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Handbook of X-ray Imaging
Physics and Technology
Series in Medical Physics and Biomedical Engineering
Edited by
Paolo Russo
University of Naples “Federico II”
Department of Physics “Ettore Pancini”
Naples, Italy
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
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without intent to infringe.
Preamble..................................................................................................................................................................................................ix
Foreword..................................................................................................................................................................................................xi
Series Preface........................................................................................................................................................................................ xiii
Preface....................................................................................................................................................................................................xv
Editor................................................................................................................................................................................................... xvii
Scientific Board..................................................................................................................................................................................... xix
Contributors.......................................................................................................................................................................................... xxi
3. X-ray Generators...........................................................................................................................................................................93
Rolf Behling
v
vi Contents
24. Physical Image Quality Evaluation of X-ray Detectors for Digital Radiography and Mammography.............................469
Nicholas W. Marshall and Pascal Monnin
29. Radiation Dose in X-ray Mammography and Digital Breast Tomosynthesis....................................................................... 575
David R. Dance
48. Influence of Scatter in X-ray Imaging and Scatter Correction Methods for Industrial Applications...............................959
Carina Stritt, Mathieu Plamondon, Jürgen Hofmann, and Alexander Flisch
62. Computer Analysis of Computer Tomography Images for Lung Nodule Detection..........................................................1259
Maria Evelina Fantacci and Alessandra Retico
64. Display for Medical Imaging and DICOM Grayscale Standard Display Function Fundamentals..................................1283
Wei-Chung Cheng and Aldo Badano
66. Radiation Protection Issues in X-ray Radiology, Fluoroscopy, and Computed Tomography...........................................1309
Francis R. Verdun and Nick Ryckx
68. Tables of X-rays Mass Attenuation Coefficients of K and L—Energy, of K, L, and M Fluorescence Yield
of Kα/Kβ, Lα/Lβ, and Lα/Lγ Ratios.................................................................................................................................... 1337
Roberto Cesareo
Index................................................................................................................................................................................................... 1367
Preamble
Contemporary medical physics starts with the discovery of the The Handbook includes about 1400 pages, organized into four
X-rays and their medical application. Currently, X-ray imaging large sections:
examinations are more than three-quarters of all medical imag-
ing examinations and deliver the highest patient dose of these. • Basic Physical and Technological Aspects (16 chapters)
The field of X-ray imaging technology is also very dynamic and • X-ray Radiography and Fluoroscopy (15 chapters)
new methods/equipment are constantly introduced in the clinical • X-ray Computed Tomography (17 chapters)
practice. This requires special attention to the subject of X-ray
• Phase-Contrast X-ray Imaging and Other Aspects
Imaging—from the points of view of supporting research in the
(20 chapters)
field; of safe and effective translation of this research into prac-
tice; of educating the staff applying these methods; and of pro-
All chapters of the Handbook are very well illustrated—having
viding them with reliable reference material.
in total over 1300 images and diagrams, together with detailed
The Handbook of X-ray Imaging: Physics and Technology,
tables with data, and thousands of references.
edited by Prof. Paolo Russo, is without a doubt the most com-
The scientific quality of the Handbook is underpinned by the
prehensive handbook on the subject ever produced. The publica-
team of established professionals who have prepared the chapters
tion has several specific features that distinguish it from previous
of this monumental publication. This text will be undoubtedly an
publications on X-ray imaging:
important resource for the medical physics profession and will
find its place in most scientific libraries over the world.
• The Handbook presents a very broad overview of the
The Handbook of X-ray Imaging: Physics and Technology is
field, combining not only medical X-ray imaging, but
an unique publication, which gives a detailed overview of a whole
also other related applications of X-ray imaging (e.g.,
branch of the medical physics profession. This huge project will
industrial)
support the education of all medical physics students/trainees
• The Handbook includes information on the physics of and the work of thousands of colleagues worldwide. Books such
the processes and also on X-ray image engineering— as this one are an evidence of the fruitful collaboration between
opening its scope to a specific field of medical engi- the CRC Press (Taylor & Francis) and the IOMP (International
neering and industry Organization for Medical Physics) through the Series in Medical
• The Handbook includes aspects related to clinical (and Physics and Biomedical Engineering.
