PHYSICAL

Perry Sprawls, Jr.

 PHYSICAL
PRINCIPLES
of
MEDICAL
IMAGING
■ ■ ■ ■ ■
Second Edition

Perry Sprawls, Ph.D.

FACR, FAAPM, FIOMP

Distinguished Emeritus Professor

Department of Radiology
Emory University
Atlanta, Georgia

Medical Physics Publishing

Madison, Wisconsin
 Copyright 1993 by Aspen Publishers, Inc.
Copyright 1995 by Perry Sprawls and Associates, Inc.
All rights reserved

Library of Congress Cataloging-in-Publication Data

Sprawls, Perry.
Physical principles of medical imaging / Perry Sprawls, Jr. -2nd
ed.
p. cm.
Includes index.
Originally published: Gaithersburg, Md.: Aspen PubHshers, 1993.
ISBN 0-944838-54-5 (hardcover)
I. Diagnostic imaging. 2. Medical physics. I. Title.
[DNLM: 1. Diagnostic Imaging. 2. Health Physics. WN l lO S767pb
1993a]
RC78.7.D53S63 1995
6l 6.07'54-<lc20
DNLM/DLC
for Library of Congress 95-14209
CIP

Perry Sprawls grants permission for photocopying for limited per­sonal or internal
use. This consent does not extend to other kinds of copying, such as copying for
general distribution, for advertising or promotional purposes, for creating new
collective works, or for resale.
For infonnation, contact Perry Sprawls at [email protected].

Every reasonable effort has been made to give factual and up-to-date information
to the reader of this book. However, because of the possibility of human error and
the potential for change in the medical sciences, the editor, publisher, and any
other persons involved in the publication of this book cannot assume responsibility
for the validity of all materials or for the consequences of their use.

Library of Congress Catalog Card Number:

ISBN: 0-944838-54-5

Printed in the United States of America

 Table of Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Chapter I-Image Characteristics and Quality . . . . . . . . . . . . . . . . . . 1

Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Image Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tissue Characteristics and Image Views . . . . . . . . . . . . . . . 9
Image Viewing Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Observer Perfonnance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I3

Chapter 2-Energy and Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . I7
Energy Fonns and Conversion . . . . . . . . . . . . . . . . . . . . . . . 18
Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Energy Units and Related Quantities . . . . . . . . . . . . . . . . . . 20
Electron Volt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
The Quantum Nature of Radiation . . . . . . . . . . . . . . . . . . . . 23
Electrons and Energy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Electrical Quantities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
The X-Ray Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Alternating Current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Chapter 3-Radiation Quantities and Units . . . . . . . . . . . . . . . . . . . . . 37

Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Unit Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Quantities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Photons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

iii
iv Physical Principles of Medical Imaging

Exposure 41
Energy 44
Absorbed Dose 46
Biological Impact 48
Light 50
Radio Frequency Radiation 52

Chapter 4—Characteristics and Structure of Matter 53

Introduction and Overview 53
Nuclear Structure 53
Nuclear Stability 60
Nuclear Energy 63
Electrons 64

Chapter 5—Radioactive Transitions 69

Introduction and Overview 69
Isobaric Transitions 71
Isomeric Transitions 77
Alpha Emission 80
Production of Radionuclides 82

Chapter 6—Radioactivity 83
Introduction and Overview 83
Radioactive Lifetime 83

Activity and Time 87

Radioactive Equilibrium 90
Effective Lifetime 96

Chapter 7—X-Ray Production 97

Introduction and Overview 97
The X-Ray Tube . . . 97
ElectronEnergy 101
Bremsstrahlung 102
Characteristic Radiation 104
Efficiency 107
Efficacy (Output) 109

Chapter 8—Energizing and Controlling the X-Ray Tube Ill

Introduction and Overview Ill
KV Production Ill
Rectification 115
 Table of Contents v

Voltage Waveform and X-Ray Production 117

Capacitors 120
High-Frequency Power Supplies 123
MA Control 123
Exposure Timing 124
Quality Assurance Procedures 125

Chapter 9—X-Ray Tube Heating and Cooling 127

Introduction and Overview 127
Heat Production 127
Heat Capacity 129
Focal Spot Area 131
Anode Body 138
TubeHousing 139
Summary 140

Chapter 10—Interaction of Radiation with Matter 141

Introduction and Overview 141
Interaction Types 141
Photon Interaction Rates 149
Competitive Interactions 156

Chapter 11—Radiation Penetration 159

Introduction and Overview 159
Photon Range 159
Half Value Layer 161
X-Ray Beam Quality 164
Filtration 165
Penetration with Scatter 167
Penetration Values 170

Chapter 12—X-Ray Image Formation and Contrast 171

Introduction and Overview 171
Contrast Types 171
Effects of Photon Energy (KVp) 175
Area Contrast 178

Chapter 13—Scattered Radiation and Contrast 181

Introduction and Overview 181
Contrast Reduction 181
Collimation 184
vi Physical Principles of Medical Imaging

Air Gap 185

Grids 186
Grid Penetration 187
Grid Selection 194

Chapter 14—Radiographic Receptors 197

Introduction and Overview 197
Screen Functions 197
Receptor Sensitivity 199
Image Blur 203
Image Noise 205
Artifacts 205

Chapter 15—The Photographic Process and Film Sensitivity 207

Introduction and Overview 207
Film Functions 207
Optical Density 209
Film Structure 211
The Photographic Process 212
Sensitivity 216
Processing Quality Control 222

Chapter 16—Film Contrast Characteristics 227

Introduction and Overview 227
Contrast Transfer 227
Film Latitude 235
Film Types 236
Effects of Processing 239
Film Fog 241

Chapter 17—Radiographic Density Control 243

Introduction and Overview 243
The X-Ray Generator 244
Receptor Sensitivity 248
Patient 249
Distance and Area 249
Automatic Exposure Control 250

Chapter 18—Blur, Resolution, and Visibility of Detail 253

Introduction and Overview 253
Blur 253
 Table of Contents vii

Visibility of Detail 255

Unsharpness 257
Resolution 258
Modulation Transfer Function 263

Chapter 19—Radiographic Detail 267

Introduction and Overview 267
Object Location and Magnification 267
Motion Blur 270
FocalSpot Blur 270
Receptor Blur 276
Composite Blur 278

Chapter 20—Fluoroscopic Imaging Systems 283

Introduction and Overview 283
Intensifier Tubes 284
Video Systems 289
The Optical System and Cameras 296
Receptor Sensitivity 301

Chapter 21—Image Noise 303

Introduction and Overview 303
Effect Visibility
on 303
Quantum Noise 305
Receptor Sensitivity 307
Grain and Structure Noise 313
Electronic Noise 314
Effect of Contrast on Noise 314
Effect of Blur on Noise 315
Image Integration 315
Image Subtraction 316

Chapter 22—Digital Imaging Systems and Image Processing 317

Introduction and Overview 317
Digital Images 317
Digital Image Production and Conversion 322
Image Processing 329
Image Storage and Retrieval 334
Image Display and Analysis 337
Digital X-Ray Imaging Systems 338
viii Physical Principles of Medical Imaging

Stimulable Phosphor Receptor

Image Processing

Chapter 23—Computed Tomography Image Formation 343

Introduction and Overview 343
The X-Ray System 345
Detectors 347
Computer 350
Display Unit and Camera 352
Scanning 353
Image Reconstruction 355

Chapter 24—Computed Tomography Image Quality 361

Introduction and Overview 361
Contrast Sensitivity 361
Visibility of Detail, Blur, and Resolution 363
Noise 367
Artifacts 369

Chapter 25—Ultrasound Production and Interactions 371

Introduction and Overview 371
Ultrasound Characteristics 374
Interaction of Ultrasound with Matter 381

Chapter 26—Ultrasound Imaging 389

Introduction and Overview 389
Echo Amplitude 389
Tissue Characteristics 393
Scan Patterns 395
Transducer Scan Methods 395

Chapter 27—Ultrasound Imaging of Cardiac Motion and

Flowing Blood 407
Introduction and Overview 407
Motion Mode 407
Doppler Imaging 407

Chapter 28—The Magnetic Resonance Image 415

Introduction and Overview 4^
The MR Image 412
The MR Imaging System 41 g
 Table of Contents ix

Radio Frequency Radiation 422

Spatial Characteristics 422
Control of Image Quality 424

Chapter 29—Nuclear Magnetic Resonance 427

Introduction and Overview 427
Magnetic Fields 427
Magnetic Nuclei 429
Nuclear Magnetic Interactions 432
Tissue Magnetization 436
Chemical Shift and Spectroscopy 439

Chapter 30—Magnetic Characteristics of Tissue 443

Introduction and Overview 443
ContrastSensitivity 444
Proton Density 445
Tl, Longitudinal Relaxation Time 446
T2, Transverse Relaxation Time 451
Contrast Agents 454

Chapter 31—Imaging Methods 457

Introduction and Overview 457
The Imaging Cycle 457
Spin-Echo Methods 463
Small Angle Gradient Echo Methods 467
Magnetization Preparation Methods 473
Echo Planar Method 474

Chapter 32—Spatial Characteristics of the Magnetic

Resonance Image 475
Introduction and Overview 475
Signal Acquisition 475
Image Reconstruction 476
Image Characteristics 477
Gradients 477
Slice Selection 479
Frequency Encoding 483
Phase Encoding 485
The Gradient Cycle 488
Image Reconstruction 488
x Physical Principles of Medical Imaging

Chapter 33—Image Detail, Noise, and Acquisition Speed 4yi

Introduction and Overview 491
Image Detail 492
Image Noise 494
Noise Sources 495
Signal-to-Noise Considerations 495
Image Acquisition Time 498
Procedure Optimization 500

Chapter 34—Magnetic Resonance Imaging of Flowing Blood 5G3

Introduction and Overview 503
Time Effects 503
Flow-Void Effect 506
Phase Effects 508
Angiography 513

Chapter 35—MRI Artifacts 519

Introduction and Overview 519
Motion-Induced Artifacts 519
Aliasing Artifacts 525
Chemical-Shift Artifacts 527

Chapter 36—The Gamma Camera 529

Introduction and Overview 529
Camera Characteristics 530
Collimators 532
Crystals 537
Photomultiplier Tube Array 537
Image Formation 539
Spectrometry 539
The Pulse Height Analyzer 547

Chapter 37—Radionuclide Image Quality 551

Introduction and Overview 551
Contrast 551
Blur and Visibility of Detail 554
Image Noise 551
Uniformity 554
Spatial Distortion 555
 Table of Contents xi

Chapter 38—Radionuclide Tomographic Imaging 567

Introduction and Overview 567
Positron EmissionTomography 567
Single Photon Emission Computed Tomography 572

Chapter 39—Statistics 575

Introduction and Overview 575
Counting Error 577

Chapter 40—Patient Exposure and Protection 587

Introduction and Overview 587
X-Ray Exposure Patterns 587
Radiation and Image Quality 591
Factors Affecting Exposure 591
Exposure Determination 595
Radionuclide Dosimetry 597
Absorbed Dose 602
Estimation of Dosage Values 606

Chapter 41—Personnel Exposure and Protection 607

Introduction and Overview 607
Effective Dose Equivalents 607
Exposure Limits 607
Exposure Sources 610
Area Shielding 611
Personnel Shielding 611
Exposure from Radioactive Sources 612

Chapter 42—Radiation Measurement 615

Introduction and Overview 615
Ionization Chambers 615
Survey Meters 619
Activity Measurement 624

Index ^33
 Preface

The effective use of any medical imaging modality and the interpretation of
images requires some understanding of the physical principles of the image for¬
mation process. This is because the ability to visualize specific anatomical struc¬
tures or pathologic conditions depends on the inherent characteristics of a particu¬

lar modality and the set of imaging factors selected by the user. The relationship
between visibility and imaging factors is rather complex and often involves com¬

promises and trade-offs among the different aspects of image quality.

All imaging methods deposit some form of energy in the patient's body. This is
not always without risk. Radiation exposure is usually a variable factor and often

has an effect on image quality. An optimized image procedure is one in which

these two factors—image quality and radiation exposure—are properly balanced.
This book provides the physics and scientific knowledge that enables the physi¬
cian to make appropriate technical decisions in all phases of the imaging process.
It is written primarily for the physicians studying in a radiology residency pro¬

gram and is also a useful reference for the practicing radiologist who is often faced
with day-to-day decisions concerning imaging equipment, procedures, and patient

safety.
This text contains much of the material from the author's previous books: The

Physical Principles of Diagnostic Radiology, The Physics and Instrumentation of

Nuclear Medicine, and the first edition of Physical Principles ofMedical Imaging
and it has been updated and supplemented especially in the areas of ultrasound,
emission tomography and magnetic resonance imaging.
The selection of topics and presentation of concepts is based on the physics
component of the radiology residency program at Emory University. It assumes
no previous knowledge of physics but rather a sincere desire on the part of the

reader to understand the physical principles of the medical imaging profession.

xiii
xiv Physical Principles of Medical Imaging

The specific objectives are to enhance the reader's ability to:

•
understand the basicprinciples of image formation
•
selectimaging factors that are appropriate for specific clinical requirements
•
optimize imaging procedures with respect to image quality and patient expo¬
sure

•
communicate effectively with members of the technical staff
•
make intelligent decisions when selecting equipment and imaging supplies
 Acknowledgments

The preparation of this book has been aided by the significant contributions of
many individuals, which are gratefully acknowledged.
Margaret Nix typed and edited the manuscript and coordinated its production.
Dr. Jack E. Peterson has provided much valuable advice and editorial support.

My wife Charlotte has graciously provided editorial assistance throughout the

production process.
I wish to express my sincere appreciation to Dr. H.S. Weens, former Chairman,

Department of Radiology, for his many years of encouragement and support in the
development of diagnostic radiological physics at Emory University. It was his
interest and high standards in training future radiologists that has made this book

possible.
The support and guidance of Dr. William J. Casarella, Chairman, Department
of Radiology, has been a significant factor in the development of the educational

programs and materials for the new imaging modalities which are contained in
this edition.

xv
 Chapter 1

Image Characteristics and Quality

INTRODUCTION AND OVERVIEW

To the human observer, the internal structures and functions of the human body
are not generally visible. However, by various technologies, images can be cre¬
ated through which the medical professional can look into the body to diagnose
abnormal conditions and guide therapeutic procedures. The medical image is a
window to the body. No image window reveals everything. Different medical im¬

aging methods reveal different characteristics of the human body. With each
method, the range of image quality and structure visibility can be considerable,
depending on characteristics of the imaging equipment, skill of the operator, and
compromises with factors such as patient radiation exposure and imaging time.
Figure 1-1 is an overview of the medical imaging process. The five major com¬
ponents are the patient, the imaging system, the system operator, the image itself,
and the observer. The objective is to make an object or condition within the
patient's body visible to the observer. The visibility of specific anatomical fea¬
tures depends on the characteristics of the imaging system and the manner in

which it is operated. Most medical imaging systems have a considerable number

of variables that must be selected by the operator. They can be changeable system
components, such as intensifying screens in radiography, transducers in
sonography, or coils in magnetic resonance imaging (MRI). However, most vari¬
ables are adjustable physical quantities associated with the imaging process such
as kilovoltage in radiography, gain in sonography, and echo time (TE) in MRI.

