as a pair into a thin flat case for use in radiography.
This case is called a cassette.
This shows the cassette upside down, with the cover closed.
This surface is made with material that has uniform and low
X-ray absorption characteristics.
This is the side that is placed in contact with the patient's skin.
Cover
Fastener
The stacked film and intensifying

screens are placed in here.

JIS Size Names and Dimensions
Nominal Cut Dimensions and Cut Dimensions and

Common Name
Dimensions (cm) Tolerance (mm) (JIS Name) Tolerance (mm)
(JIS Name) Short Side Long Side Short Side Long Side
13  18 128.0  1.0 178.0  1.0 JX (4 3/4  6 1/2) 119.0  1.0 164.0  1.0
15  30 148.0  1.0 298.0  1.0 JX (6 1/2  8 1/2) 164.0  1.0 214.0  1.0
18  24 178.0  1.0 238.0  1.0 JX (8  10) 201.0  1.0 252.0  1.0 Mutsugiri (sixths)
24  24 238.0  1.0 238.0  1.0 JX (10  12) 252.0  1.0 303.0  1.0 Yotsugiri (fourths)
24  30 238.0  1.0 298.0  1.0 JX (11  14) 279.0  1.0 354.0  1.0 Tairiku (continental)
30  40 298.0  1.0 398.0  1.0 JX (14  14) 354.0  1.0 354.0  1.0 Daikaku (large square)
35  35 354.0  1.0 354.0  1.0 JX (14  17) 354.0  1.0 430.0  1.0 Hansetsu (half)
35  43 354.0  1.0 430.0  1.0 JX: Indicates film
13  18 128.0  1.0 178.0  1.0 JI: Indicates intensifying screen
2.4.2 Indirect Radiography

 Indirect Fluorescent Screens
Light
Film
X-Rays
Fluorescent Screen Camera (for indirect fluorescent screens)
The camera is used to take a photograph of the X-ray image that appears on the fluorescent
screen. The film is either a 35 to 100 mm wide roll or 100  100 mm cut sheets.
Fluorescent screens and intensifying screens are almost the same thing, but the intensifying
screen is used in combination with film.
Since film has smaller dimensions and reduces storage space, it is often used for applications
such as mobile clinics or group examinations.
 Indirect Image Intensifier (I.I.)

Light
Film
X-Rays
Camera (for
I.I. (Image Intensifier) indirect I.I.)
The image output from the image intensifier is photographed with the camera.
The camera for indirect image intensifiers uses the same film as the camera for indirect
fluorescent screens.

Cameras for indirect image intensifiers include the following types.

(1) Cameras that take one photograph at a time
(2) Cameras that can automatically take a series of images (6 fps, 8 fps, or 12 fps)
(3) Cameras capable of cine radiography (up to 150 fps using 35 mm film)
 Image Intensifiers (I.I.)

Often referred to as image amplifiers (IA) at Shimadzu, they are also commonly called image
tubes.
An electron tube commonly used to amplify the brightness of fluorescent images.
X-Rays
Light
Fluorescent Input Photocathode Focusing Cup Anode Fluorescent

Surface Light  Electrons Focuses Accelerates Output Surface
X-Rays  Light Electrons Electrons Electrons  Light
Output End
Input End
Image Intensifier Tube

The image on the fluorescent output surface is several thousand times brighter than the
fluorescent input surface. The image on the fluorescent output surface is then captured on film
using a camera or captured with a video camera for viewing on a CRT screen.
The size of the fluorescent input surface (field of view), which determines what range of the
body or other object appears in images, is normally indicated in terms of inches, but product
catalogs also indicate centimeters.
Common sizes include,
7 inch diameter (18 cm diameter)
Other sizes include,
In addition, some units allow switching between sizes depending on the desired field of view.
Example: 6/9/12-inch 3-way switchable
4.5/6/7.5/9-inch 4-way switchable
2.4.3 X-Ray Television (XTV)
Video Camera
TV Monitor
X-Rays Light
I.I CRT
Video Tape
VTR
Transferred
to Film
XTV systems use a video camera to capture the I.I. output image and display it on a TV monitor
(CRT screen) or record it on media.
The camera, monitor, and electronic circuits used for this purpose are all monochromatic (black
and white).
 Television Fluoroscopy
Television fluoroscopy systems are used to observe the incremental movements of subjects.
In this context, X-ray systems refer to fluoroscopy systems with an I.I.-TV configuration.
 Television Radiography – Recording and Storage

(1) Moving images are recorded on video tape.
(2) Instantaneous still images are converted to film in a recording system for televisions.
Multiple Camera – Records the CRT screen image with an optical camera.
Laser Imager – The TV signal is converted to a laser light beam, which is then pointed directly
onto film to record images.

 Digital Fluorography DF
X-ray television systems are not only simply used to capture and view images, but by converting
the television signal (analog) to digital, the data can be manipulated using computer technology
to achieve various images not possible with X-ray images using conventional film and
intensifying screens.
Digital fluorography will become increasingly important in the future. This technology is
commonly called "DF."
Example of DF: DSA (Digital Subtraction Angiography)
DSA: Removes bone images from images showing both bones and blood vessels.
Blood Vessels and Bones Bones
Blood Vessels

 X-Ray Tube
X-Rays
Focusing Cup
Focus Filament
Anode Cathode
Rotation
Target Disk
Anode Filament and Focusing Cup
Target Disk Cathode
Rotating Anode X-Ray Tube
Target Disk Rotates at about 3000 to 10,000 rpm.

Helps dissipate heat generated at the focus.
Filament Emits electrons.
Focusing Cup Focuses electron flow to the desired shape.
Focus Surface where electrons collide and X-rays are emitted
There are various focus sizes, such as 0.2, 0.3, 0.6, 0.8, 1, 1.2, 1.5, and 2 mm along one side.
Normally, a single X-ray tube has two foci. Example: 0.6 and 1.2 mm
Tube Voltage Practical range of 20 to 150 kV

Tube Current Practical range of a few mA to a few hundred mA
The X-ray tube is housed in a metal housing.
X-Ray Tube + Tube Housing = X-Ray Tube Unit
A rotating anode X-ray tube has a rotating anode.
Shimadzu X-ray tubes are named CIRCLEX.

 Grids for Eliminating Scattered X-Rays

Used to reduce fogging and improve contrast
Incident X-Rays
When X-rays penetrate an object:
 Some of the X-rays pass through the object
to create the image.
Scattered Rays  Most of the X-rays are absorbed, resulting in
secondary X-rays being radiated in all
directions from various parts of the body. This
Film is called scattered rays.
If the scattered rays reach the film, they can cause
fogging.
 This reduces contrast.
Therefore, a grid is introduced to filter out the

scattered X-rays.
The grid is used by stacking it on the cassette
(containing the film and intensifying screens).
Grids are also used with image intensifiers.
Strips of lead or other metal with high X-ray
absorption are arranged in a grid configuration.
Aluminum, wood, or plastic is used as a
supporting material between the strips.
Grid Lead
Fixed Grids
The grid pattern can appear on the image as stripes.
Moving Grid – Bucky
The grid is moved during radiography to blur stripe pattern.

 Collimator
When X-rays are emitted from the X-ray tube focus, they radiate out at a fairly wide angle.
A collimator restricts X-rays to only the area of the object they are needed.
Tubes with fixed collimating range – Localizing cones

Tubes with user adjustable collimators – Adjustable collimators
X-Rays emitted from focus

Collimating blades (coated with lead)
Adjustable collimators are tubes with moveable baffles.
Range of collimated X-rays

Irradiation Field
Focus
Collimator
X-Ray Tube Unit
Before emitting X-rays, it is necessary to know about what range is to be exposed to X-rays.
Therefore, there is a rangefinder on the collimator with a lamp used to confirm the irradiation
field before emitting X-rays.
Automatic collimators that move the baffles automatically according to the selected film size or
intended size of irradiation field are also commonly used. For example, an automatic collimator
is always used for R/F tables described in the next section.
Automatic collimators can be operated manually as well.

2.5 X-Ray Systems
2.5 X-Ray Systems

An X-ray system is a combination of equipment that efficiently produces high quality X-ray
images.
X-Ray System X-Ray Generator X-Ray Tube Unit X-Ray Tube
Collimator Tube Housing
X-Ray High Voltage High Voltage Generator

Generator (1)
X-Ray Controller
X-Ray Mechanical R/F Table (2)

Equipment
Radiography Table (3)
Support Unit (4)
Imaging Unit (5)
Related Equipment
(1) Assembly of electrical components that supplies power to the X-ray tube unit and is used
to control X-ray emission (such as kV, mA, time, and count)
(2) Equipment used to position a person for fluoroscopy or radiography
The X-ray tube unit and imaging unit are attached to this table. This is often called a
fluoroscopy table.
(3) Equipment used to position a person for radiography
Both or either the X-ray tube unit and/or imaging unit are attached to this table.
(4) Unit that physically supports the X-ray tube unit, image intensifier, and imaging unit.
Supports are either mounted to the ceiling or installed on the floor.
(5) General term for equipment used to observe or record X-ray images
An imaging unit is always installed on an R/F table (or fluoroscopy table) and sometimes
installed on a radiography table.

X-Ray Emission Port Tube Housing
High-Voltage Cable Socket X-Ray Tube
X-Ray Tube Unit
Optical System (lens, etc.)
Tube Housing
Image Tube
Image Intensifier (I.I.)

2.5 X-Ray Systems
Table-Side Operated Model X-Ray Tube Unit

Automatic
Collimator
Compression
I.I. and XTV Camera
Cone
Examination Table (Tabletop)

Remote-Operated Model
X-Ray Tube Unit and Automatic Collimator

(below table)
R/F Tables
Fluoroscopy Image Monitor (XTV)
X-Ray Parameter Display Panel
R/F Table Control

Console
Combined X-Ray Control and Remote-Operated R/F Table Control Console

Acquisition Information Reference

FPD Monitor Display Unit Monitor
Cybergrip
Examination Table
C-Arm
Collimator X-Ray Local Control IVR NEO Control

Tube Console Console
Examination
Room Foot
Switch
Floor-Mounted Support Unit
X-Ray Tube Unit
Collimator
Ceiling-Mounted Support Unit

2.5 X-Ray Systems
Collimator
X-Ray Tube Unit
Arm
Touch Panel Monitor

X-Ray Control Panel
Drive Handle
Hand Switch
Imaging Unit
LAN Cable
Mobile X-Ray Systems
Examination Table (Tabletop)
Cassette and Grid

(Film and Intensifying Screens)
Radiography Table

2.6 X-Ray Examinations

X-ray examinations involve obtaining an X-ray image of the target part of the body, then
observing (reading) the image to make a diagnosis.
Plain Radiography
Methods used to create X-ray images Contrast Radiography
Fluoroscopy
2.6.1 Plain Radiography

Plain radiography, often using direct radiography (with intensifying screens and film).
Indirect radiography is used commonly as well (with a fluorescent screen plus camera or I.I. plus
camera).
No special measures are required for the patient for radiography of areas such as the bones,
chest, or abdomen.
This is the most common type of radiography.
Chest Area Neck Area

2.6.2 Contrast Radiography

If there is only a small difference in X-ray absorption between an organ of interest and
surrounding organs, it may be difficult to distinguish between them in images (cannot tell the
difference between light and dark areas) due to inadequate contrast.
However, an X-ray image of the organ of interest can be obtained by injecting contrast medium
in the organ to provide a difference in X-ray absorption between target and surrounding organs.
 Types of Contrast Media

(1) Positive Contrast Media
Substances with high X-ray absorption – Appears white in images
(a) Barium sulfide (for the stomach, duodenum, intestines, etc.)
(b) Iodine (for the vascular system, gallbladder, bronchial tube, etc.)
(2) Negative Contrast Media
Substances with low X-ray absorption – Appears dark in images
Air, carbon dioxide gas, etc. (such as cerebral ventricles)
(3) Both Positive and Negative Contrast Media
Double-contrast radiography
Barium sulfide and air (for the stomach, duodenum, intestines, etc.)
 Actual Contrast Radiography

When using contrast media, fluoroscopy is used to confirm that the medium has entered the
organ of interest, then the area is promptly exposed with X-rays. If too much time elapses, the
contrast medium could move to a different area.
An X-ray TV system (I.I. plus video camera) is used for fluoroscopy.
2.6.3 Fluoroscopy
An X-ray TV system that combines an image intensifier with a television system is used for
fluoroscopy.
This allows observing a moving image of human and contrast media movements.
 Spot Filming/Spot Radiography Fluoroscopy + Radiography

When a camera is used to take a photograph, one looks through a viewfinder to find the desired
irradiation field, then presses the shutter. Similarly in radiography, a fluoroscopic image can be
monitored on TV to decide the exact moment to emit X-rays. This technique is called spot
filming and the imaging system used for spot filming is called the spot imaging unit.
In the early period of X-ray television, image quality was poor and fluoroscopy was used simply
as a viewfinder for positioning purposes, but just as with televisions for the home, fluoroscopy
images have become much sharper as technology has improved.
Fluoroscopy is now increasingly used to diagnose affected areas, with film used for storage and
follow-up diagnoses.
Fluoroscopic television images are often recorded on video tape.

2.6.4 Tomography, Magnification Radiography, and Stereo

Radiography
 Tomography
X-rays are emitted while simultaneously moving the X-ray tube focus from A to A' and the film
from B to B' concentrically around point C (), as shown below.
The images are linked so that points located on the cross section, indicated with black dot ()
and white square (), remain in the same respective locations on the film. This ensures the
black dot () and white square () points do not blur.
However, points away from the cross section, such as those indicated with a white dot (),
move relative to the linked points and, consequently, blur.
This means only the cross section image appears sharp.
X-Ray Tube Focus

Movement
This figure makes it appear
as though there are two
films, but actually there is
Object only one film, which moves
from B to B'.
Cross Section
Film Movement
With plain radiography, parts of the object closer and farther from the tube appear overlapped,
making it difficult to determine how deep the affected area is located from the body surface.
By using tomography to obtain multiple images while incrementally moving the cross section
position makes it clear how many centimeters an affected area is from the body surface.
Focus
Focus
Affected Area
Cross Section
Film
Film
Plain Radiography Tomography

 Magnification Radiography and Stereo Radiography
Magnification Radiography and Contact Radiography
Focus
Magnification radiography positions the object

Object at an intermediate position between the focus
and film, as shown to the left, to obtain
magnified images.
Since this makes finer details appear larger, it
is often used in radiography of fine blood
vessels.
Magnified Direct Contact
Magnification Rate
Magnification Stereo and Contact Stereo
(Radiography)
Stereo radiography involves performing
Focus
radiography from two foci spaced an
appropriate distance apart and viewing the
two films with both eyes to achieve a stereo
Object
image of the object.
X-ray tubes equipped with two foci are
available for use in stereo radiography.
Left Film Left Film
Right Film Right Film This type of radiography is often used for
Magnification Stereo Contact Stereo contrast radiography of complicated and
The left film is radiographed from the left focus, then overlapping cerebral blood vessels.
the film is exchanged and the right film is
radiographed from the right focus.
(Viewing)
Stereo Viewing
Naked Eyes
Glasses
Right Left Left Right

Film Film Film Film
Naked Eyes Stereo Viewing

Glasses
Left Eye Right Eye Left Eye Right Eye
The films are arranged on opposite sides depending on whether viewing via the naked eyes or
stereo glasses. This can result in amusing interactions between doctors that are both
diagnosing stereo images, one with and the other without viewing glasses, because the depth
perception will appear opposite.

2.7 Examples of Contrast Radiography

There is a wide variety of contrast radiography applications. The following describes some
typical types used for gastrointestinal X-ray examinations and angiography.
2.7.1 Gastrointestinal X-Ray Examination

Contrast radiography of the gastrointestinal tract (abbreviated GI).
The gastrointestinal tract, to which the liver, gallbladder, and pancreas are connected, extends
from the mouth to the anus.
Oral Cavity: Opening for teeth, tongue,

Nasal Cavity and gastrointestinal tract, and
where food mixes with saliva
Oral Cavity Esophagus: Tube through which food and
Pharynx liquids pass
Larynx Liquids pass in about 1 to 6
seconds, whereas solids in
about 30 to 60 seconds
Stomach: Temporary food storage,
Esophagus
where food/liquids mix
thoroughly with stomach
Liver
fluids. Foods become a
semifluid mass.
Gallbladder Stomach
2 to 5 hours
Duodenum: Receives digestive fluids
Duodenum Pancreas from the liver, gallbladder,
and pancreas, and mixes
Ascending Transverse
them with food.
Colon Colon
Jejunum Small Intestine (jejunum and ileum):
Ileum Digests and absorbs
Descending
Cecum Colon nutrients in about 7 to 9
Sigmoid Colon hours.
Appendix
Cecum (starting point of large intestine):
Rectum Prevents backflow
Anus
Large Intestine (ascending, transverse, descending, and sigmoid colons):

Absorbs moisture in about 25 to 30 hours.
Rectum (ending point of large intestine) and Anus:
Solid waste builds up in the sigmoid colon until excreted from the rectum and anus
in about 30 to 120 hours.
Liver: Secretes bile (digested fats) and serves as a nutritional base that chemically
processes the nutrients sent to it and sends them throughout the body.
Gallbladder: Temporarily stores and condenses bile.
Pancreas: Secretes pancreatic fluids (digested fats, carbohydrates, and proteins).

Operation Room Examination Room
Lead Glass Window

X-Ray Tube Unit
Fluoroscopy Adjustable Collimator
TV Monitor
Operator Person being examined
Remote-Operated
R/F Table
Spot Filming Unit

(Film Intensifying Screens)
Image Intensifier and High

Optical System (Lens) Voltage
Generator
Video Camera
Remote Control Unit for X-Ray Controller and

Fluoroscopy/Radiography Unit
Overview of Remote-Operated X-Ray TV System
(1) Contrast Radiography of Gastrointestinal Tract

Identification of cancers and ulcers
(2) Contrast Media
Liquid barium sulfide and air
Orally (for stomach, duodenum, etc.) or by local injection (large intestines, etc.)
(3) Contrast Radiography Methods
Images can be obtained from various angles (standing, supine, or tilted).
If the patient lies horizontally on the examination table, facing upward (supine position),
barium will flow to the rear stomach wall (toward the patient's back) – rear wall
radiography.
If faced downward (prone position), barium will flow to the front wall of the stomach –
front wall radiography.
Other various
 Stomach
In English, the prefix used in medical terminology to indicate the stomach is gastro, whereas in
German, it is magen. Consequently, magen is commonly used in Japan, such as for magen
fluoroscopy, magen examinations, and so on.

 Contrast Radiography of the Gastrointestinal Tract
Direction of X-Rays
Gastrointestinal Tract
Mucosal Folds
Lumen
Positive Contrast Media

Difference in Many Many
Transmission X-Ray Few Few Few
Dose
X-Ray Image
Expressions for Contrast Radiography Images of Gastrointestinal Tract
Compression
Relief Contrast Filled Contrast Double Contrast
Name Contrast
Radiography Radiography Radiography
Radiography
Main Body
Supine Standing and supine Supine Standing and supine
Positions
Media Type
Compression
Diagram of
Contrast
Status
Tract Tract
Wall Lumen Positive Wall Positive Negative Positive Positive Contrast Media
Contrast Contrast Media Contrast Contrast
Media Media Media
Illustration
Image Type
of X-Ray
Image
Double Contrast
Name Relief Image Filled Image Compression Image
Image
Basic Contrast Modes for Gastrointestinal Tract and Their Corresponding Images (from the
book written by Dr. Akira Yoshida, M.D.)
Relief Contrast Radiography: Small amount of barium is applied thinly to mucous membrane.
Enhances relief appearance (mucosal folds).
Filled Contrast Radiography: Image obtained with tract filled with barium. Enhances the
appearance of the edges.
Double Contrast Radiography: After applying a thin coat of barium, the tract is inflated with air
(delivered via a tube or, in the case of the stomach, a foaming
agent is swallowed to create gas in the stomach) to stretch out
the relief before performing radiography.
Compression Contrast Radiography:
External pressure is applied to flatten the tract before
radiography. Enhances the appearance of the front and rear
walls. Applicable areas are limited.

Esophagus Stomach
Double Contrast Radiography
Spine Position
Stomach Large Intestine

Filled Image
Prone Position

2.7.2 Angiography
 Contrast Radiography of Blood Vessels

 Vascular lesions
(i) Stenosis
Atheroma Atheroma
Atheromatous plaque
Primary causes of hardening of arteries,
formation of blood clots, stenosis, and
occlusions
(ii) Occlusions
Blood Clot Blood Clot
If either (i) or (ii) occurs, the tissue supported by that blood vessel can become oxygen
starved and malnourished.
Symptoms include numbness, cold sensation, limping, pain, dead tissue, and so on.
Cerebral thrombosis (ii-1)

Example: Cerebral infarction
Cerebral embolism (ii-2) (ii-3)
Angina (i)
Heart disease
Myocardial infarction (ii)
(iii) Vasodila[ta]tion
(iv) Aneurysm
Dissecting aneurysm (blood entering artery

through a damaged inner lining)
(v) AV-Shunt, AV-Fistula

Arteriovenous Malformation (AVM)
Malformation (unwanted compression or
bleeding of tissue)
Shunt, fistula
Artery Vein (varicose veins or risk of ruptured aneurysm)
Capillaries (oxygen deficient or malnourished tissue)

(vi) Angiectopia
Collateral vessels or blood flows and natural bypasses
If a particular blood vessel is blocked, a bypass forms to compensate.
Deviations
Tortuosity (twisted)
(vii) Internal bleeding

Trauma (such as an artery severed in a car accident)
Lesion (such as a bleeding tumor or ruptured aneurysm)
 Cancer/tumor
If a cancer or tumor develops, vessels form to support it. Theses blood vessels are called
feeding vessel.
Observation and diagnosis of feeding vessel supplying cancerous tumors
 Congenital and acquired heart disease
The list goes on and on, but angiography is effective in examining almost all disorders related to
blood circulation.
 Contrast Media
Contrast media is a liquid containing iodine that is injected through a catheter (narrow plastic
tube) embedded a target blood vessel.
 Contrast Radiography Methods

Due to the rapid flow of blood and blood vessel movements, X-ray exposures are repeated at
high speed (about 1 to 150 frames per second, depending on the area being exposed).
 The patient is placed on the examination table.
 A catheter (or needle) is inserted in the target area. The catheter position is monitored using
fluoroscopy.
Video Camera
Catheter
X-Ray Tube
 An automatic contrast medium injector (or manual syringe) is connected to the catheter.
A test injection is performed to confirm the catheter position and contrast position.

 Direct radiography
X-Ray Tube The radiography X-ray tube and

film changer are aligned with the
target area of interest.
Film Changer Automatic

Injector
 Image intensifier + cine camera / Image intensifier + video camera
Video Camera Cine Camera
(i) The I.I. image is captured

using a cine camera.
(ii) The I.I. image is captured
using a video camera.
X-Ray Tube
 X-rays are emitted in synchronization with the contrast medium injection.

 Observation (diagnosis)
Direct radiography – Film
I.I. + cine camera – cine film
I.I. + video camera – TV monitor or recorded on film with multiple cameras or a laser imager
 Film Changer
Unit used to feed a 14  14 film at high speeds, up to four sheets per second
 Cine Camera
Camera that advances 35 mm movie film at rates up to 150 frames per second
 Herz
Herz is the German word for heart. Many people at hospitals in Japan use this German word for
heart.
Saying that a person has a bad heart might imply the person has weak character, but to say that
they have a bad herz expresses that they have a heart illness.

Coronary Artery Hepatic Artery

Stenosis and Occlusion Liver Cell Cancer
(Heart)
Common Iliac Artery Cerebral Artery

2.8 Interventional Radiology

The interventional radiology is hereinafter referred to as "IVR."
What is IVR? – Procedure that uses diagnostic X-ray technology for treatment.
Treating illnesses without surgery (cutting, removing, or stitching). Minimizes
impact to patients.
Currently extremely popular.
Example 1: Cancer was discovered in liver cells during an angiography examination.

Surgery Cut, remove, and stitch.
IVR Insert a catheter into the artery feeding the cancer and insert anti-cancer
drugs or inject a substance to block the artery and starve the cancer.
Example 2: A blood clot was discovered blocking a blood vessel during an angiocardiography
examination. The clot was causing the myocardial infarction.
Surgery Cut open the chest, expose the heart, and connect an artificial heart and
lung.
Create a bypass using a blood vessel previously taken from another part
of the patient's body (cut holes in the blood vessel and sew the bypass
blood vessel to the holes).
Remove the artificial heart and lung. Sew the chest shut.
IVR Guide a catheter to the blood vessel blockage and inject a clot dissolving
agent or inflate the tip of the catheter to expand the vessel.
Example 3: A biliary tract is blocked with pus. The blockage was discovered with fluoroscopy.
Surgery Cut, remove, and stitch.
IVR Guide a tube (similar to a syringe needle) to the pus blockage and drain
the pus.

2.9 Damage X-Rays (Radiation) Can Cause to Humans
2.9 Damage X-Rays (Radiation) Can Cause to

Humans
Though being exposed to X-rays causes no pain or even a heat sensation to human, it can
nevertheless cause various types of harm.
Damage to humans Bodily harm Acute

(to the person exposed)
Delayed (after latent period)
Genetic effects
(to children and grandchildren)
2.9.1 Acute Symptoms

(1) Single exposure to entire body
Exposure Dose in Gy (grays) Symptoms

Max. 0.25 Minimal symptoms
0.5 Temporary drop in white blood cell count
1 Nausea, entire body fatigue, radiation sickness
2 5 % fatal
3 50 % fatal
6 90 % fatal
7 100 % fatal
Reference: One X-ray exposure is about 0.001 Gy.
100 days
Time Remaining in the Body
10 days A Damage to hemopoietic organs and death

of bone marrow
1 day B Intestinal death
10 hours Intestinal function stops and intestinal
cells die within about 1 week.
1 hour C Neural death
Damage to central nervous system
10 minutes
1 minute
10 100 1000
Dose (Gy)
Relationship Between Exposure Dose and Time Remaining in Body (Mice)

(2) Radiation Sensitivity

Cells especially sensitive to radiation include cells that rapidly divide, cells that will divide
rapidly in the future, and undifferentiated cells.
Lymph system, hemopoietic organs (bone marrow, etc.), small and

High Sensitivity
large intestines, gonads (testes or ovaries), etc.
Skin, cornea, esophagus, rectum, uterus, urinary tract, etc.
Thyroid gland, kidneys, liver, pancreas, etc.
Low Sensitivity Muscle, nerves, bone, etc.
Gonads Temporarily infertile at about 0.3 Gy

Permanently infertile at about a few grays
Skin Up to 3 Gy After 3 weeks Hair loss

Up to 10 Gy After 2 weeks Hair loss and erythema (dry
skin rash)
Up to 18 Gy After a week Permanent hair loss and
blister (moist skin rash)
Over 20 Gy After a few days Ulcers and erosion
(radiation ulcers)
Radiation Sickness Over 0.5 Gy Whether exposure is localized or over entire

body
Headache, dizziness, vomiting, diarrhea, arrhythmia,
abnormal blood pressure, mental instability
Blood (hemopoietic organs) Especially high sensitivity

White blood cells are especially vulnerable.
People working near radiation are obligated to have regular
blood examinations.
2.9.2 Delayed Symptoms

Symptoms can appear after a latency period of a few years to several decades.
(1) Cancer
Latent period of at least a few years for hemopoietic organs, skin, liver, etc.
Leukemia: Hemopoietic organs become cancerous.
(2) Cataracts
Symptoms appear after latency period of a few years after a single exposure of a few grays
or cumulative smaller exposures of a dozen or more grays.
(3) Shorter life expectancy
Accelerated aging
Shorter life expectancy due to cancer
2.9.3 Genetic Effects

Currently there are no known cases of genetic disorders in children confirmed to be caused
solely by radiation exposure of parents.

2.9 Damage X-Rays (Radiation) Can Cause to Humans
2.9.4 Effects on Fetuses

Fetuses are highly sensitive to radiation.
Women who are pregnant or may become pregnant should use particular caution in avoiding
radiation, unless there are special circumstances.
2.9.5 Manifestation of Disorders

Occurrence of
Disorders
 Exposure Dose
A The occurrence of genetic effects, leukemia, and cancer increases with higher dose levels.
B Acute symptoms and some delayed symptoms appear after exposure exceeds a certain
dose level. These have threshold values.
 Even if symptoms appear from radiation exposure, humans have a natural recovery
capacity that tends to eliminate or reduce symptoms.
 Give the identical total exposure level, symptoms can manifest differently depending on
number of doses into which the exposure was divided. A single dose results in more serious
symptoms.
 Exposure of the entire body has more serious symptoms than if the exposure is localized.
 Genetic effects only accumulate, with no recovery.
2.9.6 Everyday Radiation Exposures
Foods Nuclear Weapons Testing

Nuclear Power Plant Accidents
Cosmic Rays Earth
Radium Hot Springs Building materials
Everyday exposure levels depend on the region, latitude, altitude, soil components, and building
structure, but are normally thought to be about 0.0024 Sv (or 0.0024 Gy for X-rays) per year.

2.9.7 Avoiding Radiation Damage
 Three Rules of Radiation Protection

(1) Shielding
Lead, lead glass, lead aprons, etc.
(2) Distance
Stay farther from the X-ray source.
Radiation levels decrease at a rate proportional to the square of the distance from the
source.
(3) Time
Minimize the time exposed to radiation.
There are no other means of protection.
References
 Introduction to Radiation and Isotopes
Japan Radioisotope Association
 Authorized Chief X-Ray Inspection Engineer
Training Manual
Electron Science Institute

3.1 Categories of X-Ray Systems
3 Introduction to X-Ray Systems

3.1 Categories of X-Ray Systems
The following gives a brief introduction to the major types of X-ray systems, from the perspective
of their use for diagnostic purposes. Fig. 3.1.1 lists the systems described in this section.
Diagnostic X-Ray Systems
Portable X-Ray Systems
Mobile X-Ray Systems
General Radiography Systems
Gastrointestinal Diagnostic Systems
Table-Side Operated Diagnostic Systems
Remote-Operated Diagnostic Systems
General Purpose Systems
Specialized Systems Multidirectional Diagnostic Systems
Specialized Indirect Radiography Systems
Cardiovascular Diagnostic Systems
Tomography Systems
Surgical Diagnostic Systems
Diagnostic Mammography Systems
Group Examination Systems
Pediatric Diagnostic Systems
Diagnostic Urology and Gynecology Systems
Dental X-Ray Radiography Systems
Fig. 3.1.1 Types of Systems Used for Diagnostic Purposes

3.2 Portable X-Ray Systems

Portable X-ray systems are X-ray systems that can be carried. Their compact size and light
weight design allows them to be easily carried. X-ray output levels are limited, but they offer the
advantage being available for use anywhere, such as outdoors. An example is shown in Fig.
3.2.1.
Fig. 3.2.1 Example of a Portable X-Ray System
3.3 Mobile X-Ray Systems

Mobile X-ray systems are designed to be moved around within a hospital. They do not require a
special power supply source, but rather can be connected to any normal power outlet to enable
use in patient rooms, treatment rooms, or other areas. Battery powered models are also
available for use in rooms without a power supply. An example is shown in Fig. 3.3.1.
Fig. 3.3.1 Example of a Mobile X-Ray System

3.4 General Radiography Systems

An example of a general radiography system is shown in Fig. 3.4.1.
Fig. 3.4.1 Example of a General Radiography System
The major components in a general radiography system include a horizontal radiography table,
radiography stand, support unit, and X-ray high voltage generator. These systems allow using
the horizontal radiography table to perform radiography of the abdomen and head areas. In
addition, radiography of the chest is possible using the radiography stand. These systems offer
the advantage of a simple configuration and broad applicability.