other) applications of X-ray imaging—opening its Having myself been a Coordinating Editor of a large reference
scope to medical and other specialists material, I fully appreciate the hard work of the entire team and
• The Handbook gives a brief historical perspective on especially of the Main Editor Prof. Paolo Russo. On behalf of the
a number of X-ray imaging areas, and also covers the IOMP, I want to congratulate all the authors of the Handbook for
newest developments in X-ray imaging (e.g., phase- this enormous achievement.
contrast imaging)
• The Handbook not only covers the theoretical aspects, Prof. Slavik Tabakov, PhD, Dr.h.c., FIPEM, FHEA, FIOMP
but also many practical aspects of X-ray imaging, such President IOMP
as test objects and quality control procedures Coordinating Editor of the Encyclopaedia of Medical Physics
• The Handbook has attracted as authors about 120
specialists from 18 countries, which makes it truly
international
ix
Foreword
I have a beautifully polished glass X-ray tube insert, mounted on technology, as well as different phase extraction methodolo-
a hardwood pedestal, sitting on a coffee table in my living room. gies. The other aspects of this section address X-ray scatter, and
Most of my nonscientific friends see it and ask, “what’s that?”. physical and mathematical phantoms for image quality and dose
I tell them that it’s what I owe my livelihood to; a device that assessment. Other important chapters in this section discuss
produces X-rays for medical imaging. With its gray-metal anode, computer-aided diagnosis, education, display hardware, optimi-
shiny cathode housing and precise bearings, it is a small monu- zation, calibration and quality assurance, and radiation protec-
ment to the advancements that medical imaging has experienced tion. This section rounds out this handbook, describing various
over the past century. interpretation strategies for X-ray images using computer and
To my scientific friends, I can point to this Handbook of X-ray human observers.
Imaging, edited by my friend and colleague, Prof. Paolo Russo. Finally, a series of tables provide up-to-date physical data use-
This tome is not polished on the outside; its beauty is the science ful to the X-ray scientist.
described between its covers. This book is a digest of X-ray sci- From a one-dimensional application in documenting attenu-
ence that presents a wide-ranging scientific discussion of a par- ation in a Pb-shielded wall to a five-dimensional application
ticularly valuable region of the electromagnetic spectrum. To the depicting a dual-energy CT movie of a beating heart, the X-ray
X-ray scientist, this book is both an important scientific reference has proven to be a ubiquitous tool for better understanding the
text and a comprehensive description of X-ray science, address- physical world, and for providing important medical diagnostic
ing mainstream modalities and niche applications. The authors information quickly and in a cost-effective manner. I sometimes
who have contributed to this compilation are world-class authori- wonder about the thousands of stories that my coffee table X-ray
ties on their subject matter, and their collective effort gives this tube contributed to before its retirement; how many broken bones,
Handbook impressive depth and breadth. foreign bodies, and pulmonary nodules did the X-rays produced
Section I introduces the Basic Physical and Technological by this very X-ray tube reveal? As readers peruse this outstanding
Aspects of X-ray interaction and production, and it focuses on Handbook of X-ray Imaging, they should remember that the sci-
the foundation of X-ray physics including X-ray source technol- ence and technology so eloquently described herein have impor-
ogy, X-ray interactions, X-ray spectra, and detector technology tant real-world consequences in improving human health through
used for X-ray imaging. This section grounds the reader in the better diagnoses, analyzing thirteenth century Italian relics, dis-
basic science of X-ray physics in an interesting and approachable covering faulty pipeline welds—and a million other important
manner. applications. Roentgen would be very impressed.
Section II discusses X-ray Radiography and Fluoroscopy; at a
clinical level these topics are the bread and butter of any X-ray
imaging facility, but this section delves deeper than rad/fluoro
and includes chapters on X-ray discovery, mammography, dental
radiography, industrial radiography, and forensic radiography. It
also includes chapters on limited angle tomography—tomosyn-
thesis—as well as radiation dose and its potential risks.
