FRCR Clinical Radiology Lectures
2
Diagnostic Radiology
Fluoroscopy and Fluorography
Jenny Wilson
Physicist
Objectives
• To understand the basic physics of the
production of X-rays
• To describe basic measures of image
quality
• To state radiation quantities and
understand the relationship between
them
• To understand the basic physics of
image receptors
What should you know by the end?
• Do you understand how X-rays are
produced?
• Do you understand what happens when
X-rays pass through the patient and
create an image?
• What happens at the film or image
receptor? Why do you get artefacts?
• What factors affect image quality and
patient dose?
Image Receptors and Processing
• Film
• Image Intensifier
• Phosphor Plate / Computed Radiography
Cassette
• CCD (Charge Coupled Device)
Film Composition
Double sided Emulsion
• X-ray film very
similar to Protective coating
photographic film Emulsion
• Can be double sided
or single sided Base
(mammography)
Emulsion
• Silver Bromide
crystals sup[ported Protective coating
by gelatine emulsion
Film Emulsion
• Silver halides are the light sensitive
compound of the film
• Form cubic lattice – crystals or grains
suspended and separated in the
gelatine
• Mainly AgBr but impurities (silver
iodide) are added
• Sensitivity centres are created by the
Ag2S
Photochemical Process 1 Silver Ion, Ag +
Free Ag + Bromide Ion, Br -
Electron trap/
Sensitivity Speck
Free Electron
X ray Exposure
Grain not hit by
X-ray
Latent Image Formation
Photochemical Process 2 Silver Ion, Ag +
Bromide Ion, Br -
Latent Image
Formed Electron trap/
Sensitivity Speck
Development Silver Atom
Centre
Developed Image Fixed Image
Processing
• Developing time and temperature need
to be optimum for the type of film
• Temperatures typically 33 – 36oC
• Times typically 90s – 3min
Processing Problems
• Latent Image may fade if film not
developed quick enough
• Strong developer may blacken grains
which were not exposed – fog is caused
by low level developing of unexposed
grains
• Poor washing may cause further
blackening of film with time
Film types
• Optical sensitisers are added to extend
sensitivity to longer wavelengths
– Monochromatic film has no extra
sensitisers; good for UV and blue light
– Orthochromatic film uses rare earth
sensitisers; good for green or green and
blue light
• If used with an intensifying screen the
film/screen combination MUST match
Film Grain Size
• Grain size affects
sensitivity; large
grains are more
sensitive (contrast)
but reduce
resolution
(graininess)
• Mixed grains give
greater latitude (low
contrast)
Intensifying Screens
• Transfer (or ‘transduce’) X-ray energy
into light
• Amplifies incoming X-ray photons into
many more outgoing light photons
• Visible light from the screen exposes
the film
• Patient doses can be reduced as less
radiation is required to form the image
– image is intensified, shorter exposure
Intensifying Screens 2
• Screen made of plastic or cardboard coated
with fluorescent crystals stuck onto a rigid
substrate
• Crystals (e.g. rare earth phosphors or calcium
tungstate) emit blue or green light after
absorbing X-rays = FLUORESECENCE
• Film used with the phosphor screens is
chosen to be sensitive to the wavelength of
light given out
• Screens also have a speed depending on size
of crystals and thickness etc.
Intensifying Screens 3
Intensifying Screen Properties
• Reduce dose but increase blurring (light
emitted diffuses over a larger area on
the film)
• Reduction in spatial resolution (film is
better)
• Noise (Quantum mottle) is apparent on
very fast screens
• Not generally used for fine detail work
Characteristics of Film
Film Optical Density
• Optical Density is the amount of blackening on
the film
OD = log10 (IO/I)
Where IO is the intensity of the film viewing box,
I is the intensity transmitted by the exposed
film
OD = 1 represents a medium grey level
OD = 0 represents a totally clear film
Typically OD s range between 0.2 and 2.5
Film Optical Density
As eye response is also logarithmic,
objective OD measurements should
agree with subjective measurements
Logarithmic scales allow a wide range of
transmitted light ratios to be included
Due to properties of logs it can be shown
that the total OD = OD1 + OD2 +…
Contrast
Contrast is the difference in optical
densities
Contrast = OD1 – OD2
High contrast - e.g. black and white
Low contrast – e.g. grey and grey!
Characteristic Curve (H-D Curve)
Optical • Plotting OD against
Density
log exposure gives
the Characteristic
Curve of the X-ray
film
• Different types of
film – subtle
differences but all
basically the same
Log exposure
Characteristic Curve
Optical • Plotting OD against
Density
log exposure gives
Linear Saturation
the Characteristic
Region
Curve
Solarisation
Fogging
Log exposure
Characteristic Curve
Optical • Gradient of linear
Density
region = Gamma
Linear
Region = OD2 – OD1
log E2-log E1
• Gamma describes
the linear part of the
Latitude
curve
Log exposure
Gamma
Optical • Gamma depends on
Density
– Emulsion
Linear
– Size and distribution
Region
of grains
– Film developing
• Can use average
gradient/gamma
• Gamma ~ Contrast
Log exposure
Film Speed
• Definition: 1 / ExposureB+F+1
• Reciprocal of Exposure to cause an OD
of 1 above base plus fog
• Speed of film = sensitivity = amount of
radiation required to produce a
radiograph of standard density
• Speed shifts H-D curve left and right
Fast film requires less radiation
Speed = Sensitivity
• Fast film requires less radiation (less
patient dose)
• Speed is generally used as a relative
term defined at a certain OD; one film
may be faster than another at a certain
point on the curve
Factors affecting speed
• Size of grains – larger means faster
This is the main factor and conflicts with the
need for small crystals to give good image
sharpness.
Fast films are therefore grainier but reduce
patient dose
• Thickness of emulsion – double layers of
emulsion give faster films
• Radiosensitisers added
• (X-ray energy)
Exercises
• Chapter 4, Physics for Diagnostic
Radiology by Dendy and Heaton (blue
and silver book)
• Questions 1 - 10