3.5 Gastrointestinal Diagnostic Systems

Diagnostic systems for the gastrointestinal system are widely used mainly to diagnose disorders
of the gastrointestinal system. Applicable organs include the esophagus, stomach, small
intestine, large intestine, and other hollow organs part of the gastrointestinal tract, the liver,
gallbladder, biliary tract system, pancreas, and other organs for external secretion that function
as digestive glands. Examinations of the gastrointestinal tract are performed using positive
contrast media, such as barium sulfide or other agents and negative contrast media such as air
and carbon dioxide gas. Technology and devices for diagnosing stomach disorders has been
advancing dramatically, with adoption of double contrast media methods that involve
simultaneously placing both barium and air into the stomach for radiography.
The basic configurations and types of diagnostic systems for the gastrointestinal system are
shown in Fig. 3.5.1 and 3.5.2.
X-Ray Imaging System Table-Side

Operated
Diagnostic Systems
System for Receiving Image X-Ray R/F Table
X-TV
Gastrointestinal
Camera for Indirect Diagnostic General
Radiography Systems Purpose
Image Intensifier Systems
Spot Filming Unit
Remote-Operated Multidirectional
Diagnostic Systems Diagnostic
X-Ray Emission System
Systems
X-Ray Tube Unit Specialized
Systems
X-Ray High Voltage
Specialized Indirect
Generator Radiography
Systems
Fig. 3.5.1 Basic System Configuration Fig. 3.5.2 Types of Systems
R/F tables are equipped with an X-ray TV system that allows using fluoroscopy to monitor the
status of the area being examined, then record images on film as needed. Currently, the use of
endoscopic examinations for gastrointestinal tract diagnosis is also gaining popularity, but
diagnostic X-ray offers the advantage of enabling diagnosing an overview of the area and
enables determining accurate sizes, particularly for adequately determining the deformation
shape of depressed lesions. Therefore, it continues to be widely used. Advances are also being
made in diagnostic X-ray technology for the gallbladder-liver-pancreas system, such as by
enabling using X-ray jointly with endoscopy or direct needle puncture to examine areas
including the gallbladder, liver, and pancreas.
Since currently, there is increasing demand for displaying and diagnosing images immediately
and for compatibility with PACS, customers continue to shift to digital technology. In addition,
systems with flat panel detectors (FPD) instead of X-ray TV systems are gaining popularity as
well.

3.5.1 Table-Side Operated R/F Table Systems

An example of a table-side operated R/F table system is shown in Fig. 3.5.3.
Fig. 3.5.3 Example of a Table-Side Operated R/F Table System
The major system components include a table-side operated R/F table, radiography stand,
support unit, and X-ray high voltage generator. To diagnose the gastrointestinal system, an R/F
table, X-ray tube mounted in an R/F table, image intensifier, and TV system are used. Since the
operator is standing near the patient during operation, it offers the advantage of being able to
communicate with the patient. On the other hand, X-ray exposure is unavoidable.
R/F tables include an internal bucky device that can be used as a horizontal radiography table
by installing a second X-ray tube and support unit. This provides the benefit of being able to
perform radiography of the abdomen and head areas. In addition, radiography of the chest is
possible using the radiography stand. One advantage of this system is its broad applicability.

3.5.2 Remote-Operated R/F Table Systems

An example of a remote-operated R/F table system is shown in Fig. 3.5.4.
Fig. 3.5.4 Example of a Remote-Operated R/F Table System
The major system components include a remote-operated R/F table and X-ray high voltage
generator. This gastrointestinal diagnostic system allows the operator to operate the system
and perform diagnoses remotely. Since the operator operates the system from a separate room,
this offers the benefit of operators not needing to wear protective aprons and minimizing
exposure to the operator.
a. General Purpose Systems

These are versatile systems that can be used for other applications besides the
gastrointestinal tract as well. An example is shown in Fig. 3.5.5.
Fig. 3.5.5 Example of a General Purpose System

b. Specialized Systems
Specialized systems include multidirectional radiography systems and indirect radiography
systems. An example of a multidirectional radiography system is shown in Fig. 3.5.6. It has
been designed to enable viewing target areas from any angle.
Fig. 3.5.6 Example of a Multidirectional Radiography System
An example of an indirect radiography system is shown in Fig. 3.5.7. This system captures
images from the image intensifier using a 100 mm or 110 mm indirect camera and is mainly
used for group examinations.
Fig. 3.5.7 Example of a Specialized Indirect Radiography System

3.6 Cardiovascular Diagnostic Systems

Cardiovascular diagnostic systems are used to perform contrast radiography examinations and
treatment (interventional radiography) of blood vessels and the heart. Areas diagnosed include
the heart, head, neck, abdomen, extremities, and others. An example of a cardiovascular
diagnostic system is shown in Fig. 3.6.1.
Fig. 3.6.1 Example of a Cardiovascular Diagnostic System
This system has been designed to enable viewing complicated vascular pathways from any
angle. Since the heart and blood vessels consist of soft tissue, contrast media are used to
provide adequate contrast in X-ray images. Examples of clinical images are shown in Fig. 3.6.2
and 3.6.3.
Fig. 3.6.2 Clinical Image of a Heart (Coronary Artery) Fig. 3.6.3 Clinical Image of a Head

3.7 Tomography Systems

Major system components include the tomography unit and X-ray high voltage generator.
An example of a tomography system is shown in Fig. 3.7.1. Tomography systems obtain cross
sectional images by simultaneously moving the X-ray tube and film according to specific rules.
Fig. 3.7.1 Example of a Tomography System
3.8 Surgical Diagnostic Systems

Surgical diagnostic systems are fluoroscopy/radiography systems used in surgery, repositioning,
emergency rooms, and other applications. They are designed to allow freely positioning the
various parts of the system as necessary to accommodate patients that cannot be moved.
An example is shown in Fig. 3.8.1.
Fig. 3.8.1 Example of a Surgical Diagnostic System

3.9 Diagnostic Mammography Systems

Diagnostic mammography systems are radiography
systems used for breast examinations. Since the soft tissue
of the mammary glands make it difficult to obtain adequate
contrast, radiography is performed using low tube voltage
levels of 20 to 40 kV. In addition, molybdenum is used as the
X-ray tube target material. The arm is designed to rotate so
the breasts can be examined from various angles.
It also includes a mechanism for compressing breasts to a
uniform thickness.
The system includes an X-ray generator capable of
generating low-energy X-rays, a radiography table equipped
with a mechanism for positioning breasts for radiography, an
image receiving unit, and other related equipment.
An example is shown in Fig. 3.9.1.
Fig. 3.9.1 Example of a Diagnostic

Mammography System
3.10 Group Examination Systems

Group examination systems are used to examine groups of patients and are available for
mammography or for gastrointestinal and chest examinations.
Fig. 3.10.1 shows an example of a group examination system for mammography, installed in a
bus. In this example, the system is also designed as a diagnostic ultrasound system.
Fig. 3.10.1 Example of a Group Mammography System

3.10 Group Examination Systems
Group examination systems for the gastrointestinal examination often use a specialized indirect
radiography system with a remote-operated R/F table system installed in a bus. Currently, with
the increasing switch to digital technology, sales of both indirect mirror X-ray cameras and
indirect spot filming X-ray cameras have been discontinued.
Examples of indirect mirror radiography and indirect image intensifier radiography systems are
shown in Fig. 3.10.2 and 3.10.3, respectively.
Spot Filming
Image Intensifier Camera
Rotating Indirect X-Ray X-Ray Tube Unit Subject Primary Lens
Fluorescent Screen Mirror Camera
Beam
X-Ray X-Ray Grid Mirror Optical Splitter
Tube Unit Subject System
Adjustable Fluorescent
X-Ray Input Surface X-Ray TV
Collimator System
Imaging Lens Image Orthicon

(2 and 3-inch)
R/F Table X-Ray High TV Spot
Voltage
Controller Generator Controller Filming
Camera
Controller
TV
Monitor
Fig. 3.10.2 Indirect Mirror Radiography Fig. 3.10.3 Indirect Image Intensifier Radiography

3.11 Pediatric Diagnostic Systems

Pediatric diagnostic systems are X-ray systems specialized for children. The major areas of
interest for pediatric diagnostic X-ray examinations include the head, chest, abdomen, and
extremities. The most important requirement for these systems is lower radiation exposure dose
levels for children, which means it is important to reliably perform examinations in as short a
time as possible, without causing fear or pain. Therefore, systems include an integrated
radiography table specifically designed for infants and children that enables safe and reliable
restraint and easy and reliable positioning.
In addition, since children are more susceptible to infection than adults, the structure needs to
facilitate easy sterilization. For contrast radiography examinations that require fluoroscopy, a
specialized accessory component is attached to the standard R/F table. Pediatric systems are
fundamentally the same as regular X-ray systems, but their structure is designed to be suitable
for examining infants.
An example of a system is shown in Fig. 3.11.1.
Fig. 3.11.1 Example of a Pediatric Diagnostic System

3.12 Diagnostic Urology and Gynecology Systems
3.12 Diagnostic Urology and Gynecology Systems

Diagnostic urology and gynecology systems are used for both or either general examinations
including endoscopy and/or diagnosis by X-ray photographs with respect to the urinary tract or
reproductive system disorders. If it is necessary, they are used as a treatment table. It is
applicable for the entire urinary tract, such as the kidneys, urinary duct, bladder, and urethra,
and reproductive organs, such as the seminal vesicles, uterus, and fallopian tubes.
An example of a system is shown in Fig. 3.12.1.
Fig. 3.12.1 Example of a Diagnostic Urology and Gynecology System
A basic system is configured as shown in Fig. 3.12.2 and is capable of fluoroscopy using an
X-ray TV system or digitizing X-ray images by combining it with a spot filming system and DR
system.
X-Ray Tube Unit

TV Monitor
Adjustable Collimator
Subject
Spot Filming
Unit
Image Intensifier Examination
Table
X-Ray Video Camera

Indirect I.I. Camera High Voltage Generator X-Ray Controller
Fig. 3.12.2 Configuration of a Diagnostic Urology and Gynecology System

3.13 Dental X-Ray Radiography Systems

Dental radiography systems are mainly intended for radiography of the teeth and surrounding
tissue. The basic configuration of the X-ray generator is fundamentally the same as a typical
medical X-ray system, but the X-ray capacity is lower.
In general, there are three types, as follows, which are used based on diagnostic objectives.
a. Intra-oral (dental) radiography system
b. Panoramic radiography system
c. Cephalometric radiography system
Examples of intra-oral, panoramic, and cephalometric radiography systems are shown in Fig.
3.13.1, 3.13.2, and 3.13.3, respectively.
Fig. 3.13.1 Intra-Oral Radiography System Fig. 3.13.2 Panoramic Radiography System
Fig. 3.13.3 Cephalometric Radiography System

4.1 Overview
4 Overview of X-Ray Generators

4.1 Overview
The components included in medical X-ray systems are specified by JIS Z 4701-1997, as follows.
However, regulations indicated in this chapter are based on JIS Z 4702 for X-ray high voltage
generator, which was revised in 1999.
X-Ray System X-Ray Generator X-Ray Source X-Ray Tube Unit

(including Unit (JIS Z 4704)
stand-alone X-ray
generator units Diagnostic Adjustable
equipped with a Collimator
beam limiting
device) High Voltage Cables with Plugs
(JIS Z 4732)
X-Ray High Voltage

High Voltage Generator
Generator
(JIS Z 4702)
X-Ray Controller
X-Ray Apparatus
X-Ray Imaging Device
X-Ray Image Processor
Related Equipment
To satisfy strong demands for improved diagnostic performance, IVR (interventional radiology)
applications, reduced exposure levels to patients and technologist, easier operability, and more
compact and light weight systems, the following improvements are being made.
 X-ray tube units with small foci and higher output capacity
 Combining units with digital image processors
 Changing to using inverters in high voltage generators

4.2 Meaning and Definitions of Key Terminology

4.2.1 Meaning and Units of Various Types of Dose Levels
SI Units Conversion Between SI

Item Definition
and Older Units
Symbol Term
1 atomic disintegration per
Radiation Bq Bequerel 1 Bq = 2.7027  10-11 Ci
second
(coulombs Quantity of X-rays (or gamma 1 C/kg = 3,876 R
Exposure
C/kg per rays) that creates 1 coulomb = 33.84 Gy*1
Dose
kilogram) of ions per kilogram of air = 33.84 Sv*2
Absorbed dose resulting from
Absorbed applying 1 joule of ionizing
Gy Gray 1 Gy = 100 rad
Dose radiation energy to 1 kilogram
of a substance
Product of absorbed
dose  radiation quality
Dose
Equivalent
Sv Seuvert factor  correction factor 1 Sv = 100 rem
(for X-rays, the quality and
correction factors are about 1)
1: Absorbed dose of air
2: Dose of air
4.2.2 Tube Voltage

The tube voltage is applied to both electrodes in the X-ray tube during X-ray emission. Normally,
tube voltage is expressed as a peak value in terms of kilovolts (kV). For capacitor type X-ray
high voltage generators, the value is the result of subtracting the voltage drop due to discharge
resistance from the charge voltage of capacitor for radiography.
4.2.3 Tube Current

This is the anode current that flows due to the electron beam hitting the X-ray tube anode during
X-ray emission. Tube current is expressed as an average value (mA). However, for radiography
performed using a capacitor type X-ray high voltage generator, it is the wave peak value (mAp).
Note: Tube current is normally measured at the anode, but in the case of metal clad X-ray tubes,
the tube current is considered the current flowing through the cathode.
4.2.4 Long-Term Rating

This is the rating applicable for performing fluoroscopy. It indicates the maximum tube voltage
that can be applied continuously to the X-ray tube for over ten minutes and the maximum tube
current at that tube voltage.

4.2 Meaning and Definitions of Key Terminology
4.2.5 Short-Term Rating

This is the rating applicable for performing radiography. It is expressed as a combination of the
maximum tube current that can be applied to the X-ray tube, generally for at least one second
(0.1 seconds for inverter-type X-ray high voltage generators), and the maximum tube current
that can be applied at that voltage. However, for inverter-type X-ray high voltage generators with
capacitor energy storage or capacitor type X-ray high voltage generators, it indicates the
maximum tube voltage (kV) that can be applied to the X-ray tube multiplied by the duration the
tube current is applied (mAs). Alternatively, it can be expressed as the capacitor capacity (F)
used for radiography.
4.2.6 Maximum Nominal Power Supply

This is the maximum power that can be applied to an X-ray tube for the load time indicated in the
instruction manual.
For inverter or transformer models, it is the usable tube voltage, given a tube voltage of 100 kV
applied for 0.1 seconds, multiplied by the maximum tube current, calculated as follows.
P = U  I  f  10-3
Where,
P: Maximum nominal power (kW)
U: Tube voltage (kV)
I: Tube current (mA)
f: Constant determined based on the percent ripple of tube voltage, as follows.
f=1 10 % ripple or less
f = 0.95 More than 10 % ripple, but 25 % or less
f = 0.74 More than 25 % ripple
The percent ripple for tube voltage is determined using the following formula.
U max  U min
Percent Ripple of Tube Voltage = 100 (%)
U max
In this case,
Umax: Maximum value of tube voltage waveform
Umin: Minimum value of tube voltage waveform (excluding spikes in constant voltage circuits)
4.2.7 Exposure Time

This is the length of time the X-ray exposure dosage exceeds a level useful for radiography,
which is defined as follows, depending on the method used for the X-ray high voltage generator.
(1) Models with Inverters or 6/12 Peak Transformers
The time extending from when the voltage reaches 75 % of the specified tube voltage on the
up-slope and down-slope of the tube voltage waveform.
Tube Voltage
Waveform
Tube Voltage
Time
Exposure Time
Switched ON
Fig. 4.2.1 Exposure Time of Inverter-Type and 6/12 Peak Waveform X-Ray High Voltage Generators

(2) Double-Peak Transformer Models

The portion exceeding an electrical angle of 45 degrees is counted as one pulse.
Tube Voltage
Waveform
Tube Voltage
Time
Switched ON
Exposure Time (3 pulses)
Fig. 4.2.2 Exposure Time of Double-Peak Waveform X-Ray High Voltage Generators
4.2.8 IGBT
An IGBT (insulated gate bipolar transistor) combines a MOS-FET (metal oxide semiconductor
field effect transistor) input gate with a bipolar transistor output gate on a single semiconductor
element. IGBT are actuated by voltage between gate emitters and are self-extinguishing
devices that can be switched ON/OFF by an input signal. Therefore, because they are capable
of high-speed switching at high power levels, they are often used for inverters in inverter-type
X-ray systems. Normally, if the system includes a 3-phase inverter, four sets of independent
power supplies are required for gate signals, but because IGBT gate current levels are low, the
charge stored in a capacitor can be used for actuation.
4.3 X-Ray High Voltage Generator

X-ray high voltage generators are a combination of a portion that generates high voltage
supplied to the X-ray tube and a portion that controls the X-rays. Normally, this consists of a high
voltage generator and an X-ray controller.
There are three categories of X-ray high voltage generators – inverter, transformer, and
capacitor based models. Constant voltage X-ray high voltage generators are included in each of
these categories.
4.3.1 Transformer-Type X-Ray High Voltage Generators

Transformer-type X-ray high voltage generators comprise a high voltage transformer, high
voltage rectifier, power supply voltage regulator, X-ray tube, voltage regulator, X-ray tube
current regulator, exposure time controller, radiography parameter display unit, and other
supplemental circuitry and miscellaneous parts. They can be categorized as either single-phase
full-wave rectifier or three-phase full-wave rectifier, based on the type of power supply voltage.

(1) Single-Phase Full-Wave Rectifiers

These models use a single-phase power supply and have a relatively simple design. They
are often used in general radiography and fluoroscopy systems, but such applications are
now increasingly switching to inverter-type models.
Control System High Voltage

Timer Generator
High Voltage
Transformer
Rectifier
X-Ray Tube
Heating Transformer
Fig. 4.3.1 Basic Circuit of Single-Phase Full-Wave Rectifiers
(2) Three-Phase Full-Wave Rectifiers

Three-phase full-wave rectifiers use either of two methods – 6-peak or 12-peak rectification.
High voltage control method is also available to control or switch tube voltage using tetrode
or triode tubes.
Using a three-phase power supply makes it easy to supply high power levels to achieve
high power output levels. In addition, for the same tube voltage and tube current,
three-phase rectifiers provide higher X-ray levels per unit time than single-phase full-wave
rectifiers, due to a high voltage waveform with a higher number of peaks and lower percent
ripple.
Control System High Voltage Generator

High Voltage Rectifier
Timer
Transformer
X-Ray Tube
Heating Transformer
Fig. 4.3.2 Basic Circuit of Three-Phase 12-Peak Full-Wave Rectifiers

4.3.2 Inverter-Type X-Ray High Voltage Generators

(1) Inverters
Inverters are a power conversion system that converts direct current to alternating current.
They are used in medical system support units and fluoroscopy tables to control actuation
speed, for example. Due to recent improvements in semiconductors used for high-speed
high-power applications, they are now even used for X-ray high voltage generators,
replacing the transformers and capacitors conventionally used in the past.
Fig. 4.3.3 shows the basic circuit of an inverter.
When switches S1 and S4 are switched ON
(closed), the load current flows in the direction from
S1 to the load and S4. Next, when S1 and S4 are Load
switched OFF (opened) and S2 and S3 are
switched ON, the current flows to the load in the
opposite direction. By repeating this process, a
square wave is applied to the load.
Fig. 4.3.3 Principle of Inverters
In other words, it converts direct current to
alternating current. Any frequency can be achieved by varying how often the flow is
switched. If a period when all switches are OFF (idle period) is provided, then no current
flows during that time, which results in intermittent flow of load current. Without this idle
period, maximum power is applied to the load, but a longer idle period reduces the load
power.
Therefore, the power (inverter output) applied to the load can be controlled in this way.
(2) Principle of Inverter-Type X-Ray High Voltage Generators

In contrast to transformer-type X-ray high voltage generators, which apply power to the high
voltage generating unit at the same frequency as the power supply (50 or 60 Hz), power
supplied to inverter units, as shown in Fig. 4.3.4, is rectified and smoothed. At that point, it is
converted to a high frequency (typically between several kHz to tens of kHz) before being
applied to the high voltage generating unit.
A high voltage generating unit is basically the same as a regular single-phase transformer,
but due to the higher frequency, the voltage is smoothed by the stray capacity of the high
voltage cable, providing a direct current with minimal ripple to the X-ray tube.
As a result, even with a single-phase power supply, an inverter system can provide a
smoother output than from a three-phase X-ray system.
High Voltage
Rectifier Inverter
Generating Unit
Variable
Voltage
Current X-Ray Tube
DC/AC
Conversion
X-Ray
Controller
Fig. 4.3.4 Inverter-Type X-Ray High Voltage Generator

The inverter is explained in more detail below.

Inverter circuits either produce sine waves (resonant) or square waves (non-resonant),
which are used depending on the instrument. A semiconductor switching element is used
for switching.
Category Circuit Component Waveforms
Sine Wave
(resonant)
Ｉ
Thyristor
Square Wave
Ｉ
Power
transistor
Fig. 4.3.5 Inverter Circuit Types
Sine-wave models use series LC resonance for the load side, typically with thyristors as a
switching element.
They work on the same principle as shown in Fig. 4.3.3, where thyristors S1 and S4 switch
ON in response to an external gate pulse, causing resonant LC current to flow to the load.
A large current flows during the positive half-cycle, but the thyristor switches to reverse bias
during the negative half-cycle, which mostly blocks the current flow and stops the
resonance. Next, when a gate pulse is applied to thyristors S2 and S3, this time the
resonant current flows in the opposite direction, which results in a similar action.
A sinusoidal output waveform is obtained by repeating this process.
The switching period of the switch is determined by the resonant frequency of the LC (in
other words the amplitude of the output sine wave). Output is controlled through a
combination of switching the C value and controlling the length of idle time.
An example of a resonant inverter-type X-ray high voltage generator circuit is shown in Fig.
4.3.6.

Rectifier Circuit Inverter Circuit
Power
Supply X-Ray
Tube
Heating
Circuit
Inverter Drive Circuit Actual Signal
Comparison
Irradiation Signal
Irradiation Signal
CPU Control Circuit kV Setting Signal
Condition Setting
mA Setting Signal
Fig. 4.3.6 Circuit of Resonant Inverter-Type High Voltage Generator
The gate pulse for the inverter circuit is controlled by feedback of X-ray tube voltage from
the high voltage side.
Square-wave models use a power transistor as a switching element.
Without a resonant circuit, the power transistor conducts only the external gate pulse
amplitude.
Consequently, output is controlled through a combination of gate pulse amplitude (i.e.
switched-ON time) and the length of idle time.
Recently, IGBTs for power control have started being used as switching elements.
An example of a square wave inverter-type X-ray high voltage generator circuit is shown in
Fig. 4.3.7.
In this way, the inverter output (i.e. the X-ray output) wave can be controlled by controlling
the pulse amplitude and idle time, but significantly changing either of these (especially the
length of idle time) changes the output frequency, which changes the degree of high voltage
smoothing, due to the stray capacity of the high voltage cable. In other words, changing
them is undesirable because it would significantly change the percent ripple of the tube
voltage for each set of X-ray parameters.
Therefore, the inverter input voltage is varied as a method of varying the output without
changing the frequency. A chopper circuit serves that purpose in the example shown in Fig.
4.3.7, which shows how both the chopper circuit and inverter circuit are controlled as the
control/drive circuits that determine X-ray parameters.
In diagnostic X-ray systems, the tube voltage and tube current both need to be controlled
over an extremely wide range of values. Furthermore, if possible, the percent ripple should
be small over a wide range. Actual systems incorporate a certain amount of special
modifications for each instrument, based on the basic control circuits described above.

High Voltage Generator

Chopper
(solid insulation)
Rectifier Circuit Circuit Inverter Circuit High Voltage
Cable
mA Detector
Power
X-Ray
Supply
Tube
Tube Tube
Drive Circuit Voltage Current Heating
Detection Detection Circuit
Control Circuit
Fig. 4.3.7 Circuit of Square Wave Inverter-Type X-Ray High Voltage Generator
(3) Performance
a. Power Supply Equipment
Transformer models must supply all power required during X-ray exposures from the
power supply line, no matter how short the exposure time, but inverter models require
less instantaneous power from the power supply line, due to an averaging effect of the
high capacity capacitor. In addition, voltage is rectified and smoothed, either
single-phase or three-phase power supplies may be used. However, a high apparent
resistance of the power supply line can cause output to drop or trip the power supply
circuit breaker. Therefore, it is important to check the power supply line during
installation and maintenance.
b. High Voltage Generators
The constituent parts are basically the same as a transformer-type system, but because
the high voltage transformer is operated at high frequency, they can be designed
smaller and lighter, due to the smaller iron core and fewer coil windings required.
This results in systems that are about 1/3 to 1/10 the weight of conventional models.
c. Waveform of Tube Voltage
Due to low tube voltage percent ripple levels of about 2 to 20 %, depending on the
circuit configuration, some systems have ripple levels equivalent to or better than
3-phase 12-peak systems. This means that compared to a double-peak transformer
models, the output dose at a given mAs level is higher and ON/OFF times can be
shorter, which permits shorter exposure times and lower levels of undesirable soft
X-rays. Percent ripple is affected by the circuit configuration, inverter frequency, and
stray capacity of the X-ray high voltage cable. The stray capacity of high voltage cables
is about 250 pF/m, resulting in an effective capacity of about 1250 pF when using a
10 m long cable, for both (+) and (-) charges.
d. Short Radiography Times
A semiconductor device capable of high speed switching is used to switch X-rays
ON/OFF. Additionally, high voltage transformers have a high dynamic frequency, which
enables short exposure times of about 1 ms. However, though the tube voltage rise time
is good, the lower the tube current, the more the fall time is affected by the stray
capacity of the high voltage cable. The shorter the exposure time, the greater the effect
tube voltage rise and fall times have on the linearity of X-ray output and image darkness.
The exposure timer error used to be governed by JIS Z 4702-1993 and specified in terms
of mean percent error, but JIS Z 4702 was revised in 1999 and now error is specified as

 (10 % + 1 ms), for both transformer and inverter systems.

e. EMC (electromagnetic compatibility)
Inverter systems handle high power levels, up to 30 to 100 kW for high frequency
square waves, which can not only cause a negative effect on the instrument's own
images and functions due to the high frequencies generated, but can also cause
damage to other equipment. Manufacturers have worked hard to improve this problem,
but EMC problems can also be caused by the power supply equipment, unit layout,
grounding method, and other factors. Therefore, particular care is required during
installation and maintenance.
4.4 High Voltage Generators

High voltage generators convert the voltage supplied from the X-ray controller to the high
voltage levels required for the X-ray tube and supply it to the X-ray tube. They include the
following components.
 High voltage transformer (main transformer)
 X-ray tube filament heating transformer
 High voltage rectifier
 X-ray tube selector (high voltage switch)
 X-ray high voltage cable receptacles
 X-ray tube voltage detector (for some inverter models, etc.)
 X-ray tube current detector (for some inverter models, etc.)
 For capacitor-type X-ray systems, a high voltage capacitor. Systems with a triode X-ray tube
include a controller and other components.
 Systems using secondary high voltage control include a tetrode tube and corresponding
controller circuits or a high voltage capacity semiconductor element.
 If a microfocus X-ray tube is used for magnification radiography, then a grid voltage control
circuit
4.4.1 Rectified Tube Voltage Waveform

(1) Single-Phase Full-Wave Rectification
kV
High Voltage
Transformer
X-Ray
Tube
Fig. 4.4.1 Basic Circuit of Single-Phase Fig. 4.4.2 Tube Voltage Waveform of
Full-Wave Rectification Single-Phase Full-Wave Rectification

4.4 High Voltage Generators
(2) 3-Phase 12-Peak Rectification

High Voltage Transformer
kV
X-Ray
Tube
Fig. 4.4.3 Basic Circuit of Three-Phase Fig. 4.4.4 Tube Voltage Waveform for
12-Peak Rectification Three-Phase 12-Peak Rectification
(3) Inverter Systems

The tube voltage waveform of inverter-type systems is close to a constant voltage profile,
but can vary depending on the inversion method (square wave or resonant), load, and
filament heating method.
An example of a waveform for an inverter frequency of 15 kHz, 80 kV, 200 mA, and 50 ms is
shown.
DG UNIT 1
Fig. 4.4.5 High Voltage Circuit for Inverter-Type Fig. 4.4.6 Tube Voltage Waveform for
System Square Wave Inverter
4.4.2 Voltage Transformer

The induced electromotive force E of a high voltage transformer is expressed by the following
formula.
E = 4.44  f N B Q(V)
In this case, f= Frequency (Hz)
N = Number of windings
B = Magnetic flux density (Wb/m2)
Q = Cross sectional area (m2) of iron core
It shows that by increasing the frequency f, the number of windings n and iron core cross
sectional area Q can be decreased. Inverter-type systems utilize this characteristic to achieve
smaller and lighter high voltage transformers by increasing the frequency. For example, by
using an inverter frequency of 10 kHz, while keeping the number of windings N and flux density
B the same, the iron core cross section can theoretically be reduced to 50/10000 = 1/200 of a
50 Hz transformer, which allows reducing the size significantly. However, actual high voltage
generators require a certain amount of creepage distance for insulation and higher frequencies
result in higher losses (iron loss). In addition, the filament transformer, high voltage switches,
and other component remain the same size, so the weight is about 1/3 or 1/10.
Transformer cores are generally made of silicon steel plates, but to reduce iron losses,
inverter-type systems use materials with lower losses at high frequencies, such as amorphous
or ferrite.