Section III is on X-ray Computed Tomography, and chapters
in this section describe important aspects of CT technology such
as reconstruction methods, small animal, dual energy, and cone
beam imaging applications; CT dosimetry, industrial, antiquity,
and metrology applications of CT imaging; high temporal res-
olution CT, and both kV and MV applications of this technol-
ogy. Like CT itself, this section represents topics with different
angles, all which focus upon the central theme. John M. Boone, PhD, FAAPM, FSBI, FACR, FAIMBE, FSPIE
Section IV focuses on Phase-Contrast X-ray Imaging Professor of Radiology and Biomedical Engineering
and Other Aspects. The phase-contrast chapters cover theory, University of California—Davis/USA
breast imaging, and tomosynthesis applications of this emerging Fair Oaks, California
xi
Series Preface
The Series in Medical Physics and Biomedical Engineering membership of 80 national and 6 regional organizations, together
describes the applications of physical sciences, engineering, and with a number of corporate members. Individual medical physi-
mathematics in medicine and clinical research. cists of all national member organisations are also automatically
The series seeks (but is not restricted to) publications in the members.
following topics: The mission of IOMP is to advance medical physics practice
worldwide by disseminating scientific and technical information,
• Artificial organs fostering the educational and professional development of medi-
• Assistive technology cal physics and promoting the highest quality medical physics
• Bioinformatics services for patients.
A World Congress on Medical Physics and Biomedical
• Bioinstrumentation
Engineering is held every three years in cooperation
• Biomaterials with International Federation for Medical and Biological
• Biomechanics Engineering (IFMBE) and International Union for Physics
• Biomedical engineering and Engineering Sciences in Medicine (IUPESM). A region-
• Clinical engineering ally based international conference, the International Congress
• Imaging of Medical Physics (ICMP) is held between world congresses.
IOMP also sponsors international conferences, workshops and
• Implants
courses.
• Medical computing and mathematics The IOMP has several programmes to assist medical
• Medical/surgical devices physicists in developing countries. The joint IOMP Library
• Patient monitoring Programme supports 75 active libraries in 43 developing coun-
• Physiological measurement tries, and the Used Equipment Programme coordinates equip-
ment donations. The Travel Assistance Programme provides
• Prosthetics
a limited number of grants to enable physicists to attend the
• Radiation protection, health physics, and dosimetry world congresses.
• Regulatory issues IOMP co-sponsors the Journal of Applied Clinical Medical
• Rehabilitation engineering Physics. The IOMP publishes, twice a year, an electronic bul-
• Sports medicine letin, Medical Physics World. IOMP also publishes e-Zine, an
• Systems physiology electronic news letter about six times a year. IOMP has an agree-
ment with Taylor & Francis for the publication of the Medical
• Telemedicine
Physics and Biomedical Engineering series of textbooks. IOMP
• Tissue engineering members receive a discount.
• Treatment IOMP collaborates with international organizations, such
as the World Health Organisations (WHO), the International
The Series in Medical Physics and Biomedical Engineering Atomic Energy Agency (IAEA) and other international pro-
is an international series that meets the need for up-to-date texts fessional bodies such as the International Radiation Protection
in this rapidly developing field. Books in the series range in level Association (IRPA) and the International Commission on
from introductory graduate textbooks and practical handbooks Radiological Protection (ICRP), to promote the development
to more advanced expositions of current research. of medical physics and the safe use of radiation and medical
The Series in Medical Physics and Biomedical Engineering devices.
is the official book series of the International Organization for Guidance on education, training and professional development
Medical Physics. of medical physicists is issued by IOMP, which is collaborating
with other professional organizations in development of a pro-
fessional certification system for medical physicists that can be
The International Organization implemented on a global basis.
The IOMP website (www.iomp.org) contains information on
for Medical Physics
all the activities of the IOMP, policy statements 1 and 2 and the
The International Organization for Medical Physics (IOMP) “IOMP: Review and Way Forward” which outlines all the activi-
represents over 18,000 medical physicists worldwide and has a ties of IOMP and plans for the future.
xiii
Preface
In October 2014, the Publications Committee of the International medical physics residents, biomedical engineering students,
Organization for Medical Physics (IOMP) (www.iomp.org) dis- technology students in radiology, students in medical radiology,
cussed, among other topics for the diffusion of publications, physicists and engineers in the field of nondestructive industrial
to propose new books and e-books in various fields of medical testing techniques using X-rays, radiology technicians, scientists
physics, also with reference to the Series in Medical Physics and interested in understanding and using X-ray imaging techniques.
