From Rays to Resonance:

The Physics Revolution in Modern Medical Imaging

(X-Ray, CT Scan, PET, and Ultrasound)
Ali Akbar, Joayquen Wong, Keanan Wongso, Sherien Dinta, Seeman Butt

Abstract. This research paper reveals the role physics has in reshaping medical
diagnostics, surrounding X-ray, Ultrasound, PET scan, and CT scan technologies. By
examining both advantages and challenges, this research contributes to an
understanding of the evolving landscape of medical imaging, directing towards which
technology is suitable and is the safest for the specified conditions.

1. Introduction
The landscape of medical imaging has undergone a profound transformation over the decades. This
paper, titled “From Rays to Resonance: The Physics Revolution in Modern Medical Imaging,”
embarks on a journey through the evolution of medical imaging technologies (X-ray, Ultrasound,
PET scan, and CT scan) and the underlying physics principles that have fueled this revolution.

In 1895, X-Rays was founded by Wilhelm Roentgen. Since then, it has set the stage for a
revolutionary shift in medicine, introducing a tool that allowed physicians to observe the human
body without surgical intervention. This then led to the development of Ultrasound in 1956,
Positron Emission Tomography (PET) in 1961, and Computed Tomography (CT) scans in 1967
which were inspired by the combination of physics and medicine.

We aim to unravel the complexity of the technologies and their implications for medical
diagnostics. By understanding the physics behind these technologies, we aspire to gain insights
into their strengths and limitations.

2. Formalism
−μ𝑥
Attenuation (I) of X-rays: I = 𝐼𝑜𝑒
I = Transmitted intensity
𝐼𝑜= Initial intensity before absorption.
μ = Attenuation (or absorption) coefficient of the material.
x = Thickness of material.

−α𝑥
Attenuation (I) of Ultrasound: I = 𝐼𝑜𝑒
I = Intensity of reflected beam.
𝐼𝑜= Intensity of incident ultrasonic beam.
α = Absorption coefficient.
x = Distance travelled through the material.

Acoustic impedance (Z): density (p) x speed of sound (c)

 2
𝐼𝑟 (𝑍2−𝑍1)
Intensity reflection fraction: 𝐼0
= 2
(𝑍2+𝑍1)

𝐼𝑟 = Ratio of reflected intensity.

𝐼𝑜= Intensity of the incident ultrasonic beam.
I = Intensity of the reflected beam.
𝑍1 = Acoustic impedance of first material.
𝑍2 = Acoustic impedance of second material.

Energy of Photon: E = hf
E = Energy of Photon.
h = Planck’s constant.
f = Frequency of Photon.

𝐸
Momentum of Photon: p = 𝑐
p = Momentum of Photon
E = Energy of Photon.
c = Speed of electromagnetic radiation in a vacuum.

3. X-Ray Technology

3.1 The Marvels of X-Ray Vision: Why X-Ray?

X-rays, also known as X-radiation are a form of electromagnetic radiation, which has a much
higher energy than visible light and can pass through objects, including the body, painlessly. The
founder of X-rays, Wilhelm Conrad Röntgen, initially named them X-rays due to the fact that
their nature was unknown. X-ray technology serves as an essential tool in various fields, with its
primary role lying in the realm of medical diagnostics. Its diagnostic precision allows healthcare
professionals to obtain quick and detailed images of internal structures, without the need for
surgical intervention, facilitating the
detection and diagnosis of a broad spectrum of conditions, from fractures to tumours. The speed
and efficiency of X-rays is also crucial in emergencies.

3.2 Unveiling The Mechanism of X-Ray Technology

X-ray beams pass through the body, and the body tissues/bones will absorb and block the beam in
varying amounts depending on density. There will be a detector on the other side of the body that
will detect X-rays once they’ve passed through. It will then produce an image on a computer
based on the detection in the detector.

Healthy bones will appear white since the calcium blocks the passage of radiation, air appears
black, and muscles/soft tissues are less absorbing, so the film is blackened and the intensity of the
X-rays’ beam gradually decreases, called attenuation1.
Bone X-rays can typically spot fractures, infections, or tumours in the bone. X-rays of fluid can
spot signs of infection or tumours in the chest such as lung cancer.

1
Attenuation: the gradual decrease of intensity of radiation as it passes through a medium.
 Fig .1 Fig. 2

On the other hand, ionising radiation2—a type of radiation that can damage living tissue—is
produced by X-rays. The risk rises as an individual's lifetime exposures accumulate over time.
However, there is often little chance of getting cancer as a result of radiation exposure.
However, the diagnostic advantages of X-ray scans far outweigh the risks when performed
properly.