4.5 X-Ray Controller

X-ray controllers are systems used to control the X-ray tube voltage, X-ray tube current, and
X-ray exposure time for acquiring X-ray photographs consistent with clinical objectives. They
include the following components.
 Power Supply Voltage Regulator:
This adjusts the power supply voltage to compensate for any fluctuations. As recent
systems become increasingly electronic and automated, they do not necessarily include a
voltage regulator.
 X-Ray Tube Voltage Regulator:
Controls the high voltage for X-ray tubes to the target voltage level.
 X-Ray Tube Current Regulator:
Controls the current that flows through X-ray tube filaments and to the target tube current
level and corrects for increases/decreases in tube current depending on the space charge
effect.
 Exposure Time Controller:
Controls the irradiation exposure level per pulse of X-rays.
 Radiography Parameter Display:
Device that displays the specified X-ray exposure parameters to the user or X-ray
exposure parameters used for X-ray output during radiography
 Radiographic Technique Selector:
Controls the method of deciding X-ray parameters for radiography and areas where the
radiography method is selected.
 Automatic Exposure Controller:
Automatically controls radiography parameters according to the film or detector sensitivity
levels.
4.5.1 X-Ray Tube Voltage Controller

Currently, inverter-type X-ray tube voltage controllers are commonly used, but the
conventionally controlled systems are also explained.
(1) Non-Inverter Systems
Transformer-type systems use a transformer and tap switch or servo-controlled sliding
transformer. These include a correction function that compensates for voltage drops due to
load current, based on radiography tube current. Some 3-phase systems control high
voltage using tetrode or triode tubes or semiconductor elements tolerant of high voltages.
(2) Inverter Systems
Inverter-type systems generally detect secondary tube voltage and use feedback control to
control high voltage.
In many of the systems, the high voltage level is control by controlling inverter voltage,
controlling inverter frequency, or controlling the inverter duty cycle.

4.5 X-Ray Controller
4.5.2 X-Ray Tube Current Regulator

The tube current is controlled by controlling the power for heating the X-ray tube filament.
To prevent effects by power supply voltage drops during X-ray exposure, current is adjusted
through a stabilized alternating current power supply using power supply winding resistors or by
using an inverter referred to as a semiconductor direct current heating type. The semiconductor
direct current heating method is able to reduce ripple in the filament heating current by
increasing the inverter frequency and also reduce X-ray tube current ripple. Current
inverter-type systems include systems with an inverter frequency of about 50 kHz.
(1) Correction for Space Charge Effect
This compensates for the space charge effect by correcting X-ray tube filament current to
ensure a specified tube current flows even if the tube voltage varies.
Inverter-type systems often detect secondary tube current and use filament current for
feedback control to make sure tube current remains constant even if the tube voltage is
varied.
(2) Preheating Circuit
To improve the X-ray tube current rise time and extend the service life of filaments, filaments
are continuously preheated with a filament heating power level that is sufficiently low to
prevent current from flowing through the tube.
(3) Tube Current Measurement Problems
Measuring Intermediate Points: The AC current due to the stray capacity of the secondary
coil of the high voltage transformer is superimposed with the charging current of high
voltage cables. This effect is more prominent the lower the tube current, such as for
fluoroscopy, where the effect of stray capacity of the secondary coil of the high voltage
transformer is to increase current by 0.5 to 1 mA at 100 kV.
An example of a tube current detector circuit for a single-phase double-peak
transformer-type system is shown in Fig. 4.5.1.
For inverter-type systems, tube current is measured by connecting a tube current meter to
the X-ray tube anode terminal, due to the large stray capacity effect.
Primary Voltage Transformer High Voltage Rectifier X-Ray Tube Unit
Rectifier for
Measuring mA
Compensation
Transformer
Charge current in tube current and high voltage cables

AC current due to stray capacity of secondary coil Indicates polarity
AC current due to compensation circuit
Fig. 4.5.1 Basic Circuit for Single-Phase Double-Peak Tube Current Detection

(4) Automatic X-Ray Exposure Controller

This system detects X-ray exposure and stops X-ray exposure when the film reaches an
appropriate level of darkness. Three detector types are available, an ion timer type, a
phototimer type, and a semiconductor detection type, where most systems made in Japan
are phototimer type detectors. X-ray detection methods include front photo pickup, where
the detector is positioned in front of the image intensifier or cassette, and rear photo pickup,
where the detector is positioned behind the image intensifier or cassette.
a. Operating Principle
An example of a fluoroscopy spot filming system configured with an automatic X-ray
exposure controller is shown in Fig. 4.5.2.
The figure also shows how X-rays that pass through the object are converted to visible
light and amplified by the image intensifier (I.I.). Part of the light output from the I.I.
passes via a splitter and is sent to a photomultiplier tube, where it is converted to an
electric signal. This electric signal is integrated in an integrating circuit, where the
integrated values, which correspond to the film light exposure level, are compared by a
comparator to a reference value specified by a film darkness setting unit. When the
integrated value reaches the specified value, an X-ray OFF signal is generated to stop
X-ray exposure.
Tabletop
Video Camera Splitter Cassette
X-Ray Tube Unit
Photomultiplier
Tube
Automatic Exposure X-Ray High Voltage

Amplification Integration Controller Generator
Circuit Circuit
X-Ray OFF X-Ray High Voltage
Comparison
Signal Controller Generator
Circuit
Darkness Circuit
Setting
Circuit
Fig. 4.5.2 Components of an Automatic X-Ray Exposure Controller
b. Characteristics
Performance characteristics of the automatic X-ray exposure controller include
response time characteristics, tube voltage characteristics, detector photo pickup field
characteristics.
In terms of detector photo pickup characteristics, front photo pickup method affects
detector X-ray absorption and scattered rays, compared to rear photo pickup method,
and has the disadvantage of a greater decrease in image quality and higher patient
exposure dose.
Also, the greater the detector thickness, the farther the distance between the object and
film, which means that, given a certain X-ray tube focus size, the geometric blurring is
greater and image quality suffers.
The rear photo pickup method has generally higher X-ray absorption due to the
cassette and film being located between the X-ray source and detector and it also has

4.6 X-Ray Tube Units
worse dependence on tube voltage. If the rear absorption of the cassette is reduced to
reduce tube voltage dependence characteristics, the film becomes more vulnerable to
the effects of rearward scattered rays.
c. Response Time Characteristics
For single-phase double-peak systems, the minimum exposure time of one pulse is
about 1/100 or 1/120 seconds. However, since automatic exposure control can shut off
X-rays at any time, there are problems with variability in film darkness. This effect can
be particularly significant in the short-time region. In contrast high voltage tetrode
controlled inverter systems allow shutting off X-rays at any time desired. Therefore, film
darkness is stable even in the short-time region.
d. Tube Voltage Characteristics
Since detectors and the sensing material used for radiography (film and intensifying
screens) have different X-ray quality characteristics (the efficiency of converting X-rays
to electrical quantities or photometric quantities is dependent on the X-ray quality), the
difference in their respective X-ray absorption levels results in a difference in X-ray
quality due to a filtering effect.
To correct for this effect, many automatic exposure controllers include a tube voltage
correction circuit, based on the intensifying screen and film used by the user.
Automatic exposure controllers for indirect radiography detect exposure levels by
splitting the visible light from a mirror camera or other fluorescent screen or image
intensifier used for radiography. Therefore, automatic exposure controllers
fundamentally have low dependence on tube voltage.
e. Detector Photo Pickup Field Characteristics
Detector photo pickup field characteristics occur due to a combination of factors
including the area being diagnosed and shape and position of the detector, and due to
differences in average darkness requirements. Some detectors are equipped with
multiple detector photo pickup fields, which allows combining one or more depending
on objectives.

4.6.1 Overview
Medical X-ray tube units used for diagnostics are either fixed anode X-ray tube units or rotating
anode X-ray tube units. X-ray tube units are also available for treatment applications, but except
for mammography systems, this section primarily focuses on rotating anode X-ray tube units for
diagnostic applications. (X-ray tubes for mammography are described in the section on
mammography systems.)
Rotating anode X-ray tube units are available with either glass tubes or metal tubes. Glass has
traditionally been used for tubes, but they are fragile and special care is required to protect them
from mechanical shock and vibration during transport or handling. On metal X-ray tubes, metal
is used for the emission port and the area around it. Therefore, it can tolerate higher loads than
glass tubes and provide better contrast due to lower X-ray absorption. Glass is used for
non-metal portions, so it still must be handled with the same care as glass tubes.
The rotor rotation mechanism is available in bearing and liquid metal bearing types. Rotors with
liquid metal bearings were developed as an alternative to conventional ball bearings. These use
a metal lubricant that is a liquid at ambient temperatures. The liquid metal bearing provides
better cooling performance, enables smaller and lighter units, and provides lower vibration and
noise than normal bearings.

Fig. 4.6.1 shows X-ray tubes used in rotating anode X-ray tube units. The left photo is of a glass
tube, which shows how the anode and filaments are configured. The center photo is of a metal
tube, which does not permit seeing inside. The right photo is of a metal tube equipped with liquid
metal bearings for the rotating mechanism.
Glass Tube Metal Tube Metal Tube

(standard bearing) (standard bearing) (liquid metal bearing)
Fig. 4.6.1 Tube Construction
4.6.2 Definitions and Meaning of Key Terminology

The following definitions are from JIS Z 4704-1994 X-ray tube assemblies for medical use.
(1) Effective Focus
Vertical projection of a real focus on a reference surface. Normally referred to simply as the
focus. The nominal size of the effective focus is a dimensionless number normally
expressed in terms of the dimension perpendicular to the X-ray tube axis (width) and the
dimension in the direction parallel to the X-ray tube axis (length) in millimeter (mm) units.
Target
Effective Focus
Electrons
Electron
Collision
Real Focus
Surface
Fig. 4.6.2 Electron Impact Surface and Focus of a Rotating Anode (Target)
(2) X-Ray Tube Current

This is the electron beam current incident to an X-ray tube target (normally referred to as the
tube current). Tube current is expressed as a mean value in milliamperes (mA). However,
for radiography performed using a capacitor-type X-ray high voltage generator, it is
expressed as a peak value in units of milliampere peak (mAp).
Note: Tube current is normally measured at the anode, but if a metal clad X-ray tube is
used, then the tube current is considered the current flowing through the cathode.
(3) Percent Ripple of Tube Voltage

Percent Ripple of Tube Voltage = (Umax - Umin)/Umax  100 (%)
Where, Umax: Peak value of tube voltage waveform
Umin: Minimum value of tube voltage waveform
(excluding spikes in constant voltage circuits)

(4) Heat Unit

Unit used to express the amount of residual or cumulative heat in an X-ray tube. The symbol
for heat units is HU, values for which can be determined using the following formula based
on the X-ray tube circuit.
HU Value = Peak Value of Tube Voltage Waveform (kV)  Mean Tube Current Value
(mA)  Load Time (seconds)  Coefficient
Coefficients are indicated in Table 4.6.1.
Table 4.6.1 Coefficients for Heat Unit Calculation
Type of X-Ray Tube Circuit Coefficient

Single-phase full-wave rectifying circuit 1.00
3-phase full-wave rectifying circuit or circuit
1.35
with equivalent percent ripple
Constant voltage circuit, inverter type 1.41
However, for capacitor-type systems, it is determined using the following formula.

HU Value = 0.71 Ws  C  (U12 - U22)
C = Capacitor capacity (F)
U1 = Tube voltage (kV) when discharge starts
U2 = Tube voltage (kV) when discharge ends
The heat unit (HU) is being replaced by the SI unit, the joule (J), which can be calculated as
follows.
1 HU = 0.71 Ws = 0.71 J
(5) Anode Input

The anode input is the power applied to the X-ray tube anode to generate X-rays and is
calculated as follows.
Anode Input = U  I  f  10-3 (kW)
Where, U: Tube voltage (kV)
I: Tube current (mA)
f: Constant determined based on percent ripple of tube voltage. Therefore,
f = 1.0 for percent ripple levels of 10 % or less
f = 0.95 for percent ripple levels of more than 10 %, but not exceeding 25 %
f = 0.74 for percent ripple levels of more than 25 %
(6) Anode Cooling Curve

The anode cooling curve is a graph of the anode heat content as a function of time, as the
anode cools after a load is applied until the anode heat level reaches the anode's maximum
heat capacity and the anode input is then set to zero.
Note: The proportional decrease in anode heat over this time is called the anode cooling
rate, where the maximum rate is called the maximum anode cooling rate.

(7) Heel Effect

As shown in Fig. 4.6.3, the intensity distribution in the X-ray tube axial direction (from anode
to cathode) is not uniform, but rather has a maximum intensity point closer to the cathode.
Therefore, intensity gradually diminishes, the closer it is to the anode. This intensity profile
in the tube axial direction is called the heel effect. Since the heel effect is dependent on the
target angle, particular care is required with respect to the film size and direction of
radiography.
To obtain uniform image brightness in chest radiography, it is common to utilize this
characteristic by orienting the anode toward the head.
Fig. 4.6.3 Intensity Distribution in Tube Axial Direction (Heel Effect)
(8) Space Charge Effect

Since negatively charged electrons in the tube inhibit electron flow, this phenomenon
restricts the flow of electrons discharged from the cathode. Even if the filament heating
power is constant, this effect causes tube current to increase when the tube voltage
increases. This is especially prominent the higher the tube current.
An example is shown in Fig. 4.6.4. For example, given a filament current of 4.75 A and an
X-ray tube voltage of 40 kV, the X-ray tube current is about 105 mA and at 100 kV it is about
160 mA. This difference is about 55 mA, whereas for a filament current of 5.25 A, it is about
215 mA at 40 kV and about 385 mA at
100 kV, which is a difference of
170 mA.
To correct for this space charge effect,
Tube Current (mA)
Filament Voltage (V)
125 to 150 kV
a compensation transformer is used to
reduce filament current when the tube
voltage increases and prevent the
tube current from changing even if the
tube voltage is varied.
Inverter-type systems often detect
secondary tube current and use
filament current for feedback control to
ensure tube current remains constant
Filament Current (A)
even if the tube voltage is varied.
Fig. 4.6.4 Characteristic Curves of X-Ray Tube
Filament Heating and Tube Current

(9) Recoil Electron Flow

Some of the thermal electrons that collide
with the X-ray tube anode form a flow of
recoil electrons, which can cause
off-focus X-rays. Metal clad X-ray tubes
(metal X-ray tubes) can be used to
reduce off-focus X-rays by grounding this
recoil electron flow via the metal cladding. 100 % 92 %
Since this recoil electron flow is 7 to 10 % Metal Cladding Recoil Current
of the anode current, caution is required
when measuring the tube current of metal
X-ray tubes. Fig. 4.6.5 Diagram of Recoil Electron Flow
4.6.3 X-Ray Tube Function and Performance

(1) Target Angle
Target angles of 16 to 18 degrees used to be the norm, but now use of low angle X-ray tubes
(10 to 12 degrees) is increasing. Given the same effective focus size, low angle X-ray tubes
have a larger real focus size (surface area where electrons collide with the target).
Therefore, a higher tube current can be achieved. This makes possible for low-kV
short-exposure radiography, which helps improve image quality. However, this results in a
narrower effective cone beam and increases the intensity of the heel effect, so low angle
X-ray tubes should only be used for appropriate applications.
(2) X-Ray Tube Housing
Of the total power applied to the X-ray tube, only about 1 % is converted to X-rays, which
means the remaining 99 % or more is converted to heat. Various measures are used to cool
this heat, such as by installing an external fan, circulating insulating oil, or cooling the
insulating oil via a heat exchanger.
(3) Loading Parameters and Size of Focus
The focus size of X-ray tubes varies depending on loading parameters, which varies more,
the lower the tube voltage, the higher the tube current, or the smaller the focus. This is due
to mutual repulsion between electrons as the electron density increases.
(4) Off-Focus X-Rays
Off-focus X-rays are generated from the entire anode, where their
quantity can be as much as 20 to 30 % of on-target X-rays for individual X-ray tubes. These
cause general fogging, which reduces contrast. With metal X-ray tubes, recoil electron flow
is grounded via the metal cladding to reduce off-focus X-rays.
Placing a shielding plate near the focus is an effective way to reduce off-focus X-rays.
Therefore, sometimes a lead cone is attached to the emission port or a baffle, which is a
barrier that restricts the cone beam, is installed at the emission port of adjustable X-ray
collimators.

4.6.4 Allowable Load

(1) Load Types
a. Short-Term Load
Since the focus surface on the target quickly becomes extremely hot when a load is
applied during radiography, the allowable load is limited by the focus surface
temperature.
b. Long-Term Load
During fluoroscopy, the input level is relatively low. Therefore, due to thermal
conductivity, the focus surface temperature is not a problem. However, due to
accumulated heat, the load is limited by the temperature increase of the overall anode.
c. Mixed Loads
If multiple short-term exposures are performed in succession or if alternating between
fluoroscopy and radiography, loads consist of a mixture of short-term and long-term
loads, which can cause the cooling efficiency of the anode and X-ray tube housing to
become a limiting factor.
d. Other Loads
Thermal characteristics of X-ray tube units must take into consideration filament loads,
stator loads (heat generated during startup and braking), and other factors.
(2) Diagram of Thermal Characteristics
a. This diagram shows that heat accumulates as
load inputs are applied to X-ray tube units for Residual (or Cumulative) Anode Heat (kJ)
fluoroscopy and radiography.
b. Characteristic curves for applying inputs to X-ray
tubes units for fluoroscopy and radiography
include anode thermal characteristic curves for
only the anode and total thermal characteristic
curves for the overall X-ray tube unit.
c. Anode thermal characteristic curves include
anode heating and anode cooling curves.
d. If an averaged constant input is applied, such as
for fluoroscopy, accumulated heat increases Heating Cooling
according to the heating curve.

e. The allowable limit for accumulated heat is Cooling (or Loading Time) (min)
referred to as the anode heat capacity (anode Fig. 4.6.6 Anode Thermal Characteristics
cumulative heat capacity).
f. The system must be operated so that the total heat value for the input never exceeds
this range, regardless of circumstances.
g. If input to the X-ray tube is stopped, accumulated anode heat cools according to the
cooling curve.
h. The slope of a line tangent to the cooling curve indicates the cooling rate at that
temperature (residual heat). Therefore, the slope at the maximum temperature
(maximum heat) indicates the maximum cooling rate (in watts (W) or HU per unit time).
i. These maximum cooling rates indicate the proportional release of heat when the anode
or X-ray tube unit is at its maximum allowable temperature. This means that a
proportionally equivalent load can be applied for extended periods. This is called the
long-term allowable load.
Based on the maximum cooling rate, the current value can be calculated for the
long-term allowable load at any particular tube voltage point, as follows.
Maximum Cooling Rate (J/s) or (W)

= Tube Current (mA)
Tube Voltage (kV)

The following illustrates using this formula to calculate the tube current using the tube
parameters indicated below.
Example: Given a 80 kV load applied to an inverter-type system with an X-ray tube
having a maximum cooling rate of 475 W, the current is calculated as follows.
Maximum Cooling Rate (J/s) or (W) 475 (W)

= = 6 (mA)
Tube Voltage (kV) 80 (kV)
(3) Load Curve

When loads corresponding to the maximum
Residual (or Cumulative) Anode Heat (HU)
Cools according to
cooling curve cooling rate are applied, heat saturation level is
reached at point Hm, as indicated by curve (a) in
the figure to the left. If a larger load is applied, as
indicated by curve (b), heat saturation is reached
at point t1, at which point the load must be stopped
and restarted only after cooling has occurred
according to the cooling curve. If a smaller load is
Cooling Curve applied, as indicated by curve (c), heat saturation
occurs below the Hm level, which means it can
Load Curve
continue to be operated indefinitely at that level.
Cooling (or Loading) Time (min)

Fig. 4.6.7 Temperature Increase of X-Ray
Tube and Tube Housing Due to
Continuous Loads
(4) Continuous Radiography

Loads during continuous radiography, which are
Allowable Focus Temperature
applied as much as several times per second,
generate heat at the anode according to the
Focus Surface process shown in Fig. 4.6.8.
Therefore,
Temperature
Pulse a. The repeated pulse-type loads applied to the

Load Target focus surface dramatically increase the
temperature of the target surface.
b. This increases the temperature of the entire
X-Ray Tube target and also the anode rotor.
Housing
Overall Anode c. As long as repeated loads are applied, the
tube housing temperature increases due to
Loading Time thermal radiation and thermal conductivity.
Fig. 4.6.8 Temperature Increase of X-Ray
Tube and Tube Housing Due to
Repeated Loads
Therefore, as a simple method for determining the allowable load for continuous exposures
such as this, the total actual loading time, which is equal to a single exposure dose multiplied by
the number of exposures (number of film sheets), must be within the range indicated in the
X-ray tube maximum load rating table.

4.6.5 Measurement Method and Allowable Tolerance for Focus

Size
The tolerances and methods for measuring focus size are specified in JIS, IEC, and other
standards, but these standards are periodically reviewed, so refer to the latest regulations. In
this section, the following is based on JIS Z 4704-1994. In addition, particular care is required
when measuring actual focus size, because it can be affected by the measuring environment
(such as how the X-ray tube unit is fastened and the measurement charts and jigs installed),
variations in elapsed time, and other factors.
(1) Measurement Methods
Focus size can be measured using either the pin-hole camera method or slit camera
method. For nominal focus sizes of 0.3 or less, a resolving power method (parallel pattern
camera method or star pattern camera method) may be used.
The focus size varies depending on the X-ray tube load level, so testing parameters are
specified as followings.
Table 4.6.2 X-Ray Tube Load Parameters
Nominal Maximum Tube

Test Tube Voltage (kV) Test Tube Current (mA)
Voltage U (kV)
50 % of maximum
Nominal maximum tube allowable tube current for
U  75
voltage 0.1 seconds at the test
tube voltage
75 < U  150 75 kV Same as above
50 % of nominal maximum
150 < Same as above
tube voltage
(2) Allowable Tolerance

Care is required due to the differences in allowable tolerances for different measuring
methods. The following is an example of tolerances using the pin-hole camera method.
Table 4.6.3 Focus Size Allowable Tolerances for the Pin-Hole Camera Method
Nominal Focus Size f Tolerance (%)
F < 0.8 0 to +50
0.8  f  1.5 0 to +40
1.5 < f 0 to +30

4.7 Adjustable X-Ray Collimator
4.6.6 Service Life of X-Ray Tube Units

X-ray tube unit service life is determined primarily due to a drop in X-ray output, pressure
resistance failure, filament failure, rotor rotation failure (bearing failure), or damaged focus. The
primary causes of reduced X-ray output include spatter deposition on X-ray tube internal walls
due to filament or anode vaporization, and decreased vacuum levels. The effect is greater, the
lower the voltage or higher the current. Spatter deposition can lead to changes in X-ray quality
and affects image quality due to not only reduced X-ray output, but also an increase in inherent
filtration. The lower the radiography voltage level, the greater these effects can be, which can
cause image quality problems of trabeculae not being visible in orthopedic images of extremities,
for example. The cause can be determined by measuring the inherent filtration level of the X-ray
tube, but that is difficult to measure on-site. In addition, it can also be determined somewhat
from measuring aluminum equivalence, but often the problem is not clearly determined until the
X-ray tube is replaced with a new X-ray tube. Therefore, X-ray dose output and aluminum
equivalence should be periodically measured and the data managed.
The primary causes of a pressure resistance failure include filament vaporization, rotor rotation
failure (gas emitted within tube due to higher anode temperatures), and other factors.

These devices attached to X-ray tube units and governed by JIS Z 4712 standards are cone
beam restricting devices that provide a means of continuously adjusting the X-ray irradiation
field.
They serve an important role of reducing exposure dose levels and improving image quality.
Needless to say, lower exposure dose helps focus the useful cone beam onto the image
receiving surface. Some recent models include built-in filters to eliminate longer wavelengths
(lower energy waves). In terms of improving quality, functions are available that eliminate
off-focus X-rays emitted from X-ray tube units, use mirrors to correct for heel effects related to
X-ray tube unit target angle to achieve more uniform X-ray intensity.
4.7.1 Meaning of Key Terminology

a. Light Irradiation Field: Range where the reference light from the adjustable collimator
shines on the image receiving surface of the imaging unit. The
boundary is tracked as the point where irradiation level is 1/4 of the
maximum within that range.
b. X-Ray Irradiation Field: Irradiation range of the beam being used, including the image
receiving surface, where the boundary is tracked as the point
where irradiation is 1/4 of the maximum exposure dose rate
c. Off-Focus X-Rays: X-rays emitted from areas other than the focus on the X-ray tube
unit anode
d. Inherent Filtration: Filtration of the usable cone beam due to permanent structural
materials in the adjustable collimator
e. Total Filtration: Total filtration by all areas penetrated by the usable cone beam
between being emitted from the X-ray tube focus and reaching the
body surface
f. SID: Source-to-image distance, from the X-ray tube focus to the image
receiving surface
g. PBL Mechanism: Positive beam limitation mechanism that tracks changes in SID
and image receiving area to adjust the X-ray irradiation field

4.7.2 Structure
The primary structures are governed by JIS Z 4712 in the following.
a. Eccentricity between the X-ray irradiation field and image receiving field center points and
the eccentricity between the X-ray irradiation field and reference light irradiation field center
points, must be adjustable to within 1 % of SID. Eccentricity between the X-ray irradiation
field and image receiving surface on models including a PBL mechanism must be
adjustable to within 2 % of SID.
b. Irradiation fields must be continuously and smoothly adjustable.
c. The lamp for the reference light must be securely attachable and easily replaceable and the
filament position must be adjustable.
d. A timer must be provided to limit reference light illumination to about 30 seconds.
e. An effective means for reducing off-focus X-rays must be provided.
A typical adjustable collimator structure is shown below.
(14)
(19)
(13) Acrylic Plate
(10)
(11)
(9) (1)
(17) (2)
(8)
(1), (2) Baffles for restricting the cone beam (13) Insertion groove
(3) (3), (4) Lower baffles (14) Protective guard
(18) (7) (5), (6) Baffles for reducing off-focus X-rays (15) Ring
(4) (7) Lamp (16) Attachment ring
(8), (9) Mirrors (17) Reference light switch
(12) (10) Indicator (18) Knob
(11) Indicator scale (19) Cross hair plate
(15) (16) (5) (12) Added filter
(6)
Fig. 4.7.1 Example of Adjustable Collimator Structure

4.7.3 Key Performance Desirable in Adjustable X-Ray

Collimators
Table 4.7.1 Key Performance Desirable in Adjustable X-Ray Collimators
Item Performance
Maximum X-ray irradiation field Max. 35 cm  35 cm for an SID of 65 cm
Minimum X-ray irradiation field Min. 5 cm  5 cm for an SID of 100 cm
Average illumination of light

Min. 100 lx for an SID of 100 cm. Over 160 lx is preferable.
irradiation field
Illumination ratio of light irradiation

Installed models: Min. 4; Other models: Min. 3
field
Max. error between X-ray irradiation field and indicated

Aperture display error
aperture of 2 % of SID
Max. 3  10-5 C/kg (= 116 mR) per hour at 100 cm distance

Leakage dose
from focus
Min. nominal value displayed (70 kV for maximum

measurement voltages of 70 kV or greater and the
Inherent filtration
maximum voltage used for maximum measurement
voltages less than 70 kV)
Exposure leakage current Max. 0.1 mA
Impedance between touchable metal parts and protective

Protective ground
ground terminal is 0.1  or less.
Max. 5.16  10-7 C/(kg.h) per hour at 5 cm distance from

Dark current X-rays (Note 1)
touchable surfaces at the center of the useful cone beam
Note 1: When using a 3-phase X-ray tube in a capacitor-type X-ray high voltage generator.