Biomedical Engineering of CRC Press, an official book series This Handbook is the result of the dedication and competent
of IOMP. As a member of this Committee, with reference to my authorship of as many as 132 scientists, and of the careful review
scientific interests in the field, I launched the idea to edit a book of a Scientific Board, which includes as many as 39 scientists,
related to the physical aspects of diagnostic radiology: these were during a period as long as three years. I warmly thank all of
the origins of the present Handbook of X-ray Imaging: Physics them. The profound scientific and technical competence of all
and Technology, which sees the light of day November 7th, the of them is at the basis of this Handbook, which I hope will be
International Day of Medical Physics 2017 (Marie Curie’s birth- welcome in the field.
day) and that of November 8th (when X-rays where first observed I thank my former mentor, Professor Alberto Del Guerra,
by Roentgen in 1895). who introduced me (almost 30 years ago) into the field of digi-
The title should declare its vocation: use of X-ray imaging tal radiography, a continuous source of scientific interest for
techniques, in the medical and biological fields as well as in other me.
applied fields, for example, industrial testing, requires the under- I acknowledge the many helpful discussions with my colleague
standing of the physical and technological aspects at the basis of Professor Giovanni Mettivier.
techniques and devices. However, given the wide scope of such I thank all my graduate and PhD students in medical physics,
a field, the related material can be found only in a number of this Handbook was prepared also for them.
books and textbooks. Hence, I was thinking of a comprehensive I thank all CRC Press officials who contributed to publishing
Handbook which could represent a condensed reference for clas- this volume, first of all, Francesca McGowan: her smiling and
sic aspects as well as recently introduced advancements in X-ray gentle attitude and professional advices were always appreciated
imaging: this implied the preparation of a completely new publi- during the long period of preparation of the Handbook. CRC
cation in such diverse fields as X-ray radiography and tomogra- Press’ Rebecca Davies was an important reference point in the
phy for medical diagnosis and biomedical research, for dentistry last two years: I thank Rebecca for her professional editorial work
imaging, for industrial testing and for veterinary diagnosis, pre- and courtesy.
pared by many contributors. Eventually, this last application field I dedicate this editorial effort to my daughter, Elena: I would
was dropped from the Table of Contents, since I could not recruit have hardly gone to the end of it, without her continuous sup-
contributors. port and patience and without her editorial assistance (though at
The Handbook is divided into four sections (Basic Physical 6700 km distance) in keeping records of all material produced,
and Technological Aspects, X-ray Radiography and Fluoroscopy, in keeping contacts with all the contributors (via thousands of
X-ray Computed Tomography, Phase-Contrast X-ray Imaging, emails exchanged with authors, editors, and publisher), in solv-
and other aspects). While in organizing the Handbook structure ing a large number of editorial issues.
I tried to cover the most relevant aspects of each topic, some of My final thanks go to my wife, Lucia and my son, Gabriele:
them remained uncovered in the final version of the manuscript, they understood and supported me once again, for this new effort.
though initially foreseen: future editions of the Handbook will
try to fill the gap of these missing topics. Paolo Russo
The Handbook of X-ray Imaging is directed to a vast audience University of Naples Federico II
including graduate students in medical physics, PhD students, Naples, Italy
MATLAB® is a registered trademark of The MathWorks, Inc. For product information, please contact:
xv
Editor
Paolo Russo was born in detectors, to digital mammography with photon-counting detec-
Naples (Italy) in 1958. In tors, to small animal SPECT and semiconductor compact
1981 he graduated in physics gamma cameras, to a prototype scanner for cone beam breast
at the University of Naples computed tomography using attenuation-based and phase-
Federico II, where he was a contrast-based methods. From 2008 to 2012 he was the associate
research associate from 1984, editor of Physica Medica (European Journal of Medical Physics)
an associate professor from for the field of medical imaging, and since January 2013 he is the
1992, and a full professor of editor-in-chief of this journal. He is the vice-chair of Publications
medical physics from 2001. Committee of IOMP (International Organization for Medical
His scientific activity is Physics) and chair of Publications and Communications
related to the development of Committee of EFOMP (European Federation of Organisations
medical imaging systems, for in Medical Physics). He serves as reviewer for several journals
digital radiography, com- in medical physics, and for research projects for European
puted tomography, and nuclear medicine. Applications range Research Foundations. He has coauthored over 140 papers on
from autoradiography with microstrip and pixel semiconductor peer-reviewed journals and scientific book chapters.
