PHYSICS OF RADIOLOGY o Anode (+)

I. OBJECTIVES o Tungsten
 Explain how x-ray radiation is formed  Vacuum tube
 Describe how x-ray interacts with the body  External energy source and controls
 Describe the process of x-ray image
formation A. THERMIONIC EMISSION

A. ELECTROMAGNETIC ENERGY

i. Properties of Electromagnetic Energy

 Frequency
 Wavelength
 Indirectly proportional

ii. Electromagnetic Energy

 Ionizing
 Non-ionizing

II. X-RAY PRODUCTION

i. TUNGSTEN

 Electron source
o Cathode (-)
o Tungsten
 Rare earth
 Tangent material
 Atomic #74
  A change in mAs results in amplitude
ii. Tube Interactions change of the x-ray emission spectrum
 Heat- 99%  A change in kvP results in amplitude and
 X-rays- 13% spectral change
 A change in atomic number of target
X-RAY PRODUCTION material affects both quantity and quality of
 Bremsstrahlung x-rays
 Characteristic x-ray
 Rare occurrence ii. FILTRATION
 Selective process to remove low energy
B. BREMSTRAHLUNG electrons
 Hardening the x-ray beam
o Increase in average energy
 Maximum energy is not affected
 Aluminum

III. X-RAY INTERACTION WITH MATTER/TISSUE

A. X-RAY INTERACTS WITH MATTER
 Photon is scattered
o Coherent scattering
o Compton scattering
 Photon disappears
o Photoelectric effect
o Pair production
 The released photon E is polychromatic
o Photodisintegration
o Mixture of low energy and high
 Photon penetrates without
energy photons
interaction
o kVp applied determines the keV of
photons
A. PHOTON IS SCATTERED
 Filters
i. COHERENT SCATTERING
o Remove low energy photons
 No ionization
 Change in x-ray direction
C. CHARACTERISTIC RADIATION
 <5% of radiation
 Not important in diagnostic radiology

2 Types:
 Thomson scattering
o 1 orbital electron only is involved

 Rayleigh scattering

o All orbital electrons are involved

o Atom not ionized nor excited
i. EFFECT OF mAs, kVp and TARGET MATERIAL
ii. COMPTON SCATTERING

 Incident photon hits the nucleus

 Photon disappears
 Production of 2 particles:
o Positron
o Negatron/electron
 Does not occur in diagnostic radiology
range
 Important PET scan

iii. PHOTODISINTEGRATION
 Incident photon interacts with outer shell
electron and ejects it from its shell (recoil
electron) continues on a deflected path as
a lower energy photon
 Almost all the scattered radiation in
diagnostic radiation in diagnostic radiology
comes from Compton scattering
 A major source of radiation to the
radiologist/rad tech

B. PHOTON IS ABSORBED
i. PHOTOELECTRIC EFFECT

 Photon with extremely high energy, 7-15

MeV interacts with nucleus
 Releases a nucleon

D. DIAGNOSTIC RADIOLOGY
 What matters?
o Photoelectric effect/ absorption
o Compton effect/ scattering
o Photons that pass through the body
 Factors influencing photon-tissue interaction
o Photon energy (kvP)
o Atomic # of absorber (eg. Calcium=
20; lead = 82)
 Incident photon interacts with inner shell
o Density and thickness of absorber
electron
 Also occurs at diagnostic radiology range
IV. SCATTER RADIATION
 Also called photoelectric absorption
 These are secondary radiation resulting from
lower energy x-rays from deflected photons
ii. PAIR PRODUCTION
 Image contrast is reduced depending on
the amount of scatter radiation
 Contributes to film fog
 many silver many silver silver halide
A. EFFECTS OF SCATTER RADIATION halide halide crystals not
 Assumed that the object shown here is not crystals crystals are exposed
penetrated and would produce 100% exposed
contrast if no scatter radiation