4.7.4 Variations in X-Ray Quality Due to Mirrors

Most of the filtration in inherent filtration of adjustable collimators is due to filtering effects of
mirrors, which depends on the mirror material and thickness. Mirrors are angled at about 30 to
45 degrees from the useful cone beam axis and, assuming a half value layer of 1 at the useful
X-ray cone beam axis, the effective X-ray transmission thickness varies due to the X-ray
collimator aperture angle (), as shown in Fig. 4.7.2. This means the X-ray intensity differs
between the center and periphery. X-ray intensity also varies depending on the SID.
X-Ray Tube Focus
Mirror
Fig. 4.7.2 Filtering Effect Due to Mirrors
The intensity distribution of X-rays emitted from X-ray tube units also differs in the tube axial
direction, between the anode and cathode ends, which is normally referred to as the heel effect.
Carefully consider the combination of mirror tilt angle and the X-ray tube anode-cathode
orientation before installation in an X-ray tube unit, because they can vary the X-ray intensity
distribution and X-ray quality, as shown in Fig. 4.7.3.
Mirror
Mirror
Fig. 4.7.3 Example of Change in X-Ray Quality Due to Combination of X-Ray Tube Axial Direction and Mirror

4.7.5 Exposure Reference Lamp

Halogen lamps are often used as a light source for reference lamps, because the illumination
level remains constant until the filament fails, they have a long service life, and so on.
Contamination of halogen lamps can cause inadequate illuminate during use or affect the
service life of the lamps. Therefore, do not touch the glass portion with bare fingers and clean
any contamination with alcohol after installation. Halogen lamps become very hot during use.
Typically, a small cooling fan is installed, functionality of which should also be inspected.
In addition, cleaning and checking the mirror is also important. Mirrors are located close to the
X-ray source and are, consequently, constantly radiated with large amounts of X-rays, which
causes decreased light reflectivity as mirror materials age. Therefore, it is important to
periodically check their illuminance.
4.7.6 X-Ray Exposure Dose Reduction Filter

X-rays emitted from X-ray tube units include long wavelength X-rays (soft X-rays). Except for
specialized radiography, such as mammography, soft X-rays have the potentially be absorbed
within the body and cause damage without ever reaching the image receiving field. Therefore,
various X-ray filters are used to reduce these soft X-rays. Recently there are even adjustable
X-ray collimators that automatically insert the optimal X-ray filters for operating parameters. An
example of the effect of an X-ray filter is shown in Fig. 4.7.4.
Relative Dose
Without Copper Filter
With
Copper
Filter
Energy
Fig. 4.7.4 Example of Effect of X-Ray Filter

4.7.7 Size of Irradiation Field and Scattered Rays

While using X-rays for diagnostics, a large amount of scattered rays are generated within the
body, which irradiate the film, image intensifier, and other surfaces. These scattered rays
decrease image quality and, therefore, must be reduced as much as possible.
They are expressed by the following formula, where ID is the intensify of rays that pass directly
through the body and hit the film or other sensing means and IS is the intensity of scattered rays.
Content of Scattered Rays = IS/(ID + IS)
The relationship between the size of the irradiation field and the scattered ray content is shown
in Fig. 4.7.5. It reveals how using a adjustable X-ray collimator to restrict the irradiation field to
only the minimum necessary area results in reducing scattered rays, improving image quality,
and reducing exposure dose.
Object: 10 cm water
Content of Scattered Rays (%)
Without Grid
With 5:1 Grid
Area of Irradiation Field (cm2)

Fig. 4.7.5 Size of Irradiation Field and Content of Scattered Rays

4.8 X-Ray High Voltage Cable with Plug

X-ray high voltage cables with plugs are used to connect the high voltage generator, X-ray tube
unit, and other high voltage circuits.
4.8.1 Models
High voltage cables with plugs for medical X-ray tube units are specified by JIS Z 4732-1993 as
follows.
Example:
Indicates length (m)

3: Indicates a terminal on the other end is a 3-prong plug
4: Indicates a terminal on the other end is a 4-prong plug
3: Uses a 3-core high voltage cable for X-ray use
4: Uses a 4-core high voltage cable for X-ray use
3: Indicates a terminal on one end is a 3-prong plug
4: Indicates a terminal on one end is a 4-prong plug
Indicates maximum operating voltage (kV)

Indicates a high voltage cable with plugs for use with medical X-ray systems
4.8.2 Key Performance Specifications

Insulation Resistance Between Contact Pins:
Insulation resistance between each contact terminal on plugs must be at least
2000 M.
Connection Between Contact Pins:
Contact points corresponding to mating sets of contact terminals on high voltage cables
with plugs must connect securely with no more than 0.33  resistance per meter (at
20 C).
Connection Between Shielded Connectors:
Shielded connectors on one end must connect securely to shielded connectors
on the mating end with no more than 1  resistance per meter.
Allowable Length:
2 % for lengths 5 m or less, or 1 % for lengths over 5 m
Terminal on One End Terminal on Other End

Length
Fig. 4.8.1 Length of High Voltage Cable with Plugs


5 Image Receiving Device/System

In a broad sense of the term, image receiving devices include X-ray film, X-ray image
intensifiers (I.I.), flat panel detectors (FPD), imaging plates (IP), and so on.
At first, the characteristics of the devices that function to render X-rays into an image, are
summarized in the table below.
Configuration Rendering Process
Indirect radiography. The image is Intensifying screens convert X-rays to light,
captured directly on film using intensifying which creates a latent image on the film.
Cassette + film
screens placed in the cassette. The film is then developed to create an
image on the film.
I.I. indirect radiography. An I.I. is used to The I.I. converts the X-rays to light, which
convert the X-ray transmission image to a is sent via an optical system to create a
I.I. + film
light image, which is captured by latent image on film. The film is then
Analog
projecting the light image onto film. developed to create an image on the film.
I.I. indirect radiography. An I.I. is used to The I.I. converts the X-rays to light, which
convert the X-ray transmission image to a is sent via an optical system to a camera
light image, which is projected onto a tube, where it is converted to an electrical
I.I. + camera tube camera tube to obtain a fluoroscopic signal and displayed on a monitor, but the
(one without digital image. This fluoroscopic image is viewed image is generally not recorded.
processing) on a monitor and can be recorded on Images can be recorded using analog
video tape or other recording media. recording media, such as by linking the
Radiographic images are indirectly fluoroscopic image to a video tape
captured on film. recorder.
Images are captured directly on an X-rays are converted to a latent image on
imaging plate using a combination of the imaging plate, then a special reader is
cassette and imaging plate. Images are used to read the digital signal and convert it
Imaging plate read using a special reader. to an electrical signal. This signal is
optimized by an image processing unit for
viewing on a monitor or recording on digital
record media.
The image obtained by the camera tube, The I.I. converts the X-rays to light, which
as described above, is converted to a is sent via an optical system to a camera
digital signal to handle it as a digital tube, where it is converted to an electrical
I.I. + camera tube
image. Images are recorded in a memory signal. This is converted to a digital signal,
+ digital processor
or media such as a hard disk, then an which is optimized in an image processor
imager or other printer is used to record for viewing on a monitor or recording on
any images needed onto film. digital record media.
This system replaces the camera tube The I.I. converts the X-rays to light, which
Digital
above with a CCD camera, which is sent via an optical system to the CCD
I.I. + CCD provides a more digital system. camera, where it is converted to a digital
+ digital processor signal. This signal is optimized in an image
processor for viewing on a monitor or
recording on digital record media.
Unlike previous systems, systems Direct conversion:
equipped with a flat panel detector can X-rays are converted to a digital signal by
acquire X-ray images directly, where flat pixel sensors in a semiconductor ionization
panel detectors are either chamber. This signal is optimized in an
direct-conversion or indirect-conversion image processor for viewing on a monitor
type, depending on how the X-rays are or recording on digital record media.
Flat panel detector received. Also, FPDs are also available Indirect conversion:
as either still image or moving image X-rays are converted to light by a
models, depending on how fast they can photosensitive material before being
acquire images. converted to a digital signal by pixel
sensors. This signal is optimized by an
image processor for viewing on a monitor
or recording on digital record media.
Reference: Radiological Sciences, published February 2000, Development of New X-Ray
Radiography System – Flat Panel –
http://www.kenkobunka.jp/kenbun/kb26/ishiga26.html

5.1 X-Ray Image Intensifier (I.I.)

The I.I. is what converts the X-rays that pass through the object into visible light. It comprises the
X-ray image intensifier tube (I.I. tube) with a housing and/or power supply unit. In addition to
converting X-rays to visible light, it also amplifies its brightness by several thousand times.
Since the vacuum tube has an extremely high vacuum level, its sensitivity changes over time.
Because the I.I. is the most important component in an X-ray TV system for determining image
quality, this change in brightness must be monitored over time.
5.1.1 Operating Principle of Image Intensifiers

Fig. 5.1.1 shows how an I.I. is configured and its operating principle is described in points a
through f.
a. X-rays emitted from the X-ray tube and passing through the object form an X-ray image on
the fluorescent input surface of the I.I.
b. At the fluorescent input surface, the X-ray image is converted to a visible light image, which
causes photoelectrons to be emitted from the photoelectric surface (cathode) in contact with
the fluorescent input surface.
c. The photoelectrons are focused and accelerated by an electrostatic lens system, consisting
of a focusing cup and anode, to form a smaller electron image on the photoelectric output
surface.
d. The electron image is converted to a visible light image on the fluorescent output surface.
e. The brightness at the fluorescent output surface is proportional to (1/image
magnification)2  (anode voltage).
The gain from the (1/image magnification)2 term is determined by the increase in electron
density.
The higher the anode electron density, the higher the resolution as well, which is controlled
by the I.I. voltage resistance.
f. A photoelectric system transmits the output image to a video camera for viewing on a
monitor or a camera for recording images.
Fluorescent Focusing
Object Cups
Incident Input Surface
Surface Fluorescent
Output Surface
Primary Spot Camera or

Electron Beam Lens Cine Camera
X-Rays
(Electrostatic Lens System)
Rotating Mirror
Equipotential
X-Ray Tube Surface
Anode
300 to 800 V
50 to 200 V Video Camera
Photoelectric Surface 30 kV
Fig. 5.1.1 Operating Principle of an Image Intensifier

5.1.2 Conversion Factor of Image Intensifiers

Degradation in I.I. brightness can cause danger of overloading the TV system, increasing
patient exposure levels, or decreasing image quality. For example, if sensitivity of the imaging
system decreases by half, it is estimated that the X-ray dose for fluoroscopy must be doubled or
more to achieve the equivalent TV brightness. To avoid this, the I.I. brightness must be
periodically measured. Decreased brightness can be caused by various factors, but cannot be
restored, so the I.I. must be replaced depending on the level of degradation. As a general
guideline, replace the I.I. when its brightness falls below 50 % of its original level. Of course, this
means that the user needs to be contacted regarding the brightness degradation status before
that stage, so that a replacement time can be predicted.
The brightness performance of I.I. tubes is strictly regulated by IEC standards (IEC Publication
573, 1977), where JIS Z 4721 regulations for medical X-ray image intensifiers are specified in
detail in accordance with this IEC standard.
 Definition of Conversion Factor 

I.I. brightness is expressed in terms of a conversion factor, which is indicated by the symbol
CF or Gx. Gx is the ratio between the brightness of the fluorescent output surface brightness
L (in units of cd/m2) and the incident X-ray dose level X (in units of C/kgs) hitting the I.I.
incident surface, as follows.
L (Brightness of I.I. Output)

Gx (X-Ray Conversion Efficiency) =
X (Incident X-Ray Dose Level)

5.1.3 Degradation of I.I. Brightness

I.I. brightness is thought to be a function of the number of photoelectrons and conversion
efficiency of the fluorescent output surface.
Since the number of photoelectrons is essentially determined by the conversion efficiency of the
photoelectric surface, then in terms of the tube structure, brightness is determined by both the
photoelectric surface and fluorescent output surface. The photoelectric surface is thought to
deteriorate due to damage from residual gases in the I.I. tube. Though the tube has a high
vacuum level, there are still some gases that remain inside the I.I. tube, which collide with
high-speed electrons when the I.I. tube is operating, resulting in ionization. These ions collide
into the photoelectric surface on the fluorescent input surface, causing vaporization.
In addition, after long periods of continuous bombardment by 30 keV of high-speed electrons,
some of the fluorescent output surface becomes burned.
Based on experience, it is apparent from long-term observations that brightness decreases
independently in each case of the following.
a. Natural Degradation (During Storage)
Even if the I.I. is stored unused, without any voltage applied to it, brightness generally
decreases. In the electron tube manufacturing industry, the natural decrease in I.I. tube
brightness during storage is referred to as shelf life. This natural decrease in brightness is
also observed in the I.I. and can be expressed base on experience using the following
equation.
B(t) = B0exp(-t/)…..A
In this case, B(t) is the brightness after time t, B0 is the initial brightness, and  is a
characteristic constant predicted for each I.I. tube, where  is the length of elapsed time it
takes for brightness to fall to 36 % of its initial level, which is referred to as the shelf life.
B0 can be measured when a tube is first created, but there is no way to predict .
Fig. 5.1.2 shows a graph of the natural decrease in brightness of an I.I. tube over time, after
 values of 1, 3, 5, and 10 years. In reality,  differs depending on the I.I. model and
production year.
Relative Sensitivity
1 year 2 years 3 years
t (in years)
Fig. 5.1.2 Natural Decrease in I.I. Brightness Over Time

b. Decrease Due to Fatigue (During Operation)

When voltage is applied to an I.I. and it is continuously exposed to X-rays, the brightness
decreases in proportion to the cumulative X-ray dose level received by the I.I. A graph of I.I.
X-ray exposure dose on the horizontal axis would look like the graph in Fig. 5.1.3 (using one
example of experimental values).
Incident X-Ray Dose 14.96  10-4 (c/kg)/H (5.8 R/H)
Relative Conversion Factor (%)
Cumulative Incident Dose to I.I. (R)

Fig. 5.1.3 Decrease in Conversion Factor with Respect to I.I. Incident Dose
The I.I. incident X-ray dose is measured using a dosimeter in front of the I.I. (at the rear of
the X-ray grid), but the following indicates typical values. (Older units are customarily easier
to understand for this part of the explanation, so older units are indicated as well.)
X-Ray TV Fluoroscopy 0.76  10-6 (C/kg)/min (3.0 mR/min)
Plain Radiography 0.12  10 (C/kg)/film
-6
(0.5 mR/film)
I.I. Indirect Radiography 0.025  10-6 (C/kg)/frame (0.1 mR/frame)
Cine Radiography 0.007  10-6 (C/kg)/frame (0.03 mR/frame)
For X-ray TV systems, I.I. X-ray exposure dose is calculated assuming a hospital that
examines 20 patients per day, 300 days per year, with 10 minutes of fluoroscopy and 10
radiography exposures per person, as follows:
(3  10-3  10 + 0.5  10-3  10)  20  300 = 53.8 mC/kg (210 R)
For cine radiography systems, I.I. X-ray exposure dose is calculated assuming a hospital
that examines 10 patients per day, 300 days per year, with 30 minutes of fluoroscopy and
ten 10-second 50 fps exposures of cine radiography per person (which is quite a lot), as
follows:
(3  10-3  30 + 0.03  10-3  50  10  10)  10  300 = 184.3 mC/kg (720 R)
Based on the fatigue curve, brightness would drop to 88 % for 53.8 mC/kg and to 80 % for
184.3 mC/kg.
c. Degradation of I.I. Brightness During Usage for Long Periods
Consequently, the graph of the decrease in I.I. brightness after elapsed time t is determined
from the product of the natural decrease multiplied by the fatigue decrease, described
above. For the example in section b above, with a usage of 53.8 mC/kg per year, and
assuming a  value of 5 years, the natural decrease is exp(-3/5) = 0.55 and fatigue
decrease is 0.82, resulting in 0.45 when multiplied.
d. Degradation in Performance Other Than Brightness
Degradation of most other performance parameters which vary over time is caused by the
same factors as brightness degradation. When the photoelectric surface and fluorescent
output surface are bombarded by ionized gases, it causes a decrease in brightness.
However, if the bombardment is concentrated in a limited area, it can lead to other problems
as well. If impacts are concentrated at the photoelectric surface, it probably would cause
uneven color or blotches. If concentrated at part of the fluorescent output surface, it would

cause uneven brightness. Impacts to an electrode or inner bulb wall could cause arcing
within the tube and increase background emission levels, which can generate ion spots.
In addition, lower brightness and higher background intensity can cause secondary effects,
such as lower imaging system resolution or lower contrast characteristics, though they are
not directly related to brightness degradation or a decrease in resolution of the I.I. itself.
5.2 Flat Panel Detector

For general radiography systems, the quality of digital X-ray images, such as images obtained
using a flat panel detector (FPD), now rival the image quality of chest and other X-ray
photographs obtained by conventional means. Currently, in addition to FPDs for still images
used in plain radiography, FPDs capable of acquiring moving images for use in angiography
systems have been developed. FPDs are now included or available on almost all new systems
being developed. FPD-equipped X-ray TV systems are also being developed.
Compared to image intensifiers, they provide significantly better image quality (especially in
terms of spatial resolution). Unlike image intensifiers, the resolution does not change when
switching field-of-view sizes.
Therefore, the following briefly describes the composition and signal conversion methods of
FPDs, which continue to be adopted for mainstream use.
5.2.1 Types of FPDs

FPDs are available as direct-conversion or indirect-conversion types, each with their own
characteristics. Various measures have been used to make improvements to the disadvantages
of each type. As a result, though they currently still have some unique characteristics as
elements, the disadvantages no longer present any problems for practical use.
a. Characteristics of Direct-Conversion FPDs
Direct-conversion FPDs have a two-dimensional electrode array structure consisting of a
fine matrix of electrodes on one side of an X-ray detecting layer. Depending on this structure
and the characteristics of the semiconductor used, unique characteristics can appear. Since
silicon semiconductors typically used for dosimeter and other applications have a lower
mass, FPDs currently in practical use utilize selenium or other more massive materials for
the semiconductor.
Advantages: X-rays are converted directly to electrical charge. Therefore, it provides
very sharp images with extremely low blurring or effects from neighboring
pixels.
Since semiconductors are used, they have a low energy threshold for X-ray
detection, which means they can detect even low-energy X-rays.
Disadvantages: Because charges must travel through a chamber, it takes a long time for
the charge to reassociate and for the charge to reach the electrodes,
though that also depends on how the high voltage is applied to the chamber.
Extra care is required due to the use of high voltage.
b. Characteristics of Indirect-Conversion FPDs
Simply described, indirect-conversion FPDs consist of CCD-like flat sensors adhered to a
scintillator. In other words, the X-ray detector uses a scintillator to temporarily convert
X-rays to light. Then photosensors are used to convert the generated light to an electrical
charge. This structure results in unique characteristics.
Advantages: The fluorescent substance used in the scintillator has relatively high mass,
which provides relatively high X-ray energy absorption, meaning the
detection layer can be made comparatively thin.
Disadvantages: X-rays are first temporarily converted to light, which generates light blurring
within the scintillator. Images can persist for a long time in the scintillator
after exposing to intense X-rays, which can affect the next image acquired.

5.2 Flat Panel Detector
5.2.2 Basic Structure of FPDs

As shown in Fig. 5.2.1, direct-conversion type FPDs consist of a panel with an X-ray detection
layer added on top of a two-dimensional array of detector elements, and electrical circuits along
the periphery. Indirect-conversion type FPDs consist of a panel with a layer of X-ray fluorescent
substance added on top of a two-dimensional array of photodetector elements, and electrical
circuits along the periphery. The electric charge generated in response to X-ray energy received
by the X-ray detection layer is accumulated in pixel capacitors located in the array of detector
elements. When the X-ray fluorescent substance generates light, it is converted to electrical
charge and accumulated within photodetectors. Then the charges from each pixel are removed
as an image signal by opening/closing semiconductor switches. The charge level of the output
signal is used as analog values. Normally, the analog charge values output from the FPD are
converted to a digital signal before being output as image data.
X-Ray Detection
X-Rays Layer X-Rays
Detector Array of Photodiodes
Element and Detector Elements
Array
Substrate
Scintillator
Structure of Direct-Conversion FPDs Structure of Indirect-Conversion FPDs
X-Ray Detection Layer
Semiconductor Switch
Pixel Selection Signal
Pixel 2-Dimensional
Switching Array
Image Data Reading Circuits
Configuration of FPD Peripheral Circuits
Fig. 5.2.1 Structure of Flat Panel Detectors
5.2.3 Structure and Function of Flat Panel Detectors

Direct conversion method:
Method used to convert X-ray energy directly to electrical charge in the X-ray detection
layer.
Incident X-rays pass via surface electrodes to form electron/proton pairs in the X-ray
detection layer, depending on the X-ray energy level. If left alone, the electron-proton
pairs that were formed reassociate (rebond) and disappear. Therefore, to capture ionized
charges efficiently, an appropriately high voltage is required between electrodes. The
higher the voltage value, the more efficiently charges can be gathered, but an appropriate
value is selected based on the relationship to the material being used. In FPDs in practical
use today, a high voltage (about 10 kV/mm to 15 kV/mm) is applied to the X-ray detection
layer in a sandwich configuration, then the ionized electron pairs are accumulated at

respective pixel electrodes. This charge is read out as an image signal.

Indirect conversion method:
X-rays are first converted to light, then the light is converted to an electrical charge signal
by photodiodes or other photosensitive element.
Energy from the incident X-rays is converted to light in the scintillator. If a simple
fluorescent substance were used, X-rays would diffuse the light it generates, causing blur
or loss of sensitivity. Therefore, in an effort to increase detection efficiency,
needle-shaped fluorescent crystals are used, which are all oriented vertically to facilitate
efficient delivery to the photoreceptor elements and reduce blurring. The light generated
at this point is converted to an electric charge using a two-dimensional array of
photodiodes or other photodetectors, arranged in a grid pattern. This converted charge is
read out as an image signal.
X-Ray X-Ray
Electrode
X-Ray
Ionized Electron Pair Applied Scintillator
Detection
Layer Voltage
Pixel Electrodes Photodiodes Pixel Electrodes
Substrate Substrate
Structure of Direct-Conversion FPDs Structure of Indirect-Conversion FPDs
Fig. 5.2.2 Structure of Flat Panel Detectors
5.2.4 Precautions for Handling Flat Panel Detectors

Flat panel detectors require special care when handling, due to their layered structure
consisting of different materials and the use of high voltage or scintillators. Care is particularly
required during transport or when they are moved.
 Do not place FPDs in a location exposed to sudden changes in temperature.
Temperature changes can cause problems with internal joints or cause cracking or other
problems with the two-dimensional detector element array.
 Do not leave FPDs in highly humid locations.
Humidity can cause problems with the scintillator on indirect-conversion models or problems
with high voltage circuits on direct-conversion models.
 Do not expose FPDs to impacts, which could cause cracking or other problems with the glass
or semiconductor materials used for the substrate and internal materials.
Flat panel detector specifications must be thoroughly understood before handling.
References:
Sharp Corporation Techinical Jounal No.24
Diagnostic large-area X-ray detector using a TFT array
http://www.sharp.co.jp/corporate/rd/27/27-1.html
Shindengen Electric Manufacturing Co., Ltd.
New medical X-ray sensor is jointly developed by three companies.
http://www.shindengen.co.jp/top_topics/fpd.html
Radiological Sciences
Published February 2000, Development of New X-Ray Radiography System
– Flat Panel –
http://www.kenkobunka.jp/kenbun/kb26/ishiga26.html

5.3 Computed Radiography Systems
5.3 Computed Radiography Systems

Computed radiography (CR) systems replace the conventional screen and film with an imaging
plate (IP) as the X-ray sensor.
When an IP is irradiated with X-rays, the X-ray energy is initially accumulated inside the IP, then
read with a laser beam and converted to a digital signal to render an image.
5.3.1 Imaging Plate (IP)

The IP was independently invented by Fuji
Photo Film Co., Ltd. (currently Fujifilm
Corporation) and announced in 1981 as a Surface
Protective
key device used in digital X-ray imaging Layer Fluorescent
systems "Fuji Computed Radiography – Support Layer
FCR."
Fig. 5.3.1 Structure of an Imaging Plate
5.3.2 Operating Principle of an Imaging Plate

An IP is a material with stimulable phosphor coated on the support and functions as a
two-dimensional integrating radiation detector. Stimulable phosphor is a special type of
fluorescence having photostimulated luminescence (PSL) characteristics, that glows again
when irradiated with longer wavelength light than the light generated after excitation of
fluorescent substance with X-rays, an electron beam, ultraviolet rays, or other radiation. The
dependence of the amount of photostimulated luminescence from the IP on the amount of X-ray
radiation exhibits a nice linear relationship over a wide range of more than four digits. This wide
dynamic range is one of the advantages of the CR system.
5.3.3 How Computed Radiography (CR) Forms Images

When the IP exposed with X-rays is irradiated with excitation light from a semiconductor laser,
the energy accumulated in the IP is emitted as a blue light (photostimulated luminescence). This
luminescence is converted to an electrical signal by a photomultiplier tube (PMT), which is
further converted to a digital signal via A/D conversion, optimized by image processing, and
then rendered as an image.
PMT A/D
Polygon Mirror CPU
Conversion
Image Processing
Semiconductor
Excitation Light
Laser
Photostimulated
Luminescence
Image Plate
Image Plate
5.3.2 How Fuji Computed Radiography (FCR) Forms Images

5.3.4 Repeated Use of IP (Recording / Reading / Deleting)

Images can be deleted from IPs exposed to X-rays, by
irradiating them with white light to discharge any Imaging plate before use
accumulated energy.  X-ray information is recorded
This allows using the same IP over and over. Subject
X-ray source
 X-ray information is acquired

Optical scan
Laser light
 X-ray information is deleted
Light source for deleting

information
Fig. 5.3.3 Repeated Use of IPs
5.3.5 Dual-Side Reading Method

To convert the X-ray energy absorbed in the IP more efficiently into photostimulated
luminescence, some modes feature a dual-side reading method. This method uses a
transparent IP support with detectors on the support as well, then the image data detected by
each detector is added in the optimal proportion before being used as the final image data. This
reduces the effects of X-ray photon noise on image quality and achieves a high DQE (detective
quantum efficiency) level.
Photodetector
光検出器 Photodetector IP
光検出器 Protective Layer
保護層
IP レーザー光
レーザー光
Laser Light Protective Laser Light
保護層 Layer
Light Guide Phosphor
蛍光体層 Layer
光ガイド
Light Guide Phosphor
蛍光体層 Layer 光ガイド Mirror
ミラー
Mirror
ミラー Photostimulated Transparent
Luminescent 透明支持体
Support
IP 輝尽発光光
Light
Photostimulated
Luminescent
支持体
Support
IP 輝尽発光光
Light Light Barrier
光遮光層 Light
Layer 光ガイド
Guide
光検出器
Photodetector
Fig. 5.3.4 Single-Side Reading Fig. 5.3.5 Dual-Side Reading

5.4 X-Ray TV Systems

X-ray TV systems use a lens system and camera to display images from the I.I. output surface
on a monitor. A block diagram of an X-ray TV system is shown in Fig. 5.4.1. Recent models have
rapidly adopted the use of CCD sensors for the camera head, which replaces the conventional
camera tube. Many CCD cameras include easy image processing functionality that helps
improve image quality.
X-Ray Tube I.I. Iris
CCD Camera
Object Lens
CCU
AMP DCC AGC A/D PROC
IBS AMP D/A
X-Ray High Voltage

Generator
Monitor for Monitor for
Fluoroscopy Images in
Images Memory
Fig. 5.4.1 Example of X-Ray TV Imaging System

(1) Scanning
Scanning is a method used to resolve or synthesize picture elements in a fixed direction
across the screen. In TV systems, scanning refers to consecutively scanning horizontally
from left to right and top to bottom.
(2) Picture Element
Also called a pixel, it is the tiny area elements used to form an image.
(3) Synchronization
Matching one phenomena or action with another in terms of a given relationship in time
(4) Deflection
Changing the direction of an electron beam
(5) Composite Video Signal
Composite video signals comprise an image signal, blanking signal, and synchronization
signal.
(6) AGC (Automatic Gain Control)
AGC is a mechanism that detects any increase/decrease in an input signal and
automatically increases/decreases the circuit gain.
(7) ABL (Automatic Black Level Control)
ABL maintains the black level of a video single at a fixed electrical potential level.
(8) Black Level
Signal voltage at the darkest area on the screen
(9) White Level
Signal voltage at the brightest area on the screen

(10) 2:1 Interlace

This method transmits a single image by first roughly scanning the image at equally spaced
intervals, then going back and scanning the intermediate lines in the next scan.
(11) Aperture Distortion
A loss in image sharpness due to the limited size of the scanning point
(12) Shading
Phenomena where image brightness is not consistent across the entire screen
(13) Aspect Ratio
The horizontal-to-vertical ratio of the scanning area. For X-ray TV systems, it is usually 1:1.
(14) Gamma ()
Given a log-log graph of input versus output, gamma is a coefficient that indicates the slope
of the graph at the point being used. Gamma characteristics are defined in terms of incident
light intensity and output current for camera tubes, input and output voltage for circuits, input
voltage and CRT brightness for image receiving tubes.
(15) Horizontal Resolution
Image resolution in the horizontal direction, which is mostly determined by the image
bandwidth of the camera control system
(16) Vertical Resolution
Image resolution in the vertical direction, which is determined by the number of scan lines
(17) Raster
The image rendered by scan lines on the fluorescent surface of the image receiving tube
and the size of the illuminated area when no image signal is input.
(18) Ringing
Vertical stripes visible on the screen or that appear to the right of the border, which suddenly
change from white to black or black to white. This can occur in circuits with poor
characteristics or due to inadequate grounding.
(19) Sawtooth Wave
Synchronous waveforms with a sawtooth shaped amplitude profile, which rise in a linear
manner with respect to time, then suddenly drop back to their original value
(20) Signal-to-Noise Ratio (S/N)
Ratio of the peak-to-peak signal current value in a specified bandwidth to the effective noise
level included in the output current
(21) Burn-In
A pseudo-signal that remains after a still object is removed
(22) Afterimage
Time lag of output signal with respect to temporal changes in incident light
(23) Microphonics
Pseudo-signal generated by vibration of parts inside the tube
(24) Blanking
The image disappearing while the electron beam in a camera tube returns to the starting
point after finishing a scan or when the image signal disappears synchronously with the
insertion of a synchronization signal
(25) Flicker
When the screen brightness flickers due to fluctuations in the signal output of each field
(26) Blooming
A phenomenon where an intense incident light causes image blurring
(27) Flare
Pseudo-signal caused by diffuse reflections of incident light

(28) Auto Iris

If the amount of incident light suddenly changes using a adjustable video camera lens
aperture, the auto iris measures the amount of light based on image signal level or other
parameters and feeds it back to control the incident light to a specific level by opening or
closing the lens aperture.
(29) Quantum Noise
At low X-ray dose levels, X-rays quantize. In other words, they become spatially or
temporally discontinuous, so that they can no longer stimulate the input surface uniformly.
The coarse grainy appearance of images that looks like they are covered in sand is referred
to as low-dose quantum noise.
In the case of X-ray TV, quantum noise becomes noticeable unless a minimum 3.0 mR/min
of incident X-rays enter the I.I. fluorescent input surface.
(30) High-Definition Television
TV systems with a large monitor featuring a higher number of scan lines, such those using
high-definition technology developed by NHK (Japan Broadcasting Corporation). The
screen's fine detail is comparable to movie screens and provides a heightened sense of
presence.
5.4.2 Optical Lens System

Due to the small size and relative darkness
of the I.I. output image, the lens system
used to transfer the image onto the camera
tube in video camera requires special L1 L2
consideration.
Typically, a pair of lens is used in a tandem D1 D2
configuration.
Light from I.I. output image D1 is collimated
by objective lens L1. Therefore, the lens is F1 F2
positioned so the output image is aligned
(Focal length of L1) (Focal length of L2)
with the focal plane of the objective lens.
Furthermore, camera lens L2 is positioned D1 / D2= F1 / F2
so that the photoelectric surface of the Fig. 5.4.2 Tandem Lens
camera tube is aligned with the focal plane
of L2. This lens configuration is called a tandem lens. The relationship between the tandem lens,
the focal lengths of respective lenses, F1 and F2, and the respective image sizes, D1 and D2, is
shown in Fig. 5.4.2. Since a tandem lens forms an image from collimated (parallel) light, it offers
advantages such as sharp images with minimal aberration, a lens system with good brightness,
and the ability to insert an image splitter in the path of the collimated light. However, longer
distances between lenses tends to make images appear darker toward the edges than in the
center. This tendency of lower light levels toward the periphery is called vignetting.
A method of using a fiberglass plate, without any lenses, to supply the I.I. output image to the
camera tube input surface is also in practical use.