xvii
Scientific Board
Elizabeth Krupinski
xix
Contributors
xxi
xxii Contributors
Ke Li Pascal Monnin
Department of Medical Physics and Institute of Radiation Physics (IRA)
Department of Radiology Lausanne University Hospital (CHUV)
University of Wisconsin-Madison Lausanne, Switzerland
Madison, Wisconsin
Bruno Morgan
William R. B. Lionheart University of Leicester Imaging Department
School of Mathematics University Hospitals of Leicester
University of Manchester Leicester Royal Infirmary
Manchester, United Kingdom Leicester, United Kingdom
You Zhang
Annalisa Trianni
University of Texas Southwestern Medical Center
Azienda Sanitaria Universitaria Integrata di
Dallas, Texas
Udine (ASUIUD)
Polo Ospedaliero “S. Maria della Misericordia” Otto Zhou
Udine, Italy Department of Applied Physical Sciences
and
Srinivasan Vedantham Department of Physics and Astronomy
Department of Medical Imaging The University of North Carolina at Chapel Hill
The University of Arizona Chapel Hill, North Carolina
Tucson, Arizona
Uwe Zscherpel
Francis R. Verdun Division of NDT–Radiological Methods
Institute of Radiation Physics Bundesanstalt für Materialforschung und–prüfung
University Hospital of Lausanne (BAM)
Switzerland Berlin, Germany
Section I
e che se potemmo dare mentita nel passato a chi Italia aveva detto
nome geografico e nulla più, non era stato che per ciò solo che mai
non avevamo perduto lo scettro dell’Arti Belle.
Discorso dell’origine, del progresso e dello stato attuale delle
escavazioni, quantunque il perimetro della città non sia peranco
interamente sterrato; pure dai fatti esperimenti fu dato misurarne
l’estensione che si computa a circa quattro miglia, compresi i
sobborghi, ed è concesso di fornirne la topografia.
Pompei venne costruita su di una collina digradante al mare che in
passato la circondava da due lati e ne costituiva quasi una penisola.
Se si riguarda alla pietra su cui si fonda e che è di natura vulcanica,
anzi direbbesi antichissima lava, si avrebbe argomento a credere
che il terribile incendio del Vesuvio del 79 fosse stato ne’ tempi
caliginosi della storia preceduto da altri non minori cataclismi, pei
quali la lava o fosse fin qui fluita da quel formidabile serbatojo, o
avesse trovato altri aditi divisi dal cratere per uscire ad allagare la
circostante pianura; seppure questa collina stessa non fosse una
bocca vulcanica pari ad altre che si veggono attorno al Vesuvio.
Strabone portò l’egual congettura, constatando prima la sterilità della
vetta cinericcia del Vesuvio, poi le sue profonde caverne e le diverse
spaccature, e reputò doversi per avventura attribuire al suo fuoco e
alle sue ceneri la miracolosa fertilità, per la quale va la Campania
distinta.
Ma più specialmente catastrofi non di molto dissimili toccate a’ paesi
circostanti, sia per tremuoti come in quello memorabile da me riferito
del 63 di Cristo, sia per eruzioni ed anche a Pompei, lo attesterebbe
il nome stesso della città, se è vero quel che afferma la Dissertatio
Isagogica di C. Rosini, che essa venisse chiamata dapprima
Pompìa, e che ciò significhi fuoco spento [109]. Nella Via delle Tombe
inoltre vennero trovati in qualche luogo negli scavi, esistenti sotto le
costruzioni di romana origine, avanzi di altre precedenti opere
muratorie d’epoca assai remota e oggetti d’origine etrusca. Dalla
parte opposta a Napoli, da cui dista forse una quindicina di
chilometri, ho già detto che il seno che vi formava il mare ed entro
cui aveva la propria foce il Sarno, avesse costituito naturalmente un
porto capace di molte navi, anzi, secondo alcuni, perfino di una
intera flotta e che giovava ai bisogni non della sola Pompei, ma di
Acerra e di Nola, onde per i legni che scendevano o risalivano di
continuo codeste sponde, avesse ragione Strabone di designarlo
come un importante porto e di far della città un vero emporio, molto
più che, navigabile allora il Sarno, avesse preferenza sui porti di
Stabia e d’Ercolano, per il vantaggio che offriva del trasporto delle
merci che giungevano nell’interno del territorio.
Più in là del porto e verso Stabia — ed or direbbesi verso la via che
scorge a Castellamare, città che sorge appunto sulle rovine di
Stabia, fatte prima da Silla e compiute poi dal Vesuvio — erano le
Saline di Ercole, di cui si veggono oggi pur le vestigia nel luogo detto
Bottaro e la palude a cui fa cenno L. G. Moderato Columella, non
che il verso seguente che ne fa gradevole menzione: