Medical Imaging and Nuclear Medicine

X-RAY PLANAR RADIOGRAPHY AND COMPUTED

TOMOGRAPHY

Part 1

X-Ray Radiography
Gizeaddis L.
Jimma University
Jimma Institute of Technology
Biomedical Engineering Department
EM waves for medical Imaging
 X-rays
– are invisible

– penetrate matter

– can be diffracted

– ionize gases

– Change a photo emulsion

– create light emission in different substance

– induce biological changes in living tissue

 X-ray Production
• X-rays are produced when highly energetic electrons interact
with matter and convert their kinetic energy into
electromagnetic radiation.
• A device that accomplishes such a task consists of
– an electron source,
– an external energy source to accelerate the electrons
– an evacuated path for electron acceleration,
– a target electrode,
 X-ray Production
Requirements:
– a source of fast moving electrons
– must be a sudden stop of the electrons’ motion
– in stopping the electron motion, kinetic energy (KE) is
converted to EMS energies
• Infrared (heat),
• light
• x-ray energies
 X-ray Production
• Positive voltage (kVp) is applied to ANODE

• Negative electrons from CATHODE = attracted across the

tube to the positive ANODE.

• Electrons “slam into” anode – suddenly stopped.

• X-RAY PHOTONS ARE CREATED

 X-ray Production
• Electron beam is focused from the cathode to the anode target by
the focusing cup
• Electrons interact with the electrons on the tungsten atoms of
target material
• PHOTONS sent through the window PORT
 X-ray Production
• Principle Parts of the X-ray Imaging System
– Operating Console

– High-voltage generator

– X-ray tube

• The system is designed to provide a large number of e- with

high kinetic energy focused to a small target
 Tube Interactions
• possible tube interactions
• Heat
– Most kinetic energy of projectile e- is converted into heat
– Projectile e- interact with the outer-shell e- of the target atoms
but do not transfer enough energy to the outer-shell e- to
ionize.

• x-rays

• X-rays = Characteristic (20%) or Bremsstrahlung (80%)

 Heat is an excitation
rather than an ionization
 Characteristic Radiation
• The incident electron interacts with the K-shell electron via a
repulsive electrical force.

• The K-shell electron is removed leaving a vacancy in the K-shell.

• An electron from the adjacent L-shell (or possibly a different shell)

fills the vacancy.

• A characteristic x-ray photon is emitted with an energy equal to

the difference between the binding energies of the two shells.
 Characteristic Radiation
• It is called characteristic
because it is characteristic
of the target element in the
energy of the photon
Produced
• characteristic x-rays require
a tube potential of at least
70 kVp
 Characteristic Radiation

Only K-
characteristic
x-rays of
tungsten are
useful for
imaging
 Characteristic Radiation
• has discrete
energies
based on the
e- binding
energies of
tungsten
 Bremsstrahlung Radiation
• Bremsstrahlung radiation arises from energetic electron
interactions with an atomic nucleus of the target material.

• In a "close" approach, the positive nucleus attracts the

negative electron, causing deceleration and redirection,
resulting in a loss of kinetic energy that is converted to an x-
ray.

• The x-ray energy depends on the interaction distance

between the electron and the nucleus; it decreases as the
distance increases.
 Bremsstrahlung Radiation
• Brems can be
produced at any
projectile e- value
• Major factors that
affect x-ray
production
efficiency are
– the atomic number
of the target
material and
– the kinetic energy
of the incident
electrons
 Bremsstrahlung Radiation
• Brems x-rays have a range of energies and form a continuous
emission spectrum
 x-ray tube
• The x-ray tube provides an environment for x-ray production
via bremsstrahlung and characteristic radiation mechanisms.
• Major components are
– the cathode,
– anode,
– rotor/stator,
– glass (or metal) envelope,
– and tube housing
x-ray tube
 Cathode
• Cathode is a helical filament of
tungsten wire surrounded by a
focusing cup
• This structure is electrically
connected to the filament circuit.
• Electrical resistance heats the
filament and releases electrons
via a process called thermionic
emission.
Cathode
 Anode
• The anode is a metal target electrode that is maintained at a
positive potential difference relative to the cathode.
• Electrons striking the anode deposit the most of their energy
as heat, with a small fraction emitted as x-rays.
• Tungsten is the most widely used anode material because of its
high melting point and high atomic number.
• The high atomic number of tungsten provides better
bremsstrahlung production efficiency compared with low-Z
elements
Rotating Anode X-ray Tube
Anode angle and focal spot size
Tradeoffs in choosing anode angle
 Focal spot geometry

