FRCR: Physics Lectures

Diagnostic Radiology
Lecture 1
An introduction to radiography with X-rays and the X-ray tube

Dr Tim Wood
Clinical Scientist
 Lecture aims
• Revision of the physics of x-ray interactions and production

• Describe how the x-ray tube is constructed and understand

the importance of each component

• Basic understanding of x-ray generators

• Explain what factors affect the output of an x-ray tube

INTRODUCTION
 A little bit of history…
• Wilhelm Röntgen discovered X-rays on
8th Nov 1895
• Took first medical X-ray of wife’s hand
(22nd Dec 1895)
• Used to diagnose Eddie McCarthy’s
fractured left wrist on 3rd Feb 1896 (20
min exposure)
• Awarded first Nobel Prize in Physics in
1901 for his discovery of ‘Röntgen rays’
A little bit of history…
Thankfully, things improved!…
 What is diagnostic radiology?
ra·di·ol·o·gy
The science dealing with X-rays and other high-
energy radiation, especially the use of such
radiation for the diagnosis and treatment of
disease

Origin:
1895–1900; radio- + -logy

Related forms:
ra·di·ol·o·gist, noun
 What is diagnostic radiology?
• The underlying principle of the majority of diagnostic
radiological techniques is that X-rays display
differential attenuation in matter
– When the X-ray beam is targeted at a patient, the different
tissues in the body will remove a different number of X-
rays from the beam
• The resulting modified X-ray flux can then be
‘captured’ by some form of detector to produce a
latent image or radiation measurement
– Detection may be through film, phosphor screens, digital
detectors, etc
 X-ray Properties
• Electromagnetic photons of radiation
• Emitted with various energies & wavelengths not
detectable to the human senses
• Travel radially from their source (in straight lines) at
the speed of light
• Can travel in a vacuum
• Display differential attenuation by matter
• The shorter the wavelength, the higher the energy
and hence, more penetrating
• Can cause ionisation in matter
• Produce a ‘latent’ image on film/detector
 Planar or three-dimensional?
• Planar imaging is the most common technique used
in diagnostic radiology
– General radiography e.g. PA chest
– Mammography screening
– Intra-oral dental radiography
– Fluoroscopy (but some modern ones can do 3D)
• The anatomy that is in the path of the beam is all
projected onto a single image plane
– Tissues will overlap and may not be clearly visible
– Contrast is generally poorer than in 3D imaging techniques
Planar or three-dimensional?
 Planar or three-dimensional?

1 1 1
Subject contrast
1 7 1 7:1

1 1 1
2D detector
2D image contrast
3 9 3 3:1
 Planar or three-dimensional?
• 3D imaging offers superior contrast to 2D
• More techniques are becoming available
– Computed Tomography (CT), Cone beam CT, Tomosynthesis,
etc
• Compromise is that doses tend to be much higher
than the planar image
– e.g. CT chest = 6.6 mSv c.f. PA chest = 0.02 mSv (a factor of
330 difference!)
• Hence, despite being less common, they account for a
significant proportion of the UK populations exposure
to medical radiation
– CT accounts for 11% of examinations, but 68% of dose (HPA
2008 review)
 X-ray interactions with matter
• It is the physics of the interactions with matter that
determine how each imaging technique works, and
how it is used in clinical practice
• So, a bit of revision…
 Attenuation & imaging
• Contrast in an image is generated by the differential attenuation of
the primary X-ray beam
• Scatter occurs in all directions, so conveys no information about
where it originated – can degrade image quality, if it reaches
film/detector
P ass through
A bsorption
A ttenuation
S catter
 Attenuation
• For a mono-energetic photon beam:
 x
I  I 0e
where, I = final intensity, I0 = incident intensity, µ =
attenuation coefficient, x = thickness
• Equal thicknesses of material reduce the intensity by
the same fraction (half-value thickness).
 Attenuation
• Attenuation coefficient, µ, decreases with increasing
photon energy (except for absorption edges)
• Increases with atomic number of material, Z
• Increases with density of material, ρ
• Transmission of radiation @ 70 kVp;
– 1 cm of soft tissue  66% transmitted
– 1 cm bone  17% transmitted
– 1 cm tooth  6% transmitted
 Forward vs. Back-scatter
• Forward scatter is most likely, but ...
• Forward scatter is attenuated by the patient, and
• Deeper layers receive a smaller intensity, so there are
fewer scattering events
• Overall, see more back scatter.
• Advantage for image quality (less scatter, but more
attenuation at the detector), but may pose a risk in
terms of radiation protection
Forward vs. Back-scatter
Interaction Processes