The values selected will determine the quality of the image and the visibility of
specific body features.
The ability of an observer to detect signs of a pathologic process depends on a
combination of three major factors: (1) image quality, (2) viewing conditions, and
(3) observer performance characteristics.

1
 Interpet Observ
!

Image

Artifacts Blur
Contrast Noise
Distorin

MPImtrewohdaciegsln
SImysategming Transfer Parmetrs Select\i//,
Operator

Patient
CAosmpocniaetetds
1-1
Figure
 Image Characteristics and Quality 3

IMAGE QUALITY

The quality of a medical image is determined by the imaging method, the char¬
acteristics of the equipment, and the imaging variables selected by the operator.
Image quality is not a single factor but is a composite of at least five factors:
contrast, blur, noise, artifacts, and distortion, as shown in Figure 1-1. The relation¬
ships between image quality factors and imaging system variables are discussed in
detail in later chapters.
The human body contains many structures and objects that are simultaneously

imaged by most imaging methods. We often consider a single object in relation to

its immediate background. In fact, with most imaging procedures the visibility of
an object is determined by this relationship rather than by the overall characteris¬

tics of the total image.

Consider Figure 1-2. The task of every imaging system is to translate a specific
tissue characteristic into image shades of gray or color. If contrast is adequate, the
object will be visible. The degree of contrast in the image depends on characteris¬
tics of both the object and the imaging system.

Image Contrast

Contrast means difference. In an image, contrast can be in the form of different

shades of gray, light intensities, or colors. Contrast is the most fundamental char¬
acteristic of an image. An object within the body will be visible in an image only if
it has sufficient physical contrast relative to surrounding tissue. However, image
contrast much beyond that required for good object visibility generally serves no

useful purpose and in many cases is undesirable.

Patient Image

Contrast
♦

Tissue Shades of Gray

Characteristics

Figure 1-2 Medical Imaging Is the Process of Converting Tissue Characteristics into a
Visual Image
4 Physical Principles of Medical Imaging

The physical contrast of an object must represent a difference in one or more

tissue characteristics. For example, in radiography, objects can be imaged relative
to their surrounding tissue if there is an adequate difference in either density or

atomic number and if the object is sufficiently thick.

When a value is assigned to contrast, it refers to the difference between two

specific points or areas in an image. In most cases we are interested in the contrast
between a specific structure or object in the image and the area around it or its
background.

Contrast Sensitivity
The degree of physical object contrast required for an object to be visible in an
image depends on the imaging method and the characteristics of the imaging sys¬
tem. The primary characteristic of an imaging system that establishes the relation¬

ship between image contrast and object contrast is its contrast sensitivity. Con¬
sider the situation shown in Figure 1-3. The circular objects are the same size but
are filled with different concentrations of iodine contrast medium. That is,
they
have different levels of object contrast. When the imaging system has a relatively
low contrast sensitivity, only objects with a high concentration of iodine (ie, high
object contrast) will be visible in the image. If the imaging system has a high
contrast sensitivity, the lower-contrast objects will also be visible.

We emphasize that contrast sensitivity is a characteristic of the imaging method

and the variables of the particular imaging system. It is the characteristic that re¬
lates to the system's ability to translate physical object contrast into image con¬
trast. The contrast transfer characteristic of an imaging system can be considered
from two perspectives. From the perspective of adequate image contrast for object
visibility, an increase in system contrast sensitivity causes lower-contrast objects
to become visible. However, if we consider an object with a fixed
degree of physi¬
cal contrast (ie, a fixed concentration of contrast medium), then
increasing con¬
trast sensitivity will increase image contrast.
It is difficult to compare the contrast sensitivity of various
imaging methods
because many are based on different tissue characteristics. However, certain
methods do have higher contrast sensitivity than others. For
example, computed
tomography (CT) generally has a higher contrast sensitivity than conventional ra¬
diography. This is demonstrated by the ability of CT to image soft tissue objects
(masses) that cannot be imaged with radiography. The specific factors that de¬
termine the contrast sensitivity of each imaging method are considered in later
chapters.
Consider Figure 1-4. Here is a series of objects with different
degrees of physi¬
cal contrast. They could be vessels filled with different concentrations of
contrast
medium. The highest concentration (and contrast) is at the bottom. Now
imagine a
curtain coming down from the top and covering some of the
objects so that they
 5
Image Characteristics and Quality

Figure 1-3 Increasing Contrast Sensitivity Increases Image Contrast and the Visibility of
Objects in the Body

0s Invisible t
Increase
r 25 H
(0
(0
k-
Contrast Sensitivity
Decrease
o 50 H
o
■*->

n
O
75 H
•
Visible
# I
O
• • • ^
100

Figure 1-4 Effect of Contrast Sensitivity on Object Visibility

6 Physical Principles of Medical Imaging

are no
longer visible. Contrast sensitivity is the characteristic of the imaging sys¬
tem that raises and lowers the curtain. Increasing sensitivity raises the curtain and
allows us to see more objects in the body. A system with low contrast sensitivity
allows us to visualize only objects with relatively high inherent physical contrast.

Blur and Visibility of Detail

Structures and objects in the body vary not only in physical contrast but also in
size. Objects from large organs and bones to small structural features such
range
as trabecula patterns and small calcifications. It is the small anatomical features

that add detail to a medical image. Each imaging method has a limit as to the
smallest object that can be imaged and thus on visibility of detail. Visibility of
detail is limited because all imaging methods introduce blurring into the process.
The primary effect of image blur is to reduce the contrast and visibility of small
objects or detail.
Consider Figure 1-5, which represents the various objects in the body in terms
of both physical contrast and size. As we said, the boundary between visible and
invisible objects is determined by the contrast sensitivity of the imaging system.
We now extend the idea of our curtain to include the effect of blur. It has little
effect on the
visibility of large objects but it reduces the contrast and visibility of
small objects. When blur is present, and it always is, our curtain of invisibility
covers small objects and
image detail. Blur and visibility of detail are discussed in
more depth in Chapter 18.

Object Size (mm)

Figure 1-5 Effect of Blur on Visibility of Image Detail
 Image Characteristics and Quality 7

Gamma Camera

Ultrasound

MRI

♦
CT
■ »

Fluoroscopy

Radiography

I ! 1 1 1 1—I I I I 1 1 1 1 1 I I I |
10 5 2 1 .5 .2 .1
Blur (mm)

Figure 1-6 Range of Blur Values and Visibility of Detail Obtained with Various Imaging
Methods

The amount of blur in an image can be quantified in units of length. This value
represents the width of the blurred image of a small object. Figure 1-6 compares
the approximate blur values for medical imaging methods. As a general rule, the
smallest object or detail that can be imaged has approximately the same dimen¬
sions as those of the image blur.

Noise

Another characteristic of all medical images is image noise. Image noise, some¬
times referred to image mottle, gives an image a textured or grainy appearance.
as

The source and amount of image noise depend on the imaging method and are
discussed in more detail in Chapter 21. We now briefly consider the effect of
image noise on visibility.
In Figure 1-7 we find our familiar array of body objects arranged according to

physical contrast and size. We now add a third factor, noise, which will affect the
boundary between visible and invisible objects. The general effect of increasing
image noise is to lower the curtain and reduce object visibility. In most medical
imaging situations the effect of noise is most significant on the low-contrast ob¬
jects that are already close to the visibility threshold.

Artifacts

We have seen that several characteristics of an imaging method (contrast sensi¬

tivity, blur, and noise) cause certain body objects to be invisible. Another problem
is that most imaging methods can create image features that do not represent a
8 Physical Principles of Medical Imaging

Object Size (mm)

Figure 1-7 Effect of Noise on Object Visibility

body structure or object. These are image artifacts. In many situations an artifact
does not significantly affect object visibility and diagnostic accuracy. But artifacts
can obscure a
part of an image or may be interpreted as an anatomical feature. A
variety of factors associated with each imaging method can cause image artifacts.

Distortion

A medical image should not only make internal body objects visible, but should
give an accurate impression of their size, shape, and relative positions. An imag¬
ing procedure can, however, introduce distortion of these three factors.

Compromises
It would belogical to raise the question as to why we do not adjust each imaging
procedure to yield maximum visibility. The reason is that in many cases the vari¬
ables that affect image quality also affect factors such as radiation
exposure to the
patient and imaging time. In general, an imaging procedure should be set up to
produce adequate image quality and visibility without excessive patient exposure
or imaging time.

In many situations, if a variable is changed to

improve one characteristic of
image quality, such as noise, it often adversely affects another characteristic, such
 Image Characteristics and Quality 9

as blur and
visibility of detail. Therefore an imaging procedure must be selected
according to the specific requirements of the clinical examination.

TISSUE CHARACTERISTICS AND IMAGE VIEWS

A combination of two factors makes each imaging method unique. These are
the tissue characteristics that are visible in the
image and the viewing perspective.
The specific tissue characteristics that produce the various shades of gray and

image contrast vary among the various modalities and methods.

A radiologist uses an image to search for signs of a pathologic condition or

injury in the body. Signs can be observed only if the condition produces a physical
change in the associated tissue. Many pathologic conditions produce a change in a
physical characteristic that can be imaged by one method but not another.
Imaging methods create images that show the body from one of two perspec¬
tives, through either projection or tomographic imaging. There are advantages and
disadvantages to each.
In projection imaging (radiography and fluoroscopy), images are formed by

projecting an x-ray beam through the patient's body and casting shadows onto an
appropriate receptor that converts the invisible x-ray image into a visible light
image. The gamma camera records a projection image that represents the distribu¬
tion of radioactive material in the body. The primary advantage of this type of

image is that a large volume of the patient's body can be viewed with one image.
A disadvantage is that structures and objects are often superimposed so that the

image of one might interfere with the visibility of another. Projection imaging
produces spatial distortion that is generally not a major problem in most clinical
applications.
Tomographic imaging, ie, conventional tomography, computed tomography
(CT), sonography, single photon emission tomography (SPECT), positron emis¬
sion tomography (PET), and MRI, produces images of selected planes or slices of
tissue in the patient's body. The general advantage of a tomographic image is the
increased visibility of objects within the imaged plane. One factor that contributes
to this is the absence of overlying objects. The major disadvantage is that only a

small slice of a patient's body can be visualized with one image. Therefore, most
tomographic procedures usually require many images to survey an entire organ
system or body cavity.

IMAGE VIEWING CONDITIONS

Our ability to see a specific object or feature in an image depends on the condi¬
tions under which we view the image. We must deal with the effects of viewing
 10 Physical Principles of Medical Imaging

conditions in many activities in addition to the professional interpretation of medi¬

cal images. Dim candlelight enhances the pleasure of a fine dinner but often makes
it difficult to read the menu. The glare of an oncoming automobile headlight re¬
duces our ability to see objects in the road and also produces discomfort and stress.
We quickly learn that there is an optimum viewing distance for television sets,

newspapers, etc. A small object dropped onto the smooth surface of the dining
table is easier to see than an object dropped onto a textured carpet or sandy beach.
With these experiences in mind, let us consider the factors associated with image

viewing conditions and how they affect our ability to visualize body structures.
Figure 1-8 shows the primary factors that affect our ability to see or detect an
object in an image. We will assume a circular object located within a larger back¬
ground area. The ability of an observer to detect the object depends on a combina¬
tion of factors including object contrast and size, background, brightness (lumi¬
nance) and structure (texture), glare produced by other light sources, distance
between the image and the observer, and the time available to search for the ob¬
ject.
Figure 1-9 is an image of the array of objects we used to demonstrate the effects
of image quality factors. We now use it to demonstrate how the factors associated
with the viewing process affect our ability to see the
objects. You can use this
actual image to test the factors discussed below.

OBJECT
Size
Contrast
Edge Sharpness

Figure 1-8 Viewing Condition Factors That Affect Object Visibility

 Image Characteristics and Quality 11

Object Contrast
The ability to see or detect an object is heavily influenced by the contrast be¬
tween theobject and its background. For most viewing tasks there is not a specific
threshold contrast at which the object suddenly becomes visible. Instead, the accu¬

racy of seeing or detecting a specific object increases with contrast.

The contrast sensitivity of the human viewer changes with viewing conditions.
When viewer contrast sensitivity is low, an object must have a relatively high
contrast to be visible. The degree of contrast required depends on conditions that

alter the contrast sensitivity of the observer: background brightness, object size,
viewing distance, glare, and background structure.

Background Brightness

The human eye can function over a large range of light levels or brightness, but
vision is not equally sensitive at all brightness levels. The ability to detect objects
generally increases with increasing background brightness or image illumination.
To be detected in areas of low brightness, an object must be large and have a

relatively high level of contrast with respect to its background. This can be demon¬
strated with the image in Figure 1-9. View this image with different levels of illu¬
mination. You will notice that under low illumination you cannot see all of the
small and low-contrast objects. A higher level of object contrast is required for

visibility.

Object Size (mm)

Figure 1-9 Effect of Viewing Conditions on Object Visibility
 12 Physical Principles of Medical Imaging

Viewbox luminance (brightness) can have a significant effect on the visibility

of an image. For general image viewing, viewboxes should have a
objects within
luminance of at least 1,500 nits. A brighter viewbox of at least 3,500 nits is recom¬
mended for mammography. A nit is a unit of brightness and is described in more
detail in Chapter 3.

Object Size
The
relationship between the degree of contrast required for detectability and
forbackground brightness is influenced by the size of the object. Small objects
require either a higher level of contrast or increased background brightness to be
detected.
The
detectability of an object is more closely related to the angle it forms in the
visual field. Theangle is the ratio of object diameter to the distance between image
and observer. In principle, a small object will have the same
detectability at close
range as a larger object viewed at a greater distance.

Viewing Distance
The relationship between visibility and viewing distance is affected by several
factors. When the viewing distance is reduced, an object creates a larger angle and
is generally easier to see. However, the eye does not focus and exhibit maximum
contrast sensitivity at close range. Therefore, the
relationship between detectabil¬
ity and viewing distance generally peaks at a distance of approximately 2 ft.

Glare

Glare is produced by bright areas or light sources in

the field of view and has
several undesirable effects. One effect is to reduce the
perceived contrast of the
objects viewed. When light from the glare-producing source enters the eye, some
of it is scattered over other areas within the visual field. This in turn reduces con¬
trastsensitivity. The extent to which it is reduced depends on the brightness and
size of the glare source and its proximity to the object viewed.
Glare is a major problem when some of the bright viewbox area is not covered
by the film. Visibility is improved by masking when viewing small films as in
mammography.

Background Structure
The structure or texture of
object's background has a significant effect on its
an

visibility. A smooth background produces maximum visibility; visibility of low

 Image Characteristics and Quality 13

contrastobjects is often reduced because of the texture of surrounding tissues or

image noise.

OBSERVER PERFORMANCE

In many situations, the presence of a specific object or sign is not obvious but
requires establishment by a trained observer. The criteria used to establish the
presence of a specific sign often vary among observers. Individual observers also
use different criteria, often influenced by the clinical significance of a specific

observation.
Let us assume we have
relatively large number of cases to be examined by
a

means of a medical
imaging procedure, and that a specific pathologic condition is
present in some and absent in others. The ideal situation would be if the condition
were diagnosed as positive when present and negative when absent. In actual prac¬

tice, this is usually not achieved. A more realistic situation is represented in Figure
1-10. Here we see that a fraction of the pathological conditions were diagnosed as

positive. This fraction (or percentage) represents the sensitivity of the specific di¬
agnostic procedure. We also see that the condition was not always diagnosed as
negative when absent. The percentage of these cases diagnosed as negative repre¬
sents the specificity of the procedure.
The diagnoses derived from the imaging procedure divide the cases into four

categories, as shown in Figure 1-11: true positives, true negatives, false positives,

PATHOLOGY
Present Absent
100

O n r\ O
« 40 Diagnosed Diagnosed
as
O as 3
Positive Negative
20-
° °
o
O o o

Figure 1-10 Sensitivity and Specificity

 14 Physical Principles of Medical Imaging

PATHOLOGY
Present Absent
100 100
False
O °
O Positive
80- o False 80
Negative
O
>»
-

60 >

'o
■*-> O O O O h—

tn 40- True True I- 40 o

c a>
o o Positive ° Negative o.
(/) C/>
O
20 20
° °
o
o o O

Figure 1-11 Relationship of True and False Diagnostic Decisions to Sensitivity and
Specificity

and false negatives. In the ideal situation, there are only true positives and true
negatives. This would be a diagnostic process with 100% accuracy.
False negatives and false positives occur for a number of reasons,
including
inherent limitations of a specific imaging method, selection of
inappropriate imag¬
ing factors, poor viewing conditions, and the performance of the observer (radi¬
ologist).
In general, if an observer is aggressive in
trying to increase the number of true
positives (sensitivity), the number of false negatives (decreased specificity) also
increases. The relationship between
sensitivity and specificity for a specific diag¬
nostic test (including observer performance) can be described
by a graph (shown
in Figure 1-12) known as a receiver
operating characteristic (ROC) curve.
The ideal diagnostic test produces 100%
sensitivity and 100% specificity as
shown. If a diagnostic procedure has no
predictive value, and the diagnosis is
obtained by a random selection process, the
relationship between sensitivity and
specificity is linear as shown. The observer determines the actual operating point
along this line. Since this particular diagnostic procedure is providing no useful
information, an attempt to increase the sensitivity by calling a greater number of
positives will produce a proportionate decrease in the specificity.
The relationship between
sensitivity and specificity for most medical imaging
procedures is between the ideal and no predictive value. The ROC curve shown in
Figure 1 -13 is typical. The characteristics of the imaging method and the
quality of
the resulting image determine the
shape of the curve and the relationship between
 Image Characteristics and Quality 15

sensitivity and specificity for a specific pathological condition. The criteria used
by the observer to make the diagnosis determine the point on the curve that pro¬
duces the actual sensitivity and specificity values.

ROC Curve
100

80

> 60

]>
'35 40
c
0)
</>
20

0
100 80 60 40 20 0
Specificity (%)

Figure 1-12 Comparison of ROC Curves for an Ideal Diagnostic Procedure with One That
Produces No Useful Information

ROC Curve
100 Ir

J-f 1—~—i 1 1
100 80 60 40 20 0
Specificity (%)

Figure 1-13 An ROC Curve for a Specific Imaging Procedure. The Actual Operating Point
Is Determined by Characteristics of the Observer.
 Chapter 2

Energy and Radiation

INTRODUCTION AND OVERVIEW

There are two components of the physical universe: energy and matter. In most
physical processes there is a constant interaction and exchange between the two;
medical imaging is no exception. In all imaging methods, images are formed by
the interaction of energy and human tissue (matter). A variety of energy types are
used in medical imaging. This is, in part, what accounts for the difference in imag¬

ing methods. In this chapter we review some basic energy concepts and then look
in detail at radiation, which is energy on the move, and the role of electrons in

energy transfer.
Images of internal body structures require a transfer of energy from an energy
source to the human body and then from the body to an appropriate receptor, as

shown in Figure 2-1. Although the types might be different, certain characteristics

apply to all energy used in imaging.

A basic requirement is that the energy must be able to penetrate the human

body. Visible light is the primary type of energy used to transfer image informa¬
tion in everyday life. However, because it usually cannot penetrate the human

body, we must use other energy types for internal body imaging.
Another characteristic of any energy used for imaging is that it must interact
with internal body structures in a manner that will create image information.
A common element of all imaging methods is that a large portion of the energy
used is deposited in the human tissue. It does not reside in the body as the same

type of energy but is converted into other energy forms such as heat and chemical
change. The possibility that the deposited energy will produce an undesirable bio¬
logical effect must always be considered.
As we approach the process of medical imaging, it is helpful to recognize two
broad categories of energy. One category is the group of energy forms that require
a material in which to exist. The other category is energy that requires no material
 18 Physical Principles of Medical Imaging

Figure 2-1 Role of Energy in Medical Imaging

object for its existence. Although the latter category does not require matter for its
existence, it is always created within a material substance and is
constantly mov¬
ing and transferring energy from location to another. This form of energy is
one
radiation; all energy forms used for medical imaging, with the exception of ultra¬
sound, are forms of radiation.

ENERGY FORMS AND CONVERSION

The significance of matter-related energy forms in medical imaging is that they

supply the energy to form radiation and later recapture it when the radiation is
absorbed.
A basic physical principle of the universe is that energy can be neither created
nor destroyed. However, we can transform it from one form or type to another.
Figure 2-2 shows some of the energy forms used in the production of an
x-ray
image. Various components of the imaging system convert the energy from one
form to another.

RADIATION

Radiation is energy that moves through space from one object, the source to
another object where it is absorbed. Radiation sources are generally collections of
matter or devices that convert other forms of
energy into radiation. In some cases
 Energy and Radiation 19

Energy Forms Energy Converters

Electrical

Heat

X-ray.

Chemical -

Heat -

Light

Chemical

Figure 2-2 Forms of Energy Involved in the Production of an X-Ray Image

the energy to be converted is stored within the object. Examples are the sun and
radioactive materials. In other cases the radiation source is only an energy con¬
verter, and other forms of energy must be applied in order to produce radiation;
light bulbs and x-ray examples.
tubes are
Most forms of radiation can penetrate through a certain amount of matter. But in
most situations, radiation energy is eventually absorbed by the material and con¬

verted into another energy form.

Electromagnetic Radiation
There are general types of radiation, as shown in Figure 2-3. In one type,
two
the energy is "packaged" in small units known as photons or quanta. A photon or
quantum of energy contains no matter, only energy. Since it contains no matter, it
has no mass or weight. This type of radiation is designated electromagnetic radia¬
tion. Within the electromagnetic radiation family are a number of specific
radiation types that are used for different purposes. These include such familiar
radiations as radio signals, light, x-radiation, and gamma radiation. The designa¬
tions are determined by the amount of energy packaged in each photon.
20 Physical Principles of Medical Imaging

RADIATION
Photons

X-ray Energy
Energy Gamma
Absorber
Source Light
Radio

Particles
Beta
Electrons Internal
Positrons Conversion
Auger
Alpha

Figure 2-3 Comparison of the Two Basic Types of Radiation

Particle Radiation

The other general type of radiation consists of small particles of matter moving
through high velocity. They carry energy because of their motion.
space at a very
Particle radiation primarily from radioactive materials, outer space, or ma¬
comes

chines that accelerate particles to very high velocities, such as linear accelerators,
betatrons, and cyclotrons. Particle radiation differs from electromagnetic radiation
in that the particles consist of matter and have mass. The type of particle radiation
encountered most frequently in clinical medicine is high-velocity electron radia¬
tion. Particle radiation is generally not used as an imaging radiation because of its
low tissue penetration. Also, when x-radiation interacts with matter, such as hu¬
man tissue, it transfers energy to electrons, thus creating a form of electron radia¬

tion within the material. Several types of particle radiation are produced as
byproducts of photon production by a number of radioactive materials used in
medical imaging.

ENERGY UNITS AND RELATED QUANTITIES

There are occasions on which we must consider the quantity of energy involved
in a process. Many units are used to quantify energy because of the different unit
systems (metric, British, etc.) and the considerable range of unit sizes. At this
time, we consider only those energy units encountered in radiological and medical
imaging procedures. The primary difference among the energy units to be consid¬
ered is their size, which in turn determines their specific usage. We use the basic

x-ray system in Figure 2-4 to introduce the various energy units.

 Energy and Radiation 21

Energy Forms Units

Electrical joule (j)

Heat joule, heat unit (HU)

X-ray Photons kiloelectron volt (keV)

joule, erg

Absorbed in Tissue joule, gram-rad, erg

*
j l I i > ' * Light Photons electron volt(eV)
> > li ti i

Figure 2-4 Energy Units Encountered in X-Ray Imaging

Joule

The joule (J) is the fundamental unit of energy in the metric International Sys¬
tem of Units (SI*). It is the largest unit encountered in radiology. One joule is
equivalent to 1 watt second. A 100-watt light bulb dissipates 100 J of energy per
second. In the next chapter we consider the full range of quantities and units used

specifically for radiation; several are energy-related and are defined in terms of the
joule or other energy units.
In general the joule is used when relatively large quantities of energy are in¬
volved.

Heat Unit

The heat unit was developed within radiology as a convenient unit for express¬

ing the amount of heat energy produced by an x-ray tube. One heat unit is 71 % of
a joule. The use of the heat unit is discussed in Chapter 9; it is gradually being

replaced by the joule.

*From the French name, Le Systeme International d'Unites.

22 Physical Principles of Medical Imaging

Gram-Rad

The gram-rad is another unit developed in radiology to express the total radia¬
tion energy absorbed by the body. Its usage is discussed in the following chapter.
A general trend is to use the joule for this application rather than the gram-rad.

Erg

The erg is a metric energy unit but is not an SI unit. It is much smaller than the
joule. Its primary use in radiology is to express the amount of radiation energy
absorbed in tissue.

Electron Volt

The electron volt (eV) is the smallest energy unit. It and its multiples,
kiloelectron volt (keV) and megaelectron volt (MeV), are used to express the en¬
individual light photons is
ergy of individual electrons and photons. The energy of
in the range of a few electron volts. X-ray and gammaphotons used in imaging
procedures have energies ranging from approximately fifteen to several hundred
kiloelectron volts.
The relationships of the three basic energy units are
1 joule = 107 ergs
1 joule = 6.24 x 1018 electron volts.

Power

Power is the term that expresses the rate at which energy is transferred in a
particular process. The watt is the unit for expressing power. One watt is equiva¬
lent to an energy transfer or conversion at the rate of 1 J/sec. As mentioned above,
a 100-watt light bulb converts energy at the rate of 100 J/sec. In medical imaging,

power is used to describe the capability of x-ray generators, the limitations of

x-ray tubes, the output of ultrasound transducers, the rate at which energy is de¬
posited in tissue during magnetic resonance imaging (MRI), etc.

Intensity

Intensity is the spatial concentration of power and expresses the rate at which
energy passes a unit area. It is typically expressed in watts per square
through
meter or watts per square centimeter. Intensity is also used to express relative

values of x-ray exposure rate, light brightness, radio frequency (RF) signal
strength in MRI, etc.
 Energy and Radiation 23

THE QUANTUM NATURE OF RADIATION

We have seen that electromagnetic radiation is packaged as individual photons

or quanta. This is sometimes referred to the quantum nature of radiation and
as
becomes an important concept in understanding how radiation is created and ab¬
sorbed.

Figure 2-5 illustrates the basic quantum characteristics of both radiation and
matter. When we consider the structure of matter in
Chapter 4 we will find that
electrons within atoms generally reside at specific energy levels rather than at
arbitrary energy levels. Electrons can move from one energy level to another, but
they must go all the way or not at all. These discrete electron energy levels give
matter certain quantum characteristics. In simple terms, matter prefers to ex¬

change energy in predefined quantities rather than in arbitrary amounts. Radiation

travels through space as a shower of individual photons.
Eventually the photon is absorbed by transferring its energy back to an electron.
The chance of its absorption is greatly enhanced if it encounters a material with
electron energy levels close to its energy content. The important point here is that
radiation photons are created and absorbed individually through energy exchanges
within certain materials.

Although radiation photons are differentiated by several physical quantities, as

shown in Figure 2-6, all electromagnetic radiation travels with the same velocity
through space. Because light is one of the most common forms of electromagnetic
radiation and its velocity is known, it is often said that electromagnetic radiations
travel with the speed of light. In free space, this is a velocity of about 3 x 108 m/
sec. If we assume that the average x-ray photon travels 1 m between the time it is

Electron Electron

-j _i
Lii Ui
> Photon >
UJ UJ

>- >-
O O
oc oc
LU UJ
z z
UJ UJ

Figure 2-5 The Quantum Nature of Radiation and Matter

 24 Physical Principles of Medical Imaging

E=hf Energy (E) E = 1240/A

(eV)

Frequency (f) Wavelength (\)

(hz) (nm)

f=c/A Velocity (c) A=c/f

(3X108 m/sec)

Figure 2-6 Physical Characteristics of a Photon

created and the time it is absorbed, the average lifetime of a photon would be 3.3 x
lO-9 seconds. Photons cannot be stored or suspended in space. Once a photon is
created and emitted by a source, it travels at this very high velocity until it interacts
with and is absorbed by some material. In its very short lifetime, the photon moves
a small amount of energy from the source to the absorbing material.

In Figure 2-7 the scales for the three quantities are shown in relationship to the
various types of radiation. While it is possible to characterize any radiation by its

photon energy, wavelength, or frequency, the common practice is to use different

quantities for different types of radiations, as discussed below.

Photon Energy
Since aphoton is simply a unit of energy, its most important characteristic is the
quantity of energy it contains. Photon energies are usually specified in units of
electron volts or appropriate multiples.
If the various types of electromagnetic radiation were ordered with
respect to
photon energies, as shown in Figure 2-7, the scale would show the electromag¬
netic spectrum. It is the energy of the individual
photons that determines the type
of electromagnetic radiation: light,
x-ray, radio signals, etc.
An important aspect of photon
energy is that it generally determines the pen¬
etrating ability of the radiation. The lower energy x-ray photons are often referred
to as soft radiation, whereas those at the
higher-energy end of the spectrum would
be so-called hard radiation. In most situations, high-energy (hard) x-radiation is
more
penetrating than the softer portion of the spectrum.
If the individual units of energy, photons or particles, have energies that exceed
the binding energy of electrons in the matter through which the radiation is
pass¬
ing, the radiation can interact, dislodge the electrons, and ionize the matter.
 Energy and Radiation 25

X-ray and Gamma

10 keV 500 keV
L I

Visible Light
Red Green Blue
MRI
Radio Frequency 700 nm
1 Mhz

Photon Energy (eV)

10-6 | 1CT4 1CT2 102 104 106

Wavelength (nm)
1010 110s 106 104 102 10-2

Frequency (Hz)
106 108 1010 1012 1014 1016 101£

Figure 2-7 The Electromagnetic Spectrum

The minimum radiation energy that can produce ionization varies from one
material to another, depending on the specific electron binding energies. Electron
binding energy is discussed in more detail in Chapter 4. The ionization energies
for many of the elements found in tissue range between 5 eV and 20 eV. There¬

fore, all radiations with energies exceeding these values are ionizing radiations.
Photon energy quantities are generally used to describe radiation with relatively

high photon energy, such as x-ray, gamma, and cosmic radiation.

Frequency

Frequency is a rate of vibration or oscillation. One of the laws of physics that

applies to electromagnetic radiation is that a photon's energy (E) and frequency (f)
are directly proportional, with the relationship being

E = hf.

In this relationship, h is Planck's constant, which has a value of 6.625 x 10-27 erg-
second, and f is frequency in hertz (Hz, cycles per second).
Frequency is the most common quantity used to characterize radiations in the
lower end, or the RF portion, of the electromagnetic spectrum and includes radia¬
tion used for radio and television broadcasts, microwave communications and

cooking, and MRI. For example, in MRI, protons emit signals with a frequency of
42.58 MHz when placed in a 1-tesla magnetic field. Although, theoretically,
x-radiation has an associated frequency, the concept is never used.
26 Physical Principles of Medical Imaging

Wavelength

physical phenomena observed with electromagnetic radiation suggest

Various
has certain wavelike properties. A characteristic of a wave is the
that the radiation
distance between two successive peaks, which is the wavelength (A,). This is also
the distance the radiation moves forward during the period of one oscillation.
Wavelength can be expressed in any unit of length. Radio and television signals
have relatively long wavelengths that are usually expressed in meters. For higher

energy photons, such as light and x-ray, two smaller length units are used. These
are:
O

1 Angstrom unit (A) = lCH°m

1 nanometer (nm) = 109m

The relationship between photon energy and wavelength is

E (keV) = 1.24 / A, (nm)
Thisrelationship allows the conversion of photon energy into wavelength and
vice versa.In some literature, x-ray photon spectra are given in terms of wave¬
length rather than photon energy. This causes the spectrum curve to have an en¬
tirely different appearance. By using the relationship given above, it is possible to
convert a spectrum of one kind into the other. Since energy and wavelength are

inversely related, the highest energy on the spectrum corresponds to the shortest
wavelength.
Wavelength is most frequently used to describe light. At one time it was used to
describe x-radiation but that practice is now uncommon. Wavelength is often used
to describe radio-type radiations. General terms like "shortwave" and "micro¬

wave" refer to the wavelength characteristics of the radiation.

ELECTRONS AND ENERGY

Electronsare the smallest particles found in matter. An electron has a mass of

9.1 10~28 g, which means it would take 10.9 x 1026 electrons to equal the weight
x

of 1 cm3 of water. The question might be raised as to why such a small particle can
be the foundation of our modern technology. The answer is simple—numbers.
Tremendous numbers of electrons are involved in most applications. For example,

when a 100-watt electrons race through the wires carrying

light bulb is turned on,
energy to it at the rate of 5.2 x 1018 electrons per second. In addition to its mass,
each electron carries a 1-unit negative electrical charge. Itis the charge of an elec¬
tron that enables it to interact with other electrons and particles within atoms.

Because an electron has both mass and electrical charge, it can possess energy
of several types, as shown in Figure 2-8. It is the ability of an electron to take up,
transport, and give up energy that makes it useful in the x-ray system.
 Energy and Radiation 27

Rest Mass Energy

Even when an electron is at rest and has no apparent motion, it still has energy.
In fact, according to the laws of physics, an object has some energy just because of
its mass. Under certain conditions, mass can be converted into energy and vice
versa. Einstein's famous equation

E = mc2

predicts the amount of energy that could be obtained if an object with a mass, m,
were completely converted. In this
relationship, c is the speed of light. Although it
is not possible with our present technology to convert most objects into energy,
certain radioactive materials emit particles, called positrons, that can annihilate
electrons. When this happens, the electron's entire mass is converted into energy.

According to Einstein's relationship, each electron will yield 510 keV. This en¬
ergy appears as a photon. The annihilation of positrons and electrons is the basis
for positron emission tomography (PET).

Kinetic Energy

Kinetic energy is associated with motion. It is the type of energy that a moving
automobile or baseball has. When electrons are moving, they also have kinetic
energy.
Generally, the quantity of kinetic energy an object has is related to its mass and
velocity. For large objects, like baseballs and cars, the energy is proportional to the

Different Energy
Levels

Rest Moss Kinetic Potential

Figure 2-8 Types of Energy Associated with Electrons

28 Physical Principles of Medical Imaging

mass object and the square of the velocity. Doubling the velocity of such an
of the
object increases its kinetic energy by a factor of 4. In many situations, electrons
travel with extremely high velocities that approach the velocity of light. At these
high velocities, the simple relationship between energy and velocity given above
does not hold. One of the theories of relativity states that the mass of an object,
such as an electron, changes at high velocities. Therefore, the relationship be¬
tween energy and velocity becomes complex. Electrons within the typical x-ray

tube can have energies in excess of 100 keV and can travel with velocities of more
than one-half the speed of light.

Potential Energy

Potential energy is the type of energy possessed by an object because of its

location configuration and is essentially a relative quantity. That is, an object
or

will have more or less energy in one location or configuration than in another.

Although there is generally not a position of absolute zero potential energy, cer¬
tain locations are often designated as the zero-energy level for reference.
Electrons can have two forms of potential energy. One form is related to loca¬
tion within an electrical circuit, and the other is related to location within an atom.
One important aspect of electron potential energy is that energy from some source
is required to raise an electron to a higher energy level, and that an electron gives
up energy when it moves to a lower potential energy position.

Energy Exchange

Because electrons are too small to see, it is sometimes difficult to visualize what
is meant by the various types of electron energy. Consider the stone shown in
Figure 2-9; we will use it to demonstrate the various types of energy that also
apply to electrons.
Potential energy is generally a relative quantity. In this picture, the ground level
is arbitrarily designated as the zero potential energy position. When the stone is
raised above the ground, it is at a higher energy level. If the stone is placed in a
hole below the surface, its potential energy is negative with respect to the ground
level. However, its energy is still positive with respect to a position in the bottom
of a deeper hole. The stone at position A has zero potential energy (relatively

speaking), zero energy because it is not moving, and a rest-mass energy propor¬
tional to its mass. (The rest-mass energy of a stone is of no practical use and is not
discussed further.) When the man picks up the stone and raises it to position B, he
increases its potential energy with respect to position A. The energy gained by the
stone comes from the man. (We show later that electrons can be raised to
higher
potential energy levels by devices called power supplies.) The additional potential
 Energy and Radiation 29

V
0
(Ston^ Ground Level fstoneT
Zero" Potential
Energy/"/ t \ \
Sound,Heat,Etc.
// IU

Figure 2-9 Transfer of Energy from One Form to Another

energy possessed by the stone at B can be used for work or can be converted into
other forms of energy. If the stone were connected to a simple pulley arrangement
and allowed to fall back to the ground, it could perform work by raising an object
fastened to the other end of the rope.
If the man releases the stone at B and allows it to fall back to the ground, its
energy is converted into kinetic energy. As the stone moves downward, decreas¬
ing its potential energy, which is proportional to its distance above the ground, it
constantly increases its speed and kinetic energy. Just before it hits the ground, its
newly gained kinetic energy will be just equal to the potential energy supplied by
the man. (Electrons undergo a similar process within x-ray tubes where they swap

potential for kinetic energy.) Just as the stone reaches the surface of the ground, it
will have more energy than when it was resting at position A. However, when it
comes to rest on the ground at D, its energy level is the same as at A. The extra

energy originally supplied by the man must be accounted for. In this situation, this
energy is converted into other forms, such as sound, a small amount of heat, and
mechanical energy used to alter the shape of the ground. When high-speed elec¬
trons collide with certain materials, they also lose their kinetic energy; their en¬

ergy is converted into heat and x-radiation.

Energy Transfer

One of the major functions of electrons is to transport energy from one location
to another. We have just seen that individual electrons can possess several forms
30 Physical Principles of Medical Imaging

of energy. The principle of electrical energy transportation is that electrons pick

up energy in one location and then move to another where they pass the energy on
to some other material. Generally the arrangement is such that the electrons then

move back to the energy source and repeat the process.

The pathway electrons travel as they transfer energy from one point to another
is a circuit. A basic electrical circuit is shown in Figure 2-10. All circuits must
contain at least two components (or devices) as shown. One component, desig¬
nated here as the source, can convert energy from some other form and transfer it
to the electrons. Batteries are good examples of electron energy sources. The other

component, designated here as a load, performs essentially the opposite function.

As the electrons pass through the device they lose their energy as it is converted
into some other form; a light bulb is a good example of a load in which their

energy is converted into light and heat.

The energy source and load are connected with two conductors over which the
electrons can freely move. The ideal conductor offers no resistance to the flow of
the electrons. If the conductor offers significant resistance, the electrons lose some
of their energy there. The lost energy is converted into heat. Electrical circuits
neither create nor destroy electrons. The electrons are always present within the
conductive materials. Energy is given to and taken from the electrons as they
move around the circuit.
The energy carried by the electrons is a form of potential energy. Even though
the electrons are moving through the conductors, their velocity is not sufficient to
give them significant kinetic energy. When electrons are moving through free
space, they can carry significant kinetic energy, but they cannot when they are
moving through solid conductors. In the typical electrical circuit, one conductor

SOURCE LOAD

^ @ e

Qo° o+° o O o °q+o o

Figure 2-1-10 A Basic Electrical Circuit

 Energy and Radiation 31

has higher potential energy than the other conductor. In principle, the energy
source elevates the electrons to the higher potential energy level which they main¬
tain untilthey give up the energy in passing through the load device. The electrons
at the lower
potential level return to the energy source to repeat the process.
The connection points (terminals) between the source and load devices and the
conductors are designated as either positive or negative. The electrons exit the
source at the negative terminal and enter the
negative terminal of the load. They
then exit the positive terminal of the load device and enter the source at the posi¬
tive terminal. In principle, the negative conductor contains the electrons at the
high potential energy level. The positive conductor contains the electrons that
have lost their energy and are returning to the source. In direct current (DC) cir¬
cuits the polarities do not change. However, in alternating current (AC) circuits
the polarity of the conductors is constantly alternating between negative and posi¬
tive.

ELECTRICAL QUANTITIES

Each electron
passing through the circuit carries a very small amount of energy.
However, by collective effort, electrons can transport a tremendous amount of
energy. The amount of energy transferred by an electrical circuit depends on the
quantity of electrons and the energy carried by each. We now consider these spe¬
cific electrical quantities and their associated units.

Current

When an electrical circuit is in operation, electrons are continuously moving or

flowing through the conductor. The number of electrons that move past a given
point per second is referred to as the current. Since, in the typical circuit, the num¬
ber of electrons per second is quite large, a more useful unit than this number is
desirable. The basic unit of current is the ampere (A). One ampere is defined as the
flow of 6.25 x 1018 electrons per second. In x-ray machines, the current is typically
a fraction of 1A, and the milliampere (mA) is a more appropriate unit. As indi¬

cated in Figure 2-11, a current of 1 mA is equal to the flow of 6.25 x 1015 electrons

per second past a given point. The current that flows through an x-ray tube is
generally referred to as the "MA." When used to mean the quantity, it is written as
MA. When used as the unit, milliampere, it is written as mA.

Electron Quantity and Charge

In addition to the rate at which electrons are flowing through a circuit, ie, the
current, it is often necessary to know the total quantity in a given period of time. In
32 Physical Principles of Medical Imaging

CURRENT
1 mA = 6.25 x 1015 electrons per second

1 mAs = 6.25 x 1015 electrons

CHARGE

Figure 2-11 Electrical Current and Charge

x-ray work the most appropriate unit for specifying electron quantity is the milli-
ampere-second (mAs). The total quantity of electrons passing a point (MAS) is the
product of the current (MA) and the time in seconds (S). Since a current of 1 mA
is a flow of electrons per second, it follows that 1 mAs is a cluster of 6. 25 x 1015
electrons, as shown in Figure 2-11.
It should be recalled that all electrons carry a negative electrical charge of the
same size. In some situations the quantity of electrons might be specified in terms

of the total electrical charge. If extra electrons are added to an object, it is said to
have acquired a negative charge. However, if some of the free electrons are re¬
moved from an object, a positive charge is created. In either case, the total charge
on the object is directly proportional to the number of electrons moved.
Generally
speaking, charge is a way of describing a quantity of electrons. The basic unit of
charge is the coulomb (C), which is equivalent to the total charge of 6.26 x 1018
electrons; 1 C is equivalent to 1,000 mAs.

Voltage
We pointed out earlier that electrons could exist at different potential energy
levels, because of either their different positions within the atom or their different
locations within an electrical circuit. Consider the two wires or conductors shown
in Figure 2-12. The electrons contained in one of the conductors are at a higher
potential energy level than the electrons in the other. Generally, the electrons in
the negative conductor are considered to be at the higher energy level. An electri¬
cal quantity that indicates the difference in electron potential energy between two
points within a circuit is the voltage, or potential difference, suggesting a differ-
 Energy and Radiation 33

High Energy Electrons

Potential Energy Difference

or

Voltage

J
c~o~o o o n
[ o o o o (j
Low Energy Electrons

Figure 2-12 Electron Potential Energy or Voltage

ence inpotential energy. The unit used for voltage, or potential difference, is the
volt. The difference in electron potential energy between two conductors is di¬
rectly proportional to the voltage. Each electron will have an energy difference of
1 eV for each volt. It is the quantity of energy that an electron gains or loses,

depending on direction, when it moves between two points in a circuit that are 1 V
apart. In the basic x-ray machine circuit the voltage is in the order of thousands of
volts (kilovolts) and is often referred to as the KV. When used to mean the quan¬

tity, voltage or potential, it is written KV or KVP. When used as the unit it is

written as kV or kVP.

Power

Power is the quantity that describes the rate at which energy is transferred. The
watt and is equivalent to an energy transfer rate of 1 J/second.
is the unit of power
The power in an electrical circuit is proportional to the energy carried by each
electron (voltage) and the rate of electron flow (current). The specific relation¬
ship is
Power (watts) = Voltage (volts) x Current (amperes).
34 Physical Principles of Medical Imaging

Total Energy

The amount of energy that an electrical circuit transfers depends on the voltage,
current, and the duration (time) of the energy transfer. The fundamental unit of
energy is the joule. The relationship of total transferred energy to the other electri¬
cal quantities is

Energy (joules) =Voltage (volts) x Current (amperes)x Time (seconds).

THE X-RAY CIRCUIT

The basic circuit shown in Figure 2-13 is found in all x-ray machines. The
power supply that gives energy to the electrons and pumps them through the cir¬
cuit is discussed in detail in Chapter 8. The voltage between the two conductors in
the x-ray circuit is typically in the range of 30,000 V to 120,000 V (30 kV to 120
kV), and in radiology this kilovoltage is generally adjustable and an appropriate
value can be selected by the operator of the x-ray equipment.
In this circuit, the x-ray tube is the load. It is the place where the electrons lose
their energy. The energy lost by electrons in passing through an x-ray tube is con¬
verted into heat and x-ray energy.

ALTERNATING CURRENT

some electrical circuits, the voltage and current remain constant with respect
In
totime, and the current always flows in the same direction. These are generally
designated as direct current (DC) circuits. A battery is an example of a power
supply that produces a direct current.
Some power supplies, however, produce voltages that constantly change with
time. Since, in most circuits, the current is more or less proportional to the voltage,

High Voltage
Power Supply

Figure 2-13 The X-Ray Circuit

 Energy and Radiation 35

it also changes value. In most circuits of this type, the voltage periodically changes
polarity and the current changes or alternates direction of flow. This is an alternat¬
ing current (AC) circuit. The electricity distributed by power companies is AC.
There are certain advantages to AC in that transformers can be used for stepping

voltages up or down, and many motors are designed for AC operation.

If a graph of the instantaneous values of either the AC voltage or current is

plotted with respect to time, it will generally be similar to the one shown in Figure
2-14. This representation of the voltage with respect to time is known as the wave¬
form. Most AC power sources produce voltages with the sine-wave waveform,
shown in Figure 2-14. This name is derived from the mathematical description of
its shape.
One characteristic of an alternating voltage is its frequency. The frequency is
the rate at which the voltage changes through one complete cycle. The time of one

complete cycle is the period; the frequency is the reciprocal of the period. For
example, the electricity distributed in the United States goes through one complete
cycle in 0.0166 seconds and has a frequency of 60 cycles per second. The unit for
frequency is the hertz, which is 1 cycle per second.
During one voltage cycle, the voltage changes continuously. At two times dur¬
ing the period it reaches a peak, but remains there for a very short time. This means
that for most of the period the circuit voltage is less than the peak value. For the

purpose of energy and power calculations, an effective voltage value, rather than
the peak value, should be used. For the sine-wave voltage, the effective value is
70.7% (0.707) of the peak voltage. This is the waveform factor, and its value de¬

pends on the shape of the voltage waveform.

+ -i

4>
O)
(0
0
O Time
>

• — 1 /60 sec •

Frequency = 60 Hz (cycle/sec)

Figure 2-14 Waveform of an Alternating Voltage

 Chapter 3

Radiation Quantities and Units

INTRODUCTION AND OVERVIEW

There are many different quantities and units used to quantify radiation, be¬
cause there are a of an x-ray beam or gamma radiation
number of different aspects
that can be used to express the amount of radiation. The selection of the most

appropriate quantity depends on the specific application. The primary objective of

this chapter is to help the reader develop a conceptual understanding of the various
radiation quantities and units and gain sufficient factual knowledge to support
their usage.

UNIT SYSTEMS

A complicating factor is that American society is undergoing a slow change in

the units used to express a variety of physical quantities. In everyday life we see
this as a change from the conventional British unit system (feet, pounds, miles) to
the metric system (meters, kilograms, kilometers). In radiology we are experienc¬

ing a change not only to the general metric units but also to the proposed adoption
of a set of fundamental metric units known as the International System of Units (SI
units). The adoption of SI radiation units is progressing rather slowly because
there is nothing wrong with our conventional units, and SI units are somewhat
awkward for a number of common applications. Throughout this text we use the
units believed the most useful to the reader. In this chapter both unit systems are
discussed and compared.
Table 3-1 is a listing of most of the physical quantities and units encountered in

radiology. It is a useful reference especially for the conversion of one system of

units to another.

37
 38 Physical Principles of Medical Imaging

Table 3-1 Radiation Units and Conversion Factors

Conversions
Quantity Conventional Unit SI Unit
coulomb/kg of air (C/kg) 1 C/kg 3876 R
Exposure roentgen (R) =
1 R = 258 pC/kg
1 Gy 100 rad
Dose rad gray (Gy) =

Dose equivalent rem sieved (Sv) 1 Sv = 100 rem

curie becquerel (Bq) 1 mCi 37 MBq

Activity (Ci) =

QUANTITIES

quantities used to describe a beam of x-radiation fall into two general

Radiation
categories as shown in Figure 3-1. One category comprises the quantities that ex¬
press the total amount of radiation, and the other comprises the quantities that
express radiation concentration at a specific point. We need to develop this dis¬
tinction before considering specific quantities.
A characteristic of an x-ray beam or any other type of radiation emitted from a

relatively small source is that it is constantly spreading out or diverging as it

moves away from the source, as shown in Figure 3-2. At any point along the beam,

the width of the area covered is proportional to the distance from the source. At a

rO On

: —r

Figure 3-1 Radiation Quantities and Units

 Radiation Quantities and Units 39

Area = 1
Exposure = 1

Area - 4
Exposure = 1/4

Area = 9
Exposure = 1/9

Figure 3-2 Inverse-Square Effect

distance of 1 m, the cross-sectional beam area unit wide and progresses to a

is one
width of two units at a distance of 2 m. At 3 m, is three units wide. There¬
the area

fore, the area covered by our x-ray beam is increasing in proportion to the square
of the distance from the source.

First, let us consider the amount of radiation passing through the three areas.
We assuming that none of the radiation is absorbed or removed from the beam
are

before it reaches the thirdarea. All radiation that passes through the first area will

also pass through the second and third areas. In other words, the total amount of
radiation is the same through all areas and does not change with distance from the
source.

Now let us consider the concentration of radiation through the three areas. In the
first area, all radiation is concentrated in a one-unit area. At a distance of 2 m from
the source the radiation is spread over a four-unit square area, and continues to
spread to cover a nine-unit square area at a distance of 3 m. If the same total
40 Physical Principles of Medical Imaging

amount of radiation is being distributed over larger areas it is obviously becoming

less concentrated.
What we radiation moves away from its
have observed here is the fact that as
source, change but its concentration de¬
the total amount of radiation does not
creases. At any given distance the concentration is inversely proportional to the

area covered by the beam, and the area covered by the beam is proportional to the

square of the distance from the source. We can conclude that the concentration of
radiation is inversely related to the square of the distance from the source. This is
commonly known as the inverse-square law.
We now introduce some quantities and the associated units that can be used to

express both the concentration and total amount of radiation.

PHOTONS

Since an x-ray beam and gamma radiation are showers of individual photons,
the number of photons could, in principle, be used to express the amountof radia¬
tion. In practice, the number of photons is not commonly used, but it is a useful

concept in understanding the nature of radiation and distinguishing between con¬

centration and total radiation. Let us go back to the situation shown in Figure 3-1

and examine the different ways the concentration of radiation delivered to a small
area on a patient's body could be expressed.

Photon Concentration (Fluence)

If we draw a 1-cm2 area on the surface of the

patient and then count the number
of photons procedure, we will have
area during a radiographic
passing through the
an indication of the concentration of radiation delivered
to the patient. During a

single abdominal radiographic exposure we would find that close to 1010 photons
would have passed through our square centimeter. The more formal term for pho¬
ton concentration is photon fluence.

Total Photons

If we count the number of photons

entering the total exposed area, we will have
an indication of the total amount of radiation energy
delivered to the patient. This
quantity depends on the size of the exposed area and the radiation concentration. If
the radiation is uniformly distributed over the exposed area, the total number of

photons entering the patient can be found by multiplying the concentration

(fluence) by the exposed area. Changing the size of the exposed area does not
affect the concentration entering at the center of the beam. However, reducing the
exposed area does reduce the total number of photons and radiation entering the
patient.
 Radiation Quantities and Units 41

EXPOSURE

Concept

Exposure is the quantity most commonly used to express the amount of radia¬
tion delivered to a point. The conventional unit for
exposure is the roentgen (R),
and the SI unit is the coulomb per kilogram of air (C/kg):

1 R = 2.58 x 10-4 C/kg

1 C/kg = 3876 R.
The reason exposure is such a
widely used radiation quantity is that it can be
readily measured. All forms of radiation measurement are based on an effect pro¬
duced when the radiation interacts with a material. The specific effect used to
measure exposure is the ionization in air produced
by the radiation.
Exposure is generally measured by placing a small volume of air at the point of
measurement and then measuring the amount of ionization produced within the

air. The enclosure for the air volume is known as an ionization chamber. The use

of ionization chambers and other radiation measuring devices is discussed in

Chapter 42. The concept of exposure and its units can be developed from Fig¬
ure 3-3. When a small volume of air is exposed to ionizing radiation (x-ray,

gamma, etc.), some of the photons will interact with the atomic shell electrons.
The interaction separates the electrons from the atom, producing an ion pair.
When the negatively charged electron is removed, the atom becomes a positive
ion. Within a specific mass of air the quantity of ionizations produced is deter-

Exposure
(1 Roentgen)

2.08 x 109 Ionizations 2.58 X 10-4

(1 electrostatic unit) Coulomb/Kilogram (of air)

©
>► o
| © o

1 cm3 of Air
(0.001293 gm at STP)

Figure 3-3 Exposure

42 Physical Principles of Medical Imaging

mined by two factors: the concentration of radiation photons and the energy of the
individual photons.
An exposure of 1 roentgen produces 2.08 x 109 ion pairs per cm3 of air at stan¬
dard temperature and pressure (STP); 1 cm3 of air at STP has a mass of 0.001293
g. The official definition of the roentgen is the amount of exposure that will pro¬
duce 2.58 x 1(H C (of ionization) per kg of air. A coulomb is a unit of electrical

charge. Since ionization produces charged particles (ions), the amount of ioniza¬
tion produced can be expressed in coulombs. One coulomb of charge is produced

by 6.24 x 1018 ionizations.

Exposure is a quantity of radiation concentration. For a specific photon energy,
exposure is proportional to photon concentration or fluence. The relationship be¬
tween exposure and photon concentration is shown in Figure 3-4; the relationship

changes with photon energy because both the number of photons that will interact
and the number of ionizations produced by each interacting photon is dependent
on photon energy. If we assume a photon energy of 60 keV, a 1-R exposure is

equivalent to a concentration of approximately 3 x 1010 photons per cm2.

Surface Integral Exposure

Since exposure expressed in roentgens or coulombs per kilogram is a concen¬
tration, it does not express the total amount of radiation delivered to a body. The
total radiation delivered, or surface integral exposure (SIE), is determined by the

exposure and the dimensions of the exposed area. It is also referred to as the expo¬
sure-area product.

Photon Fluence Exposure Energy Fluence

(3.1 X 1010 photons/err^) = (1 Roentgen) = (3000 ergs/cm2)

Figure 3-4 Relationship between Exposure and Photon Concentration

 Radiation Quantities and Units 43

The surface integral exposure is expressed in the conventional units of roent-

gens-square centimeters (R-cm2). If the radiation exposure is uniform over the
entire area, the SIE is the product of the
exposure in roentgens and the exposure
area in square centimeters. If the
exposure is not the same at all points in the
exposed area, the SIE can be found by adding the exposure values for each square
centimeter of exposed surface. Mathematically, this is the process of integrating
the exposure over the surface area. The SIE can be measured during x-ray exami¬
nations by placing a special type of ionization chamber in the x-ray beam. The

significance of SIE is that it describes total radiation imparted to a patient, whereas

exposure indicates only the concentration of radiation at a specified point.
The typical fluoroscopy examination provides an excellent opportunity to com¬

pare exposure (concentration) and SIE (total radiation). In Figure 3-5 two cases
are compared. In both instances the beam area was 10 cm x 10 cm (100 cm2); the

total exposure time was 5 minutes at an exposure rate of 3 R/min. In both instances
the SIE is 1,500 R-cm2. However, the exposure depends on how the x-ray beam
was moved during the examination. In the first example the beam was not moved

and the resulting exposure was 15 R. In the second example, the beam was moved
to different locations so that the exposure was distributed over more surface area

and the concentration became less.

Figure 3-5 Comparison of SIE and Exposure during a Fluoroscopic Examination

44 Physical Principles of Medical Imaging

Exposure
100 mR

10 R-cm2
100 R-cm2
Surface Integral Exposure

Figure 3-6 Comparison of SIE Values for a Radiographic Examination

Another important example is illustrated in Figure 3-6. Here the same exposure
(100 mR) is delivered to both patients. However, there is a difference in the ex¬
posed area: the patient on the right received 10 times as much radiation as the
patient on the left.
The important point to remember is that exposure (roentgens) alone does not

express the total radiation delivered to a body. The total exposed area must also be
considered.

