slide 2 - Brief history , Xrays were discovered on November 8, 1895, by Wilhelm Conrad Roentgen, a

German physicist.1 This new modality was put to use quickly for medical purposes, and many
sophisticated medical applications were soon devised. For example, angiography was described in 1896,
only 1 year after the initial discovery of x-rays. Roentgen’s finding revolutionized the diagnosis and
treatment of disease, and in recognition he was awarded the first Nobel Prize for Physics in 1901. More
than 110 years after their discovery, x-rays remain in widespread use for radiography and computed
tomography in people and animals.

slide 3 - X-rays and gamma rays are part of the spectrum of electromagnetic radiation. The only distinction
between x-rays and gamma rays is their source; x-rays are produced by electron interactions outside the
nucleus, and gamma rays are released from unstable nuclei having excess energy. There is a tendency to
believe that gamma rays are more energetic than x-rays, but this is not true universally. The energy of a
gamma ray depends on the amount of energy released by an unstable nucleus, and the energy of an x-ray
depends on the energy of the electron that interacts with an atom.

Slide 4 - Familiar types of electromagnetic radiation other than x-rays and gamma rays include radio waves,
radar, microwaves, and visible light (Table 1-1).

slide 6 - The distance between crests, λ, is the wavelength. Another descriptor of electromagnetic radiation is
the frequency, f, or the number of crests per unit time. The velocity (c) of electromagnetic is a constant—the
speed of light. Velocity is related to the product of wavelength and frequency; c = f × λ. Thus, because
velocity is constant, as frequency increases the wavelength must decrease, and vice versa.

slide 9 - The unit of energy for electromagnetic radiation is the electron volt (eV). One electron volt is the
energy gained by one electron as it is accelerated through a potential difference of 1 V. On an absolute scale,
this is a very small amount of energy. However x-rays with energy of only 15 eV* can produce ionization of
atoms or molecules. Ionization occurs when an electron is ejected from the atom, in this case by an x-ray.
This creates an ion pair consisting of the negatively charged electron and the positively charged atom

slide 10 - The ejected electrons can damage DNA, leading to (1) mutations, (2) abortion or fetal
abnormalities, (3) susceptibility to disease and shortened life span, (4) carcinogenesis, and (5)
cataracts.2 Radiation damage to DNA can be thought of as being amplified biologically because DNA
controls cellular processes that extend into subsequent generations of daughter cells. Although only 15 eV of
energy is required for ionization of biologic molecules, the energy of x-rays used for medical imaging is much
higher, and each photon can lead to multiple ionizations as its energy is dissipated in the tissue.

slide 11 - The principle of ionization. A photon ejects an electron from an atom, causing ionization, forming
an ion pair. The ion pair consists of the negatively charged electron and the atom; the atom is positively
charged after losing the negatively charged electron. After this ionization event, the photon, depending on its
energy, may be completely absorbed, or it may interact with other atoms to produce more ionization. The
ejected electron can also interact with biologic molecules, such as DNA, and produce damage. The relative
size of the nucleus, electrons, and orbital shells is not to scale. The “+” symbol in the nucleus designates the
normal nuclear positivity created by the presence of positively charged protons. In a neutral atom, this
positive charge in the nucleus is balanced by the negative charge of the orbital electrons. It is important to
appreciate the relative risk of biologic injury produced by x-rays or gamma rays compared to other types of
electromagnetic radiation

slide 12 - A goal in diagnostic radiology is to obtain maximum diagnostic information with minimal radiation
exposure of the patient, radiology personnel, and general public. This is achievable readily in light of the
guidelines for safe practice that have been developed, and the technology available to reduce exposure to
personnel. However, because x-rays cannot be seen or felt, the idiom “out of sight out of mind” has never
been more applicable, and it is easy to disregard the potential danger associated with occupational x-ray
exposure (Fig. 1-3). As a result, many veterinarians have developed a cavalier attitude regarding the hazards
associated with ionizing radiation and put themselves and their employees at risk, from both medical and
financial perspectives.

slide 13 - Careless approach to radiography. The radiographer has neglected to wear protective gloves, leading
to unshielded fingers (arrows) being exposed to the primary x-ray beam. These careless habits are perpetuated
because of the stealthy properties of x-rays and lead to unnecessary personnel exposure that could become
biologically significant.

slide 14 - Two related concepts are important to understand before radiation units are considered. First,
radiation exposure and radiation absorption are not the same. Some tissues absorb radiation more effectively
than others, meaning that the same exposure dose can result in different absorbed doses. Second, the biologic
effect of the same absorbed dose can also be different, being a function of both radiation type and energy. A
numeric weighting factor or quality factor has been derived to estimate the difference in biologic effectiveness of
various types of radiation

slide 16 - CGS, centimeter-gram-second system of units.