• Elastic scattering
• Photoelectric effect
• Compton effect
 Elastic Scatter
• Photon energy smaller than BE
• Causes e- to vibrate – re-radiates energy
• No absorption, only scatter
• < 10% of total interactions in diagnostic range i.e. not
significant
2
Z
Probability 
E
 Photoelectric Effect
• Process of complete absorption
• ~30% of interactions in diagnostic range
• Energy is transferred to bound e-, which is ejected at a
velocity determined by difference in photon and BE
• e- dissipates energy locally, and is responsible for
biological damage
3
Z
Probability  3
E
• Hence, main source of radiographic contrast (and
dose), and why Lead is used in protection
Photoelectric Effect
 Photoelectric Effect
• Leaves atom in unstable state – electronic
reconfiguration results in emission of X-ray or Auger
electron
• Auger emission more probable for low Z material –
short range in tissue (= more biological damage)
• Low energy X-rays reabsorbed locally
• Rapid fall-off with increasing energy
 Compton Effect
• Process of scatter and partial absorption – inelastic
scattering
• Photon collides with a free electron (photon energy >>
BE)
• Loses small proportion of its energy and changes
direction
• Energy loss depends on scattering angle and initial
photon energy
• Photon free to undergo further interactions until
completely absorbed (Photoelectric)
Compton Effect
 Compton Effect
• Compton scatter mass attenuation coefficient almost
independent of energy over diagnostic range
Z
Probability 
A
• Ratio of Z/A similar for most elements of biological
interest (~0.5) – offers little in terms of radiographic
contrast
 The Mass Attenuation Interaction
Coefficient
• Each process is independent – can add the
interaction coefficients to give the total mass
attenuation coefficient
• Z dependence is the source of contrast in
radiographic imaging
The Mass Attenuation Interaction
Coefficient
The Mass Attenuation Interaction
Coefficient
 Maximising Radiographic Contrast
• Maximise contrast due to Photoelectric absorption –
use lower energy photon beams (note, it is the mean
energy of the beam, not kVp that is important)
• Use scatter rejection techniques such as scatter grids
and air gaps
• Limit beam to smallest area consistent with diagnostic
task to minimise amount of scatter generated
• BUT…
 Maximising Radiographic Contrast
• More Photoelectric absorption means higher patient
dose
• Scatter rejection techniques attenuate the primary
beam, so a higher patient dose is required for
acceptable image receptor dose
• NEED TO BALANCE IMAGE QUALITY WITH PATIENT
DOSE!!!
• Hence, the principle of ALARA (As Low As Reasonably
Achievable)
– Use the highest energy beam that gives acceptable contrast,
consistent with the clinical requirements
The X-ray tube
 Generating x-rays
• X-rays are produced when
highly energetic electrons
interact with matter
• Require;
– An electron source (cathode)
– A target (anode) The x-ray tube insert
– Evacuated path to accelerate
across The generator
– High voltage (20-150 kV)
• However, most of the energy is
given off as heat, and x-rays are
thrown off in all directions
– Require cooling and shielding The tube housing
A bit of revision…