ENERGY

An x-raybeam and other forms of radiation deliver energy to the body. In prin¬
ciple, the amount of radiation delivered could be expressed in units of energy
(joules, ergs, kiloelectron volts, etc.). The energy content of an x-ray beam is
rather difficult to measure and for that reason is not widely used in the clinical

setting. However, considering the energy delivered by an x-ray beam is helpful in

understanding other radiation quantities.

Energy Fluence

Energy fluence (concentration) is the amount of radiation energy delivered to a

unit area. The units for
expressing radiation energy concentration are either the
millijoule (mJ) per square centimeter or erg per square centimeter. For a specific
photon energy, fluence is proportional to exposure. The relationship between en¬
ergy fluence and exposure is shown in Figure 3-4. The relationship changes with
photon energy because of the change in photon interaction rates. However, if we
 Radiation Quantities and Units 45

assume a photon
energy of 60 keV, the energy fluence for a 1-R exposure is ap¬
proximately 0.3 mJ/cm2.
The energy delivered by an x-ray beam can be put into
perspective by compar¬
ing it to the energy delivered by sunlight (see Figure 3-7). For the x-ray exposure
we will use the
fluoroscopic factors of 5 minutes at the rate of 3 R/min. This 15-R
exposure delivers x-ray energy to the patient with a concentration (fluence) of 4.5
mJ/cm2 if we assume an effective photon energy of 60 keV.
The energy delivered by the sun depends on many factors
including geographic
location, season, time of day, and atmospheric conditions; a typical midday sum¬
mer exposure on a clear day in Atlanta
produces approximately 100 mJ/sec/ cm2.
In 5 minutes a person would be exposed to an energy fluence of 30,000 mJ/ cm2.
We see from this example that the energy content of an x-ray beam is
relatively
small in comparison to sunlight. However, x-ray and gamma radiation will gener¬

ally produce a greater biological effect per unit of energy than sunlight because of
two significant differences: x- and gamma radiation penetrate and
deposit energy
within the internal tissue, and the high energy content of the individual photons

produces a greater concentration of energy at the points where they are absorbed
within individual atoms.

Total Energy

The total energy imparted to a body by an x-ray beam is determined by the

energy fluence (concentration) and the size of the exposed area. If the radiation is
uniformly distributed over the area, the total energy delivered is the product of the
fluence and the surface area.

Sun

X-ray Tube
5 Minute Exposure

□ Energy
4.5 mJ/cm? ^30,000mJ/cm2

Figure 3-7 Comparison of Energy Delivered by an X-Ray Beam and Sunlight

46 Physical Principles of Medical Imaging

ABSORBED DOSE

Concept

A human body absorbs most of the radiation energy delivered to it. The portion
of x-ray beam that is absorbed depends on the
an penetrating ability of the radia¬
tion and the size and density of the body section exposed. In most clinical situa¬
tions more than 90% is absorbed. In nuclear imaging procedures, a large percent¬
age of the energy emitted by radionuclides is absorbed in the body. Two aspects of
the absorbed radiation energy must be considered: the amount (concentration) ab¬
sorbed at various locations throughout the body and the total amount absorbed.
Absorbed dose is thequantity that expresses the concentration of radiation en¬
ergy absorbed at a specific point within the body tissue. Since an x-ray beam is
attenuated by absorption as it passes through the body, all tissues within the beam
will not absorb the same dose. The absorbed dose will be much greater for the
tissues near the entrance surface than for those deeper within the body. Absorbed
dose is defined as the quantity of radiation energy absorbed per unit mass of tissue.

Units

The conventional unit for absorbed dose is the rad, which is equivalent to 100
ergs of absorbed energy per g of tissue. The SI unit is the gray (Gy), which is
equivalent to the absorption of 1 J of radiation energy per kg of tissue. The rela¬
tionship between the two units is

1 rad =100 erg/g = 0.01 J/kg = 0.01 Gy

1 Gy = 100 rad.

For specific type of tissue and photon energy spectrum, the absorbed dose is
a

proportional to the exposure delivered to the tissue. The ratio, f, between dose
(rads) and exposure (roentgens) is shown in Figure 3-8 for soft tissue and bone
over the photon energy range normally encountered in diagnostic procedures. The

absorbed dose in soft tissue is slightly less than 1 rad/R of exposure throughout the

photon energy range. The relationship for bone undergoes a considerable variation
with photon energy. For a typical diagnostic x-ray spectrum, a bone exposure of
1 R will produce an absorbed dose of approximately 3 rad.

Integral Dose

Integral dose is the total amount of energy absorbed in the body. It is deter¬
mined not only by the absorbed dose values but also by the total mass of tissue
exposed.
 Radiation Quantities and Units 47

The conventional unit for integral dose is the gram-rad, which is equivalent to
100 ergs of absorbed energy. The
concept behind the use of this unit is that if we
add the absorbed doses (rads) for each gram of tissue in the
body, we will have an
indication of total absorbed energy. Since integral dose is a quantity of energy, the
SI unit used is the joule. The relationship between the two units is
1 J = 1,000 gram-rad.

Integral dose (total absorbed radiation energy) is probably the radiation quan¬
tity that most closely correlates with potential radiation damage during a diagnos¬
tic procedure. This is because it reflects not only the concentration of the radiation
absorbed in the tissue but also the amount of tissue affected by the radiation.

20 40 60 80 100 120 140

Photon Energy (keV)

Figure 3-8 Relationship of Absorbed Dose to Exposure

48 Physical Principles of Medical Imaging

There is no practical method for measuring integral dose in the human body.
However, since most of the radiation energy delivered to a body is absorbed, the
integral dose can be estimated to within a few percent from the total energy deliv¬
ered to the body.
Computed tomography can be used to demonstrate integral dose, as illustrated
in Figure 3-9. We begin with a one-slice examination and assume that the average
dose to the tissue in the slice is 5 rad. If there are 400 g of tissue in the slice, the
integral dose will be 2,000 gram-rad. If we now perform an examination of 10
slices, but all other factors remain the same, the dose (energy concentration) in
each slice will remain the same. However, the integral dose (total energy) in¬
creases in proportion to the number of slices and is now 20,000 gram-rad. In this

example we made the simplifying assumption that no radiation is scattered from

one slice to another. In reality, some radiation is exchanged between contiguous

slices but that does not affect the concept presented.

BIOLOGICAL IMPACT

It is sometimes desirable to express the actual or relative biological impact of

radiation. It is necessary to develop a distinction between the biological impact
and the physical quantity of radiation because all types of radiation do not have the
same potential for producing biological change. For example, one rad of one type
of radiation might produce significantly more radiation damage than one rad of
another type. In other words, the biological impact is determined by both the quan-

■Integral Dose = 2000 gm-rads

Integral Dose = 20,000 gm-rads

Figure 3-9 Integral Dose in Computed Tomography

 Radiation Quantities and Units 49

tity of radiation and its ability to produce biological effects. Two radiation quanti¬
ties are associated with
biological impact.

Dose Equivalent
Dose equivalent (H) is the
quantity commonly used to express the biological
impact of radiation on persons receiving occupational or environmental expo¬
sures. Personnel
exposure in a clinical facility is often determined and recorded as
a dose
equivalent.
Dose equivalent is proportional to the absorbed dose
(D), the quality factor (Q),
and other modifying factors (N) of the specific
type of radiation. Most radiations
encountered in diagnostic procedures (x-ray, gamma, and beta) have
quality and
modifying factor values of 1. Therefore, the dose equivalent is numerically equal
to the absorbed dose. Some radiation
types consisting of large (relative to elec¬
trons) particles have quality factor values greater than 1. For example, alpha par¬
ticles have a quality factor value of approximately 20.
The conventional unit for dose equivalent is the rem, and the SI unit is the
sievert (Sv). When the quality factor is 1, the different
relationships between dose
equivalent (H) and absorbed dose (D) are

H(rem) = D(rad)
H(Sv) = D(Gy).
Dose equivalent values can be converted from one system of units to the other by:
1 Sv = 100 rem.

Figure 3-10 is a summary of the general relationship among the three quantities:
exposure, absorbed dose, and dose equivalent. Although each expresses a differ¬
ent aspect of radiation, they all express radiation concentration. For the
types of
radiation used in diagnostic procedures, the factors that relate the three quantities
have values of approximately 1 in soft tissue. Therefore, an exposure of 1 R pro¬
duces an absorbed dose of approximately 1 rad, which, in turn, produces a dose
equivalent of 1 rem.

Relative Biological Effectiveness

When specific radiation effects rather than general risk are being considered,
the relative biological effectiveness (RBE) of the radiation must be taken into ac¬
count. The value of the RBE depends on characteristics of the radiation and the

specific biological effects being considered. This radiation characteristic is gener¬

ally not used in association with diagnostic procedures. Additional discussions of
the concept can be found in radiation biology texts.
50 Physical Principles of Medical Imaging

Exposure

Absorbed Dose
(Energy Concentration)
1 rad = 100 ergs/gram
1 gray = 1 joule/kilogram
1 gray = 100 rad

Dose Equivalent
(Biological Impact)
1 rem = 10 mSv

Q Dose Equivalent
Exposure —— Absorbed Dose ■

(0 93-0 96 ID'
1 R 1 rad (10 mGy)
-

1 rem (10 mSv)

diagnostic quality X and gamma in soft tissue

Figure 3-10 Relationship of Exposure, Absorbed Dose, and Dose Equivalent

LIGHT

The basic light quantities and units encountered in radiology can be conven¬
iently divided into two categories: those that express the amount of light emitted
by a source and those that describe the amount of light falling on a surface, such as
a piece of film. The relationships of several light quantities and units are shown in

Figure 3-11.

Luminance

Luminance is thelight quantity generally referred to as brightness. It describes

the amount of light being emitted from the surface of the light source. The basic
unit of luminance (brightness) is the nit, which is equivalent to 1 candela
per m2 of
source area.

The conceptof luminance is somewhat easier to understand if it is related to the

number of light photons involved. The quantity for specifying an amount of light
is the lumen. One lumen of light with wavelengths encountered in
x-ray imaging
systems (540 nm) is equivalent to 3.8 x 1015 photons per second. Another factor
that determines luminance is the concentration of light in a given direction. This
can be described in terms of a cone or solid
angle that is measured in units of
steradians (sr).
 Radiation Quantities and Units 51

LUMINANCE ILLUMINANCE
(Brightness)

I nit B I candelo /m* I lux « I lumen/ m*

I candela « I lumen / steradian I footcandle ■ 10.764 lux
I lumen ■ 3.8x10'" photons/sec (at 540nm)
I footlambert = 3.426 nits

Figure 3-11 Light Quantities and Units Encountered in Radiology

If a light source produces an intensity of 1 cd/m2 of surface area, it has a lumi¬

nance of 1 nit. Perhaps it is more realistic to consider the quantity of light that
would be emitted from a 1-mm2 area of a source, such as the output screen of an
image intensifier. One millimeter square is 10-6 m2. If the intensifier has a lumi¬
nance (brightness) of 1 nit, the
intensity from an area of 1 mm2 would be 1CH
lumen in a 1-unit solid angle. This would be equivalent to 3.8 x 109 photons per
second, leaving the 1-mm2 area through a cone (solid angle) of 1 sr.
Another unit used for specifying luminance is the foot-lambert, which is
equivalent to 3.426 nits.
Viewbox brightness is measured in the units of nits. It is generally in the range
of 1,500 nits to 2,000 nits for most image viewing except
mammography where it
should be at least 3,500 nits.

Illuminance

Illuminance is a specification of the quantity of light falling on or illuminating a

surface. The basic unit is the lux. A surface has an illuminance of 1 lux when it
receives 1 lumen/m2 of surface area.Consider a small area on a piece of film that
is 1 mm2. Forlight with a wavelength of 540 nm, there are 3.8 x 1015 photons per
second per lumen. An illuminance to the film of 1 lux would be equivalent to
3.8 x 109 photons per sec to a 1-mm2 area. The total light exposure to a film is
52 Physical Principles of Medical Imaging

found by multiplying the illuminance, in lux, by the exposure time, in seconds,

and isexpressed in units of lux-seconds.
Another unit used in some literature for specifying illuminance is the foot-
candle, which is equivalent to 10.764 lux.

RADIO FREQUENCY RADIATION

Radiofrequency (RF) radiation is used in magnetic resonance imaging (MRI).

During an imaging procedure, pulses of RF energy are applied to the patient's
body where most of it is absorbed. Conventional energy units are used to express
the amount of RF energy imparted to the body.
Power is the rate at which energy is transferred. The unit for power is the watt,
which is equivalent to an energy transfer at the rate of 1 joule/second. During the

acquisition phase of MRI, the system transfers energy to the patient's body at
some specific power level. The actual power (watts) used depends on many fac¬

tors associated with the examination.

From the standpoint of effect on the patient's body a more significant quantity
is the concentration of power in the tissue. This is expressed in the units of watts
per kilogram of tissue and is designated the specific absorption rate (SAR). Since
RF energy is not uniformly distributed within the body, two quantities must be
considered: the SAR in a specific location and the average SAR within the total

body. The RF energy absorbed by the tissue is converted into heat. Therefore, the
power concentration is an indication of the rate at which heat is produced within
specific tissue.
 Chapter 4
Characteristics and Structure
of Matter

INTRODUCTION AND OVERVIEW

Radiation is created and then later absorbed within some material substance or

matter. Certain materials are more suitable than others as both radiation sources

and absorbers. In this chapter we consider some basic physical characteristics of

matter that determine how the materials interact with radiation. Radiation interac¬
tions, both formation and absorption, occur within individual atoms. We therefore
begin with a brief review of atomic structure with an emphasis on atomic charac¬
teristics that affect interactions. We then discuss the collective properties of atoms
within a material.
Atoms consist of two major regions: the nucleus and the electron shells. Each
region has role in radiation interactions. The nucleus is the source of energy for
a
the radiations used in nuclear medicine procedures. Although the nucleus is not
the source of x-ray energy, it is involved in the production of x-ray photons. In
most instances radiation is absorbed by interacting with the electrons located in

the shells surrounding the nucleus. Transitions in the shell electrons also produce
one form of x-radiation.