• Toward the anode side of the field the projected length of

the focal spot shortens, whereas it lengthens towards the
cathode side of the field.
Heel effect (angle dependent attenuation )

• It is a loss of
intensity on the
anode side of the x-
ray field of view.
• It is caused by
attenuation of the x-
ray beam by the
anode.
Off-focus radiation
X-ray tube heating
X-ray tube collimator assembly
 Interaction of X-ray with matter
• Several modes of interaction of x-rays with matter:
– Scattering

» Thompson or Rayleigh scattering,

» Compton scattering)

– Photoelectric absorption (transfer its energy to atoms

of the target material)

– Pair production
 Rayleigh scattering
• It is the collision of a photon with an electron such that the
photon is deflected into a new direction…elastic scattering

• Energy of incident photon same as the scattered photon

Compton scattering
 Compton scattering
• The energy of the scattered photon is

• The wavelength of the scattered photon increases over the

incident photon, and thus its energy decreases.

• Compton scattering is the major source of tissue damage due

to X-rays. For these reasons, this phenomenon is very
undesirable
 Photoelectric effect
• All of the incident photon energy is transferred to an
electron, and eject the electron from the atom.
 Photoelectric effect
• If this electron has a binding energy Eb, then this is the
amount of energy required to remove the electron from its
shell.

• If E>Eb, then the remainder of the energy ends up as kinetic

energy.

• The moving electron is the photoelectron.

Photoelectric effect
 Pair production
• Occurs when a photon of high energy (>1.02MeV) interacts
with a nucleus.
Different modes of interaction
 Attenuation of photons in matter
• At low photon energies (<26 keV), the photoelectric effect

dominates the attenuation processes in soft tissue.

• When higher energy photons interact with low Z materials (e.g.,

soft tissue), Compton scattering dominates.

• Rayleigh scattering occurs with low probability, 10% of the

interactions in mammography and 5% in chest radiography.

• Only at very high photon energies (>1.02 MeV), pair production

contribute to attenuation.
Attenuation of photons in matter
Attenuation of photons in matter
 Linear attenuation coefficient

• The linear attenuation coefficient is the sum of the individual

linear attenuation coefficients for each type of interaction:

• linear attenuation coefficient is proportional to the density of

the material.
– For instance
Attenuation of photons in matter
 Mass attenuation coefficient

• For a given thickness, the probability of interaction is

dependent on the number of atoms per volume.

• This dependency can be overcome by normalizing the linear

attenuation coefficient for the density of the material, called
the mass attenuation coefficient:
 Half value layer

• The thickness of material required to reduce the intensity

of an x- or gamma-ray beam to one-half of its initial
value.
 Mean free path

• One cannot predict the range of a single photon in matter.

• However, the average distance a photon traveled before

interaction is called the mean free path (MFP) of the photon
beam,
Example 1
• A narrow beam containing 2000 monoenergetic photons is
reduced to 1000 photons by a slab of copper 0.01m thick.
– What is the total linear attenuation coefficient of the copper slab for
these photons?

– What is the HVL?

Solution

The HVL of a monoenergetic beam of x

or γ-rays in any medium is
Example 2
• A 2mm thickness of material transmits 25% monoenergetic
beam of photons, calculate the HVL of the beam and mean
free path of a photon.
 Planer Radiography/Projection
imaging
• the acquisition of a
2D image of the
patient's 3D
anatomy
Basic principles
 Instrumentation of Planer
Radiography
• Basic components of a planar X-ray radiography
system are:
– X-ray tube
– a collimator
• reduce the patient dose and amount of Compton scattered X-rays,

– an anti-scatter grid
• reduce further the contribution of scattered X-rays to the image,

– a detector
• converts the energy of the transmitted X-rays into light
 X-ray Detectors

• Traditional x-ray film

– Screen-film radiography

• Digital detectors
– Computed radiography

– Digital radiography
 Screen-film cassette

• The screen-film detector system used for general

radiography consists of
– a cassette,

– one or two intensifying screens,

– a sheet of film.

• The film is a sheet of thin plastic with a photosensitive

emulsion coated onto one or both sides.
A typical screen film cassette and its cross-section
 The Latent Image
• The silver halide grains, fixed in a thin gelatin film, oxidize
when exposed to photons.

• Chemical development of the exposed film precipitates the

fine silver particles, making them opaque to visible light.