THE PHYSICS OF X-RAY

PRODUCTION
 The physics of X-ray production
• Electron reaches the anode with kinetic energy
equivalent to the accelerating potential (kVp)
• Electrons penetrate several micrometres below the
surface of the target and lose energy by a combination of
processes
– Large number of small energy losses to outer electrons of the
atoms = heat
– Account for about 99% of all energy dissipated from e- beam in
the diagnostic range
– Relatively few, but large energy loss X-ray producing
interactions with inner shell electrons or the nucleus
 Heat generating processes
• When an electron (e-) strikes the target, most likely
interaction is with loosely bound e-s that surround
nuclei
• Relatively weak interactions – slight deflection,
ionisation or excitation
• Small amount of energy transfer (per interaction) –
observed as heat
• However, accounts for ~99% of all energy dissipated
from e- beam in the diagnostic range
Bremsstrahlung
 Bremsstrahlung
• Radiates energy in all
directions, up to a maximum
equivalent to kVp =
continuous spectrum
• High energy cut-off (≡ kVp)
due to release of all energy
in head on collision
• Low energy cut-off due to
self-attenuation by x-ray tube
• >80% of X-rays produced are
Bremsstrahlung (except for
mammography)
Bremsstrahlung
 Characteristic x-rays
• Interactions with tightly bound e-
(typically K-shell)
• If energy of e- exceeds binding
energy (BE) → ionisation
• Vacancy leaves atom unstable
– e- from higher state drops down,
releasing X-ray photon (energy
= difference in BE)
• Gives characteristic peaks on X-
ray spectrum that are specific to
the target
– For Tungsten target, Kα = 58-59 keV
and Kβ = 67 keV
– Not observed below 70 kVp
Characteristic x-rays
 The X-ray spectrum
• Combination of Bremsstrahlung and characteristic x-rays
yields characteristic spectrum
4.00E+05 60 kVp
3.50E+05
80 kVp
120
3.00E+05 kVp
2.50E+05
Intensity

2.00E+05

1.50E+05

1.00E+05

5.00E+04

0.00E+00
0 20 40 60 80 100 120 140
Energy (keV)
 The X-ray spectrum
• The peak of the continuous spectrum is typically one
third to one half of the maximum kV
• The average (or effective) energy is between 50% and
60% of the maximum
– e.g. a 90 kVp beam can be thought of as effectively
emitting 45 keV X-rays (NOT 90 keV)
• Area of the spectrum = total output of tube
– As kVp increases, width and height of spectrum increases
– For 60-120 kVp, intensity is approximately proportional to
kVp2 x mA
 Controlling the X-ray spectrum –
Exposure factors
• Increasing kVp shifts the spectrum up and to the
right
– Both maximum and effective energy increases, along with
the total number of photons
• Increasing mAs (the tube current multiplied by the
exposure time) does not affect the shape of the
spectrum, but increases the output of the tube
proportionately
• kV waveform – three-phase or high frequency
generators will have more high energy photons than
single phase. Hence, output and effective energy are
higher
 Quality & Intensity
Definitions:
• Quality = the energy carried by the X-ray photons (a
description of the penetrating power)
• Intensity = the quantity of x-ray photons in the beam

• An x-ray beam may vary in both its intensity and

quality
 Quality
• Describes the penetrating power of the X-ray beam,
and is governed by the kilo-voltage (kVp)
• Usually described by the Half-Value Thickness
– i.e. the thickness (in mm) of Al required to half the beam
intensity for a given kVp
• Typically >2.5 mm Al for general radiography
• Changing the quality of the beam will change the
contrast between different types of tissue.
• A highly penetrating beam is referred to as ‘Hard’
and a poorly penetrating beam as ‘Soft’
 Intensity
• Intensity - is the quantity of energy flow onto a given
area over a given time; the ‘brightness’ of an x-ray
beam
• The tube current (mA) is a measure of X-ray beam
intensity
• Intensity is directly proportional to mA.
– i.e. Double the mA, double the dose (quality not affected)
• Intensity is also affected by kVp
The mechanics of making an x-ray