NUCLEAR STRUCTURE

The conventional model of an atom consists of a nucleus containing neutrons

and protons surrounded by electrons located in specific orbits or shells, as shown
in Figure 4-1. The nucleus is shown as a ball or cluster of particles at the center of
the atom. The nucleus is quite small in comparison to the total dimensions of the
atom. However, most of the mass of the atom is contained within the nucleus. The
components of the atom in Figure 4-1 are not drawn to scale. Actually, the elec¬
trons in the K, L, and M shells are much smaller than the protons and neutrons that

make up the nucleus, and the electrons are located at a much greater distance from
the nucleus than shown.

53
54 Physical Principles of Medical Imaging

Nucleus

Electron Shells

Figure 4-1 Structure of an Atom

Composition
All nuclei are composed of two basic particles, neutrons and protons. Neutrons
and protons are almost the same size but differ in their electrical charge. Neutrons
have no electrical charge and contribute only mass to the nucleus. Each proton has
a positive charge equal in strength to the negative charge carried by an electron.
Most physical and chemical characteristics of a substance relate to the nuclei's

neutron-proton composition. The number of protons in a nucleus is the atomic

number (Z) and establishes the chemical identity of the atom. Each atomic number
corresponds to a different chemical element; there are now approximately 106
known chemical elements that correspond to nuclei containing from 1 to 106 pro¬
tons.

Because of their very small size it is not convenient to express the mass of
nuclei and atomic particles in the conventional unit of kilograms. A more appro¬
priate unit is the atomic mass unit (amu), the reference for which is a carbon atom
 Characteristics and Structure of Matter 55

with a mass number of 12, which is assigned a mass of 12.000 amu. The relation¬
ship between the atomic mass unit and kilogram is
1 amu = 1.66 x 10-27 kg.
The difference in mass between a neutron and proton is quite small: approxi¬
mately 0.1%. The larger difference is between the mass of these two particles and
the mass of an electron. More than 1,800 electrons are required to equal the mass
of a proton or neutron.

The total number of particles (neutrons and protons) in a nucleus is the mass
number (A). Since neutrons and protons have approximately the same mass, the
total mass or weight of a nucleus is, within certain limits, proportional to the mass
number. However, the nuclear mass is not precisely proportional to the mass num¬
ber because neutrons and protons do not have the same mass, and some of the
mass is converted into energy when the nucleus is formed. The relationship be¬

tween mass and energy is considered in more detail later.

There is a standard method for labeling different nuclear compositions: The
mass number is designated by either a superscript preceding the chemical symbol,

such as 14C or 131I, or by a number following the symbol, such as C-14,1-131, etc.
The atomic number is added as a subscript preceding the chemical symbol. Add¬

ing the atomic number to the symbol is somewhat redundant since only one atomic
number is associated with each chemical symbol or element.
With the exception of ordinary hydrogen, all nuclei contain neutrons and pro¬
tons. The lighter elements (with low atomic and mass numbers) contain almost

equal numbers of neutrons and protons. As the size of the nucleus is increased, the
ratio of neutrons to protons increases to a maximum of about 1.3 neutrons per

proton for materials with very high atomic numbers. The number of neutrons in a
specific nucleus can be obtained by subtracting the atomic number from the mass
number. One chemical element may have nuclei containing different numbers of
neutrons. This variation in neutron composition usually determines if a nucleus is

radioactive.

Nuclides

there are 106 different atomic numbers or elements. Since

As stated previously,
one element can numbers, there are obviously more
have several different neutron
than 106 different nuclear compositions. Actually, at least 1,300 different neutron-

proton combinations are now known. The term element refers to the classification
of a substance according to its atomic number, and the term nuclide refers to its
classification by both atomic number and number of neutrons. In other words,
whereas there are at least 106 different elements, there are about 1,300 different
nuclides known.
56 Physical Principles of Medical Imaging

The structuralrelationship of various nuclides is often shown on a grid gener¬

ally referred to as a nuclide chart, as shown in Figure 4-2. The scale in one direc¬
tion represents the number of protons (atomic number), and the scale in the other

21

20

19

18

17

18 r

15 ill n
14
i
13
z
QC
UJ n
12

H-
/
■
CD 11
^ 10 p!
Z 9
S>
>
Z
o
8 i IIIIMI mmmm

cr 7
/
p
I—
3 6
LU
^ 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

ATOMIC (PROTON) NUMBER

Figure 4-2 Chart of Nuclides Arranged According to the Neutron-Proton Composition of
the Nucleus
 Characteristics and Structure of Matter 57

direction represents the number of neutrons. Each

square in the grid represents a
specific nuclear composition or nuclide. Not all areas in the chart are occupied.
Many neutron-proton combinations represent unstable combinations and do not
exist as nuclei. The nuclides that do exist are located in a
relatively narrow band
that runs
diagonally up through the chart.
The charts in this text show only the first 16 elements because our immediate
interest is in the characteristics of the chart, and not the details of all elements.
Charts are published that show all known nuclides. Certain
relationships between
specific nuclides now need to be considered.

Isotopes
The nuclides of an element may contain different numbers of neutrons. Nu¬
clides that belong to the same chemical element (and have the same atomic num¬
ber) but have different numbers of neutrons are known
isotopes. It should be
as

emphasized that the term isotope describes a relationship between or among nu¬
clides rather than a specific characteristic of a given nuclide. An analogy is that

persons who have the same grandparents but not the same parents are known as
cousins. The isotopes of each element are located in the same vertical column of
the nuclide chart as shown in Figure 4-3.
There seems to be a general misconception that the term isotope means radioac¬
tive. This is obviously incorrect, since every nuclide is an isotope of some other
nuclide. Most elements have several isotopes. In most cases some of the isotopes
of a given element are stable (not radioactive), and some are radioactive. For ex¬

ample, iodine has 23 known isotopes with mass numbers ranging from 117 to 139.
Two of these, 1-127 and 1-131, are shown in Figure 4-4. The relationship between
the two nuclides is that they are isotopes. 1-131 is an isotope of 1-127, and 1-127 is
also an isotope of 1-131. For most elements the most common or most abundant
form is the stable isotope. The radioactive forms are therefore isotopes of the more
common forms, explaining the strong association isotopes have developed with

radioactivity.

Isobars

Nuclides having the same mass number (total number of neutrons and protons)
but different atomic numbers are known as isobars, as shown in Figure 4-5.1-131
and Xe-131 are isobars of each other. A
pair of isobars cannot belong to the same
chemical element. The relationship among isobars in the nuclide chart is illus¬
trated in Figure 4-3, showing aluminum-29, silicon-29, phosphorus-29, and sul-
fur-29.
Our major interest in isobars is that in most radioactive transformations one
nuclide will be transformed into an isobar of itself. For example, the 1-131 shown
58 Physical Principles of Medical Imaging

[Stable
H Radioactive

Isobars
Aluminum-29
Silicon -29
Phosphorus-29 n
Sulfur -29 w

Isotopes
Carbon -16
li
Carbon -15
<e Carbon -14
Carbon -13
<r Carbon -12
K- Carbon -11
ii ■Carbon -10
Carbon 9
m -

I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

ATOMIC (PROTON) NUMBER

Figure 4-3 Relationships among Isobars and Isotopes on a Nuclide Chart

in Figure 4-5 is radioactive and is converted into Xe-131 when it undergoes its
normal radioactive transformation.

Isomers

Nuclei can have the same neutron-proton composition but not be identical; one
nucleus can contain more energy than the other. Two nuclei that have the same
 Characteristics and Structure of Matter 59

131 127

Isotopes

53 Protons<—same -> 53 Protons

78 Neutrons 74 Neutrons
31 127
Figure 4-4 Comparison of Two Isotopes

131 131
Xe

Isobars

53 Protons 54 Protons
78 Neutrons 77 Neutrons

131 < -same > 131

Figure 4-5 Comparison of Two Isobars

composition but varying energy are known as isomers. An example of a pair of

isomers is shown in Figure 4-6. Technetium-99 can exist in two energy states; the

higher of the two is a temporary state generally referred to as a metastable state.

The symbol for a nuclide in the metastable state is obtained by adding the letter m
to the mass number (Tc-99m). A nucleus in the metastable state will eventually

give off its excess energy and change to the other isomer. Such isomeric transi¬
tions have an important role in nuclear medicine and are discussed in detail later.
60 Physical Principles of Medical Imaging

99 .

99 m
Tc

Isomers ^
U0

43 Protons
43 Protons
56 Neutrons 56 Neutrons

99 ■same 99

Figure 4-6 Comparison of Two Isomers

Isotones

Nuclides that have the same number of neutrons are known as isotones. This
relationship, mentioned here for the sake of completeness, is not normally encoun¬
tered in nuclear medicine.

NUCLEAR STABILITY

Theability of a nucleus to emit radiation energy is related to its level of stabil¬

ity. Figure 4-7 illustrates three levels of nuclear stability. A stable nucleus will not
undergo internal changes on its own. This is the condition of all non-radioactive
material. The radioactive nuclei are stable enough to remain unchanged for a pe¬
riod of time, but will spontaneously undergo a transformation in which they will
emit a burst of energy and become more stable; the second state is either a more
stable radioactive state or a completely stable state. Many hypothetical nuclear

compositions (neutron-proton mixtures) are completely unstable and cannot exist

as intact nuclei. As stated
previously, only about 1,300 different neutron-proton
combinations, found among the stable and radioactive nuclides, will stick together
as a nucleus.
Nuclear stability is determined by the balance of forces within the nucleus.
There are forces that
cause the nuclear particles (protons and neutrons) to be both

attracted to and repelled from each other. Since each proton carries a positive
electrical charge, protons repel each other. A short-range attraction force between
all particles is also present within nuclei.
 Characteristics and Structure of Matter 61

UNSTABLE

Figure 4-7 The Three Levels of Nuclear Stability

The most significant factor that determines the balance between the internal
forces and therefore the nuclear stability is the ratio of the number of neutrons to
the number of protons. For the smaller nuclei, a neutron-proton ratio of 1 to 1
62 Physical Principles of Medical Imaging

produces maximum stability. The ratio for stability gradually increases with in¬
creasing atomic number up to a value of approximately 1.3 to 1.0 for the highest
atomic numbers.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ATOMIC (PROTON) NUMBER
Figure 4-8 Nuclide Chart Showing the Relationship of Unstable Radioactive and Stable
Nuclear Structures
 Characteristics and Structure of Matter 63

If the neutron-proton
ratio is slightly above or below the ratio for stability, the
nucleus will generally be radioactive. Ratios considerably different from those
required for stability are not found in nuclei because they represent completely
unstable compositions. In an unstable
composition, the repelling forces override
the forces of attraction between the nuclear
particles.
The relationship between nuclear stability and
neutron-proton ratio is illustrated
in Figure 4-8. The stable nuclides, those with a
neutron-proton ratio of approxi¬
mately 1 to 1, are located in a narrow band running diagonally through the nuclide
chart. The radioactive nuclides are located on either side of the stable band. All
other areas on the nuclide chart represent neutron-proton mixtures that cannot ex¬
ist as a nuclei.

NUCLEAR ENERGY

Whenever a nucleus changes to a more stable form, it must emit energy. Several
types of nuclear changes can result in the release of energy. Under certain condi¬
tions a nucleus can,
by fission, break apart into more stable components. This
process takes place in nuclear reactors where the energy released is often used to
generate electrical energy. The fusion of two small nuclei to form a larger nucleus
is the process that creates energy within the sun and the hydrogen bomb. In
nuclear medicine, radiation energy is created when nuclei undergo spontaneous
radioactive transitions to create more stable nuclear structures.
The energy emitted during nuclear transitions is created by converting a small
fraction of the nuclear
mass into energy. When such a conversion takes place, the

relationship between the amount of energy (E) and the amount of mass (m) in¬
volved is given by Einstein's equation:

E = mc2,

where c is the
velocity of light. A significant aspect of this relationship is that a
tremendous amount of energy can be created from a relatively small mass. The
mass of 1 g, completely converted, would produce 25,000,000 kilowatt-hours.
In clinical applications we are interested in the amount of energy released by an
individual atom. This is expressed in the unit of kiloelectron volts (keV), a rela¬
tively small unit of energy. The relationship between some other energy units and
the keV are:

1 erg = 6.24 x 108 keV

1 j = 107 erg = 6.24 x 1015 keV.

The energy released in the radioactive transitions used in nuclear medicine is

typically in the range of 100 keV to 500 keV. This corresponds to a nuclear mass
64 Physical Principles of Medical Imaging

change of 0.0001 amu to 0.0005 amu. The amount of nuclear mass used to pro¬
duce the radiation energy is relatively small.
The energy equivalent of one electron mass is 511 keV. This value is often
referred to as the rest-mass energy of an electron. In some situations in nuclear
medicine procedures, the masses of individual electrons are completely converted
into energy. The result is a photon with the characteristic energy of 511 keV.

ELECTRONS

Electrons are located in orbits or shells in the space

surrounding a nucleus and
have several important roles in image formation. In certain types of radioactive
transitions, the orbital electrons become involved in the actual emission of energy
from the atom. When radiation interacts with materials, such as human tissue, the
interaction is usually with the electrons rather than the nuclei of the atoms.

Number

The number of electrons contained in a normal atom is equal to the number of

protons in the nucleus. This number is the atomic number (Z) of the particular
chemical element. Each electron has a negative electrical charge equivalent in

strength to the positive charge of a proton. Under normal conditions, when the
number of electrons and protons in an atom is the same, the positive and negative

charges balance so that the atom has no net charge. However, if an electron is
removed from an atom, the atom is said to be ionized and will have a positive

charge.

Energy Levels

Electrons located in discrete shells surrounding the nucleus, identified by

are

letters of the alphabet beginning with K for the shell closest to the nucleus as
shown in Figure 4-1. Each shell has a limited electron capacity. The maximum

capacity of the K shell in any atom is 2 electrons; the L shell, 8 electrons; the M
shell, 18 electrons; etc. The electron shells are generally filled beginning with the
K shell and extending out until the total number of electrons have been placed.
Electrons are bound to the positive nucleus of an atom by their negative electri¬
cal charge. The strength of this binding can be expressed in terms of energy. This

binding energy of an electron is equal to the amount of energy that would be re¬
quired to remove the electron from the atom. Binding energy is a form of electron
potential energy. As with any form of potential energy, some point must be desig¬
nated the zero energy level. In the case of electrons, a location outside the atom
 Characteristics and Structure of Matter 65

where the electron is no longer under the influence of the nucleus is

designated the
zero point. Consider a golf ball resting on the ground. For the golf ball, the ground
level would be the zero energy level. When an electron enters an atom, it
drops to
a lower
energy level, just as the golf ball does when it rolls into a hole. Electrons
within atoms are generally considered to have negative energy, since
energy from
some source must be added to raise them to the zero level. Likewise, the
golf ball
in the hole has negative energy with respect to the surface of the ground. It takes

energy from some source to lift it back to zero level.