• Careful attention to exposure time and development produces

a degree of blackening across the film which varies with the
original variation in photon flux and thus produces a 2D
latent image.
X-ray film
 Intensifying Screens
• Screens are made of a scintillating material, which is called a

phosphor.

• When x-rays interact in the phosphor, visible or ultraviolet (UV)

light is emitted.

– a radiographic transducer - converts x-ray energy into light.

• It is the light given off by the screens that principally causes the

film to be darkened.
Principles Intensifying Screens
Screen cassette with x-ray interaction

• QDE (quantum absorption efficiency) of a screen is defined as the

fraction of incident X-ray photons interact with it.
Digital Detectors
 Computed Radiography
• CR differs from analog in that the CR cassette contains a
phosphor plate instead of a sheet of film
 Computed Radiography
• When the x-ray energy is absorbed by the BaFBr :Eu phosphor,
the absorbed energy excites electrons associated with the europium
atoms,
• The excited electrons become mobile, and some fraction of them
interact with a so called F-center.
• The F-center traps these electrons in a higher-energy, metastable
state, where they can remain for days to weeks.
• The number of trapped electrons per unit area of the imaging
plate is proportional to the intensity of x-rays incident at each
location during the exposure.
Imaging plate
CR Reader

– The next step is

the cassette is
placed into reader
and processor unit.

– The plate is
scanned with a
very small laser
beam.
CR Reader

– The laser beam stimulates

the plate causing light to
be produced.

– The light that is produced

is proportional to the x-ray
exposure to that specific
spot.
Reading Phase

• The light is amplified and

converted to electrical
signals by photomultiplier
tubes (PMT) and digitized.

• The digital data is stored as

a digital image.
The scintillator photomultiplier tube detector

• Photons enter the photomultiplier

tube where electron current

amplification takes place along the

chain of dynode photocathodes

held at successively higher

voltages.
CR Plate
 Digital Radiography
• Unlike CR, DR does not need a separate read-out device.
 X-RAYS
DR
DETECTORS

ADC
11011101
 X-RAYS
CR
CR PLATE

SCANNER

ADC
11011101
 Digital radiography detectors

• There are two types of digital radiography (DR) detectors,

– Indirect flat panel detectors

– Direct flat panel detectors.

• Indirect-conversion is most commonly used,

– X-ray energy is first converted into light by a CsI:TI scintillator, and
then the light is converted into a voltage using a two-dimensional
array of photodiodes.
 Indirect flat panel detector
• When an X-ray is absorbed in a CsI rod light will be produced.
• The light is converted to an electrical signal by the photodiodes in the
thin film transistors (TFT) array and stored in capacitors which are
formed at the junction of the photodiodes.
• This signal is then read out line-by-line in parallel using a multiplexer.
• The signals are amplified and digitized using analogue-to-digital
(A/D) converter.
Indirect flat panel detector
Indirect flat panel detector
 Direct flat panel detector

• Eliminates the intermediate step of converting X-ray energy

into light,

• Uses direct absorption of the X-ray photons to produce an

electrical signal.

• Materials such as amorphous selenium (alloyed with arsenic)

have been used.

• X-ray absorption is not as efficient as for CsI:Tl

Scattered radiation in Projection
Radiography
Scattered radiation in Projection
Radiography
Contrast
Contrast
 Anti-scatter grid
• Anti-scatter grid is composed of a
series of lead grip strips aligned with
the x-ray source.
• They are used to reduce the amount
of scattered radiation reaching the
detector by utilizing geometry
• Grid is placed between patient and
detector
 Anti-scatter grid
• Grid ratio: is the ratio of the
height to the width of the inters
paces (not the grid bars) in the
grid.

• Grid ratios of 8: 1, 10: 1, and 12:

1 are most common in general
radiography, and a grid ratio of
5: 1 is typical in mammography.
 Anti-scatter grid
• The grid is essentially a one-dimensional collimator, and
increasing the grid ratio increases the degree of collimation.

• Higher grid ratios provide better scatter cleanup, but they

also result in greater radiation doses to the patient.

• A grid is quite effective at attenuating scatter that strikes the

grid at large angles (where 0 degrees is the angle normal to
the grid), but grids are less effective for smaller-angle scatter.
 parameters that
describe anti-scatter grid properties
Example
Specialized X-ray imaging
techniques

1. Mammography
2. Fluoroscopy
3. Digital Subtraction
Angiography
 1. Mammography
• Mammography is a radiographic examination that is
specially designed for detecting breast pathology.

• It uses a low-dose x-ray system to examine breasts.