THE X-RAY TUBE

 X-ray tubes – an overview

• The x-ray tube insert is where we make the x-rays used in x-ray
imaging systems
– Cathode, anode, glass/metal enclosure under vacuum
• The x-ray tube housing supports and shields the tube insert
• The x-ray generator supplies the power
• kV, mA and exposure time are selectable by the operator
THE X-RAY TUBE INSERT
 The cathode
• The negative electrode
– Composed of a filament (source of electrons)
and a focussing cup
– Often have two filaments for broad and fine
focus
• Filament heating current applied (approx.
10 V, 7 A)
• Process of thermionic emission releases
electrons from the surface of the filament
– Heat up to ~2200°C
– ‘Free’ electrons in the metal gain enough
energy to overcome the binding potential
– Tungsten metal is ideal material
• Need to apply high voltage to move these
electrons across to the anode
 Electron production in the X-ray tube
Applied voltage chosen to give
correct velocity to the electrons
kV

mA

- +

Filament Target
(heats up on prep.)
 The anode
• Metal target electrode, held at a large positive potential difference
relative to the cathode
• Electrons strike the anode and convert kinetic energy to mostly
heat, with relatively few x-rays released
– So to get an acceptable output from the tube, a lot of heat must be
generated that has to be dealt with
– Don’t want to blow the tube up!
• Limits are placed on exposure factors to avoid damage
• Choice of material important
– Alloys of 10% rhenium and 90% tungsten are resistant to surface damage
– good for general x-ray tubes
• Also other design features used to limit heat damage…
 Stationary or rotating?
• Simple x-ray tubes (e.g. dental) have
tungsten insert on a solid copper block
– Conducts heat away from focal spot
– Limited to low tube currents as heat builds
quickly
• Rotating anodes used for most diagnostic
applications
– Bevelled disc on a rotor assembly
– Spins 3,000-10,000 rpm
– Spread the heat out over a large area
– Allows greater loading and higher x-ray output
– Tube does not energise until the disc is up to
speed
– Cooled via radiative emission transferring
heat to tube insert and surrounding oil bath
The rotating anode
The rotating anode
 Anode angles
• The x-ray generating surface of the anode is angled (7-20⁰)
• Actual focal spot is the area of anode struck by electrons
• Apparent focal spot size is much smaller due to geometry
– Heat spread out over a large area without affecting resolution
 Anode angles
• Smaller angles allow greater tube loading and finer resolution
• BUT, limits maximum field size due to cut-off on anode side
• Focal spot size varies across the image field
– Anode side = shorter effective focal spots
– Cathode side = elongated effective focal spot
• Optimal target angle depends on clinical application
 The focal spot
• Typical focal spot sizes are
– 0.15-0.3 mm for mammography
– 0.6-1.2 mm for general radiography
– 0.6 mm for fluoroscopy
– 0.6-1.0 mm for CT
 The anode heel effect
• Ideally, the X-ray beam would be uniform across whole image
• However, this is not the case due to the anode heel effect
– The steeper the target angle, the worse the effect
• The electrons penetrate a few micrometres below the surface of the
anode before generating X-rays
– Hence, the X-rays that are generated in the target may be attenuated on their
way out
• X-rays travelling towards the anode edge of the field (A) will pass
through more of the target before exiting the tube
– Hence, attenuation will be greater on this edge, and beam intensity will be
lower than on the Cathode side of the field (B)
– Roughening of the anode surface as the tube ages make this worse
• Generally not noticeable on most images
• Can be minimised by using greater focus-to-detector distances,
smaller fields and shallower target angles
The anode heel effect
Geometric unsharpness and the focal spot
• Spatial resolution is dependent upon :
– Geometrical unsharpness
– Motion unsharpness
– Absorption unsharpness
• Geometric unsharpness is related to the fact that we
cannot (and in fact do not want to) produce an ideal
point source of X-rays
– The focal spot of the X-ray tube has a finite size that results
in blurring across the edge of structures
– Can be reduced by using a smaller focal spot, decreasing
the object-film distance (OFD) or using a longer focus-to-
film distance (FFD)
 Geometric unsharpness –
The ideal point source
Ideal point source
of X-rays

FFD

Object

OFD Film/detector
 Geometric unsharpness –
A ‘real’ focal spot
Focal spot of
finite size, f

FFD

Object

OFD Film/detector
Penumbra
Geometric unsharpness and the focal spot
• So, to minimise geometric unsharpness
– The smallest focal spot should be used, especially if
magnification imaging is to be performed (but be careful
not to blow the tube!)
– The patient should be positioned as close to the detector
as possible (unless magnification imaging)
– Largest possible focus-to-detector distances to reduce
magnification and blurring (within practical limits!)
 Geometric unsharpness –
A ‘real’ focal spot
Focal spot of
finite size, f