†International System of Units.
‡Although the use of roentgen is allowable under the SI system, it is not itself an SI unit, and continued use is

strongly discouraged by the National Institute of Standards and Technology.

§Weighting factor is a radiation type-specific quantity that compares the ionization density of various types of

radiation; see Table 1-2.

slide 18 - Two materials are exposed to the same number of x-ray photons, represented by the arrows. Thus
the exposure dose, in roentgens, or in coulombs per kilogram, is the same for both materials. However, the
efficiency of x-ray absorption for the two materials is not the same. The material on the left absorbs more
oncoming photons than the material on the right. Therefore the absorbed dose will be higher in the material
on the left even though the exposure dose is the same. One real-life example of this phenomenon is a limb,
where bone would be the high-efficiency absorber and fat or muscle the low-efficiency absorber.

slide 19 - Representation of the ionization density along the paths of an x-ray and an alpha particle. The
ionization density along the path of the alpha particle is much higher because of its large mass and 2+ charge.
This will lead to greater biologic damage on a Gy-per-Gy basis, and a correction factor will be needed to
compare the damage resulting from equal absorbed doses of x-rays versus alpha particles.

slide 23 - ALARA means avoiding exposure to radiation that does not have a direct benefit to you,
even if the dose is small. To do this, you can use three basic protective measures in radiation
safety: time, distance, and shielding.

slide 27- A, Gloves were not used and the unshielded hand (arrows) is in the primary beam to facilitate
subject positioning. B, Dorsoventral skull radiograph of a dog. A sandbag is being used to secure the neck.
The radiographer has decided not to use gloves and has grasped the ears of the dog, which are outside of the
primary beam, to keep the head in the proper position. The dog’s right ear can be seen (black arrow). On the
left side, the radiographer’s fingers can also be seen (white arrow), because of exposure from radiation outside
of the primary beam. A tip of a finger is also in the primary beam (white arrowhead). A portion of the
radiographer’s hand can also be seen on the dog’s right side, peripheral to the dog’s ear but not to the extent
that it is identifiable as a hand. The most rostral portion of the dog’s nose is also visible outside of the
primary beam.

slide 28 C, A lateral radiograph of a canine skull was being made. The radiographer held the ears in the
primary beam with an unprotected hand and then covered the hand with an apron, thinking the apron would
attenuate the x-rays. It did not. The bones in the radiographer’s hand are clearly visible (black arrows) because
of x-rays penetrating the apron. D, A small patient is being restrained by an unprotected hand but a lead
glove is placed on top of the hand, similar to the situation illustrated in part C of this figure. As already stated,
this is ineffective because many of the oncoming high energy photons will penetrate the glove and strike the
hand. Also, photons penetrating the cassette and table will strike the floor and be scattered back, also striking
the hand. This radiation backscatter is also a reason that one should not sit on the edge of the x-ray table
while restraining a patient for radiography. In that instance the scattered photons are going to strike a body
part or parts that are more revered than a hand.
Improper care of lead aprons and gloves results in cracking or separation of the protective layering that
reduces their effectiveness. Aprons and gloves should be placed on racks when not in use. This decreases the
risk of creasing and folding that lead to cracking or separation of the protective layering. Use of a glove rack
also facilitates the evaporation of perspiration that reduces odor.

slide 33- Digital radiographic imaging is (1) electronic measurement of the pattern of x-ray transmission
through the patient, (2) conversion of the electronic measurement into a digital computer file, and (3) viewing
the digital file on a computer monitor. This process is much like that of acquiring a photograph with a digital
camera where the camera records the pattern of colors and intensities irradiating from an object and converts
that information to a picture. Digital radiographic imaging is not photographing a radiographic film image
with a digital camera, nor is it running a radiographic film image through a film scanner to convert the hard
copy image into a digital file.

slide 36- The size of each pixel in a digital image determines the spatial resolution of the image; that is, how
small of an object can be detected . Close-up view of the caudal thorax of a dog. A, The resolution of the
image file is 72 pixels per inch. B, The resolution is 300 pixels per inch. The effect of pixel size on image
detail is clear. The requirement for a small pixel size is one reason that digital radiographic image files are very
large.