B. FACTORS AFFECTING SCATTER

 Field size
 Thickness of subject
 kvP

V. IMAGE PRODUCTION
A. PHOTOGRAPHIC/X-RAY FILM

 Silver halide

RECAP:
 X-ray tube produces x-ray beam
 Differential interactions of x-ray photons with
tissue
 Information from transmitted x-rays are
converted into radiographic image
V. ARTIFACTS
1. Glue shoe mark

Latent Image
Air/ soft tissue Bone Amalgam/
gold
Many x-rays Fewer x-rays Few, if any, x-
penetrate penetrate rays
and expose and not as penetrate;
2. Water stain 6. Static

7. Warped cassette-light leak

3. Double exposure

4. Finger marks

5. Hyporetention
 INTERPRETATION OF CHEST X-RAY 2. Laterality
I. TECHNIQUE 3. Projection
1. 5 Radiographic Opacities o PA vs. AP
4. Artifacts
o Motion

C. PATIENT-DEPENDENT FACTORS
1. Rotation
o Non-rotated
2. Be systematic  Spinous process equidistant
3. Scan the film to the medial clavicular ends
 Both lungs equal in density
 Ribs are symmetrical
o Rotated film
 Lung is blacker in the side of
rotation
 Ribs are longer
 Clavicle is farther away from
the spinous process

II. FILM ASSESSMENT 2. Adequate inspiration

1. Study parameters o Patient inspiration
2. Patient dependent factors
3. Film quality

A. STUDY PARAMETERS
1. Name
2. Date of procedure
3. Type of procedure

o Poor inspiratory effort

B. FILM QUALITY
1. Exposure

3. Position: erect vs. supine

o Why the need for proper exposure

 To see abnormalities
 III. NORMAL RADIOGRAPHIC ANATOMY
 Heart
 Hilar regions
 Vessels
 Pleura
 Trachea
 Diaphragms and sulci
 Bones and soft tissues
 Hidden areas  Lateral view
A. HEART
 Size

o Retrosternal clear space

o Retrocardiac clear space
o CT ratio normal values o Right ventricle
 0.5 adults o Left ventricle
 0.6 pedia o Left atrium
 Contour o Aortic arch
o Moguls of the heart o Left pulmonary artery
o Main pulmonary trunk
o Left upper lobe bronchus
o Right upper lobe bronchus

B. HILAR SHADOWS
 Converging shadows
 Concave
 Similar density
 Left higher or at level with the right
 Right never higher than left
 Con be tracted upwards or downwards

C. VASCULATURE
 Tapering towards the periphery
 Paucity in the periphery
 Smooth distinct margins
 En-face vessel

D. LUNG ZONES

E. PLEURAL LININGS AND REFLECTIONS

 Parietal and visceral pleura
 Reflection form fissures
 Delineate lobes  Bones
 Major and minor in the right; major in the left

 Accessory fissures F. PROJECTIONS

 Trachea  PA
 AP
 Lateral
o Ribs superimposed on each other
o Vertebral bodies:
 Increasing lucency of
vertebral bodies
craniocaudad
 Uniform vertebral heights and
disc
 Diaphragms and sulci o Sternum
 Apicolordotic view
 Lateral decubitus
 Cone-down view
 Oblique
 CHEST X-RAY
I. ABNORMALITIES OF THE CHEST
 Too dark
 Too bright

A. TOO BRIGHT
 4 parenchymal patterns
o Alveolar
o Interstitial
o Nodule/mass
o Atelectasis
 Pleura
o Effusion
o Plaque formation
o Pleural mass

i. ALVEOLAR PATTERN
 Normal lung architecture
o Alveoli
o Interstitium
o Airways
 Alveoli can be filled with
o Fluid
o Pus
o Blood
o Cells

1. CONSOLIDATION (PUS/BACTERIA)
 Infection starts from one alveolus
 Spreads to another through Pores of Khon
 Ill-defined borders
 Delimited by fissures
 Air-bronchogram
 No loss of volume
 Bulging fissures sign (Klebsiella)
 Silhouette sign