FFD

Object

Film/detector
X-ray tube design – dual focus
THE X-RAY TUBE HOUSING
 The tube housing
• Supports, insulates and protects the tube
insert
• Oil surrounds the insert for cooling and
electrical insulation
– Expansion bellows often fitted to prevent
exposure if the oil (and hence tube) gets too
hot
– Some tubes have heat exchangers to
actively cool the oil
• Lead shielding is fitted around the tube
housing to attenuate all x-rays not
directed at the tube port
– A small fraction of these will escape –
known as leakage radiation
– Legal limits on how much leakage is allowed
 Collimators
• Adjust the size and shape of the x-
ray beam
• Two pairs of parallel blades of
high attenuation material that can
be adjusted to define the required
rectangular field size
• Has a light beam system for
visualisation
 Filtration
• Filtration is the removal of x-ray photons as the beam passes
through material
• The x-ray tube has inherent filtration due to the anode,
glass/metal envelope, cooling oil, etc
• Added filtration is the sheets of metal deliberately inserted in the
beam to reduce the number of low energy photons in the beam
– Reduce the dose to the patient
– Minimum standards on how much should be present in the beam
(depending on application)
• Can also have beam shaping filters to compensate for patient
shape and to equalize the signal on the detector e.g. ‘bow-tie’
filters in CT
X-RAY GENERATORS
 Transformers
• The x-ray generator provides
the high voltage to the x-ray
tube (20,000-150,000 Volts)
• Transformers are used to
convert low voltage (from a
mains supply) into a high
voltage through
electromagnetic induction
• Input AC power on the primary
windings, induces a voltage on
the secondary windings that is
proportional to the input
voltage and ratio of the
number of turns
 Transformers
• However, to accelerate electrons across the tube, need anode
to always be positive relative to cathode
– AC waveforms change polarity every half-cycle
• Rectifiers can prevent this
• The high frequency generator is the now the most common
type of generator
– Takes a low voltage, low frequency input and converts to low voltage
DC via rectifier and smoothing
– An inverter creates a high frequency AC waveform from this
– A transformer creates the high voltage
– Rectified and smoothed again to provide high voltage DC to tube
• A number of feedbacks are continuously checked during
exposure to ensure appropriate kV and mA
High frequency x-ray generator
 Ripple
• Ideal voltage would be
constant
• Real voltages tend to vary,
and this depends on the type
of generator used
• Ripple describes variation in
kV during exposure
– Single phase = 100% ripple
– High frequency = low ripple
• Ripple reduces the output of
the x-ray tube compared
with what would otherwise
be expected
 The operator console
• The operator can select tube voltage (kV), tube current (mA),
exposure time (s) or the product of mA and time (mAs)
• Focal spot selections on some systems
– Choice depends on resolution requirements vs damage to x-ray
tube
• May also have controls for the automatic exposure control
– The AEC determines how long exposures should be based on the
transmission of x-rays through the subject
• Pre-programmed techniques can also be found on the
operator console
• In fluoroscopy, manual kV and mA control not practical, so
automatic control systems are used
The operator console
 Automatic exposure control
• AEC measures amount of radiation incident on the
detector and terminates exposure when a pre-defined
limit is reached
• Compensates for different size patients and variations in
attenuation
• Can have some measure of manual control by using ‘fine
density’ controls to force the system terminate a little
earlier or later, depending on image quality requirements
• Usually have a choice of ion chambers that can be
selected in different configurations depending on clinical
application
– e.g. central chamber, left-right chambers, all three chambers
Automatic exposure control
Power ratings, heat loading and cooling
• Power rating is the maximum
power that a tube focal spot can
accept or the generator deliver
– Small focal spots have lower
ratings than large focal spots
• Power ratings vary significantly
and depend on the modality
being used
• Heat Units are a simple way of
expressing energy deposition
and dissipation in the anode
• Anode heating and cooling
charts show heat loading for
various
 Heat rating
• kV, mA and exposure time should be such that the
temperature of the anode does not exceed its safe
limit
– The control system is designed to prevent exposures that
exceed the tube rating
• Require much higher tube ratings for CT and
interventional fluoroscopy units
FACTORS AFFECTING X-RAY TUBE
OUTPUT
 X-ray tube output
• Output of an x-ray tube can be described in terms of;
– Quality: Penetrating power of x-ray beam (HVL)
– Quantity: Number of photons in x-ray beam
• Six major factors determine x-ray tube output;
– Anode target material
– Tube kilovoltage
– Tube current
– Exposure time
– Beam filtration
– Generator waveform
 Target material
• The efficiency of Bremsstrahlung production depends
on the atomic number of the anode material
– Incident electrons more likely to interact with high Z
materials
• The anode material also determines the energy of the
characteristic x-rays
• Target material affects both quantity and quality of the
x-ray beam
 Tube kilovoltage
• Determines maximum energy
of the x-ray beam
– Affects quality of beam
• Efficiency of x-ray production
also affected
– Quantity
• Exposure ∝ kV2
• Increasing kVp increases
efficiency (quantity) and
quality of the beam
• Must change mAs alongside
to compensate for changing
output of the x-ray tube
 The X-ray spectrum
4.00E+05
60 kVp
3.50E+05 80 kVp
120 kVp
3.00E+05