• A mammography exam, called a mammogram, is used to

aid in the early detection and diagnosis of breast diseases
in women.
 Distinguishing features of mammography equipment
from other x-ray imaging

These features are due to:-

• Cancer produce very small physical changes in the breast that

are difficult to visualize with conventional x-ray imaging.

• Mammography examination requires the highest image quality

than other x-ray procedures.
– This is because the breast consist soft tissues with relatively small
differences in density (or atomic number).
 Attenuation of breast tissues

• the attenuation differences

between normal tissue and
cancerous tissue is highest
at very low x-ray energies
(lO to 15 keV) and is poor
at higher energies (>35
keV).
A mammography system
 Mammography X-ray tube design

Cathode and Filament Circuit

• The mammographic x-ray tube is typically configured with
dual filaments in a focusing cup that produce small focal spot
sizes.

• A small focal spot minimizes geometric blurring and

maintains spatial resolution necessary for microcalcification
detection.
Mammography X-ray Tube Anode

• Most x-ray tubes use tungsten as the anode material,

• But Mostly mammography equipment uses molybdenum

anodes with an atomic number (Z) of 42 or in some designs, a
dual material anode with an additional rhodium with an atomic
number (Z) of 45 .

• These materials are used because they produce a characteristic

radiation spectrum that is close to optimum for breast imaging.
Tube assembly
• The x-ray tubes are arranged such that the cathode side of the
tube is adjacent to the patient’s chest wall,
– since the highest intensity of x-rays is available at the cathode side, and
the attenuation of x-rays by the patient is generally greater near the
chest wall of the image.
Tube Filtration

• Most x-ray machines use aluminium or "aluminium equivalent" to

filter the x-ray beam to reduce unnecessary exposure to the patient,

• Mammography uses filters that work on a different principle and

are used to enhance contrast sensitivity.

• Molybdenum (same as in the anode) is the standard filter material.

• Added tube filters of the same element as the target reduce the
low- and high energy x-rays in the x-ray spectrum and allow
transmission of the characteristic x-ray energies
• The output of a mammography x-ray system is composed of
bremsstrahlung and characteristic radiation.

• The characteristic
radiation energies of
molybdenum (17.5 and
19.6 keV) are nearly
optimal for detection of
low-contrast lesions in
breasts of 3 to 6.cm
thickness.
 Cont…

Anode-Filter combination
Collimation

• Fixed-size metal apertures or variable field size shutters

collimate the x-ray beam.

• For most mammography examinations, the field size matches

the film cassette sizes (e.g., 18 X 24 cm or 24 X 30 cm).

• The exposure switch is enabled only when the collimator is

present.

• Many new mammography systems have automatic

collimation systems that sense the cassette size
The automatic exposure control (AEC)

• It is also called a phototimer, employs a radiation sensor, an

amplifier, and a voltage comparator, to control the exposure.

• Unlike most conventional x-ray machines, the AEC detector is

located underneath the cassette.

• This sensor consists of a single ionization chamber or an array of

three or more semiconductor diodes.

• The sensor measures the residual x-ray photon flux transmitted

from the patient.

The automatic exposure control (AEC)

• During the exposure, x-ray interactions in the sensor

release electrons that are collected and charge a

capacitor.

• When the voltage across the capacitor matches a preset

reference voltage in a comparator switch, the exposure is

terminated.
The automatic exposure control (AEC)
 Compression

• Breast compression is a necessary part of the mammography

examination.

• Firm compression reduces overlapping anatomy and decreases

tissue thickness of the breast .

• This results in fewer scattered x-rays, less geometric blurring of

anatomic structures, and lower radiation dose to the breast tissues.

• Achieving a uniform breast thickness lessens exposure dynamic

range and allows the use of higher contrast film.
 Compression
• Compression is achieved with a compression paddle, a flat Lexan
plate attached to a pneumatic or mechanical assembly.

• Suspicious areas often require "spot“ compression to eliminate

superimposed anatomy by further spreading the breast tissues over
a localized area.
Dense opacity with specular border in the cranial part of the right breast;
Cluster of irregular microcalcification suggesting a low differentiated
carcinoma. (Courtesy of Dr. Van Ongeval, Department. of Radiology.)
• The two types of digital mammography are:

1. 2D mammography
• also called full-field digital mammography (FFDM),

• With 2D digital mammography, the radiologist is

viewing all of the complexities of breast tissue in a one
flat image.