3.3 Challenges and Limitations of X-Ray for Medical Imaging

In comparison with other imaging studies X-rays have some of their own downsides. X-rays are
strongest at capturing detailed images of bone; they are not very good at capturing details of soft
tissues including ligaments, muscles, and nerves. X-rays also have restricted views which only
provide 2D images, making it challenging to look thoroughly. Due to this, X-rays might not be the
ideal choice for diagnosing some illnesses especially when observing soft tissues.

4. CT-Scan

4.1 Computed Tomography (CT) Scan

CT scan sends radiation through the body like an X-ray, but offers a much higher level of detail,
showing computerised 360-degree views of the body’s structures. CT scans are fast and detailed,
though not as fast as X-rays. CT scans are mostly used for spotting abnormalities in soft tissues,
tumours, complex fractures, cancer staging, and bone fractures including subtle ones that may not
be visible on X-ray.
Fig.3 Fig.4

2
Ionising radiation: the energy produced (natural or artificial) that can cause chemical changes by breaking
chemical bonds.
4.2 Mechanism of CT Scan
A CT scanner employs a motorised X-ray source that spins around the circular opening of a
donut-shaped structure known as a gantry, as opposed to a traditional X-ray, which uses a
stationary X-ray tube. A CT scan involves the patient lying on a bed that slowly travels along the
gantry as the X-ray tube spins around them, passing through their body to emit small beams of
radiation. CT scanners use specialised digital X-ray detectors, which are placed immediately
across from the x-ray source, in place of film. The detectors take up the X-rays as they exit the
patient and send them to a computer.

Each time the X-ray source completes one full rotation, the CT computer uses sophisticated
mathematical techniques to construct a two-dimensional image slice of the patient. When a full
slice is completed, the image is stored and the motorised bed is moved forward incrementally into
the gantry. The X-ray scanning process is then repeated to produce another image slice. This
process continues until the desired number of slices is collected.

Image slices are then displayed and stacked together by the computer to generate a 3D image of
the patient that shows the skeleton, organs, and tissues as well as any abnormalities the physician
is trying to identify. This method has many advantages including the ability to rotate the 3D image
in space or to view slices in succession, making it easier to find the exact place where a problem
may be located.

4.3 How does a CT Scan differ from an X-ray?

Both CT scans and X-rays use X-ray technology. However, while X-ray images are 2
dimensional, CT scan images can be 3 dimensional. CT scans provide more detailed and
cross-sectional images of the body as the scanner combines multiple X-ray images taken from
different angles. CT scan uses a rotating X-ray machine to generate these images, allowing it to
generate a 3D image. Moreover, CT scans can more easily distinguish tissues with similar
densities (attenuation coefficients3)
Due to multiple X-ray images taken, CT scans tend to expose the patient to a higher dose of
ionising radiation. X-rays are typically used to scan the bones or chest, useful for detecting
fractures, infections and tumours. While CT scan can be used to visualise internal organs, blood
vessels, and soft tissues with greater detail.

3
Attenuation coefficient: the attenuation (or absorption) coefficient of a material is a constant that depends on
the material and the frequency of the X-rays.
5. PET-Scan

5.1 Positron Emission Tomography (PET) Scan

PET Scan is another tool that has a range of uses for investigating, diagnosing and monitoring the
treatment of cancers, heart disease, gastrointestinal disorders and brain function. The main
difference between PET scans and other scans such as CT and Ultrasound, is that the PET scan
involves some internal action , whereas both CT and Ultrasound solely scans the image from the
outside.

PET scans can show both typical and atypical metabolic activity. Typical metabolic activity such
as cellular respiration where cells break down glucose to produce energy (ATP) through a series
of biochemical reactions, this is spotted by the pattern of a region of the brain exhibiting normal
glucose metabolism and healthy muscle tissue showcasing the expected metabolic activity during
exercising. In comparison, atypical metabolic activity is like fermentation in muscle cells during
exercise where oxygen is limited and is usually spotted in an area of the lung with abnormal
glucose uptake, indicating potential tumour/infection and diseased cardiac tissue displaying
irregular metabolic activity in the context of heart disease.