5.4.3 Camera Tubes

Camera tubes are vacuum tubes that convert an optical image into an electrical signal. Since
they have the disadvantage of having to manipulate electron beams, which are vulnerable to
vibration and impact, and the tubes are vulnerable to magnetic fields, electrical noise, and other
effects. Consequently, their guaranteed service life is only about 600 hours.
There is already a shift to solid state CCDs occurring, but there are still many cameras currently
operating in the field that use camera tubes. These camera tubes have the following
characteristics.
Table 5.4.1 Characteristics of Camera Tubes
Item Characteristic
High  Increases signal output current. Excessive voltage can
Target Voltage
increase dark current and cause burn-in.
Too high  Quantum noise becomes prominent.
Sensitivity
Too low  Improves image quality, but increase exposure dose.
Too long  Quantum noise improves, but tracking becomes worse.
Afterimage
Too short  Tracking improves, but quantum noise becomes worse.
5.4.4 Video Camera Scanning

Information from the image formed at the lens is
converted to an electrical signal and scan lines
are used to divide the screen and transmit the
information to the TV monitor.
In general, television images are initially scanned
with widely spaced lines, starting from the upper
left, then the remaining intermediate lines are
scanned, where two sets of widely spaced scan
lines are used in an interlaced pattern to obtain a
complete image.
The standard number of scan lines is 525 at an
orthogonal frequency of 60 Hz and 30 frames per
second. In addition, configurations with 625 lines n Field formed from odd numbered lines
at 50 Hz, 945 lines at 60 Hz, and 1125 lines at 2 Field formed from even numbered lines
60 Hz are also used. A higher number of scan Scans progress
lines improves vertical resolution, but it also downward
increases amplifier noise due to higher scanning Fig. 5.4.3 Interlaced Scanning Method
frequency. This tends to decrease image S/N.
Since the I.I. output image is round, an aspect ratio of 1:1 is normally selected for X-ray TV
systems.
5.4.5 CCD
Instead of a camera tube, which is a vacuum tube, more and more systems are now using a
solid state CCD (charge coupled device) to acquire image signals.
Using a solid-state device to perform the photoelectric conversion permits a compact design
with excellent vibration resistance and durability.
(1) Construction
A CCD is an imaging device that outputs images by converting light to electric charges,
storing the charges, and then converting them to voltages.
The diagram below shows the structure of a CCD pixel element. A microlens is attached

over each pixel element to increase the amount of light received. When light reaches the
photodiode, a negative charge is accumulated in proportion to the amount of light. The
negative charge is transferred to the semiconductor transfer unit by applying a positive
charge to the electrode.
The transfer unit uses this principle to sequentially transfer the charges. Therefore, the
electric charge differs for each pixel and the intensity of each charge corresponds to the
light intensity, such that the image information is captured as voltage fluctuations.
The number of pixels is proportional
to the resolution: the more pixels, the Light
Microlens
better the image quality. However, Photo-Shielding Film
Silicon Semiconductor
Electrode
the amount of charge available
decreases if there are more pixels. A Electrons
CCD with 300,000 to one million
Photodiode
pixels (one megapixel) is normally Transfer Unit
used. Each pixel is extremely small, Transfer
Transfer
only 6 m, and a CCD camera
sensor is lighter and more compact
Fig. 5.4.4 Structure of a CCD Device
than a camera tube.
The diagram below shows an example when such pixel elements are combined into a CCD
sensor.
Vertical Shift Register

Transfer Gate
Photodiode
Horizontal Shift Register

Fig. 5.4.5 CCD Imaging Method (Interline Transfer Type)
The example shows the interline transfer type. The vertical transfer CCDs are arranged
between the sensors (photodiodes). The vertical transfer CCDs are connected below to
horizontal transfer CCDs and the signal charges are read by the following method:
a. The signal charge photo-converted in the sensor accumulates in the corresponding
junction capacitance.
b. The transfer gates are conductive during the vertical blanking time, such that all pixels
transfer simultaneously to the adjacent vertical transfer CCDs.
c. The changes are transferred down by the vertical transfer CCDs and move one line at a
time to the horizontal transfer CCDs from which they are sequentially output.
(2) Properties
Resolution .....Determined by the constituent number of pixels. The limit frequency
response of a CCD element is inferior to a camera tube but the mid/high
range response is superior, which produces clearer images than a camera
tube. Image processing such as edge enhancement ensures the images are
in no way inferior.
Sensitivity......Equivalent or better than a camera tube
Dividing the image plane into pixels resists blurring. Applying a filter to the

input signals prevents excessive input and eliminates image blurring due to
halation.
Distortion ...... A CCD element maintains spatial linearity, which eliminates the distortion
associated with a camera tube.
Image signal processing can also be applied to correct for distortion from the
image intensifier.
Afterimage ........... Almost no afterimage occurs.
Afterimage is required for fluoroscopic images. It can be created by
covering the quantum noise in X-ray images and using a recursive filter.
(3) Major features

a. The extremely thin CCD elements permit the camera head to be compact (thin) and
lightweight, which allows more flexible system design, such as a lower bed height.
b. CCD elements are solid-state semiconductors that improve shock-resistance and
eliminate the vibration noise unavoidable with a camera tube. The elements have no
consumable parts and a long service life.
c. Virtually unaffected by peripheral electromagnetic fields.
d. Rapid control of signal transmission from each pixel permits blanking and image
storage and can suppress halation. Digitization is simple and the elements offer high
speed, high stability and noise resistance.
e. The high-speed switching used to control the pixels makes the elements susceptible to
switching noise. Special care is required with dark images.
f. Much simpler to produce than camera tubes, so their price is low.
5.4.6 Composite Video Signal Waveforms

White
White
0.7 V (Image)
(Pedestal)
Black 0.7 V (Image)
(Pedestal)
0.3 V
(Synchronized) Black
0.3 V
(Synchronized)
(63.5 s or 53.3 s)

Waveform on Horizontal Time Axis Waveform on Vertical Time Axis
Fig. 5.4.6 Waveform of Image Signal
Composite video signals comprise an image signal, blanking signal, and synchronization signal.
An example is shown above.

5.5 Grids
5.5 Grids
5.5.1 What Are Grids?
Officially referred to as an X-ray anti-scatter grid.
When X-rays pass through an object, they are scattered and reflected by all sorts of substances
in the object. This is called X-ray scattering. If these scattered X-rays reach the film, it causes
the film to detect rays that should not be detected, which can result in blurry images with
inadequate contrast.
A grid serves as a filter to remove scattered X-rays before they reach the film.
Image Using a Microfine Grid (60 lines/cm 10:1) Without a Grid

Fig. 5.5.1 Difference in Images With and Without Using a Grid
5.5.2 Operating Principle and Structure

Grids are made of a series of foil strips with high X-ray absorption, separated and accurately
positioned by interspace material with low X-ray absorption. They are used by placing them in
front of the image receiving unit. Fig. 5.5.2 shows the grid structure and how the grid functions.
The grid permits primary X-rays that passed through the object to pass through the grid
relatively easily, but makes it relatively difficult for scattered rays generated within the object to
pass through the grid.
Interspace
Material Lead Foil
Height of
Foil Strips
Scattered X-Rays Interspace

(Absorbed) Material
X-Ray Absorbing
Foil Material (d)
Primary X-Rays X-Ray Transmitting
(Transmitted) Material (D)
Grid Density
Grid Ratio
(How a grid works) (Grid cross section and grid ratio)
Fig. 5.5.2 Function and Structure of a Grid

Grid types include the following, depending on the purpose of use and structure. Key terms
related to grids are defined below.
a. Grid types
i. Static grid
A grid used in a stationary position, relative to the X-ray image receiving surface
ii. Dynamic grid
A grid that is moved during X-ray irradiation by an actuator unit
iii. Linear grid
Grids with parallel film strips oriented in the length direction
iv. Convergent grid
Grids with the extension of foil surfaces converging to a single straight line (see Fig.
5.5.4).
v. Parallel grid
Grids with extensions of foil surfaces that are mutually parallel (see Fig. 5.5.3).
vi. Cross grid
Grids that integrate a combination of two linear grids, one overlaid on the other,
such that their respective foil strips are oriented at different angles
vii. Mammography grid
Grids designed specifically for mammography
b. Grid components
i. Foil strips
The foil strips have an especially high X-ray absorption coefficient with respect to
scattered X-rays that hit their surface. Normally, these strips are made of lead.
Tungsten, uranium and other high atomic number and high specific weight
substances are also potential candidates, but they are not used due to cost and
workability.
ii. Interspace material
A substance with high X-ray transmittance that is located between the foil strips in
grids. Typically made of an organic substance, such as wood or paper, synthetic
polymer, or aluminum, it also serves as a support for the flimsy lead foil strips.
Aluminum has relatively high X-ray transmittance for a metal and offers stable
performance as an organic interspace material, in terms of structural precision,
rigidity, weather resistance, and other characteristics.
iii. Cover
Grids are encased in aluminum sheet metal, carbon fiber reinforced plastic (CFRP),
or other low-absorption material that provides supplemental structural rigidity.
Spacing of Absorbing Foil Strips Location of Center Line

Absorbing Foil h
D d D d
Foil Height
h Cover
Fig. 5.5.3 Parallel Grid Fig. 5.5.4 Convergent Grid

5.5 Grids
5.5.3 Grid Standards

JIS Z 4910 X-ray grid standards were issued in 1962, which were subsequently revised by JIS Z
4910-1983 anti-scatter grids, to be consistent with IEC627-1978 standards. However, due to a
second version of IEC60627 being issued in 1998, which proposed unifying standards for grids
used in plain radiography and mammography, JIS standards were revised again in March 2000
as JIS Z 4910-2000 anti-scatter grids, which left parts of the previous standards required for
implementation intact. Grid dimensions are specified by a related standard, JIS 4905
photography -- Medical radiographic cassettes.
(See Table 5.5.1.)
The following information is indicated for grids.

a. Name: Anti-scatter grid (example)
b. Type and external dimensions: JG 14  17 or 38.8  46.4 cm (example)
c. Manufacturer name and corresponding code
d. Production serial number, date of manufacture, and corresponding code
e. Grid density: N40 (example)
f. Grid ratio: r10 (example)
g. Center line
h. Convergence distance: f0100 (example)
i. Side of X-ray tube: Tube side (example)
j. Name and code of interspace material: AL (example)
In addition, grids include an X-ray photograph for ensuring uniformity of striping patterns, but
they also indicate the maximum distance for use, total weight, foil thickness and height, and
physical performance values in attached documentation. The following example shows values
for a grid used in plain radiography.
External Dimensions Effective Dimensions Thickness

Type Remarks
Tolerance
Width Length Tolerance Width Length Tolerance
JG 14  17 388 464 378 454 For 14  17 film
JG 14  14 388 388 378 378 For 14  14 film

JG 11  14 313 388 303 378 For 11  14 film
JG 10  12 286 337 276 327 For 10  12 film

+0 +0 +0.5
JG 8  10 235 286 225 276 For 8  10 film
-1.0 -1.0 -0
JG 6 /2  8 /2 For 6 /2  8 /2 film
1 1 1 1
198 248 188 238
JG 4 /4  6 /2 For 4 /4  6 /2 film
3 1 3 1
153 198 143 188
JG 41  41 410 410 400 400 For 40-inch hood
JG 36  36 360 360 350 350 For 35-inch hood
Table 5.5.1 Reference Standards for Plain Radiography Grid Dimensions

5.5.4 Geometric Performance

a. Grid density: N = 1/D + d
Interspace
Number of foil strips per linear centimeter in Material Lead Foil
the horizontal direction, indicated using the
symbol N. Commercial products are
currently available with grid densities of 26
to 100 strips per centimeter. Height of
Foil Strips
b. Grid ratio: r = h/D
The ratio of a grid's height to spacing, it is
widely used as an indicator of a grid's ability
to eliminate scattered rays and a criteria for X-Ray Absorbing
Material (d)
selection. Normally, ratios from 5/1 to 14/1
X-Ray Transmitting
are most popular. The grid ratio is indicated Material (D)
by the symbol r. Grid Density
c. Lead volume: P = Ndh Grid Ratio

The lead volume is indicated for reference, Fig. 5.5.5 Grid Cross Section and Grid Ratio
as an easily compared indicator of a grid's
ability to improve contrast. The volume is indicated in terms of the cubic centimeter
volume per surface square centimeter of a grid and is indicated with the symbol P.
d. Grid convergence distance: f0 cm
The distance between the tube side of the grid and the convergence line, where
extensions of foil surfaces converge, indicated in terms of f0 cm
e. Maximum distance for use: f1 to f2 cm
The minimum distance (f1) and maximum distance (f2) between the X-ray tube focus
and incident surface of a convergent grid, given the X-ray tube is located above the grid
center line, for obtaining an X-ray image adequate for diagnostic purposes.
These quantities are not subjective, but rather physical quantities determined by
calculating the distances f1 and f2 from the X-ray focus where the loss (see Fig. 5.5.6
regarding the cut-off) of primary X-rays at the perimeter of the grid is 40 % or less, as
specified in JIS Z 4910.
Table 5.5.2 shows some examples of f1 and f2 values for plain radiography grids. These
quantities are grid-specific values. If the grid is used as a dynamic grid, with a bucky
device, for example, an additional lateral displacement is incurred with respect to the
X-ray focus. Therefore, this increases the cut-off for the overall grid surface and further
decreases image contrast in the peripheral areas. Bucky devices should be used at f
distances close to f0.
Grid
Convergence
Grid Grid X-Ray Tube
Distance X-Ray Tube
Convergence Convergence Focus
X-Ray Tube Focus
Distance Distance
Focus
Grid
Grid Grid
Film
Portion of Primary Rays Film
Portion of Primary Rays Film
Filtered by Lead Foil
Filtered by Lead Foil
Cut-off due to deviation of the distance Cut-off due to difference between Cut-off due to tilt (levelness) with
to the X-ray tube focus distance to the X-ray tube focus and respect to the distance to the X-ray
the grid center line tube focus.
Fig. 5.5.6 Function of Convergent Grids

5.5 Grids
Table 5.5.2 Examples of f1 and f2 Values for Plain Radiography Grids

Units: cm
Grid Ratio (r) (for grid dimensions: 388 to 464 mm)
f0cm
5/1 6/1 8/1 10/1 12/1 14/1
65 50 to 60 55 to 80 55 to 75 60 to 75 60 to 70 60 to 70
80 60 to 120 65 to 110 70 to 100 70 to 90 70 to 90 75 to 90
90 65 to 140 70 to 130 75 to 110 75 to 110 80 to 100 80 to 100
100 70 to 170 75 to 150 80 to 130 90 to 120 90 to 120 90 to 110
120 80 to 200 90 to 200 90 to 170 100 to 160 100 to 150 110 to 140
150 100 to 200 100 to 200 110 to 200 120 to 200 120 to 200 130 to 190
180 110 to 200 110 to 200 130 to 200 130 to 200 140 to 200 150 to 200
200 110 to 200 120 to 200 130 to 200 140 to 200 150 to 200 160 to 200
5.5.5 Physical Performance

When evaluating the performance of grids using test measurement conditions and methods
specified by JIS, the following six measurement values are obtained.
Ip = Intensity of primary X-rays entering the grid
Ip' = Intensity of primary X-rays passed through the grid
It = Intensity of all X-rays entering the grid
It' = Intensity of all X-rays passed through the grid
Is = Intensity of scattered X-rays entering the grid
Is' = Intensity of scattered X-rays passed through the grid
Based on these measurement values, the following indicators are obtained for each grid type.
Tp = Ip'/Ip Transmittance of primary X-rays
Tt = It'/It Transmittance of all X-rays
Ts = Is'/Is Transmittance of scattered X-rays
Theses values are used in the following formula to calculate the three physical performance
values required by JIS.
i. Bucky factor
Ratio of total incident X-rays to total transmitted X-rays, B = (Ip + Is)/(Ip' + Is') = 1/Tt
ii. Selectivity
Ratio of transmitted primary X-rays to transmitted scattered X-rays,  = Tp/Ts
iii. Contrast improvement factor
Ratio of transmitted primary X-rays to total transmitted X-rays, K = Tp/Tt
Table 5.5.3 shows a reference example of respective performance values for three
types of grids with commonly used aluminum interspace material.

Table 5.5.3 Reference Example of Characteristic Values for Aluminum Plain Radiography Grid
Grid Grid Bucky Factor B Selectivity  Contrast Improvement Factor K
Density N Ratio r
60
lines/cm
40
lines/cm
34
lines/cm
5.5.6 Performance-Related Maintenance Inspections

If it can be confirmed that performance of the grid was verified during an acceptance inspection
at time of purchase, then a visual inspection is usually adequate to determine whether or not
performance levels are still maintained. Therefore, having an X-ray photograph obtained using
the methods indicated under "Uniformity" in geometric performance specifications attached by
the supplier provides an important reference for judging performance. Performance can be
verified by acquiring a regular image during acceptance inspection and comparing it to the
attached image acquired without any intensifying screens, then, ideally, the attached image is
stored.
When using a grid, inspect its exterior for any deformation or damage that could have a negative
effect on images.
If possible, uniformity of film density should be periodically inspected by acquiring an X-ray
photograph of the grid by itself.
If the grid is suspected of causing image imperfections during use, this can be verified by
flipping the grid over and acquiring an image using the identical high voltage generator, cassette,
and automatic developing equipment, without changing the high voltage generator and cassette
layout configuration, then comparing the geometric relationship between the imperfections in
the two images.
Based on these results, replace the grid if it is affecting images.
5.5.7 Precautions for Use

Choose a grid based on radiography objectives, with a grid convergence distance suitable for
the exposure distance, and a grid ratio appropriate for tube voltage, object thickness, and other
parameters.
In addition, avoid any unnecessary cut-off effect (loss of primary X-rays) due to misaligned foil
strips, by being careful to ensure the X-ray tube, focus, and grid center lines are aligned and the
grid is geometrically positioned properly in terms of levelness and perpendicularity. Use
particular care with short convergence distances and high grid ratios, which can increase these
effects.
If the maximum distance for use is being referenced or a parallel grid is used, it is also
necessary to be aware that cut-off may be unavoidable at either end of the grid. For bucky grids,
it is desirable that the exposure distance be equal to the convergence distance, for the reasons
indicated in (4)-v above.

5.6 Cassettes
Since grids are made from layers of extremely thin foil, internal quality is protected by
encasement in various materials to prevent them from changing over time and to provide
supplemental rigidity, but grids still require special care in handling to avoid dropping, localized
pressures to the surface, or continuous pressure to entire surfaces. Appropriate methods are
required for storage as well to avoid damage to four sides and corners of the grid (such as by
using a specialized box or specialized storage shelf).
5.6 Cassettes
Medical X-ray film cassettes (hereinafter cassettes), which are frequently used in medical
diagnostic X-ray imaging, serve an extremely important role. The quality of cassettes can affect
diagnostic X-ray results and determine characteristics of diagnostic X-ray systems (and related
equipment). Cassettes are used in combination with X-ray photographic film (hereinafter film)
and medical X-ray intensifying screens (hereafter intensifying screens) that maximize effects on
performance. Currently, new types of products are being researched and developed in a variety
of fields to obtain X-ray images with higher diagnostic effectiveness. Currently in Japan, they are
manufactured by different companies, but the relationship between products is maintained
through JIS standards. In addition, the quality and performance of Japanese cassettes have
remained at an internationally high level.
5.6.1 Structure
Regulatory standards for cassettes date back to 1940, when the Japan Radiology Industry
Association specified frame dimensions of radiological film. Later, X-ray film was governed by
JIS. This required reconsidering film dimensions as well. Therefore, the then Japan Medical
Electrical Industries Association drafted regulations that became JIREE-P2 in 1952. In 1960,
JIS standards were drafted with additional inspection testing requirements, resulting in the issue
of JIS Z 4905 in 1962. In addition, JIS Z 4909 (light weight radiological film cassettes) was
issued in 1972. However, because SI units were beginning to be adopted around the world at
the time, the previous JIS Z 4905 and JIS Z 4909 standards were combined and overhauled to
comply with IEC standards in 1976, which resulted in the JIS Z 4905 1976 standards, due to
concerns that the existing inch-based standards would be internationally outdated.
Subsequently, these were reviewed to confirm compliance with relevant international standards
(IEC 60406) and consistency with other relevant JIS standards. Consequently, they are revised
as follows.
a. Structures must be made of appropriate light weight and sufficiently strong material that
does not readily cause reflections.
b. X-ray absorption of the surface sheet material must be equal to or less than 1.8 mm thick
aluminum and the surface must be treated to facilitate viewing the irradiation field projected
by the reference lamp.
c. On models with a lead sheet affixed to the rear cover to absorb rearward scattered X-rays,
the rear cover must have a total X-ray absorption, at a tube voltage of 100 kV, equivalent to
0.13 mm or more of lead.
d. The rear cover must be hinged to make inserting and removing film convenient, with a
single swing mechanism that is simple to operate, yet prevents accidental opening during
handling.
e. The rear surface structure must enable placing the cassette level, without any hinges,
clamping devices, or other items protruding from the surface.
f. The cassette center line must be easily apparent from the front and four sides.
g. To ensure a close fit between the film and intensifying screens, the rear cover must have
sponge material affixed to it, which does not change in thickness over time.
h. No surfaces, corners, or edges may have the potential of cutting humans.
i. The four corners of the outer frame must be chamfered or rounded, as shown in Fig. 5.6.1.

5.6.2 Performance
When cassettes are tested for light leakage, no exposure from light leakage may be observed
on photosensitive parts of the film. When the fit tightness is tested, no uneven density may be
observed on the film. The above two points are key factors that determine the performance of
cassettes.
5.6.3 Precautions for Use

a. In general, cassettes typically used for standard X-ray radiography in Japan are based on
inches.
b. Specialized cassettes are used for the following types of applications.
i. The 15  30 cm size is mainly used for orthopantomography in dentistry.
ii. The 30  90 cm size is used for applications such as angiography of the lower
extremities and radiography of scoliosis.
iii. Cassettes with a curved surface are used for applications such as radiography of joints,
such as the shoulder and knee joints, or cervical vertebrae.
iv. Mammography cassettes are used for direct radiography of the breast.
External Dimensions
Internal Dimensions
R3 to 6
Front Sheet Material Rear Cover Sponge Material
Fig. 5.6.1 Front View of Four Corners Fig. 5.6.2 Cross Section of Outer Frame
5.7 Photosensitive Materials (Film) for X-Ray

Radiography
5.7.1 Overview
In radiography, when an object (human body) is exposed to X-rays, some of the rays are
absorbed by the body. This absorption is proportional to the constituent substances in the tissue,
tissue thickness, and other parameters. The remaining rays pass through the body, where
differences in absorption generate differences in the amount of transmission X-rays (an X-ray
pattern). The photosensitive material (hereinafter film) captures these differences and renders
them into an image. However, since X-rays intrinsically have high transmittance characteristics,
this difference in absorption is very slight. This means that the contrast level produced by the
object is extremely low. If typical film were used for radiography, body organs, which produce
only a small absorption differential, would not be identifiable in the resulting images.
Furthermore, since most of the X-rays pass through the film, a massive amount of X-ray
radiation would be required to form images.
In general, silver halide photosensitive materials are designed to be especially sensitive to the
visible range of the electromagnetic wave spectrum (400 to 700 nm). Therefore, transmission
X-rays are rarely used to directly expose film for medical X-ray photographs. Instead, film is
usually used in combination with intensifying screens, which are coated with a fluorescent
substance that efficiently absorbs X-rays and converts them to visible light. In other words,

5.7 Photosensitive Materials (Film) for X-Ray Radiography
though often called an X-ray photograph, in terms of the photosensing mechanism, images are
formed by the visible light, similar to film exposures in regular cameras. Therefore, when
considering the quality and performance of X-ray film, it must always be considered as a
combined set including intensifying screens (or a fluorescent screen).
In contrast, photosensitive materials for recording images is film used to make hard copies of
image information that is in the form of an electronic signal. These configurations must be
thought of in terms of the combined CRT light emission characteristics of the CRT camera and
the laser characteristics of the laser imager.
In the field of image recording, the types of available systems are becoming very diversified,
with a sharp increase in the popularity of silver halide photothermography systems and dry
recording methods, such as direct thermal sensitive methods.
5.7.2 Structure and Types of Film

The structure of medical
photosensitive materials is (1)
shown in Fig. 5.7.1 and an (2)

overview of the types of (3)
applications are indicated in (4)
Table 5.7.1. (3)
(3) (5)
As described above, since (2)
simply exposing the body to (1) X-Ray Film for Indirect Radiography
X-rays generates extremely low X-Ray Film for Direct Radiography Film for Recording CRT Images
contrast levels, the
(1) Protective Coating Layer (P.C.) (4) Film Base
photosensitive emulsion used in (2) Emulsion Layer (Em) (5) Backcoating (B.C.)
X-ray film for direct radiography (3) Undercoating (U.C.)
is fundamentally designed to Fig. 5.7.1 Structure of Medical Photosensitive Material

provide enough sensitivity and
contrast for diagnosis.
Furthermore, with the exception of mammography film, the same photosensitive emulsion is
applied to both sides of the film base, effectively making a double-sided emulsion film.
Consequently, there is no difference between the front and back side of this type of film.
In contrast, film for indirect radiography systems, which use lenses to form a reduced size image,
film for recording images, and film for duplicating X-ray photographs, are all single-sided, with
photosensitive emulsion applied only to one side. This requires differentiating between the front
and back sides when they are used. Therefore, single-sided emulsion film sheets include a
notch along one edge, which indicates the emulsion is applied on the near side when the film is
held with the notch oriented toward the upper right.
The layer structure of these two types of film is shown in Fig. 5.7.1.
The function of each film layer is described below.
Protective Coating Layer:
Consisting primarily of gelatin, it is not only used to protect the photosensitive
emulsion, but also to prevent adhesion to the intensifying screens.
Emulsion Layer:Silver halide particles uniformly dispersed and applied in a gelatin layer. This
layer is about 2 to 6 m thick.
Undercoating: This layer ensures the photosensitive emulsion adheres securely to the film
base and it is also a gelatin-based substance.
Support: This sheet type film is typically stained a light blue color (uncolored types are
also available) and is made of highly transparent polyethylene terephthalate
(PET). This layer is about 175 m thick. However, roll-type film is 100 m
thick and triacetate (TAC) film is 135 m thick.
Backcoating: This thin gelatin layer is only applied to single-sided emulsion films to prevent
the film from curling on both sides of the emulsion.

By adding a dye to the gelatin, the layer also serves to reduce halation by
reflecting light away from the back side.
The key ingredient in photosensitive materials is silver halide, but the gelatin binder also serves
the following important functions.
a. Holds the silver halide in a uniformly dispersed state.
b. Acts as a cushioning material for external physical pressures.
c. Absorbs processing fluids and swells to help it quickly reach areas surrounding the silver
halide that have sensed light and it helps promote the exchange of new and old fluids.
On the other hand, due to these characteristics of gelatin, care is required to avoid leaving
fingerprints when handling the film or adhesion to the intensifying screens.
Table 5.7.1 Types of Medical Film by Application

Type 1 Type 2 Emulsion Sensitivity Application
High sensitivity type
General and specialized
Regular type Standard contrast type
radiography
Latitude type
Double-sided High contrast type For angiography
intensifying
screen for direct Standard contrast type For plain radiography
radiography Ortho-type For plain and
Wide latitude type gastrointestinal
radiography
Ultra-wide latitude type For chest radiography
Single-sided For radiography of four
For intensifying High contrast type
Radiography Ortho-type extremities and
screen for direct mammography
radiography Standard contrast type
For radiography with
For chest radiography
fluorescent screen
70 and 100 mm
rolls for direct Ortho-type For Indirect radiography For gastrointestinal
radiography with I.I. radiography
For X-ray cine radiography For angiography
Regular type Non-screen type 3  4 cm for oral use
For dental
radiography Regular type
Screen type For panoramic radiography
Ortho-type
Standard contrast type
For multiple
Ortho-type Latitude type
cameras
High-sensitivity type
Wet processing 633 type For recording CT,
For Recording type 680 to 890 types
For laser ultrasound, MR, RI, and DF
Images
imagers images
Dry processing
680 to 890 types
type
For thermal Direct thermal Silver salt / non-silver salt
imagers type types
Batch film For measuring X and
gamma ray dose
Duplicating film For duplicating X-ray

photographs
Other
Thermal film For recording ultrasound
images
Micro film For reducing or duplicating

X-ray photographs

5.7.3 General Characteristics of Film

(1) Color Sensitivity
The light spectrum visible to the naked Violet Blue Green Yellow Orange Red
Relative Luminosity, V
eye ranges from 400 to 700 nm, where
our visual sensitivity (relative luminosity)
level over that range is shown in Fig.
5.7.2.
It shows that maximum sensitivity is at
about 550 nm (yellow-green color) and
sensitivity decreases for both longer and
Wavelength,  (nm)
shorter wavelengths.
Fig. 5.7.2 Relative Luminosity to the Naked Eye
Similarly, the sensitivity level of
photosensitive materials varies (1)
depending on the color, or in other words,
they are color sensitive. However, their
color sensitivity profile is quite different (2)
than for the naked eye.