• Disadvantage
– Sometimes breast tissue can overlap, giving the illusion of
normal breast tissue looking like an abnormal area
2. 3D mammography/ tomosynthesis
• is a mammography system where the x-ray tube and
imaging plate move during the exposure.

• creates a series of thin slices through the breast that allow

doctors to examine breast tissue detail one slice at a time to
help find breast cancer at its earliest stages.

• allows radiologists to view the breast tissue in one

millimeter slices, so that they can provide a more confident
assessment.

• finds cancers missed with conventional 2D mammography

2. Fluoroscopy
 Fluoroscopy
• It is an x-ray imaging procedure that allows real time
imaging of a patient with high temporal resolution.
• Allows continuous viewing of a time varying x-ray image
and permits live visual evaluation of dynamic events.
• Uses TV technology which provides 30 frames per second
imaging.
• Allows acquisition of a real time digital sequence of images
(digital video) that can be played back as a movie loop.
 Fluoroscopy
• Fluoroscopy uses continuous X-ray imaging,
• The image output of a fluoroscopic imaging system is a projection
radiographic image, but in a typical 10-minute fluoroscopic
procedure a total of 18,000 individual images are produced.
• fluoroscopy is used
– to monitor interventional surgery,
• for the placement of catheters, guide-wires and pacemakers in cardiac
catheterization laboratories,

– for dynamic studies of the GI tract and cardiovascular system using

contrast agents.
Fluoroscopy chain components

Image intensifier tube

 Image intensifier (II)
• The principal component of the imaging chain that distinguishes
fluoroscopy from radiography is the image intensifier.
• Image intensifiers are used to convert the x-ray spectrum to light
energy.
• The thickness of the II here is larger than a radiographic system
to increase the detection efficiency and therefore reduce the
required X-ray dose
• The fluoroscopy image intensifiers are several thousand more
sensitive than the screen-film cassette image intensifiers.
 Image intensifier
• There are four principal components of an II:
– the photocathode (in the input
screen),
– the three focusing electrodes
(G1. G2, and G3),
G2
– the anode (part of the output G2
G1
window) .
– Output phosophor
 The input screen

• The input screen of the II consists of four different layers:

– Vacuum window keeps air out of II

– Support

– CsI needles

– photocathode
 The input screen

• X-rays must pass through the vacuum window and support, before
striking the cesium iodide (Csl) input phosphor.

• CsI forms in long crystalline needles that act like light pipes,
limiting the lateral spread of light and preserving spatial
resolution.
– It absorb the x-rays and convert their energy into visible light.

• Light strikes the photocathode causing electrons to be liberated

into the electronic lens system of the II.
 Electron optics
• The five-component ("pentode") electronic lens system of the II.
– The G1, G2, and G3 electrodes

– the input screen substrate (the cathode)

– the anode near the output phosphor

• under the influence of the ~25,000 to 35,000 V electric field, electrons are
accelerated and arrive at the anode with high velocity and considerable
kinetic energy.

• The intermediate electrodes (G1, G2, and G3) shape the electric field,
focusing the electrons properly onto the output layer.

• After penetrating the very thin anode, the energetic electrons strike the
output phosphor and cause a burst of light to be emitted.
Electron optics
 The output phosphor
• The electrons strike the output phosphor, causing emission of light.
• The thick glass output window allows light to escape the top of II.
• Light that is reflected in the output window is scavenged to reduce
glare by the addition of a light absorber around the circumference
of the output window.
 The output phosphor

• Each electron causes the emission of approximately 1,000

light photons from the output phosphor.
• The image is much smaller at the output phosphor than it is
at the input phosphor, because the 23- to 35-cm diameter
input image is focused onto a circle with a 2.5-cm diameter.
• The reduction in image diameter leads to amplification
(minification)
� �
Minification gain of II =
� �
 Characteristics of II Performance

• Parameters that are useful in specifying the capabilities of the

II,
– Conversion factor

– Brightness gain
• These are characteristics are useful in troubleshooting lIs
when they are not performing properly
 Characteristics of II Performance
• Conversion factor
– Defined as a measure of the gain of an II
�� � �/ � .
� =
�� � �� mR/see.
– 100 to 200 for new II
– Degrades over time, ultimately can lead to II replacement
– The conversion factor is the proper quantity for expressing
image intensification.
Brightness gain (BG)

• It is the product of the electronic and minification gains of the II.