5.2 Construction of Image in PET Scan

During the PET scan, a “tracer”, sometimes called FDG-18, containing radioactive glucose, will
+
be given (swallowed or injected) before the examination. This tracer will be decayed by β
emission, which is positron4 emission. Then, the positron will move circulating throughout the
body tissue, encountering an electron. When they are combined, they will mutually destroy each
other, converting their mass into pure energy in the form of two gamma-ray (γ) photons.

The two gamma-ray (γ) photons will serve as a dye agent for the imaging scan and will gather
into areas of the body that have higher levels of metabolic activity due to the high glucose
consumption. The detector; scintillated and a photomultiplier will produce the image that could
be used to identify the location of potential disease. Cancer cells tend to use more energy than
healthy cells so it has more glucose consumption, therefore the colour of the dye would appear
brighter.

Fig. 5 Fig. 6

4
Positron: the antiparticle of electrons.
5.3 Limitations of PET-Scan
Abnormal chemical balances in the body can lead to inaccurate results in PET scanning. In
particular, individuals with diabetes or those who have eaten shortly before the examination may
experience adverse effects on test results due to changes in blood sugar/insulin levels. During the
PET-Scan there will be loud banging noises while the actual scanning takes place that can damage
people’s hearing, so people will wear earplugs or noise cancellations to reduce the noise.

6. Safe Scans: Radiation-Free Ultrasound

6.1 Unveiling the Wonders of Ultrasound

Ultrasound is any sound wave produced by a vibrating source that has a frequency above the limit
of human hearing (20kHz or 20000Hz). The frequency of the source is the same as the frequency
of the waves produced. In ultrasound scanning, ultrasonic waves are produced by a varying
electrical voltage in a transducer5. Ultrasound does not seem to have any harmful side-effects,
therefore it can provide useful information on a baby’s development in the womb. Other uses such
as for measuring the speed of blood flow and direction of movement. Another functional form of
ultrasound is elastography, a technique that measures and shows the relative stiffness of tissues
that can be applied to distinguish healthy tissue from tumours.
Fig. 7

6.2 Understanding Ultrasound Technology

Ultrasound uses a small transducer to both transmit high-frequency sound waves into the body
and record the waves that echo back. Sound waves travel into the area being examined until they
hit a boundary between tissues, such as between fluid and soft tissue, or soft tissue and bone. At
these boundaries, some of the sound waves are reflected back to the transducer, while others
travel further until they reach another boundary and are reflected back. Since the speed, direction,
and distance sound waves travel differ depending on the boundary they run into, a computer can
interpret this information as a two-dimensional image on a screen.

5
Transducer: any device that changes energy from one form to another.
6.3 Echo Sounding
When a beam of ultrasound reaches a boundary between two different media, the beam is partially
refracted and partially reflected, which means the transmitted beam has changed direction. The
incident intensity of ultrasound that is reflected at the boundary depends on the acoustic
impedance6 (Z) of each material. The greater the difference in acoustic impedances, the greater
the reflected fraction of the ultrasound waves. The intensity reflection fraction of the boundary
between two materials can be found by calculating the ratio of reflected intensity (Ir) to the
incident intensity (I0).

A big change in acoustic impedance gives a large fraction of reflected intensity, which means
bones show up well in an ultrasound scan, but it is difficult to see different soft tissues. Another
problem is that the patient’s skin is in contact with air and 99.95% of ultrasound will be reflected
before it has entered the body. This is why gel is used before ultrasound, for the process of
impedance matching7.

6.4 Amplitude Scan (A-Scan) Ultrasound

In A-scan, a single ultrasound sends a pulse into the body, and the resulting reflected ‘echoes’ are
identified and presented on an oscilloscope or computer screen as a voltage-time graph. The
ultrasound transducer is controlled by a pulse generator, which is also linked to the oscilloscope’s
time base. Simultaneously, the pulse generator triggers a pulse of ultrasound that travels into the
patient and starts a trace on the screen. A-scan can be utilised to determine bone thickness by
halving the distance travelled by ultrasound. However, A-scan is primarily used to examine the
thickness of the eye lens.
In the eye examination process, anaesthetic drops are applied to numb the patient’s eyes. Then an
ultrasound wand is positioned on the eye’s front surface to produce ultrasound waves that bounce
off eye tissues and make ‘echoes’.

The term 'amplitude scan' refers to the echoes that appear as high-amplitude spikes.