In general, there are four types of color (3)
sensitivity in photosensitive materials –
regular, orthochromatic, panchromatic,
(4)
and infrared.
The photosensitive wavelength ranges
for each type are indicated in Fig. 5.7.3.
Regular color sensitivity is sensitivity to (1) Regular (3) Panchromatic
(2) Orthochromatic (4) Infrared
only the short wavelength end of the
Fig. 5.7.3 Color Sensitivity of Photosensitive Materials
visible spectrum, from violet to blue light,
which is characteristic of silver halide color sensitivity. Orthochromatic sensitivity (or ortho,
for short) is regular sensitivity extended to include the green to yellow wavelengths by
adding additional color sensitive elements to silver halide. Panchromatic sensitivity is
achieved by further extending the range to include orange to red colors.
All conventional X-ray film for direct radiography used to be only sensitive to blue-violet light,
so they only had regular light sensitivity.
However, the development of rare-earth intensifying screens about 25 years ago, which
offered grayscale gradients and maximum brightness at about 550 nm, enabled achieving
image quality sufficient for diagnostic X-ray imaging. Consequently, the use of
orthochromatic, which was direct radiography film designed to efficiently absorb the
corresponding emission spectrum, rapidly become very popular.
Note that indirect radiography film, multi-camera film for recording CT, DF, MR, and other
images, and duplicating film are all orthochromatic. Special film for laser imagers, which
have rapidly increased in popularity in recent years for recording images, is designed to
have maximum sensitivity at wavelengths corresponding to He-Ne laser light (633 nm peak)
or semiconductor laser light (680 to 890 nm peak).
(2) Characteristic Curves and Characteristic Values
If photographic film is incrementally exposed to light and then developed, the opacity due to
the blackening silver in the film varies depending on the level of exposure. The graph of this
relationship between exposure level and opacity (the log of opacity, to be exact) is referred
to as the characteristic curve. In general, this is measured by incrementally exposing the
film to the light emitted from a given light source, then developing the film in a specified
developing solution, at a specified temperature, and for a specified processing time, and
using a densitometer to measure the darkness (density) of the corresponding shades of
resulting light and dark areas. Density is indicated on the vertical axis of the graph and

exposure level (log of exposure level) on the horizontal axis (see Fig. 5.7.4).
Density indicates the darkness or, in other words, opacity of an X-ray image. It is expressed
in terms of the proportional decrease in incident light passing through a film. This means
that if 1/10 of the incident light passes through the film, then D = 1.0, if 1/100, then D = 2.0,
and if 1/1000, then D = 3.0, and so on.
This is indicated by the following relationship and Table 5.7.2.
Density (Log of Opacity)
Incident
入射光 Transmitted
透過光
Light Light
I0 I
I0 ··········· Intensity of incident light on film

I ············ Intensity of light passed through film
I/I0 ·········· Transparency, T
I0/I ·········· Opacity, O = 1/T
log I0/I ····· Density, D
Exposure Level (log

Fig. 5.7.4 Characteristic Curve
Table 5.7.2 Relationship Between Transmittance of Light and Transparency, Opacity, and Density
Intensity of Intensity of
Transparency, Density,
Incident Light, Transmitted Opacity, I0/I
I/I0 Log I0/I
I0 Light, I
Symbol – – T O D
1000 1000 1.00 1 0
1000 500 0.50 2 0.3
1000 250 0.25 4 0.6
1000 100 0.10 10 1
1000 10 0.01 100 2
1000 1 0.001 1,000 3
1000 0.1 0.0001 10,000 4
The exposure level is the product of multiplying the illuminance (Lx) of the light exposure
and the duration time (sec). The same applies not only to visible light, but also to X-rays and
gamma rays. However, whereas visible light can be accurately measured, it is difficult to
measure the level of X-rays or other radiation in terms of their effect on photographs.
Therefore, exposure levels (i.e. the horizontal axis of characteristic curves) are generally
specified in terms of relative values. An ideal method of varying the light exposure applied to
film at a constant rate is to vary the distance between the film and X-ray tube, but ensuring
accuracy requires a complicated equipment setup. Simple methods using a step-like
aluminum filter are available, but graphing the result can be time-consuming and tedious
and constraints on tube voltage and other parameters can be problematic. The use of a
step-like aluminum filter should only be used for sensory comparison purposes.
As mentioned above, the exposure level is the product of luminance and exposure time.
Therefore, as long as that product is kept constant, varying the luminance or exposure time

should not any effect on photographs (i.e. no effect on resulting photograph density). This is
referred to as the law of reciprocity. However, this law ordinarily does not hold for
photographs, where effects can be worse for especially intense or weak light. This
phenomenon is called reciprocity law failure. Due to recent advances in X-ray systems, high
capacity systems are being used to perform short exposures of only a few milliseconds, but
be aware that the problem with reciprocity law failure can still occasionally occur. In the case
of direct radiography (radiography without screens), the exposure time for individual
particles that determine photosensitivity is constantly about 10-13 seconds, regardless of
how long or short the film is exposed. Therefore, the law of reciprocity always holds and is
not a problem.
The following photograph characteristic values can be obtained from characteristic curves.
a. Sensitivity
Sensitivity can be expressed quantitatively as the reciprocal of the quantity of light
(log H) necessary to obtain a particular density on the characteristic curve. Put another
way, sensitivity expresses how little light (or radiation dose) is required to obtain the
desired density level.
In this case "a particular density" means a value representative of the most important
and useful density range for rendering images. In the case of direct radiography film,
the values often used are 0.3 above the fogging level and 1.0.
On the horizontal axis of the characteristic curve, the quantity of light is greater as you
move to the right. Therefore, this means that if multiple characteristic curves were
graphed, the curves further to the right would have lower sensitivity. If the exposure
level itself was used to express sensitivity, it would result in an apparent contradiction of
using higher values to express lower sensitivity. Therefore, the reciprocal value is used.
b. Gradient
The relationship between a fixed interval on the horizontal log H axis, log H, and the
corresponding density interval, D, is expressed as D/log H and is referred to as a
gradient. In the linear portion of the characteristic curve, density is proportional to log H
(D/log H is constant). This means that within the linear portion, black and white
images can be obtained with density that is correctly proportional to the log of the
exposure level and also with the highest gradient. The gradient of the linear portion is
indicated as the tangent to the angle alpha, formed between the log H axis and the
linear section. This gradient is called gamma (tan  = ). Gamma is an important
characteristic value that indicates the contrast of photosensitive materials. Moving
farther from the linear section, toward the bottom (the foot) or toward the top (the
shoulder), results in a successively lower gradient and decrease in ability to render
details. For clinical X-ray photographs, not only the linear section, but gradients in the
foot section are important factors as well. Therefore, average gradient (G) is often
expressed as the tangent of angle ', formed between the log H axis and a straight line
from A to B on the characteristic curve. (In actuality, specific density values are specified
for points A and B.)
c. Fogging and Maximum Density Points
The density at the zero-point for the gradient, in the foot section, is called the fogging
point, where the corresponding point in the shoulder section is called the maximum
density point (Dmax). These are also important factors for understanding the
characteristics of a photosensitive material. The shape or characteristic values of a
characteristic curve can vary significantly depending on film processing parameters.
Therefore, the status of developing solutions can be controlled by using the methods
described above to expose several sheets of film having a given amount of
photosensitive material, then processing each sheet for appropriate lengths of time.
However, if exposed film is left for long periods, the latent image can degenerate,
causing an error factor in obtained results. Methods of measuring or displaying these

types of photograph characteristics require understanding film characteristics. However,

for X-ray film used in combination with intensifying screens, which is the configuration
used for most medical X-ray photography, the diversity in intensifying screens has
made specifying light standards difficult. Consequently, standards still have not been
specified.

5.8 Intensifying Screens

5.8.1 Overview
The silver halide emulsion layer applied to both sides of X-ray film has a slight sensitivity to
X-rays, but the proportion of X-rays normally used for medical diagnostic X-rays that are
absorbed by film is at most about 1 %. Therefore, using only X-ray film for radiography would
require exposing subjects with large amounts of X-rays.
However, to utilize X-rays more efficiently, images can be obtained by using intensifying screens,
which are sheets of fluorescent substance made of elements with large atomic number, to
expose the film with fluorescent light emitted from the intensifying screens when they are
exposed to X-rays (see Fig. 5.8.1). Therefore, X-ray exposure levels and exposure times can be
significantly reduced by using intensifying screens.
Front Back
Intensifying Intensifying
Screen Film Screen
Cassette
Emulsion
Layer
Protective Layer
Fluorescent Layer
Support
Fig. 5.8.1 Function and Structure of Intensifying Screens
5.8.2 Function of Intensifying Screens

a. Significantly reduces exposure dose levels to patients.
b. Enables shorter exposure times, which allows reducing blur caused by subject movement.
c. Enables using X-ray tubes with small focuses, which allows reducing geometric blur.
d. Enables using a smaller capacity X-ray system for radiography. In addition, it extends the
service life of X-ray systems.
e. Increases the contrast level of X-ray photographs.
On the other hand, using intensifying screens increases graininess and adds blur, which
reduces sharpness for static objects, but due to the benefits listed above and from a practical
perspective, intensifying screens are currently used for almost all film-based radiography
systems, because they enable simultaneously reducing exposure levels and improving image
quality.
5.8.3 Structure of Intensifying Screens

With the exception of mammography, intensifying screens are generally used in pairs, applied to
each interior side of the cassette, with the film sandwiched in between. Of the two intensifying
screens, the one on the incident X-ray side of the cassette is referred to as the front intensifying
screen, whereas the one on the opposite side is referred to as the back intensifying screen. The
structure of intensifying screens fundamentally consists of the following three layers, listed in

order, starting from the front side.

a. A protective layer made of a thin transparent plastic, such as polyester film or a cellulose
compound, about 10 m thick
b. A uniformly applied fluorescent layer that glows brightly when stimulated by X-rays
c. A plastic support, primarily consisting of polyester film, that also serves to reflect or absorb
light
Of these, the fluorescent layer serves the most important role and determines the
characteristics of the intensifying screen.
5.8.4 Characteristics of Fluorescent Substances on

Intensifying Screens
Since fluorescent substances used on intensifying screens must emit light brightly in response
to X-ray exposure, they should have the following characteristics.
a. High X-ray absorption rate
b. High light energy emission efficiency
c. The emitted light spectrum of the fluorescent substance closely matches the
photosensitivity spectrum of the X-ray film.
X-ray fluorescent substances currently in practical use are indicated in table 5.8.1. Gd2O2S:Tb
phosphor, a rare-earth fluorescent substance that emits green light, is used for almost all
orthochromatic intensifying screens. CaWO4 phosphor is the main fluorescent substance used
for regular intensifying screens, but rare earth fluorescent substances, such as LaOBr:Tm,
BaFCl:Eu, and YTaO4, are also used for some intensifying screens.
Light Emission Powder

X-Ray Absorption
Spectrum Luminescence Characteristics
Fluorescent
Peak Energy Effective K Application
Substance Emission Specific
Wavelength Efficiency (%) Atomic Absorption Crystal Form
Color Gravity
(nm) Number Edge (keV)
CaWO4 Blue 425 5 61.8 69.53 6.1 Tetragonal
2+
BaFCI:Eu Violet 385 13* 49.3 37.44 4.7 Tetragonal
LaOBr:Tm3+ Blue 360, 460 14 49.3 38.92 6.3 Tetragonal
LaOBr:Tb3+ Blue-White 420 20* 49.3 38.92 6.3 Tetragonal Intensifying
screens
YTaO4:Nb Blue 410 11 59.8 67.42 7.5 Monoclinic (regular
YTaO4 Ultraviolet 340 – 59.8 67.42 7.5 Monoclinic systems)
3+
YTaO4:Tm Blue 360, 460 8 59.8 67.42 7.5 Monoclinic
BaSO4:Eu2+ Violet 380 6* 45.5 37.44 4.5 Orthorhombic
Y2O2S:Tb3+ Blue-White 420 18* 34.9 17.04 4.9 Hexagonal
Intensifying
screens
(ortho
Gd2O2S:Tb3+ Green 545 13 59.5 50.24 7.3 Hexagonal
systems)
Fluorescent
screens
Fluorescent
(Zn,Cd)S:Ag Green 530 19 38.4 9.66/26.71 4.8 Hexagonal
screens
BaFBr:Eu2+ Violet 390 16 48.3 37.44 5.0 Tetragonal IP
CsI:Na Blue 420 10 54.0 35.98/33.17 4.5 Cubic I.I.
ZnS:Ag Blue 450 17 26.7 9.66 3.9 Hexagonal Scintillators
* Values measured using cathode rays
Table 5.8.1 X-Ray Fluorescent Substances

To obtain optimal performance, fluorescent layers are designed with the optimal fluorescent
substance type, particle size, particle shape, and particle arrangement, and an optimal
thickness. In general, fluorescent particles are arranged in either a uniformly dispersed
arrangement or a multilayer arrangement, where the uniform dispersion arrangement offers
superior graininess characteristics and the multiple layer arrangement offers superior
sharpness. To improve sharpness, while maintaining the benefits of a uniformly dispersed
arrangement, high density uniformly dispersed arrangements are also used, which packs the
fluorescent substance more densely. This allows optimizing the balance between sharpness
and graininess (see Fig. 5.8.2). Intensifying screens are also available with a special two-layer
structure of two different fluorescent substances.
Spread of Generated Light
X-Rays X-Rays X-Rays

Protective Layer
Fluorescent Layer
Support (base)
Uniformly Dispersed Multilayer Structure Densely Packed

Structure Uniformly Dispersed
Structure
Fig. 5.8.2 Particle Arrangement in Fluorescent Layer and Spread of Light
5.8.5 Performance of Intensifying Screens

There are many types of performance parameters for intensifying screens, including factors
related to X-ray exposure level (sensitivity), factors related to X-ray photograph quality
(sharpness, graininess, and contrast), the film with which they are combined, the cassette,
radiography or other system characteristics (usability), and durability (see Table 5.8.2). Of these,
the most important are image characteristics, where in recent years there have been significant
advances in automation, energy efficiency, and faster diagnostic X-ray systems, with an
increasing use of cassetteless systems and film changers for radiography, bright room
processor for cassette radiography, or faster self-developing models. In response to this
transition in systems, customers are strongly demanding better usability (system
characteristics) for
(1) Photographic Sensitivity
intensifying screens. Performance Image Quality Sharpness
In terms of usability, the most (basic Graininess
important factors include characteristics) Contrast
improvements to how quickly (2) Usability Film adhesion (before exposure)
the intensifying screens (system Film releasability (after exposure)
characteristics) Film conveyance capabilities
adhere to the film after the Anti-static capabilities
film is loaded, how well the
(3) Durability Physical strength Surface wear resistance
film is conveyed in the Protective layer adhesion
mechanical feeder system, Coating layer strength
and how well the film is Scientific strength Contamination resistance
released after exposures. (4) Other Light persistence
Table 5.8.2 Performance Factors for Intensifying Screens

These characteristics are clearly affected by the surface characteristics of intensifying screens,
where characteristics are improved by increasing the surface roughness of intensifying screens.
Therefore, the surface profile of intensifying screens needs to be optimized for the equipment
being used. The faster the film is conveyed and exposed, the more the intensifying screens with
enhanced matte surfaces are used.

(1) X-Ray Fluorescent Substances
A general term for fluorescent substances that efficiently generate light in response to X-ray
stimulation, X-ray fluorescent substances are widely used for intensifying screens,
fluorescent screens, image intensifiers, imaging plates, scintillators, and other applications
involving X-rays
(2) Front Intensifying Screen
Intensifying screens used by placing them on the incident X-ray side of the film
(3) Back Intensifying Screen
Intensifying screens placed on the opposite side (transmitted X-ray side) of the film and
used in combination with the front intensifying screen to sandwich film in between
(4) Sensitivity
Sensitivity indicates how much an intensifying screen intensifies sensitivity. It is expressed
as a value inversely proportional to the X-ray dose level necessary to achieve equivalent
photographic density and is often expressed as a sensitivity ratio (relative sensitivity) with
respect to a standard intensifying screen.
(5) Sharpness
Sharpness indicates the degree of unsharpness and blur. It is generally evaluated using an
MTF (modulation transfer function) as a physical assessment method.
(6) Graininess
Graininess indicates the coarseness of X-ray photographs, where intensifying
screen-related factors for graininess include structure mottle, which is caused by the
structure of intensifying screens, and quantum mottle, which is caused by the luminescence
efficiency of intensifying screens. Typical evaluation methods include paired comparison
method as a psychological method and the Wiener spectrum method as a physical method.
(7) Contrast
Contrast expresses the relative darkness or lightness of adjacent locations in X-ray
photographs. Contrast not only affects the grayscale gradient of the film, but also the X-ray
energy, type of fluorescent substance used in intensifying screens, the thickness, and other
factors.
(8) Light Persistence
Phenomenon where light continues to be emitted even after X-ray stimulation has stopped.
If a fluorescent substance with a long light persistence is used for an intensifying screen, an
afterimage will remain, which can interfere with diagnoses. Therefore, fluorescent
substances with a short light persistence are used for intensifying screens.
(9) Surface Characteristics
This is a general term for the surface status of intensifying screens and typically refers to the
roughness of the surfaces. Since the surface roughness of an intensifying screen affects
how closely it adheres to the film, intensifying screen surfaces are usually prepared with a
sandblasted finish.
(10) Intensifying Screen Cleaners
This refers to cleaning agents that readily clean contaminants, debris, and other substances
from the surfaces of intensifying screen. This helps prevent static electricity and also static
marks.

5.8.7 Types of Intensifying Screens

Currently, the choice of intensifying screen/film systems has become extremely diverse. In
particular, the development of rare earth intensifying screen systems has resulted in an
overwhelming number of possible combinations.
There are three ways to classify intensifying screens, as described below.
(1) Classification by emission color of fluorescent substance
(2) Classification by intensifying screen performance
(3) Classification by intended use of intensifying screens
(1) Classification by Emission Color of Fluorescent Substance

Intensifying screen/film systems can be generally classified as either regular systems,
which combine an intensifying screen that emits a blue light with film that is sensitive to
blue light, or orthochromatic systems, which combine an intensifying screen that emits a
green light with film that is sensitive to green light. Due to performance improvements in
recent years, orthochromatic systems are now the main type used.
(2) Classification by Intensifying Screen Performance
Since there is generally a trade-off between intensifying screen sensitivity and sharpness,
many different intensifying screens have been made available with different levels of
sensitivity.
Therefore, in terms of performance, intensifying screens are classified by sensitivity,
based on the following parameters, regardless of whether they are regular or ortho
systems.
(a) High-sharpness intensifying screens
Though sensitivity is low, these screens offer high sharpness. They are used for objects
with low movement or thin objects with low X-ray absorption.
(b) Medium-sensitivity intensifying screens
These are all-purpose intensifying screens, suitable for a wide range of objectives, that
offer medium performance in terms of both sensitivity and sharpness.
(c) High-sensitivity intensifying screens
Designed mainly for sensitivity, they
Processed using FPM4000 and RD-3 35 C
offer relatively low sharpness.
These intensifying screens are
used for objects with significant
movement or areas with high X-ray
absorption. They are also useful for
radiography using low-capacity
X-ray systems.
(d) Ultra high-sensitivity intensifying
Relative Sensitivity
screens
These intensifying screens offer
significantly lower sharpness, but
sensitivity is especially high.
Therefore, they are used for
radiography of areas vulnerable to
X-ray exposure, such as the
reproductive system, or for
high-speed angiography.
Intensifying screen characteristics can
even vary depending on the X-ray
energy level used for radiography.
Therefore, especially the dependence X-Ray Tube Voltage (kV)
Fig. 5.8.3 Tube Voltage Characteristics of Intensifying
Screens for Orthochromatic Systems
of sensitivity on tube voltage (tube voltage characteristics) must be carefully considered

when using intensifying screens.
Of the elements contained in fluorescent substances used in orthochromatic systems, the
absorption edge of gadolinium (Gd) is near the effective energy 50 eV. Therefore, it offers
relatively higher sensitivity for high voltage radiography than CaWO4 based intensifying
screens. On the other hand, sensitivity efficiency tends to drop for radiography at extremely
low voltage levels (see Fig. 5.8.3).
(3) Classification by Intended Use of Intensifying Screens (Table 5.8.3)
Recent advances in diagnostic X-ray technology has been truly remarkable, with significant
progress in functional inspection capabilities, energy efficiency, automation, and other
areas.
The variety of intensifying screens is also changing in response to this transition in
radiography systems (and technology), but in terms of applications, intensifying screens
can be classified as either for cassette radiography or for mechanical feeder systems that
automatically feed the film.
In terms of areas being exposed and intended use, intensifying screens can be classified as
either general purpose screens for plain radiography or specialized screens used only for
specialized radiography methods or specific exposure areas, where intensifying screens for
plain radiography are classified by performance, as described above. Commercial
intensifying screens for specialized radiography are available in an extremely wide variety
of types, depending on the purpose of radiography, but the most frequently used types are
intensifying screens for mammography and sensitivity compensated intensifying screens.
(a) Intensifying screens for mammography
Initial diagnoses of breast cancer using mammography requires identifying tiny
calcifications about 100 m in size. Therefore, extremely high resolution intensifying
screens are required for mammography. Consequently, to completely eliminate
crossover effects and improve sharpness, single-sided orthochromatic systems are
widely used in practical use that combine single-sided emulsion orthochromatic film
with a green light emitting rare earth intensifying screen applied only to the back side.
This achieves much higher resolution than double-sided systems for plain radiography.
(b) Sensitivity compensated intensifying screens
For radiography of objects that have extremely varying levels of X-ray absorption,
sensitivity-compensated intensifying screens provide one way of compensating the
sensitivity of specific areas to enable diagnosing the entire area with a single exposure.
By partially varying the sensitivity of intensifying screens to compensate for certain
areas, sensitivity can be increased in areas of high X-ray absorption or, conversely,
decreased in areas of low X-ray absorption.
These are considered superior due to their ability to compensate sensitivity without
sacrificing contrast. Methods commonly used to compensate intensifying screen
sensitivity include adding color to the protective layer or fluorescent layer. Sensitivity
compensated intensifying screens are used for various areas, such as entire lower
extremities, the entire spine, the chest area, or for cephalometric radiography. Extra
long intensifying screens, over 1 meter long, are also used for radiography of the entire
lower extremities or entire spine.

High sharpness Chest, head, upper/lower limbs
For plain Medium sensitivity Chest, head, stomach, intestines

radiography High sensitivity Stomach, intestines, lumbar
vertebra, urinary organs
Ultra high sensitivity Lumbar vertebrae
For general Mammography
cassettes Breasts, soft tissue
(single-sided)
Sensitivity compensated Lumbar and thoracic vertebrae,
lower limbs, chest
For specialized High energy radiography Cobaltography, linacography
radiography
Simultaneous multi-layer Chest, head, abdomen
Intensifying tomography
screens Bedside radiography Chest, abdomen
High sharpness Chest

For cassetteless/ Medium sensitivity Chest, abdomen
film changers
For
mechanical High sensitivity Abdomen
feeders For high-speed
continuous High sensitivity Brain, cardiac blood vessels
radiography Ultra high sensitivity Brain, cardiac/abdominal blood
(angiography) vessels
Table 5.8.3 Diagram of Medical Intensifying Screens
5.8.8 Storage and Management of Intensifying Screens

There are many factors involved in radiography. To reliably obtain good quality X-ray
photographs, the X-ray generator, photosensitive material, developer processes, and other
factors must be routinely maintained in good condition. Among photosensitive materials,
intensifying screens are used over long periods. Therefore, it is necessary to periodically check
for deterioration over time.
Intensifying screens can deteriorate for the following three reasons.
(1) Decrease in sensitivity due to scientific contamination from X-ray films, intensifying
screen cleaners, and so on
(2) Physical decrease in image quality and decrease in sensitivity in specific areas due to
mechanical wear of intensifying screen surfaces
(3) Decrease in intensifying screen performance due to X-ray stimulation or other such
factors
Of these, (1) and (2) are the most dominant factors. Therefore, the following maintenance
inspections should be performed periodically and if any problems are discovered, the
intensifying screens should be promptly replaced. Adding a safety factor for X-ray photograph
quality assurance purposes, we recommend replacing intensifying screens every 2 years or
every 10,000 exposures for general cassette radiography and every year or 10,000 exposures
for cassetteless or changer applications.
1) Performance-Related Maintenance Inspections
(a) Inspecting the exterior
Visually inspect for distortion, scratches, contamination, or other damage to intensifying
screens that could result in artifacts in X-ray photographs. Contamination, scratches,
and debris on the surface of intensifying screens appear as white dots or uneven
density in images. Leaving intensifying screens with dirt, debris, developing solutions,
or other substances adhered to them could cause decreased image quality. Therefore,
screens must be periodically cleaned using a specialized cleaner specified by the
intensifying screen manufacturer.
(b) Inspecting photographs
One suitable method of inspecting for contamination, discoloration, or deterioration of
intensifying screens is to acquire an image without any object being exposed and

inspect the photograph for white spots or uneven density.

(c) Intensifying Screen to X-Ray Film Adhesion Test
It is safe to say that it is the cassette that determines how good or bad the X-ray
photograph is. Therefore, how closely the film and intensifying screens adhere is very
important. The level of adhesion between the film and intensifying screens is generally
evaluated using an adhesion test board specified in JIS Z 4905 (Photography -- Medical
radiographic cassettes/screens/films and hard-copy imaging films -- Dimensions and
specifications) or by exposing a metal mesh with a photograph density of 2.0 to 2.5 and
using that to judge the density unevenness. Since adhesion tests for mammography
require extremely high resolution levels, an extremely fine metal mesh (about 40
meshes) is used.
(d) Sensitivity
Typically, the sensitivity of intensifying screens is measured by using a characteristic
curve to determine the X-ray dose level (intensity) necessary to obtain equivalent
density and the relative sensitivity is determined from the reciprocal of that value.
Specific methods include the time scale method, which varies the exposure distances,
and the bootstrap method, which uses a step-like aluminum filter, but the intensity scale
method is recommended in terms of precision.
As a simple measurement method for maintenance, it is also possible to determine
sensitivity by simultaneously exposing a standard intensifying screen and sample
intensifying screen and comparing their respective image density levels.
(e) Sharpness
Along with sensitivity, sharpness is an important parameter for quality control, where a
MTF (modulation transfer function) is typically used to evaluate physical properties.
Representative MTF measurement methods include the slit method and contrast
method, but measurement using the contrast method, which uses a square wave X-ray
test chart, is relatively simple and involves fewer error factors. In addition, it offers the
advantage of being able to compare results to a chart image with the naked eye.
Therefore, the contrast method is more widely used.
As a simple evaluation method for maintenance, sharpness can be evaluated by
comparing the resolution limit of an X-ray test chart, where a resolution test chart for
that purpose is specified by JIS Z 4917.
(f) Graininess
Methods that involve determining a Wiener spectrum are typically used to evaluate
physical graininess, but these methods are tedious and not well suited to maintenance
and control purposes. Therefore, an effective qualitative evaluation method is to use a
standard intensifying screen and sample intensifying screen to acquire images without
any object being exposed, then to perform a paired comparison of the resulting
photographs with the naked eye. Graininess can vary depending on the film type,
radiography parameters, film development parameters, and other factors, so it is
important that evaluations are performed using a simultaneous comparison.

6.1 Digital Radiography
6 Image Processor
6.1 Digital Radiography
6.1.1 Overview
X-ray radiography systems have a long history of using analog images with film for detection.
X-ray photograph systems that record and fix images on film are outstanding information
recording systems that provide superior spatial resolution, simplicity, storage characteristics,
and other features. Consequently, they are still popular for diagnostic X-ray applications today.
However, in recent years, digital radiography systems have become increasing popularity.
These acquire data as digital images. DR (digital radiography) has a history that extends over
20 years, but it seems that it has finally gained traction in Japan, now that the Ministry of Health,
Labour and Welfare has approved electronic storage of diagnostic images. Consequently, there
has been a rapid increase in image networking technologies, such as in terms of immediacy and
abundant image processing and storage features.
6.1.2 Configuration of Digital Radiography Systems

An example of a digital radiography/gastrointestinal X-ray TV system is shown in Fig. 6.1.1. In
this example, a typical R/F table system has been combined with an image processor (DR unit)
and a high-definition television system. For the video camera, a high pixel count CCD camera is
used. Image data from the CCD element is converted to digital by an A/D converter, then sent to
the DR unit. The CCD interface controls the input/output of data and its timing. In addition, it
performs image processing functions such as filtering and log conversion. The image
processing block features frame memory and image calculation circuits that enable real-time
image processing. The display control block performs image grayscale processing,
enlarging/reducing, connecting to the laser imager, and other processes for displaying images.
The system control block controls data input/output to the hard disk drive, CD-R drive, or other
recording media, and also performs functions such as data compression. This block also
handles interfacing with the X-ray generator unit and image network.
DR装置
DR Unit
CCD I/F Image Process
モニタ
Monitor
Display Cont.
カメラ
Camera
Head
ヘッド L/I
I.I.
System Cont. HDD
CD-R
Ｘ線制御装置
X-Ray Controller
Fig. 6.1.1 Example of Gastrointestinal DR System

6 Image Processor
6.1.3 Digital Subtraction Angiography (DSA)

DSA systems subtract an image acquired before injecting a contrast medium (mask image) from
the image acquired after injecting the contrast medium (live image) to display only an image of
blood vessels (subtraction image). DSA systems offer superior contrast resolution.
Live Image – Mask Image = Subtraction Image
Live Image Mask Image Subtraction Image
Fig. 6.1.2 Example of Creating DSA Image
<Left Internal Carotid Artery> <Hepatic Artery>

Fig. 6.1.3 Examples of DSA Images
6.1.4 Characteristics of Digital Radiography

The following are some of the main benefits of digital radiography.
a. Superior immediacy allows viewing radiography images almost in real time.
b. Radiography images can be processed using level, window, or edge enhancement
functions, and recursive or other filters can be applied to enable viewing (or processing)
images that provide more information.
c. Large amounts of image data can be stored on compact recording media, which eliminates
any worry of the data deteriorating.
d. Resolves the problems involved in handling film in a dark room, maintaining developing
equipment, maintaining developing chemical supplies and environments, and storing film.
e. Enables connecting to a PACS (picture archiving and communication system) or an image
network within or outside hospitals.
Disadvantages include lower spatial resolution than film and a tendency to require more
equipment and more expensive equipment for viewing images.

6.2 Image Processing

Image processing can involve many different methods. Basic methods are described below.
6.2.1 Width
The width setting specifies the bandwidth range of data in memory to display on the monitor.
A diagram of the relationship between the image in memory and the image on the monitor in
terms of the width setting is shown in Fig. 6.2.1. The horizontal axis indicates the density values
in memory for the subtraction image, which can range from -2047 to +2047. The vertical axis
indicates the density value for the image displayed on the monitor, which can range from zero
(black) to 255 (white).
In Fig. 6.2.1, Width = 2047 and Level = 0 for image (1) and Width = 1023 and Level = 0 for
image (2).
Image (2) shows the results from enhancing image (1) in memory with Width = 2047 and
Level = 0 settings. There is no change in the contrast of the original image.
Image (3) shows the results from enhancing image (1) in with Width = 1023 and Level = 0
settings. The image now has twice the contrast level of the original image.
Density Value in Memory for Subtraction Image
White (255)
(2) (1)
Black (0)
-2047 -1023 0 +1023 +2047 (2) (3)

Image Displayed on the Monitor
WIDTH = 2047 WIDTH = 1023
LEVEL = 0 LEVEL = 0
(1) Image in Memory
Fig. 6.2.1 Width Value
6.2.2 Level
The level setting determines the center point of density width data to display from memory. A
diagram of the relationship between the image in memory and the image on the monitor in terms
of the level setting is shown. The horizontal and vertical axes are the same as in Fig. 6.2.1.
In Fig. 6.2.2, Width = 1023 and Level = 0 for image (1) and Width = 1023 and Level = -1023 for
image (2). Image (2) shows the results from enhancing image (1) in memory with Width = 1023
and Level = -1023 settings. Image (3) shows the results from enhancing image (1) with
Width = 1023 and Level = 0 settings. Images (2) and (3) have the same width value, so the
contrast level is the same. However, if portions of the image in memory with a density value of
zero, for example, are enhanced by settings in (1), a level of 127 is displayed on the monitor. If
enhanced by settings in (2), a level of 255 is displayed on the monitor. If the portion of the image
in memory with a density value of -1500 is enhanced with settings in (1), a totally black image is
displayed on the monitor, with the same density level as other areas with -2047 densities.