• The electronic gain of an II is roughly about 50, and the

minification gain changes depending on the size of the input
phosphor and the magnification mode.
� = � � � � � � �

– As the effective diameter of the input phosphor decreases

(increasing magnification), the brightness gain decreases.
 Automatic Brightness Control

• The purpose of ABC is to keep the brightness of the image

constant at monitor.
– By regulating the x-ray exposure rate (control kVp, mA or both)

• ABC triggers with changing patient size and field modes.

 Automatic Brightness Control
Monitor

Camera
Iris/Diaphragm
Optics

Image
Image Intensifier
Brightness
Feedback
Grid

Table

Reference Brightness

Collimator
Filter
Automatic
X ray Tube KkV,mA Brightness Generator
Control
 Fluoroscopic Data Acquisition-image
Intensified System

1. X-ray Tube
2. Patient
3. Image Intensifier
4. Output Phosphor
5. Camera
6. Monitor
 Video Camera
• Two methods are used to
electronically convert the
visible image on the output
phosphor of the image
intensifier into an electronic
signal:
– Television camera tube

– Thin film transistors (TFT)

 The television camera

• The television camera consists of cylindrical housing, approximately

15 mm in diameter by 25 cm in length, that contains the heart of the
television camera tube.

• It also contains electromagnetic coils that are used to properly steer

the electron beam inside the tube.
 The television camera

• At the TV camera , an electron beam is swept in raster fashion on

the TV target(e.g., SbS03).

• The TV target is a photoconductor, whose electrical resistance is

modulated by varying levels of light intensity.

• In areas of more light, more of the electrons in the electron beam

pass across the TV target and reach the signal plate, producing a
higher video signal in those lighter reasons.
The closed circuit TV system used in fluoroscopy.
 The television camera

• The video signal is a voltage versus time waveform that is

communicated electronically by the cable connecting the video
camera with the video monitor.
• Synchronization pulses are used to synchronize the raster scan
pattern between the TV camera target and the video monitor.
• Horizontal sync pulses cause the electron beam in the monitor to
laterally retrace and prepare for the next scan line.
• A vertical sync pulse has different electrical characteristics and
causes the electron beam in the video monitor to reset at the top of
the screen.
 The television camera

• Inside the video monitor, the electron beam is scanned in

raster fashion, and the beam current is modulated by the
video signal.

• Higher beam current at a given location results in more light

produced at that location by the monitor phosphor.

• The raster scan on the monitor is done in synchrony with

the scan of the TV target.
 The television camera

• The video signal is amplified

and is transmitted by cable to
the television monitor, where it
is transformed back into a
visible image.
 Flat panel digital fluoroscopy

• Flat pane devices are thin film transistor (TFT) pixelated arrays
that are rectangular in format and are used as x-ray detectors.
• CsI scintillator is used to convert the incident x-ray beam into
light.
• TFT systems have a photodiode at each detector element which
converts the light energy to electronic signal
 Flat panel digital fluoroscopy

• Flat panel detectors replace the image intensifier, video camera and
directly records the real-time fluoroscopic image sequence.
• The image produced by the image intensifier is circular in format,
resulting in less efficient utilization of rectangular monitors for
fluoroscopic display.
• The flat panel detector produces a rectangular image, well matched
to the rectangular format of TV monitors.
• The flat panel detector is substantially less bulky than the image
intensifier and TV system, but provides the same functionality.
 Common procedures using fluoroscopy
• Investigations of the
gastrointestinal tract (barium
swallows)

• Orthopedic surgery- guide

fracture reduction and the
placement of metalwork.

• Angiography of the leg, heart

and cerebral vessels.
Common procedures using fluoroscopy

• Urological surgery– particularly in

retrograde pyelography.

• Implantation of cardiac rhythm

management devices (pacemakers,
implantable cardioverter defibrillators
and cardiac resynchronization devices)

• Discography an invasive diagnostic

procedure for evaluation for
intervertebral disc pathology.
3. Digital Subtraction Angiography
• An imaging technique that produces very high resolution images of the
vasculature in the body, being able to resolve small blood vessels which are
less than 100 µm in diameter.
• Steps to acquire image
– acquiring a regular radiographic image,
– injecting iodinated contrast agent into the bloodstream and acquiring a
second image,
– performing image subtraction of the two digital images.

• It is used to investigate diseases such as stenosis and clotting of arteries

and veins, and irregularities in systemic blood flow.
DAS Images showing fine vessel structures
 Assignment
QUIZZ 1
• Discuss on the following topics.
– X-ray generators, their function and circuit
design.
– Image quality parameters in fluoroscopy.

Submission Deadline: Nov 12, 2014