Fig. 8

https://www.cambridge.org/core/books/abs/core-topics-in-transesophageal-echocardiography/b
asicprinciples-of-physics-in-echocardiographic-imaging-and-doppler-techniques/ACF611B9906
B302200216EB4E5E4F168

6
Acoustic Impedence: product of density of the substance and the speed of the ultrasound in the substance.
7
Impedance matching: process of ‘coupling’ transducer to skin by using a gel.
6.5 Brightness Scan (B-Scan) Ultrasound
The B-scan involves the use of ultrasound waves to create two-dimensional, cross-sectional
images of internal body structures. Unlike A-scan, B-scan provides a more detailed visual
representation of anatomical features, built up from many A-scans. In B-scan, the ultrasound
transducer emits a series of sound wave pulses into the body. The wave bounces off different parts
of organs or tissues inside and comes back as echoes. The echoes produced will then be processed
and translated into a grayscale (black-and-white) image. The brightness levels on the resulting
image show how strong the echoes are, making it possible to differentiate variations in tissue
density.
In the examination process, you’ll be requested to shut your eyes, and a gel will be applied to your
eyelids before the probe is used. You might also be instructed to move your eyes in various
directions to observe how well the eye muscles are functioning.

The term “B scan”, sometimes known as brightness scan, originates from the way ultrasound
imaging represents echo intensity. Different tissues can be seen according to their density and
composition since the brightness on the display reflects the strength of the returning echoes.

Fig. 9 Fig. 10

7. Conclusion

7.1 Exploring X-ray Possibilities

X-rays excel at imaging bones and identifying issues like fractures, dislocations, or bone
infections. This is because they are absorbed by dense tissues, making bones and joint conditions
clearly visible. Besides, X-rays are highly sensitive to density differences, allowing for varied
visualisation of organs and bones. Also, X-rays are better for emergency purposes since X-rays can
produce the images faster and more efficiently.

7.2 The Suitable Application of CT-Scan

CT scans are most effective for producing detailed cross-sectional images of the body and
detecting various conditions such as soft tissues, tumours, complex fractures and cancer staging.
This is due to the high-resolution detailed images they generate, ensuring clear visualisation.
Additionally, CT scans create 3D scanned areas, offering a more comprehensive perspective for
accurate diagnoses.
7.3 Wrapping Up PET Scan Applications
Since PET scans can show the metabolic activity of cells, PET scans are best used in cancer
detection, as they can reveal the metabolic activity of cells by highlighting areas with elevated
glucose consumption. This is derived from the way PET-Scan distributes radioactive tracers in the
body and PET scans are also sensitive in detecting disease spreading, allowing to identify whether
cancer has spread in the body.

7.4 The Suitable Function of Ultrasound

Ultrasound emerges as the best choice for monitoring fetal development during pregnancy due to
its non-invasive characteristics (doesn’t involve the use of instruments being inserted into the
body), real-time imaging capabilities allow to observe the fetus' development as it happens, and the
provision of detailed visualisation enabling the identification of potential issues. Foremost,
Ultrasound is a safe imaging technique since it doesn’t use ionising radiation that could be harmful
to the developing fetus and the sound waves used are at very low frequency.

7.5 Health Consequences of Wave Interaction

Various radiation sources can specifically impact certain body parts, and the potential health effects
of radiation exposure depend on the dose amount. This is due to Ionization Radiation that can
indirectly ionise atoms by creating free radicals - unstable molecules with unpaired electrons.
These free radicals can cause damage to cell structures such as DNA, proteins, and lipids.
Prolonged exposure may increase the risk of cancer.
The greater the energy absorption by cells, measured by Roentgen Equivalent Man (rem), the more
biological damage. For instance, 5 - 100 rem could cause possible chromosomal damage, 200 -
300 rem could cause serious sickness, and 400 - 1000 rem could cause early death.

Fig. 11
8. Acknowledgements

In the pursuit of unravelling the complexities of Physics in Medical Imaging, we extend our
heartfelt gratitude to those who have been instrumental in our journey. First and foremost, we
express our deepest appreciation to Ms Ani, our guide whose unwavering support and
encouragement have been the bedrock of our endeavours. Her guidance and expertise have been
invaluable, shaping our understanding and igniting our curiosity. Her belief in our potential has
fueled our passion for this intricate field.

We are also immensely thankful for our dedicated teammates, whose collaborative spirit and
shared enthusiasm have transformed challenges into opportunities for growth.

Together with the support of our teammates, and the wisdom of our teachers, we embark on this
intellectual exploration with gratitude in our hearts.

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