6 Image Processor
Density Value in Memory for Subtraction Image
White (255)
(Darkness) Displayed on (2) (1)
Difference in Density
the Monitor
Black (0)
-2047 -1500 -1023 0 +1023 +2047 (2) (3)

Image Displayed on the Monitor
WIDTH = 1023 WIDTH = 1023
LEVEL = -1023 LEVEL = 0
(1) Image in Memory
Fig. 6.2.2 Level Value
6.2.3 Gamma Correction

Gamma correction function is used during image processing to White
correct the density of the area being observed to a level
appropriate for viewing, depending on the area being diagnosed.
Output
Fig. 6.2.3 shows an example of a gamma table used by an

imager to record a subtraction image on film, so that the image
appears without the background that was removed by
subtraction. Black
Normally, several types of gamma tables are available, which Black
Input
White
can be selected based on the parameters. Fig. 6.2.3 Gamma Table
6.2.4 Integration
To enhance the S/N ratio of an image, the image is processed in memory by integration and
taking the average. However, care is required as too many integrations can result in poor time
resolution. Fig. 6.2.4 shows four-frame integration.
X1 + X2 + X3 + X4
Y= Y: output image
4

Density 100 object

moved from X1  X4
X1 X2 X3 X4
Density = 100/4 = 25
Density of overlapping regions = 50
Fig. 6.2.4 Four-Frame Integration
6.2.5 Recursive Filter

This method applies a coefficient to the previous images and adds the result to the next image.
It creates an electrical afterimage and reduces noise.
In the example shown in Fig. 6.2.5, the coefficient K = 2 (current information = 1/2; past
information = 1/2).
1 1 1
Yn= Xn + Xn – 1 + Xn – 2 +
2 4 8
Current Information for frame Information for frame
information before previous frame many frames in front
Information for
previous frame
Xn-3 Xn-2 Xn-1 Xn
3 images in front 2 images in front 1 image in front Current image
Yn=
Afterimage
Fig. 6.2.5 Recursive Filter, Coefficient K = 2

6 Image Processor
6.2.6 Edge Enhancement (High-Frequency Enhancement Filter)

The brightness changes sharply at the edges of blood vessels and other organs. Edge
enhancement detects and enhances such edges to increase the sharpness of images. However,
since this process can also enhance noise, smoothing or other functions are also applied to help
reduce noise. Edge enhancement uses a 3  3, 5  5, 7  7, or other matrix filter pattern to
enhance the high frequency portions of the subtraction image. This results in images with an
enhanced outline of blood vessels. This enables clearly seeing narrow blood vessels, but it does
not produce a natural image. Therefore, care is required, as inappropriately applied edge
enhancement could potentially cause a misdiagnosis.
Fig. 6.2.6 describes edge enhancement based on using a 1  3 matrix filter pattern.
Fig. 6.2.7 shows an example of using a 3  3 matrix filter pattern.
Filter matrix -1 3 -1
When shifted one pixel to the
right  (-1)
Central pixel  3
When shifted one pixel to the
left  (-1)
Raw data 0 0 0 2 2 2 0 0 0
0 0 0 -2 -2 -2 0 0 0 One pixel to the right  (-1)
0 0 0 6 6 6 0 0 0 Center  3
+) 0 0 0 -2 -2 -2 0 0 0 One pixel to the left  (-1)
0 0 -2 4 2 4 -2 0 0
Fig. 6.2.6 Edge Enhancement Filter (Example)
-1 -1 -1 -1 -1 -1 -1 -1 -1
-1 +9 -1 -1 11 -1 1/3 -1 13 -1 1/5
-1 -1 -1 -1 -1 -1 -1 -1 -1
Fig. 6.2.7 3  3-Matrix Filter Pattern (Example)

6.2.7 Smoothing (Low-Frequency Enhancement Filter)

Using a method similar to (6) above, enhances the low-frequency areas of a subtraction image
to reduce noise.
Fig. 6.2.8 provides a description using a simple 1  3 matrix filter pattern. Fig. 6.2.9 shows
examples with a 3  3-matrix filter pattern.
Filter matrix 1 1 1  1/3
Raw data 0 0 0 3 3 3 0 0 0
0 0 0 3 3 3 0 0 0
0 0 0 3 3 3 0 0 0
+) 0 0 0 3 3 3 0 0 0
0 0 3 6 9 6 3 0 0
1/3 0 0 1 2 3 2 1 0 0
Fig. 6.2.8 Smoothing Filter
1 1 1 1 2 1
1 1 1 1/9 2 4 2 1/16
1 1 1 1 2 1
Fig. 6.2.9 3  3-Matrix Filter Pattern

6 Image Processor
Some examples of the application of a 3  3-matrix filter are shown below.
Fig. 6.2.10 Original
Fig. 6.2.11 Edge Enhancement
Fig. 6.2.12 Noise Elimination (Shading) Fig. 6.2.13 Outline Extraction
6.2.8 Gamma Curve

The image levels obtained from the detector undergo background compression and other
non-linear processing and I/O conversion according the monitor brightness characteristics at
each image processing stage. As the shape of the conversion curve is similar to the Greek letter
gamma, these curves are commonly called "gamma curves." An example of a compression
table used for image processing is shown below.
4000
3500
3000
2500
LUT1
LUT2
2000 LUT3
LUT4
LUT5
1500
1000
500
0
0 500 1000 1500 2000 2500 3000 3500 4000 4500
Fig. 6.2.14 Gamma Curves (Example)

6.2.9 Unsharp Masking

Unsharp masking creates a low-frequency enhanced image (blurred image) by smoothing the
original image, then subtracting that image from the original image to display the high-frequency
components. These components are added to the original image to enhance the high-frequency
components and increase image sharpness.
6.2.10 Contrast Correction

Instead of adding the high-frequency components to the original image, as in unsharp masking,
contrast correction adds the high-frequency components to an image with the dynamic range of
the low-frequency components compressed.
In the chest area, there is a significant difference in X-ray absorption between the mediastinum
and lungs, making it extremely difficult to view the area without image processing, as the
mediastinum would appear completely black and the lungs would cause halation.
Contrast correction enables suppressing brightness in the bright areas and increasing
brightness in the dark areas without reducing the contrast for narrow guide wires and catheters.
This makes it easier to view the entire chest area.
(1) Original image
(2) Blur masking Subtraction (3) High-frequency

components extracted
((1) - (2))
(5) Dynamic range Addition (4) High-frequency

correction components enhanced
(6) Corrected image ((4) + (5))
Fig. 6.2.15 Contrast Correction Process Steps
Source:
1. Journal of Radiological Technology, Vol. 56, No. 11, Clinical Technology Course – Information
for Users of Digital Fluoroscopy System, Subcommittee on Radiography, Yoichi Eguchi
(Yamagata University Hospital)

6 Image Processor
6.2.11 Examples of Actual Image Processing

The diagram below shows an example of normal image processing flow in an angiography
system, which applies the various types of image processing described above.
Input image Output image
Signal
enhancement
Noise
reduction +
Background
compression
Fig. 6.2.16 Image Processing (Example)
The noise is reduced in the image obtained from the detector and the image is then divided into
high-frequency and low-frequency images. In some cases, noise reduction is performed at the
final stage.
A recursive filter was generally used to reduce the noise in images. However, noise reduction
that is not based on past images has recently been adopted to avoid afterimages.
The high-frequency images are imaged-enhanced, as they contain important signals about the
outlines of catheters and guide wires. However, as the high-frequency images contain a lot of
X-ray noise, in some cases noise is reduced selectively by identifying the signals and the noise.
On the other hand, the low-frequency images are blurry background images with no signal
component that contain little important information. To alleviate bright areas of halation and dark
overexposed areas, significant compression is performed at the image level, which stabilizes
the overall image brightness.
Finally, these two types of image are merged and gamma conversion applied to achieve a stable
background image with no extreme difference in brightness between the light and dark areas,
onto which is superimposed important information, such as enhanced images of the guide wires,
etc.

6.2.12 Artifact Correction

Artifacts, which can reduce image quality, can occur in areas of DSA or other subtraction images
where there is movement, due to intestinal gases, body movements, pulse, breathing, or other
factors. This is caused by a deviation of the live image from the mask image when a movement
occurs after the mask image is acquired.
Methods of reducing or correcting for artifacts include the following.
a. Remasking
This method deletes the mask image obtained by real-time acquisition and sets the live
image after the image deviation occurs as the mask image, before performing the
subtraction process.
b. Reregistration (pixel shifting)
This corrects for image shift by geometrically shifting either the mask or live image up, down,
left, or right with respect to the other image, before performing subtraction.
c. Cardiac Subtraction
This method corrects for shifts in heart phase by synchronizing image acquisition with an
electrocardiogram, then performing subtraction with heart phase-synchronized mask and
live images.
Source:
1. Computer Introduction to Image Engineering and Radiographic Technology
Shigehisa Fujii

6 Image Processor

7 Overview of X-Ray Systems

General radiography systems are diagnostic systems primarily intended for plain radiography,
without the use of special processes, such as injecting patients with contrast media, or special
equipment. They are mainly used for diagnoses ranging from the chest and abdomen area to
the skeletal system. They are characterized as being able to provide a large amount of
information using a relatively simple radiography procedure, examinations do not cause pain,
and they are used for an extremely high number of examinations. They can be used to make
direct diagnoses based on the acquired images or used to obtain information for planning other
diagnostic imaging procedures or examinations. In recent years, with the significant increase in
the use of computed radiography (CR) technology and the introduction of FPDs, general
radiography systems are now increasingly becoming digital.
Fig. 7.1.1 Example of a General Radiography System
7.1.1 Functionality
Since general radiography systems are used in an extremely high number of cases, there is a
need to perform examinations within a shorter time and more accurately. Therefore, the
following factors affect the evaluation of entire systems.
a. Obtains images with good image quality and good reproducibility
b. Does not require special skills
c. Does not burden/harm either the person giving or receiving the examination
d. System is durable and has minimal problems
e. Low operating costs for film, etc.

7.1.2 System Configuration

General radiography systems are configured from the following basic units, based on
application.
a. Equipment for positioning the object, such as a radiography stand or horizontal radiography
table
b. Equipment for positioning X-ray exposures, such as X-ray tube support units and adjustable
X-ray collimators
c. Equipment for generating X-rays, such as X-ray high voltage generators and X-ray tubes
d. Bucky units for acquiring X-ray images
This chapter describes radiography tables/stands, support units, and other mechanical
equipment, whereas the X-ray high voltage generators, adjustable X-ray collimators, and X-ray
tube units have already been discussed in Chapter 4, so are omitted here.
7.1.3 Direct Radiography Tables/Stands

(1) Horizontal Radiography Tables
Horizontal radiography tables include units commonly called bucky tables, which have a
bucky unit under the table top where cassettes can be loaded, and units equipped with
FPDs instead of bucky units.
a. Fixed Tabletop Models
The tabletop is fastened to the top of legs. The image receiving unit is installed under
the tabletop and can be moved in the longitudinal direction and fastened at the position
being exposed.
b. Movable Tabletop Models
The tabletop can move longitudinally or laterally to enable easily positioning the table
for exposing the area of interest without disturbing the patient. Either floating or electric
slides are available. Either fixed or movable image receiving units are available.
Floating tables are widely used from the viewpoint of patient comfort.
Fixed and movable tabletop models are available with adjustable height to facilitate patients
getting on or off the table or to improve safety when using radiography procedures that
involve having the patient stand on the tabletop.
Movable Tabletop Model Fixed Tabletop Model

Fig. 7.1.2 Horizontal Radiography Table

(2) Radiography Stand

a. Movable Image Receiving Unit
The image receiving unit can be moved vertically to align it with the area of interest
being exposed. These are mostly used for chest radiography and are available as
cassetteless models equipped with a film changer or a cassette model that involves
installing cassettes one-by-one. Cassette models are typically called bucky stands. In
recent years, stands are available equipped with FPD units, instead of a bucky unit.
Bucky Stand Film Changer

Fig. 7.1.3 Stands with Movable Image Receiving Units
b. Stands with Fixed Image Receiving Units

These are mainly used for chest radiography and include an image receiving unit that is
fixed on the stand. Positioning is accomplished by having patients stand on a
height-adjustable platform that can raise the area of interest to the image receiving unit.
The platform is raised and lowered electrically.
7.1.4 Image Receiving Unit

Image receiving units can be classified as either systems that record X-ray images directly onto
film using a film cassette, bucky unit, auto film changer, or other such equipment, or systems
that record image information electronically in an image processing system such as computed
radiography (CR) units or FPDs.
(1) Film Cassettes
See 5.7 regarding film and 5.6 regarding
cassettes.
(2) Bucky Units
Bucky units are used to efficiently eliminate
X-ray scattering, which is generated from the
object when it is exposed to X-rays, by moving
the grid, which is designed to eliminate scattered
X-rays, during radiography. Moving the grid also
helps improve image quality by eliminating
striping effects. Fig. 7.1.4 Bucky Unit
Due to grid improvements in recent years, ultra
high density grids with higher precision have been developed and are now becoming widely
used. Using these grids makes the grid actuation mechanism no longer necessary.

(3) Auto Film Changers

Auto film changers comprise a film supply unit, conveyer unit, compression unit, and
storage unit. Film is supplied either by suction or winding, where many systems supply a set
of fifty 14  14 inch or 14  17 inch sheets (for radiography stands).
In the radiology department of larger hospitals, film is conveyed directly from each X-ray
examination room to the development room (or machine). Such conveyance systems are
either installed on the floor, under the floor, or along the ceiling to centrally gather film from
various automatic film radiography systems via a direct conveyor system to an automatic
development room (or machine).
(4) Computed Radiography (CR) Systems
CR systems use a film shaped element that forms a latent image, instead of film. A
specialized reader is used to render an image from the latent image. The image is removed,
it is treated as digital data and can be sent to a server. A computer is used to make
adjustments to images and a printer is used to print images onto film.
(5) Flat Panel Detectors
These systems use an FPD (flat panel detector) instead of film, as described in 5.2, to
acquire image data as fixed digital image data. Many of these systems send image data to a
server without using an automatic developing system. Images are printed onto film using a
printer. Adjustments to images are made using a computer, which makes handling the
images much easier, so they are expected to become the most popular type of system.
7.1.5 Indirect Radiography Unit

Indirect radiography units are typically mirror-camera systems used for the chest area and are
available with either a straight hood or curved hood.
They are commonly used for group examinations.
7.1.6 Support Units

Support units are used to support X-ray tube units, image intensifiers (I.I.), or other components.
Not described in this section are C-arm and U-arm support units, which are used to hold the
X-ray tube and I.I. units in opposing orientations.
(1) Overview
Support units must enable easily and quickly setting the X-ray unit in a suitable position and
orientation with respect to the area of the patient being diagnosed.
Support units are available with either manual or electric positioning, where manual
systems use a spring balance mechanism with a suspended counterbalance to achieve a
compact and lightweight design with less inertia to minimize operating effort.
To prevent the equipment from falling, the safety factors of suspension cables, the strength
of supports, and the performance of mechanisms for preventing equipment from falling are
governed by JIS standards.
Each manufacturer uses a different concept regarding mechanisms for suspending
equipment and mechanisms for keeping the equipment from falling. Some systems are
designed to be maintenance-free or do not require internal inspections if parts are replaced
periodically, so be sure to follow the standards specified by the manufacturer when actually
performing any maintenance or inspections.
Most systems use electromagnetic brakes to lock the system from moving in various
directions. In this case, be especially careful of high voltage cables or anything else that
may be applying tension or the levelness of the ceiling mounting rails. These could cause
the hung equipment to spontaneously move and hit other equipment or people when the
power supply is shut off. Be careful to make sure the counterbalance system is adjusted
properly. If not, suspended equipment could fall. Many recent systems include an off-lock
mechanism that uses an electromagnet or other means to automatically apply a brake when

the power is OFF.

On electrically actuated systems, a mechanism must be provided to detect contact between
the object and front side of the I.I. unit and automatically stop movement to prevent
excessive pressure.
(2) Performance
a. Allows positioning equipment using a light force
b. The SID (source-to-image distance) can be set easily and precisely
c. The X-ray tube can be vertically and horizontally positioned easily and precisely for
many different applications.
d. Vibrations from positioning movement dissipate quickly and vibration does not occur
from the rotating X-ray tube anode
(3) Types of Support Systems
JIS Z 4703-1995 classifies support systems based on intended use, as follows.
Support systems Ceiling mounted support systems

Floor mounted support systems
Ceiling and floor mounted support systems
Wall mounted support systems
Wheel mounted support systems
a. Ceiling Mounted Support Systems

Alternating perpendicular rails are attached to the ceiling, then a telescoping support
arm is suspended from a carriage device mounted to the rails. The X-ray tube unit is
attached to the end of the support arm, so that it can move vertically or horizontally,
pivot, rotate, or swivel. An electromagnetic lock is commonly used to fix its position.
Without any structural members on the floor, this configuration allows better use of floor
space.
b. Floor Mounted Support Systems
A movable support column is mounted to two parallel rails attached to the floor. The
X-ray tube unit is attached to the end of horizontal arm that is able to slide up or down
the column. The column can move, the X-ray tube unit moves vertically, the horizontal
arm pivots and the X-ray tube unit rotates and swivels. Applications include using it in
combination with an R/F table or for surgical radiography in combination with a bucky
table.
c. Ceiling and Floor Mounted Support Systems
To reduce floor space requirements, only one rail is attached to the floor, and the other
rail is attached in a parallel orientation on the ceiling. The equipment is mounted to a
moving support column, and it has the same movement range as a floor mounted
system. Applications are the same as for floor mounted systems, but less floor space is
required and they can be integrated with a bucky table and tomography attachments for
use in tomography systems.
d. Wall Mounted Support Systems
X-ray tube units are moved vertically via rails attached to the wall and a counterbalance
mechanism. This configuration is often used in extremely space-limited applications,
such as in mobile examination vehicles used for on-site group examinations.
e. Wheel Mounted Support Systems
This refers to transportable or movable support systems mounted on a wheeled cart.
This was used for indirect radiography, radiography in regular orientation, and other
applications, but currently they are rarely used.

(4) Spring-Balanced Mechanisms

The basic configuration of spring-balanced
mechanisms consists of a spring, pulleys, a Load W
Spring
wire drum, spiral drum pulley, wire ropes, and Constant k
so on, as shown in Fig. 7.1.5.
This example shows a spring-balanced
mechanism with a tapered spiral drum pulley Wire Rope
used to ensure a constant tension is applied Pulleys
Wire Drum
even if the loading position varies.
Spiral Drum Pulley
Fig. 7.1.5 Example of Basic Spring-Balance

Mechanism
Pulley Wire Rope

(5) Counterweight Mechanism
A basic counterweight type mechanism
consists of a wire rope, pulley, counterweight, Load W
and other parts, as shown in Fig. 7.1.6.

Counterweight
This mechanism keeps the weight and support
in constant balance.
Systems include either one or two wire ropes.
Fig. 7.1.6 Example of Basic Counterweight

Mechanism
(6) Mechanism to Prevent Equipment from Falling

All support systems that involve frequent interaction with objects and operators should have
safety mechanisms provided to prevent the X-ray tube, arm, or other equipment from falling,
but that is not structurally possible for some equipment.
JIS Z 4703 specifies the following safety measures.
a. Suspension Systems Without Mechanisms to Prevent Equipment from Falling
i. Safety Factor: Static safety factor of at least 8 and an overall safety factor of at least
4.
(The static safety factor indicates the ratio of the safe operating load to the maximum
static load.)
ii. Suspension Method: If a system is configured with multiple suspension mechanisms
that independently meet safety factor regulations, a means must be provided for
notifying operators if one of those mechanisms fails.
b. Suspension Systems with Mechanisms to Prevent Equipment from Falling
i. Safety Factor: Static safety factor of at least 4 and an overall safety factor of at least
2. Mechanism to prevent equipment from falling must have the same or higher
safety factors.
ii. Performance of Anti-Falling Mechanisms: If suspension equipment is damaged and
equipment starts falling, the mechanisms for preventing equipment from falling
must stop it from falling within 30 mm. If the system remains operable even after
equipment has fallen due to a damaged suspension system (for example, on
systems equipped with an extra wire rope), a means must be provided for notifying
the user that a problem has occurred.

iii. Suspension Method: Single-suspended support systems using a wire rope or chain
are also available.
(7) Characteristics
Characteristics of roller chains and constant-force springs used in suspension mechanism
are as follows.
a. Roller Chain Characteristics
The usage limit due to wear and elongation depends on the number of sprocket teeth,
but is generally 1.5 % elongation.
b. Constant-Force Spring Characteristics
Constant-force springs are used in light-load balance mechanisms. These are
mechanisms that utilize the bending strength of thin strips of spring steel to provide
spring action, which functions differently than conventional coil springs.
Constant-force springs maintain a constant output force until they reach a pre-specified
usage limit, but after a pre-specified number of repeated uses, microcracking starts to
occur in the material. Continued use causes the cracks to gradually grow and the spring
to eventually fail. If the output force decreases during use, it indicates the constant-force
spring is at the end of its service life. The specified service life is normally designed to
be longer than the service life of the instrument, but to be safe, they should be replaced
before reaching their specified service life.
Output gradually decreases

Eventually fails
Output
Specified
Service Life
Service Life
(Maximum Number of Uses)
Fig. 7.1.7 Service Life of Constant-Force Springs
(8) Safety Standards

For suspended support systems operated above the body, the following design and
manufacturing standards have been prepared to ensure safety (refer to JIS Z 4701 and
4703).
a. Wire rope that complies with, or is equivalent to, JIS G 3535 and 3525 is used, where
the usage conditions must satisfy the
following relationships. d
 D/d  300
 D/dr  20
 S  10
where,
d: Wire rope strand diameter
dr: Wire rope diameter dr D
D: Effective diameter of pulley
S: Static safety factor Fig. 7.1.8 Wire Rope
b. Chains must satisfy JIS B 1802 and
sprockets JIS B 1802 standards, with a static safety factor for the chain and end
fastener of at least 10.
c. Detailed standards for other structural materials are specified in JIS Z 4703.
d. If a mechanism is provided to prevent equipment from falling, equipment must stop
falling within 30 mm of starting to fall.

e. To prevent electric shock, grounding terminals are provided and the charging unit must
not be exposed. The maximum protective ground resistance is 0.1 ohms between metal
surfaces that might be touched by people and the device protective ground terminal,
and between the device protective ground and the system protective ground terminals.
(The maximum protective ground resistance between metal surfaces that might be
touched by people and the system protective ground terminal is 0.2 ohms.)
f. The wire ropes, chains, other safety mechanisms, and electrical safety must be
inspected periodically.
7.2 Gastrointestinal Diagnostic Systems (R/F

Systems)
7.2.1 System Configuration
When inspecting gastrointestinal diagnostic systems, it is important to understand the
characteristics of its constituent components. These systems include specialized parts and
devices, such as I.I. vacuum tubes and flat panel detectors (FPDs), the performance of which
can vary over time and depending on usage.
Key parts and devices are described below.
A typical system configuration is shown in Fig. 7.2.1.
Spot filming device

Image intensifier
X-ray tube unit Optics
TV camera
TV monitor
High voltage Communication

generator control unit (CCU)
Fig. 7.2.1 Gastrointestinal Diagnostic System Configuration
X-Ray output system X-ray tube unit

High voltage generator
Imaging unit I.I., FPD
Optics
X-ray TV
Spot filming device
Many gastrointestinal diagnostic systems include an automatic brightness adjustment system
(referred to as IBS, ABC, or ABR systems, but hereinafter referred to as an IBS (image
brightness stabilizer) system) that varies the tube voltage and tube current level of the X-ray
high voltage generator to display images with constant easy-to-view brightness on the
fluoroscopy TV monitor, regardless of the area being exposed. These often also include a
mechanism for automatically optimizing radiography parameters. These automatic mechanisms
form an X-ray – light – electrical signal – X-ray parameter feedback system. Changes in
performance or deterioration of the parts and devices in that system can lead to decreased

7.2 Gastrointestinal Diagnostic Systems (R/F Systems)
clinical diagnostic capabilities and increased exposure levels. Another important point is that
automatic mechanisms tend to compensate for changes or deterioration in the performance of
parts and devices by adjusting the X-ray dose, which makes them less apparent and easier to
overlook. Therefore, periodic inspection is important.
7.2.2 X-Ray R/F Tables

Radiography/fluoroscopy tables (hereinafter referred to as R/F tables) enable positioning the
object for acquiring X-ray images. They include, or are installed with, an X-ray imaging unit for
fluoroscopy and radiography.
Relevant Japanese Industrial Standards include JIS Z 4701, JIS Z 4703, and JIS Z 4712.
a. Classifications
R/F Tables General R/F tables X-ray TV R/F tables Remote-operated R/F tables
Table-side operated R/F tables
Indirect X-ray R/F tables I.I. indirect R/F tables

Mirror-Camera R/F tables
Specialized R/F tables Urinary R/F tables
Other classifications include over-table tube configurations, with the X-ray tube unit located
above the table, and under-table tube configurations, where the X-ray tube unit is located
under the table. It is also possible to classify R/F tables as cassette and cassetteless
configurations. In Japan, remote-operated cassetteless configurations are most common.
In addition, R/F tables are increasingly designed for multi-purpose functionality with
diversified examination techniques, such as incorporating endoscopy examinations, easier
operation, and energy efficiency. With the increasing popularity of digital radiography, there
is a trend toward eliminating the spot filming unit from R/F tables (making them filmless).
b. Functionality
As shown in Fig. 7.2.2, basic functions include using the table to support the object, using
the imaging system support to support the I.I. unit, X-ray TV camera, FPD, or other imaging
equipment, and the spot filming unit. Each of these functions is described below.
Imaging System Support
Table
Spot Filming Unit

Fig. 7.2.2 Example of R/F Table

i. Table Unit
In addition to supporting the object, the table can be tilted or slid to allow positioning the
object. Tables are also available that can rotate or lower to help minimize patient effort.
Since these movements require supporting the object while capturing the flow of
contrast media, they must be strong, move quickly, and stop precisely. In addition,
because the object comes in direct contact with the table, it is essential they are
inspected to ensure safety.
ii. Imaging System Support
This is the support structure used to support the X-ray tube and opposing image
intensifier, the X-ray TV camera, spot filming unit, and FPD unit. To provide coverage of
organs extending from the throat to the anus, the imaging system has a wide range of
movement. In addition, to obtain more precise image information, consideration has
been given to the geometric layout, such as increasing the focus-to-image distance
(FID) or decreasing the patient-to-image input surface distance, protection from X-rays
and other safety aspects, and precise movement that does not miss the desired timing.
The X-ray unit has an adjustable collimator attached, which is used to control the
irradiation field and X-ray quality.
In recent years, significant advancements have been made in obtaining image
information by digitalizing the X-ray TV signal, for example, instead of using film, but
with the exception of the spot filming unit, not much has changed in the functionality
required from the imaging system support unit. When inspecting this section, it is
important to remember that problems in this section have an immediate effect on
images and that it involves many factors that can alter the image.
iii. Spot Filming Unit
This section is used to obtain X-ray photographs by feeding direct radiography film into
the exposure position. To capture image information confirmed with fluoroscopic
procedures in a timely manner, film must be fed into position quickly and divided and
laid out into the selected exposure sizes. After exposing the film, it is promptly conveyed
to the standby position. Cassetteless systems include a supply/receive magazine that
can store several sheets of film. Magazines are available that can store several different
film sizes, which is especially helpful for saving energy. Since this method involves a
complicated feeding mechanism, a microprocessor is used to control the exposure
program (film size and number of sheets).
Using the spot filming unit requires adequate consideration of X-ray fogging and light
fogging of the film, fogging and scratching due to static electricity from feeding the film,
and adhesion with intensifying screens, and these should be inspected.

Plain radiography results in X-ray images that show an overlay of all tissue and organs in the
direction of X-ray exposure on a single sheet of film. Tomography renders X-ray images of
specific cross sections (slices) of interest, and results in blurry images for all other cross
sections.
Currently there are two types of tomography systems, linear tracking and multiple tracking, but
due to the appearance of computed radiography (CT) systems, tomography is currently only
used for applications such as orthopedic surgery. Consequently, the number of dedicated
tomography systems is decreasing and most systems are combined with R/F tables or
general radiography systems, where linear tracking is utilized as one feature of the system.

7.3.1 Operating Principle of Tomography

In Fig. 7.3.1, the X-ray tube is integrated with the film and moves successively from position (a)
to positions (b) and (c), where M is the center pivot point of the arc. Points on cross section AB,
which is parallel to the film, are always projected via M at the same position. In other words,
points P and M are always projected on the film at the same position, regardless of X-ray tube
position, shown in (a), (b), or (c). However, points above or below plane AB, indicated by point Q,
do not move parallel to the film even if the focus moves, which creates a lateral shift in the
projected point on the film, which means it does not project to the same point. This means that
the farther a point is above or below plane AB, the greater the blurring. In other words, items
located on the slice appear clearly, but areas away from the slice appear blurred. Images are
blurrier the farther they are from the cross sectional slice. A more vivid image can be obtained by
changing the X-ray tube and film movement from a straight line to a complicated path, such that
the image from the point away from the slice is further blurred and the difference in density
between the slice image and off-slice image is increased.
(a) Initial Tube Position (b) Mid-Movement Tube (c) Final Tube Position
Position
AB: Cross Sectional Slice F: Film
Fig. 7.3.1 Operating Principle of Tomography
7.3.2 Testing the Performance of Tomography Systems

Tomography systems have many mechanically movable parts, and any vibration or loose fitting
parts can affect image quality. Therefore, be careful to ensure sufficient image quality and
reproducibility, by periodically inspecting the following parameters. Part of the test method is
indicated in detail in a recommendation by the ICRU (International Commission on Radiation
Units and Measurements) in 1962.
a. Swing Angle (X-Ray Irradiation Angle) or 3-Point Exposure
A pin-hole radiography phantom is placed at the cross section surface and a pin-hole image
is obtained to confirm the symmetry of the swing angle (X-ray irradiation angle), the
trajectory, and darkness unevenness.
b. Cross Section Position
Obtain an exposure of a microspelder and confirm the position of the cross section
(maximum, intermediate, and minimum points). If using a system with an automatic cross
section movement mechanism, confirm the movement intervals.

c. Resolution Test
Place a line chart (vertical lines) so that the lines are perpendicular to the cross section, then
position it at a 30 degree angle with respect to the table and obtain an image. Note that the
cross section will not be visible if the chart is placed incorrectly.
Performing a resolution test enables judging the movement smoothness or looseness, the
dose distribution (exposure unevenness), and other information.
Fig. 7.3.2 Line Chart Used for Resolution Test

d. Grid Alignment
Confirm that the grid stripe orientation aligns with the X-ray tube swing angle direction.
Failing to do so can cause no image to appear. Therefore, it is important to perform
exposure after inspection or repair work to confirm the alignment.