In medical digital images each pixel is assigned a shade of gray. The number of available gray shades for each
pixel will influence the contrast of the image. If a pixel can have only a few gray shades, the image can only
have a very short scale of contrast (high contrast) because there will be only black pixels, white pixels, and
pixels of a few gray shades. If, conversely, there are many gray shade options for each pixel, the scale of
contrast can be long.

slide 37 - The concept of bit depth. The number of gray shades possible in an image, depends on bit depth,
which is the range of binary values that can be assigned to a pixel. If only 0 and 1 are possible (bit depth = 1),
the pixel can be only black or white. If both 0 and 1 are possible (bit depth = 2), the possible pixel values are
00, 01, 10, and 11, and the pixel can have one of four gray shades. Other possible pixel values can be seen in
this figure, along with a representation of the possible grayscale values for bit depths of 1, 2, and 4. The sheer
number of possibilities prevents illustrating all grayscale shades for a bit depth greater than 4.

slide 38 - A, Craniocaudal radiograph of the distal antebrachium of a dog with a bit depth of 12, meaning that
4096 shades of gray are available for pixel assignment. B, is a close-up of the styloid process of the ulna
(region of arrow in A). At this magnification, individual pixels are visible, and the range of gray shades used to
create the image can be appreciated. It is easy to see how if the number of gray shades was reduced the
contrast in the image would have a very short scale with many blacks and whites but few intermediate gray
tones.
slide 39 - C, The image was acquired at a bit depth of 10. The image D was acquired at a bit depth of 8. The
inadequate range of gray tones is readily apparent in the 8-bit image.

slide 40 - In general, there are two main types of digital radiography acquisition hardware, computed
radiography (CR) and direct digital radiography (DDR).

slide 41 - Photostimulable phosphor plate. Prior to exposure, all electrons reside at a low energy state. X-rays
that exit the patient elevate electrons to a higher energy state in a pattern that represents the distribution of
incident x-rays having been transmitted through the patient. When the photostimuable phosphor (PSP) plate
is processed, it is illuminated with a laser that causes the electrons trapped at the higher energy level to return
to the ground state; their excess energy is emitted as visible light. The visible light strikes a photomultiplier
tube housed in the reader (not shown here) where the light is converted to an electronic signal. The signal is
then processed by a computer, and a digital image file is created. The pattern of visible light emission is
identical to the pattern of original incident x-ray distribution.

slide 42 - the CR plate must be processed in a plate reader following radiographic exposure. The processing
steps in the CR radiography process are summarized as follows:5
CR remains in widespread use in human imaging but is not as popular in veterinary imaging. Introduced in
the 1980s by Fujifilm Medical Systems, computed radiography (CR) was initially limited to a few select
veterinary colleges and specialty private veterinary practices because of high cost. As technology has evolved,
more and more veterinary practices have replaced conventional film-screen systems with CR.

slide 44 - Indirect flat panels measure the x-ray signal by converting from x-rays to: visible light, to
charge (i.e. electrons) and then to the digital signal. Direct flat panels skip the visible light step
and the x-rays are converted directly to electrons, and then the charge is digitized.

slide 45 - With the indirect detector, an x-ray intensifying screen converts oncoming x-ray
energy to visible light. The light interacts with the detector array, which is composed of small
elements that each contains a photodiode and an amorphous selenium detector. The light from
the intensifying screen is converted to an electronic signal by the photodiode and then readout
by the amorphous selenium detector. Readout electronics maintain spatial resolution and
transmit the information to the computer, where it is converted to an electronic file. With the
direct detector, there is no light intermediary. The oncoming x-rays strike a selenium
photodetector, where the energy is converted to an electronic signal that is collected by the
amorphous silicone detector array directly, with subsequent processing by the readout
electronics and formation of an electronic file.

slide 47 - A charge-coupled device (CCD) radiography system. X-rays from the patient strike a conventional
intensifying screen where the spatial distribution of x-rays is converted to a comparable spatial distribution of
visible light. The light is collected using fiberoptics and strikes focusing lenses that direct it onto the light-
sensitive CCD chip. Overall image quality is determined mainly by the efficiency of light collection and the
quality of the focusing lenses. All of these components are encased in a housing that must be incorporated
into the x-ray table. The housing is fixed, which means that the x-ray tube must always be perpendicular to
the face of the housing.

Radiation Protection and Physics of Diagnostic Radiology and Digital Radiographic Imaging