2.50E+05
Intensity

2.00E+05

1.50E+05

1.00E+05

5.00E+04

0.00E+00

0 20 40 60 80 100 120 140

Energy (keV)
 Tube current and exposure time
• Proportional to the number of
electrons flowing from
cathode to anode
• Therefore directly
proportional to number of x-
rays produced
– Quantity
• Exposure time is how long the
beam is on for
– Quantity
• Quantity of x-rays is directly
proportional to the exposure
factor (mAs)
• Beam quality not affected
 Beam filtration
• ‘Soft x-rays’ contribute to patient dose without
contributing to image production
• Placing Al filters in the beam will increase beam
quality – this is known as ‘Beam Hardening’
– Alternative materials may be used for filtration in
specialised applications e.g. mammography (Mo, Rh, Ag)
and fluoroscopy (Cu)
• Lowest energy photons are most readily absorbed as
photoelectric absorption dominates (proportional to
the E3)
• As the beam passes the Al, the proportion of low energy
photons is reduced, and the average photon energy
increases
Filtration
 Beam filtration
• Modifies the quantity
and quality of the x-ray
beam by preferential
absorption of the low
energy x-rays
– Reduce the number of x-
ray photons
– Increases mean energy
of the beam
 Filtration
0.5 mm Al
2.5 mm Al
7.5 mm Al
Output

0 20 40 60 80 100
keV
 Beam filtration
• Hence, Patient dose is reduced with little affect on the
radiation reaching the detector
• However;
• Radiographic contrast is reduced due to the higher mean
energy of the beam
• Greater exposure factors required to yield satisfactory dose
at film/detector (have to drive the tube harder, and hence
tube life may be reduced)
• The X-ray beam is also filtered by the target that they
are produced in, the coolant oil and the window of the
housing
• ‘Inherent filtration’ equivalent to about 1 mm Al
 Generator waveform
• Affects the quality and
quantity of the beam
– A single phase generator
has a lower potential
difference than a high-
frequency generator
– High ripple gives lower
quality and tube output
 Focus-to-skin Distance:
The Inverse Square Law
• For a point source, and
in the absence of
attenuation, intensity
decreases as the
inverse of the square of
the distance
2
• This is a statement of
D1 r
the conservation of
energy
 2
2
D2 r 1
The inverse square law

• Patient dose can be

significantly reduced by
increasing the distance to the
X-ray tube
– FSD < 45 cm should not be used
(<60 cm for chests – 180 cm
used in practice)
SUMMARY
 Summary
• X-rays are generated in the x-ray tube
• A broad spectrum of energies are produced
through Bremsstrahlung and characteristic x-rays
• Heat generation is a significant problem in the x-
ray tube
• A number of factors affect the output of the x-ray
tube, and these must all be considered and
understood to enable the best possible image to
be acquired (for the minimum radiation dose to
the patient)