7.4.1 Features
a. Power Supply
X-ray photographs can be acquired with a small capacity power supply. Models capable of
radiography using an internal battery eliminate the need to plug the system in for each
exposure and the power cord can be stowed out of the way during travel using an automatic
cord reel or on a cord hanger.
b. Easy to Move
Easily moved by manually pushing or by electric power-assist, it even rolls easily over
changes in floor height, such as elevators.
c. Easily Maneuvered Even in Small Patient Rooms
Designed for compactness and light weight, it fits easily through narrow spaces between
beds. In addition, it is simple to turn around in tight spaces.
d. Radiography Supplies
Cassettes and other items can be carried in a cassette box during travel. It also includes a
pen tray for storing markers or other writing tools and a case for radiation charts or other
records.
e. Enables Radiography of All Kinds of Body Areas
The X-ray tube support arm freely moves vertically, horizontally, or swivels to allow
exposures from various angles.
f. Easy-to-Operate Radiography
Acquiring exposures is simple, with the mAs level controlled via a touch panel and an APR
(anatomically programmed radiography) function available on some models. Radiation
exposure dose can be minimized with short exposure times and X-ray emissions can be
confirmed via a lamp or audible indicator.

g. Designed for Safety

The X-ray tube support system features balance, lock, and anti-falling mechanisms. A
deadman's brake switch automatically stops travel when released. The system is designed
to prevent tipping and minimize exposure levels to the operator.
Models equipped with a movable flat panel detector (FPD) or CR reader have been developed
recently, in response to the trend of digitization in radiography systems.
7.4.2 Basic Configuration

a. Types of Mobile X-Ray Systems
The types, performance, and other aspects of X-ray generators are governed by JIS
standards. They are available in transformer, capacitor, and inverter type models, where the
inverter type is currently the most popular. By using high output – short time control, it is
possible to acquire X-ray images that rival large systems. This is described in Table 7.4.1.
The mechanical system consists of an X-ray tube unit mounting unit, support unit, vertical
actuator unit, main column, and the main cart unit including the controller. In particular, the
arm system moves smoothly vertically and horizontally, and swivels, to enable setting the
radiography position easily.
The main components are indicated in Table 7.4.2.
Table 7.4.1 X-Ray Generator Types
Classification by Classification by Components

Classification by Power Supply
Rectification Method Included
 Integrated X-ray generator
Self-Rectifying
(high voltage generator unit is Commercial power supply
Transformer Type
integrated with the X-ray tube)
 Integrated X-ray generator (same
Full-Wave Rectified as above) Commercial power supply
Transformer Type  X-ray tube unit and high voltage Commercial power supply
generator unit
 X-ray tube unit and capacitor-type Commercial power supply or
Capacitor Type
high voltage generator unit internal battery power supply
Battery-powered internal power
 X-ray generator unit with high supply
Inverter Type
frequency inverter Commercial power supply, plus
primary capacitor

Table 7.4.2 Mechanical Components
Component Description
X-ray tube unit X-ray tube unit fore-aft rotation (rolling)
mounting unit X-ray tube unit support axial rotation (pitching)
X-Ray Tube Unit
Support Unit Horizontally movable
Vertically movable
Mechanical Lock Swivel
Electromagnetic Pantograph type arm
Lock Support arm Telescoping type arm
Anti-Falling Counterweight balanced
Mechanism Spring balanced
Constant-force spring (plate spring) balanced
Suspension wire(s) or chain
Round column
Main column Rotating or fixed
Square column
X-ray controller unit
X-ray controller unit
High-voltage generator
Cassette size 35  43 cm (14"  17")
Cassette box
3 to 10 cassettes
Deadman's brake Gripping handle releases brake
Manual
Electric
Cart Unit  DC motor driven Forward: Continuously variable or 2 or 3 speed
switchable
Reverse: Continuously variable or 1 or 2 speed
switchable
Battery storage
Wheels 4 wheels or 4 wheels plus auxiliary wheel
Other
b. Compact Transformer-Type Mobile X-Ray Units

As a mobile system, its main features are its compact size and light weight. It offers the
advantage of being able to be used conveniently instead of a stationary system. It consists
of a high voltage generator, collimator unit, control panel, support unit, cart, brake system,
and cassette box integrated into a single system.
c. Capacitor-Type Mobile X-Ray Units
Capacitor models store the energy necessary for radiography in advance in a capacitor.
Since the energy is discharged quickly via the X-ray tube, it eliminates the need to supply
the power required to generate high voltage during X-ray exposures. Consequently, high
current – short time exposures are possible using a small power supply.
Using a rotating anode triode X-ray tube enables ultra short exposures, where the residual
charge after cutting-off the wave tail is stored back in the capacitor. This significantly
shortens the recharging time for the next exposure and also enables faster response and
lower power consumption.

d. High-Frequency Inverter-Type Mobile X-Ray Units

The advantage of using a high-frequency
inverter-type X-ray system for a mobile system is
that it offers better reproducibility of X-ray output
than capacitor-type systems, due to feedback
control.
It also results in a smaller and lighter system and has
good linearity between applied mAs and X-ray
output, due to a flat kV output. Therefore, lately it
has become the most popular type for mobile
systems. In addition, since the system features a
microprocessor controlled APR (anatomically
programmed radiography) function, it is easier to
operate.
Fig. 7.4.1 High-Frequency Inverter-Type

Mobile X-Ray Unit
7.4.3 Safety
Mobile X-ray units have been designed for easy operation and safety from many different
aspects, but they require particular care in ensuring operators are aware of how to use and
operate the units, how to prevent X-ray injuries, and so on, and in ensuring such measures are
enforced.
a. Secure the X-ray tube unit (put it in the travel position) and engage the lock mechanism
before moving the unit.
b. Pay close attention to safety in the direction of travel and surrounding areas.
c. Use extra caution when operating the electric drive for travel or configuring the tube support
arm in patient rooms or near patients.
d. At the site where radiography is to be performed, stay 2 meters away from the X-ray tube
and patient and wear a lead apron or other protective gear.
e. If leaving the unit unattended, verify the floor and instrument status and remove the key
from the key switch.
f. Always use the low-speed electric travel mode (motor braking) to travel down sloped
surfaces.
g. Since the unit's center of gravity can shift easily when traveling on sloped surfaces, use
positioning to ensure safety during travel.
h. Plug the power cord into a grounded power supply outlet. To protect against electric shock
from leakage current, connect a supplemental (a second) protective ground wire.
7.4.4 Inspection
Since mobile X-ray units are constantly being moved within a hospital, they are subject to more
severe operating environments than stationary systems. Therefore, they must be inspected,
especially with respect to safety. Key inspection items are as follows.
a. Due to uneven loads applied during travel on sloped surfaces, vibration, impacts from rolling
over bumps, and so on, check for loose fasteners in mechanical assemblies or cracks in the
main structure.
b. Inspect the deadman's brake mechanism provided for safety on sloped surfaces.
c. Inspect the balance mechanism.
d. Inspect the safety switches.
e. Inspect the power cord.
f. Inspect protective ground wires.

7.5 Surgical C-Arm X-Ray Systems

7.5.1 Overview
Surgical systems are X-ray fluoroscopy systems mainly used in surgery or emergency rooms.
They are designed to allow freely positioning the various parts of the system as necessary to
accommodate patients that cannot be moved.
7.5.2 Functionality
a. Because they are designed for use in operating rooms, they must not compromise the
cleanliness of areas around patients or technologists. Since surgeries often last for many
hours, the C-arm must be able to be positioned quickly.
b. Using fluoroscopy during operations that extend over long periods can potentially expose
patients and technologists to increased radiation exposure dose. To minimize exposure
doses, pulse fluoroscopy is used, which emits X-rays intermittently.
c. With the increasing popularity of IVR, customers are demanding good fluoroscopic image
quality that allows identifying the thin guide wires.
7.5.3 C-Arm Unit

The arc-shaped arm structure, called a surgical C-arm (see Fig. 7.5.1), is used to fasten the
X-ray tube and image intensifier together as an integrated assembly. This C-arm unit is movable,
with the X-ray generator installed in the cart. This enables freely performing fluoroscopy and
radiography during surgeries, without moving the area of the patient being operated on.
Fig. 7.5.1 Surgical C-Arm Unit
7.5.4 X-Ray Generator Unit

An integrated type X-ray generator unit is used on mobile C-arm units. Early X-ray tubes were
self-rectifying, followed by a generation of single-phase full-wave rectified tubes, but current
systems are mostly inverter-type systems.
Fixed anode X-ray tubes are normally used, but units with rotating anode X-ray tubes have
started appearing due to the recent use of DSA radiography (or fluoroscopy) during surgery.

7.5 Surgical C-Arm X-Ray Systems
7.5.5 Collimators
A round fixed beam limiter that controls the X-ray irradiation field to the entire surface of the
image intensifier during fluoroscopy is typically used as a collimator on mobile C-arm units.
Therefore, because this tends to cause halation on X-ray TV images, due to X-rays that pass
directly down the sides of the object or through extremely low-absorption areas, some systems
include an internal semi-transmissive collimator (filter) as a corrective measure.
7.5.6 X-Ray TV Imaging Systems

Some mobile C-arm units use optical fiber to optically couple the I.I. tube output surface to the
camera tube input surface so they are directly interfaced. Unlike systems using a lens system,
light levels do not decrease at the periphery with this configuration, and it allows making the
video camera shorter. Currently there is a trend toward using systems with a single lens and
CCD camera.
7.5.7 Exposure Dose Reduction Video Memory System

In surgical fields, objects exposed to fluoroscopy during surgery move slowly or are often still.
Therefore, there have been efforts to offer functions that not only continuously emit X-rays to
view fluoroscopic images in real time, but also reduce exposure dose levels. These include the
following two methods.
a. Last Image Hold
If fluoroscopy is switched OFF, this function holds the last fluoroscopic image displayed.
b. Slow Rate Pulse Fluoroscopy
This function emits X-rays intermittently using the function that eliminates flicker by using an
image memory system to supplement the image between X-ray exposures.
7.5.8 Safety Precautions

Since surgical X-ray systems are used in an operating room, they are subject to special
environmental conditions. Therefore, special safety inspections are required, as indicated
below.
a. Use particular care regarding radiation exposure related precautions.
b. Be sure to verify the protective ground wire on mobile C-arm X-ray TV systems.
c. Except for models specifically labeled as explosion proof (AP devices), most models are not
designed to be explosion proof. Therefore, do not use them in environments with flammable
gases.

7.6 Mammography Systems

Many mammography systems are integrated systems that include an X-ray tube unit, X-ray
mechanical unit, and high voltage generator. In addition, since they involve special factors, such
as exposures with soft X-rays, special care is required regarding maintaining image quality and
safety when performing maintenance or repairs.
The radiography stand is configured with the X-ray tube unit and film support unit oriented facing
each other, so that it can be positioned to the area of interest by adjusting the height or swiveling,
while maintaining the geometric relationship between the tube and film. The high voltage
generators are generally high-frequency inverter-type models and X-ray tubes are cathode
grounded or anode grounded models that use a single high voltage cable.
Tube voltage for radiography is about 20 to 49 kV, tube current is 20 to 110 mA, and the mAs
range is from 20 to 630 mAs, whereas exposure times are long, with a maximum of 10 seconds.
7.6.1 Half-Value Layer

For mammography systems, the half-value layer is an important factor that is related to X-ray
image quality and patient exposure dose.
Example: Half-Value Layer of Compression Plates
Molybdenum anode / molybdenum filter plate combinations should satisfy the
following half-value layer values after breast compression plates are applied.
 Upper Limit of Half-Value Layer
Half-Value Layer (mm Al)  (Measured kV / 100) + C
provided,
C = 0.12 (combination of Mo [molybdenum] target and filter plate)
C = 0.19 (combination of Mo target and Rh [rhodium] filter plate)
C = 0.22 (combination of Rh target and Rh filter plate)
C = 0.30 (combination of W [tungsten] target and Rh filter plate)
 Lower Limit of Half-Value Layer
(Measured kV / 100) + 0.03  Half Value Layer (mm Al)
Note: During acceptance testing, the half-value layer value must satisfy the
following when the compression plates are removed.
(Measured kV / 100)  Half Value Layer (mm Al)
Half value layer: Penetration thickness at which transmitted dose is half of the
incident X-ray dose (%) (I), expressed in terms of thickness of a
specific filter material (mm).
7.6.2 X-Ray Tube

In mammography, where soft tissues like breasts are exposed,
the X-ray tube must be capable of emitting large amounts of soft
X-rays (long wavelengths with low penetration) in a short time. If
a typical X-ray tube is used for mammography, the lower
radiography voltage and filtering effect by the glass bulb and
other materials would result in hard X-rays (short wavelengths
with high penetration) that would produce images with no
contrast.
Fig. 7.6.1 X-Ray Tube for

Mammography

Furthermore, since the low tube voltage (low

acceleration voltage) results in low thermal 30 kVp
electron emission rates, it is not possible to keep Mo Anode
Relative Intensity
applying high current flow rates. Differences W Anode
compared to typical X-ray tubes are indicated
below.
a. To minimize filtering effects by the X-ray
emission window, the window is made as thin
as possible and beryllium is used to improve
the soft X-ray emission efficiency.
Molybdenum or rhenium filter plates are
used to selectively extract characteristic
X-Ray Energy (keV)
X-rays and filter out long wavelength region
Fig. 7.6.2 X-Ray Spectra of Molybdenum and
(to reduce exposure dose), as well as short Tungsten X-Ray Tubes
wavelength region that lowers contrast
levels.
b. X-ray tube anodes are mostly made of molybdenum. Characteristic X-rays from
molybdenum are used to improve the emission efficiency of soft X-rays. Some
mammography tubes enable selecting molybdenum, rhenium, or tungsten as the focus
material, depending on the size of the area being exposed.
c. Large tube currents can be applied even for low-voltage exposures.
With typical X-ray tubes, at low voltage levels the tube current will not increase no matter
how much the filament is heated. This is due to the space-charge effect, which is not a
problem with electron emission from the cathode, but rather is determined by the electric
field and electron intensity in space. Therefore, the distance between the cathode and
anode is shorter. The maximum tube voltage is low, at about 60 kV.
Cathode-to-Anode Distance: 10 to 13 mm for mammography X-ray tubes
17 to 18 mm for regular X-ray tubes
Some recent X-ray tubes feature flat filaments that
suppress secondary foci to enable acquiring photographs
with minimal blur.
X-ray tube units are attached parallel to the tube axis and
radiography stand (cassette holder) and utilize X-rays
emitted from a point near the center of the irradiation field
Primary Collimator
toward the anode. Therefore, the X-ray exposure dose
decreases in the direction from the base to the tip of the
breast. This minimizes heel effects in the intensity profile,
while ensuring the necessary irradiation field.
d. Precision and reproducibility of tube voltage
The following display precision and reproducibility
conditions should be satisfied.
i. Display Precision
 Tube Voltage Setting 25 to 32 kV: Maximum 5 %
Fig. 7.6.3 Relationship Between
 Other Tube Voltages: Maximum 10 % Exposed Area and
ii. Reproducibility X-Ray Cone
Maximum coefficient of variation of 0.02 for four
repetitions

e. Focus Performance
Given a rectangular resolution test chart placed 42.5 mm above the breast support platform,
laterally centered with respect to the image receiving unit, and 10 mm or less from the edge
of the image receiving unit at the side of the chest wall, focus performance should satisfy the
following.
Resolution in Terms of X-Ray Tube Focus Width Dimension: Minimum 13 lp/mm
Resolution in Terms of X-Ray Tube Focus Length Dimension: Minimum 11 lp/mm
7.6.3 Collimator Mechanism

Collimators used for general radiography, which have high X-ray absorption levels, cannot be
used for mammography. Also they are not suitable for mammography where exposure
conditions are characteristic. Therefore, mammography systems include collimators designed
specifically for breasts, which can adjust irradiation fields according to breast size and different
exposure areas.
Standards are also specified for consistency between the X-ray irradiation field, the light
irradiation field, and the surface of the image receiving unit, as indicated below.
a. Deviation Between Light Irradiation Field and X-Ray Irradiation Field
The sum of the deviations at the edges (left-right or front-back) must not exceed 2 % of
focus-to-image receiving unit distance.
b. Deviation Between X-Ray Irradiation Field and Image Receiving Unit Surface
The X-ray irradiation field must extend to the edge of the image receiving unit at the side of
the chest wall, provided the following conditions are satisfied.
 The X-ray irradiation field may extend not more than 5 mm beyond the edge of the breast
support platform at the side of the chest wall.
 For edges other than the side of the chest wall, the X-ray irradiation field may extend not
more than 2 % (1 % is preferable) of the SID beyond the edge of the image receiving
surface.
 For non-film image receiving units, if areas with no image information are exposed by the
collimated X-rays, then the darkness of unexposed areas may be darkened to the same
level as areas directly exposed to X-rays.
7.6.4 Breast Compression Mechanism

Mammography normally involves compressing the breast before exposure. The purpose of
compressing the breast on the radiography stand (cassette holder) is to minimize overlapping of
mammary gland tissue in images and increase contrast between different tissue, which reduces
the exposure dose required for radiography. Compression is accomplished either using
compression plates on an independent compression unit or using the bottom of the localizing
cone. However, with improvements made to compression mechanisms, the latter method is now
rarely used.
In Japan, the compression pressure is defined in JIS Z 4751-2-45:2001 (IEC60601-2-45:1998)
(Particular requirements for the safety of mammographic X-ray equipment and mammographic
stereotactic devices), as follows.
Compression devices must satisfy the following requirements regarding the operation and
display of compression pressures for all radiographic orientations specified for normal use.
a. Compression devices must not be capable of applying pressures exceeding 300 N (about
30 kgf).
b. Powered compression devices must be capable of applying at least 150 N (about 15 kgf) of
pressure, but not capable of more than 200 N (about 20 kgf).
c. Powered compression devices must be adjustable to below 70 N (about 7 kgf) of pressure.

d. If a compression pressure value is displayed, it must be displayed in units of force, with a

precision of 20 N. U.S. ACR: 1999 standards by the American College of Radiology
specify adjustability between a minimum compression pressure of 111 N (about 11 kgf) to a
maximum of 209 N (about 20 kgf).
According to the Mammography Precision Control Manual (Revised Version), published by
the Japanese Society of Radiological Technology, the guideline for maximum compression
pressure in actual practice for Japanese women is 120 N (about 12 kgf). It also indicates
that guidelines should be applied flexibly, due to differences in the physical compressive
pressure experienced by breasts for the same indicated compressive pressure, depending
on the individual.
The most important inspection parameter for these mechanisms is the maximum
compression pressure and, for units with an automatic release mechanism, the release
mechanism function must be inspected as well.
Compression mechanisms must permit quickly releasing the compression and removing
the breast from the plates, in the event of a power failure or other emergency.
The following standards are specified for compression pressure accuracy and other
parameters.
i. Precision of indicated compression pressure
20 N Max. (Within 10 N is preferable)
ii. Precision of indicated compressed thickness
5 mm Max.
iii. Other parameters
No looseness, cracking, sharp edges, or other irregularities in any part of the breast
compression device.
Note: 1 N = 0.1019 kgf
Correct Setup Incorrect Setup

Fig. 7.6.4 Configuration of Area Being Exposed

7.6.5 AEC (Automatic Exposure Control)

In mammography, small variations in tube voltage and tube current can have large effects on
image quality. (Mammography parameters result in increased dependence on tube voltage.)
Therefore, mammography systems commonly use an automatic exposure control system to
control exposure parameters. In particular, semiconductor or photomultiplier tube type detection
is used in the image receiving unit (chamber), where the layout and construction are specifically
designed for mammography. They are also provided with low-dose radiography correction
circuits and density adjustments in 9 to 17 levels to make fine adjustments to density variations
depending on the area being exposed.
It is necessary to be aware that if the AEC detector size display above the compression plates is
too small, it can cause mammography AEC system to fail.
To test reproducibility and precision, expose a phantom with uniform thickness of about 30 mm
five times in succession, and measure the differences in density, which should be within 0.25.
Greater Pectoral
Muscle
Iontomart PM
Fat Tissue Carbon Fiber Plate X-ray quality control
Grid
Phantom Cassette
Center Line Judge breast status
AEC Detector Mammary

Gland Calculate values
Tissue for 2 detectors
Detectors Filter
Fig. 7.6.5 Example of Image Receiving Unit Fig. 7.6.6 Example of Automatic Exposure
Structure Circuit
7.6.6 Bucky Mechanism

Most systems include a bucky unit that synchronizes slow grid movement, which is variable
from 1 to 1.5 seconds, with X-ray exposure timing.
7.6.7 Exposure Dose

Since mammography must render slight differences in contrast between different soft tissues, it
requires using radiography parameters with low tube voltage, but high mAs levels, which results
in higher overall exposure levels than for radiography used for other areas. Therefore, to obtain
good image quality while simultaneously keeping exposure dose levels as low as possible, it is
necessary to use highly sensitive photosensitive material, use appropriate filters, and carefully
consider radiography parameters. In particular, avoid performing mammography without adding
a filter, which can significantly increase skin dose levels and cause skin damage.
For mammography systems, it is especially important to prevent unnecessary exposure by
minimizing any error factor in each radiography parameter. Therefore, systems are now
becoming more automated. As an example, some systems are able to detect the compressed
thickness of areas being exposed, then automatically adjust the tube voltage for radiography.
In Fig. 7.6.7, no one except the object should be allowed to enter the areas outside the shaded
range. Personnel working in areas exposed to X-rays must remember to wear a film badge or
carry a pen-type dosimeter and wear protective gear.

Center Point of X-Ray Tube Unit
Object
Restricted Entry Area
Unrestricted
Entry Area
Fig. 7.6.7 Example of X-Ray Dose Distribution
7.6.8 Image Quality of Mammography Systems

According to standards specified by the Central Committee on Quality Control of
Mammographic Screening, the following standards should be observed.
a. Evaluation of Phantom Images (Visual and Digital Evaluation)
Image quality should be evaluated by exposing and evaluating the phantom with built-in
breast tissue simulation sample (hereinafter referred to as ACR phantom) and a ten-step
phantom, as indicated below.
i. Phantoms and Exposure Method
Position the ACR phantom and step phantom.
 Screen/Film System
Set parameters to achieve a density of 1.5 0.15 at the center of the ACR phantom.
 Digital System
Configure the grayscale curve shape and frequency process settings the same as for
clinical use. Once radiography parameters are clearly specified, create a hard copy
so that density at the center of the ACR phantom is 1.5 0.1.
ii. Visual Evaluation
Evaluations using the ACR phantom are specified in Guidelines for Breast Cancer
Screening Using Mammography (Mammography Precision Control Manual (Revised
Version), published by of the Japanese Society of Radiological Technology, 1997)
Fibrous structures must be detected up to step number 4 (four 0.75 mm structures),
simulated calcification clusters detected up to 3 groups (three 0.32 mm clusters), and
simulated tumors must be detected up to step 3 (three 0.75 mm tumors), for a total of
10 items. In addition, the minimum density differential between disks placed on the
phantom and the mammary gland density of the phantom must be at least 0.4. The
method of measuring the difference in density D between the disk and surrounding
areas is specified in the Precision Control Manual.
For the step phantom, it must be possible to differentiate between the 10 levels with
successively increasing (or decreasing) darkness levels, and calcifications be
observed to at least level 4 and tumors to at least level 5.
However, visual evaluation can vary significantly depending on the observer. To
supplement visual evaluation, digital evaluation is also available.

 Digital Systems
Evaluation methods are the same as for screen/film systems.
As described above, in the case of the ACR phantom, the difference in density
between the disk and mammary gland tissue must be at least 0.4 and a total of 13
items must be identified, including at least 5 simulated fibrous structures, 4
calcifications, and 4 tumors.
For the step phantom, it should be possible to differentiate between the 10 levels, and
observe calcifications to at least level 4 and tumors to at least level 5.
iii. Digital Evaluation
Use a suitable digitizer (example: VXR-12 from Vidar Systems, or equivalent) to
digitize the phantom image to a spatial resolution of at least 300 dpi (equivalent to
0.085 mm) and density resolution of at least 8 bits/pixel. Measure the signals of the
simulated substance in the phantom and the base and the standard deviation, then
the signal to noise ratio was calculated.
Taking the signal-to-noise ratio for the phantom image of each facility to the reference
image as indicating the image quality achievement level, the achievement level
should be at least 0.8. This was decided based on evaluating phantom images from
101 facilities.
 Digital System
Use a high performance laser digitizer (example: LD-5500 from Konica Minolta) to
digitize a hard copy of the phantom image, with a sampling pitch of 0.1 mm and
density resolution of 12 bits, (and preferably a density range of 0.0 to 4.0). Using that
digital image, calculate the mean digital value at the center and surrounding
background areas of the acrylic disk in the phantom image, then determine the S/N
ratio to evaluate the achievement level of each facility.
Evaluate the graininess, writing unevenness, and step phantom density profile as
well.
150mm
150 mm
15mm
15 mm
1 2 3 4 5 6 7 8 9 10
30mm
30 mm
Fig. 7.6.8 Digital Evaluation Phantom
Phantom Size and Composition

Size: 10 steps at 15 mm  30 mm  15 mm
Base Material: SZ-50 (urethane polymer) Density 1.061 g/cm3
Additive: Calcium phosphate Density 0.0243 g/cm3 (N-1)
Apply 200 m calcifications and 0.5 mm tumors to each phantom step

乳頭側 Nipple
Toward
Step Phantom
ステップファントム Step Phantom
ステップファントム
2cm 2 cm
5 10
ACR Phantom (156 phantom)
ACR推奨ファントム(156ファントム)
4 9 Tumor
腫瘤
thickness:
厚み 0.5mm
0.5 mm
1 2 3 4
3 8
Calcification
石灰化
5 6 7 8 diameter:
直径 0.2mm
2 7 0.2 mm
9 10 11 12
1 6
13 14 15 16
2 2cm
cm
胸壁側
Chest Wall Side
Fig. 7.6.9 Phantom Layout Configuration
7.6.9 Other
Some recent mammography systems include stereo radiography and other features. In addition
to general knowledge about mammography, knowing about such systems is also necessary as
well. In addition, some systems are installed in vehicles for examining groups of women. Vehicle
mounted systems involve different maintenance requirements than stationary systems, such as
inspections of mechanical components that could loosen due to vibration, inspections of
electrical circuits for broken circuits, and inspections of fluctuations in the power supply input.

SVBG-110010 Basic Infor About X-Rays and X-Ray Systems

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SVBG-110010 Basic Infor About X-Rays and X-Ray Systems

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Manual No.

Basic information about X-rays

This manual is for professional service engineers.

First edition Oct. 2011 First release

 2011 Shimadzu Corporation. All rights reserved.

SVBG-110010 Basic information about X-rays and X-ray systems i

This page is intentionally left blank.

ii Basic information about X-rays and X-ray systems SVBG-110010

1 Basic Information About X-Rays 1

SVBG-110010 Basic information about X-rays and X-ray systems Contents-1

1.7.1 X-Ray Tube............................................................................................... 16

Contents-2 Basic information about X-rays and X-ray systems SVBG-110010

2.9.7 Avoiding Radiation Damage......................................................................62

3 Introduction to X-Ray Systems 63

4 Overview of X-Ray Generators 77

SVBG-110010 Basic information about X-rays and X-ray systems Contents-3

4.6 X-Ray Tube Units................................................................................. 91

5 Image Receiving Device/System 107

Contents-4 Basic information about X-rays and X-ray systems SVBG-110010

5.5 Grids................................................................................................... 123

6 Image Processor 145

SVBG-110010 Basic information about X-rays and X-ray systems Contents-5

6.2.10 Contrast Correction................................................................................. 153

7 Overview of X-Ray Systems 157

Contents-6 Basic information about X-rays and X-ray systems SVBG-110010

1 Basic Information About X-Rays

SVBG-110010 Basic information about X-rays and X-ray systems 1

1.1.2 Electromagnetic Waves

 (frequency) = C (speed of light) /  (wavelength)

Fig. 1.1.3 Electromagnetic Waves

Fig. 1.1.5 Electromagnetic Wave Types and

 Radio waves ……… cm, m, km

2 Basic information about X-rays and X-ray systems SVBG-110010

1.1.3 X-Rays Described as Particles

E (photon energy in keV) = 12.4 /  (wavelength in Å)

1.1.4 X-Ray Characteristics and Applications

 Generates visible or ultraviolet light when they hit fluorescent substances

 Reacts with photographic film to create latent images

 Causes changes in biological tissue

SVBG-110010 Basic information about X-rays and X-ray systems 3

1.2 How X-Rays Are Generated

Fig. 1.2.1 X-Ray Generation

Z = 74, V = 100 kV = 105,  = 1.1  10-9  74  105 = 0.81 (%)

4 Basic information about X-rays and X-ray systems SVBG-110010

1.2.2 X-Rays Generated by Kinetic Energy (Continuous X-Rays)

When the path of an electron is bent by the

Fig. 1.2.3 Spectrum of Continuous X-Rays

Therefore, the intensity of continuous X-rays can be calculated as follows.

: Symbol that indicates proportionality

SVBG-110010 Basic information about X-rays and X-ray systems 5

1.2.3 X-Rays Generated by Differences in Electron Excitation

Electronucleus When an electron flies in and knocks out an

Fig. 1.2.6 Spectrum of Characteristic X-Rays

These are called characteristic X-rays and are

The intensity I of characteristic X-rays is determined experimentally based on the following

6 Basic information about X-rays and X-ray systems SVBG-110010

V0: Excitation voltage

1.3 Intensity and Quality of X-Rays

1.3.1 X-Ray Dose

1.3.2 X-Ray Quality

1.3.3 Types of X-rays

1.3.4 Electron Volts

SVBG-110010 Basic information about X-rays and X-ray systems 7