The concept of electron energy levels can be illustrated by using an energy level

diagram of the type shown in Figure 4-9. It should be noticed that this diagram
represents the electrons as being down in a hole. The electrons near the bottom are
the lowest energy level and would have the greatest binding energy.
As discussed previously, the electrons are arranged within the atoms in definite

layers, or shells. Each shell is a different energy level. The K shell, which is clos¬
est to the nucleus, is at the lowest energy level. The diagram in Figure 4-9 is for

tungsten, which has an atomic number of 74. Only the K, L, and M electron levels
are shown. Additional electrons are located in the N and O shells. These shells
would be located above the M shell and slightly below the zero level. It should be
noticed that there is significant energy difference between the various shells. All
a

of the shells, except K, are subdivided into additional energy levels. For example,
the L shell is divided into three levels designated LI, LII, and LIII.
The roles of electrons in radiation events usually involve one of two basic prin¬

ciples: (1) Energy from some source is required to move an electron to a higher
shell (such as K to L) or out of the atom; (2) If an electron moves to a lower shell
(ie, L to K), energy must be given up by the electron and usually appears as some
type of radiation. The amount of energy involved depends on the difference in the
energy levels between which the electrons move.
The binding energy for electrons in a specific shell, such as K, is related to
atomic number as indicated in Figure 4-10. It should be noticed that only the
K-shell electrons for the higher atomic number elements have binding energies in
the same range as the energies of diagnostic gamma and x-ray photons. This is
significant in several types of interactions discussed later. The binding energy of
the L-shell electrons is always much less than for the K, but it also increases with
atomic number. For most substances, the binding energy of the outermost elec¬
trons is in the range of 5 eV to 20 eV. Obviously, these are the electrons that are

the easiest to remove from an atom.

The removal of an electron from an atom is called ionization. Since x-ray and
gamma photons have sufficient energy to remove electrons from atoms, they can
be considered ionizing radiation. Visible light, which has photon energies below
the minimum binding energy in most atoms, cannot produce ionization.
66 Physical Principles of Medical Imaging

Zero Energy Level

Figure 4-9 Energy Level Diagram of Electrons within the Tungsten Atom

K shell Binding Energy (keV)

0 10 20 30 40 50 60 70 80 90
, i
\
l
\ I
\
%
%
\xv\ '
O'
C>.

\%
-A
C
a
(O
(fl
r-f
■o
<0
<23
-J
I

I
CD

X 3

0 10 20 30 40
\

\\
50 60
Atomic Number-Z
70
,/
80 90

Figure 4-10 Relationship between K-Shell Binding Energy and Atomic Number

Concentration

Photons are absorbed whenthey collide with electrons. As a photon passes

through matter, its chances of being absorbed generally depend on the concentra-
 Characteristics and Structure of Matter 67

tion of available electrons within the material. The concentration, or number of

electrons per cubic centimeter, is given by

Electrons per cc = pN(Z/A).

Thisrelationship is the number of atoms per cubic centimeter multiplied by the
atomic number, which is the number of electrons per atom. Several comments

concerning this relationship are in order. Avogadro's number, N, always has the
same value and obviously does not change from element to element. Z and A have

unique values for each chemical element. It should be noticed, however, that the
number of electrons per cubic centimeter depends only on the ratio of Z to A. The
elements with lower atomic numbers have approximately one neutron for each
proton in the nucleus. The value of Z/A is approximately 0.5. As the atomic num¬
ber and atomic weight increase, the ratio of neutrons within the nucleus also in¬
creases. This produces a decrease in the Z/A ratio, but this
change is relatively
small. Lead, which has an atomic number of 82 and an atomic weight of 207, has
a Z/A ratio of 0.4. For most material encountered in x-ray
applications, the Z/A
ratio varies by less than 20%. The single exception to this is hydrogen. Normal
hydrogen contains no neutrons and has a nucleus that consists of a single proton.
The Z/A ratio, therefore, has a value of 1.
Since Avogadro's number is constant, and the Z/A ratio is essentially constant,
the only factor that can significantly alter the electron concentration is the density
of the material. Most materials, especially pure elements, have more or less unique
density values. In compounds and mixtures, the density depends on the relative
concentration of the various elements.
The fact that electron concentration does not significantly change with atomic
number might suggest that atomic number has little to do with electron-x-ray in¬
teractions. This is, however, not the case. As x-ray photons pass through matter,
the chance of interaction depends not only on electron concentration, but also on
how firmly the electrons are bound within the atomic structure. Certain types of
interactions occur only with firmly bound electrons. Since the binding energy of
electrons increases with atomic number, the concentration of highly bound elec¬
trons increases significantly with increased atomic number.

Atomic number is essentially a characteristic of the atom and has a value that is

unique to each chemical element. Many materials, such as human tissue, are not a
single chemical element, but a conglomerate of compounds and mixtures. With
respect to x-ray interactions, it is possible to define an effective atomic number,
Zeff, for compounds and mixtures. The effective atomic number is given by

Zeff= 294V f,Z, + f2Z22-94+ f3Z32-94+ —.

In this relationship, f is the fraction of the total number of electrons associated

with each element. The exponent, 2.94, is derived from the relationship between
x-ray interactions and atomic number, which is discussed later.
68 Physical Principles of Medical Imaging

a major component of the human body, can be used to demon¬

Water, which is
strate of effective atomic number. The water molecule contains two
the concept
hydrogen atoms, which have one electron each, and one oxygen atom with eight
electrons. The electron fractions, f, are therefore 0.2 for hydrogen and 0.8 for oxy¬

gen. Substitution of these values in the above relationship gives an effective

atomic number for water of

Z =294 V 0.2.12-94 + 0.8.82-94

=
7.42.

In many x-ray systems, a variety of materials are involved in x-ray interactions.

Many of these materials are listed in Table 4-1, along with their principal physical
characteristics and relationship to the x-ray system.

Table 4-1 Physical Characteristics of Materials Involved in Photon Interactions

K electron
Atomic number* binding energy Density
Material (Z) (keV) (g/cc) Application

Beryllium 4.0 1.85 Low absorbing tube window

Fat 5.92 0.91 Body tissue
Water 7.42 1.0 Tissue "equivalent"
Muscle 7.46 1.0 Body tissue
Air 7.64 0.00129
Aluminum 13.0 2.7 X-ray filter and penetration
reference
Bone (femur) 14.0 1.87 Body tissue
Calcium 20.0 1.55 Body deposits
Copper 29.0 8.9 8.94 X-ray filter
Molybdenum 42.0 20.0 10.22 X-ray source
Silver 47.0 25.5 10.5 Absorber in film
Iodine 53.0 33.2 4.94 Contrast medium and receptor
absorber
Xenon 54.0 34.5 0.0059 Receptor absorber
Barium 56.0 37.4 3.5 Contrast medium and receptor
absorber
Lanthanun 56.0 38.9 6.15 Receptor absorber
Gadolinium 64.0 50.2 7.95 Receptor absorber
Tungsten 74.0 69.5 19.3 X-ray source
Lead 82.0 88.0 11.34 X-ray absorber for shielding

*
Effective Z of tissues from Spiers (1946).
Source: Spiers FW: Effective atomic number and energy absorption in tissues. Br J Radiol 1946;19:218.
 Chapter 5

Radioactive Transitions

INTRODUCTION AND OVERVIEW

In the previous chapter we showed that certain nuclei are not completely stable
and eventually undergo an internal change that will produce a more stable nuclear
structure. This spontaneous change is a radioactive transition. In some older litera¬

ture this event is called a nuclear disintegration. The terminology is misleading

because the nucleus does not disintegrate; it simply undergoes a slight change.
This event is illustrated in Figure 5-1. The original nucleus is designated the par¬
ent, and the nucleus after the transition is designated the daughter. In radioactive
transitions, energy is emitted as radiation. The types of radiation encountered in
nuclear medicine are shown in Figure 5-1. The radiation is in the form of either

energetic particles or photons.

Most radionuclides emit a combination of radiations; the types depend on the

physical characteristics of the nucleus and are considered in more detail later. The
daughter nucleus can be either stable or a radioactive or metastable nucleus that
will undergo another transition in the future.
In most in-vivo nuclear medicine procedures it is desirable to use a radionuclide
that emits photons in the range of 100 to 500 keV. The penetrating ability of pho¬
tons is related to their energy. Many photons in this energy range can emanate

from the body, but not penetrate through the detector and be lost. Particle radiation
is not useful in most diagnostic procedures. In fact, it is usually undesirable be¬
cause it deposits its energy in the body close to the site of origin and can contribute

significantly to patient dose without contributing to diagnostic information. With

many radionuclides, particle radiation is a byproduct of the transition required for
desirable photon emissions.
It is often useful to construct a diagram to show changes in the nucleus and the
radiation emitted during a radioactive transition. A transition diagram, sometimes
referred to as a decay scheme, is shown in Figure 5-2. Two types of changes occur

69
70 Physical Principles of Medical Imaging

Radioactive Parent

Particles Photons

Beta (electron) Gamma

X- ray
Internal Conversion electron
Auger electron annihilation

Positron ^ *
zv >

Daughter
Figure 5-1 Various Radiations Produced by Radioactive Transitions

within a nucleus: loss of

energy and, possibly, a change in atomic number in an
isobaric transition. In the transition diagram, relative nuclear
energy is represented
by vertical distance and relative atomic number by horizontal distance. The actual
scales are not usually shown as they are in Figure 5-2. The position of the nucleus
before and after the transition is represented by horizontal lines in the
diagram. In
Figure 5-2 the image of a nucleus is resting on these lines. This is not generally
found in the conventional diagram but is here to help us follow the transition. The
steps in the transition are represented by lines running downward. The transition
always moves downward because the nucleus is decreasing its energy by emitting
radiation. If the atomic number changes (isobaric transition), the transition line
will slant to the right or left.
The vertical distance between the parent and daughter positions
represents the
total transition energy. This value is always specific for the transition associated
with each radioactive nuclide. But all nuclei of the same nuclide do not
necessarily
go from the parent to daughter state in the same way. The significance of this is
discussed in detail later.
 Radioactive Transitions 71

Radioactive Parent

Intermediate

It
Isobaric
j * r
V-
Transition
, > 'r- r y<
> * "V
JO*
e>
a:
tVv '> «S v '
UJ
z
UJ

UJ
> Isomeric
Transition

UJ »
Oi
.

o:
Daughter kv *>

if1*1 i *

*^><' r Akr*J
r

*<Y
ATOMIC NUMBER Z + l

Figure 5-2 Diagram Showing Radioactive Transition

ISOBARIC TRANSITIONS

Most radioactive transitions have several steps. For most radionuclides, the first
step is an isobaric transition usually followed by an isomeric transition and inter-
72 Physical Principles of Medical Imaging

actions with orbiting electrons. The three types of isobaric transitions of interest to
us are (1) beta emission, (2) positron emission, and (3) electron capture.
In nuclear stability, the neutron-proton ratio (N/P) is crucial. If it is too low or
too high, the nucleus will eventually rearrange itself into a more stable configura¬
tion. Beta radiation, which is the emission of energetic electrons, results when an
N/P ratio is too high for stability; positron emission or electron capture occurs
when it is too low for stability. These two conditions are represented by specific
areas of the nuclide chart shown in Figure 5-3. Beta emitters are above the stable

nuclides, and positron emitters and electron capture nuclides are below.

Beta Emission

A beta transition is illustrated in

Figure 5-4. We should recall that the nuclear
N/P is too high for stability. During the transition, this
condition is relieved by the
conversion of an internal neutron into a proton, accompanied by the emission,
from the nucleus, of an electron. The electron, or beta particle, has two functions
in this transition.
One function is to carry away from the nucleus a one-unit negative charge so
that a (no charge) can be converted into a proton with a one-unit positive
neutron

charge. A fundamental principle of physics is that electrical charge cannot be cre¬

ated or destroyed. The only way to change the charge on an object, such as a
nucleus, is to transfer electrons to or from the object. The emission of a beta par¬
ticle causes the number of protons, and therefore the atomic number, of the
nucleus to increase by one unit. Since the mass number, or total number of neu¬
trons and protons, is not changed, the transition is isobaric.

The second function of the electron is to carry off a portion of the energy given

up by the nucleus. The energy is carried as kinetic energy by the electron. But the
energy carried by a beta particle is usually less than the total transition energy
given up by the nucleus. The remaining portion is removed from the nucleus by
the emission of a very small particle known as a neutrino. In each transition, the
sum of the beta and neutrino
energy is equal to the transition energy for the nu¬
clide. Unlike the beta particle, the neutrino is very penetrating and carries the en¬

ergy out of the patient's body.

A typical energy spectrum for a beta-emitting nuclide is shown in Figure 5-5.
The maximum energy corresponds to the transition energy. This is the energy a
beta particle would have in the few instances no neutrino is emitted. The average

energy value indicates the radiation dose or energy deposited in the body by the
beta radiation. The shape of the beta energy spectrum varies from nuclide to nu¬
clide. The relationship between average energy and transition energy depends on
the value of the transition energy and the atomic number of the nuclide. For most
radionuclides encountered in nuclear medicine, the average beta energy is usually
between 25% and 30% of the maximum energy.
 Radioactive Transitions 73

ATOMIC (PROTON) NUMBER

Figure 5-3 Nuclide Chart Showing the Relationship between Radioactive and Stable Nu¬
clides

Positron Emission

Two types of transitions can occur when the nuclear N/P is too low for stability.
One is positron emission. A positron is a small particle that has essentially the
same mass as an electron but has a positive rather than negative electrical charge.

The nuclear transition resulting in the emission of a positron is illustrated in Figure

5-6. The transition energy is shared between the positron and a neutrino.
74 Physical Principles of Medical Imaging

Figure 5-4 Diagram of a Transition That Produces Beta Radiation

Figure 5-5 Spectrum of Beta Radiation Energy

 Radioactive Transitions 75

In this transition a proton is converted into a neutron as the positron particle is

formed. Since a neutron is heavier than
proton, energy is required for this con¬
a

version. The energy equivalent to the mass difference between a neutron and a
proton plus the energy equivalent of the positron mass is approximately 1.8 MeV.
This means that the total transition energy must be at least 1.8 MeV for positron
emission to occur.

The positron is the antiparticle of an electron and will enter an annihilation

reaction when the two particles meet. Since electrons are normally abundant in
material, positrons are annihilated soon after their emission. Positron emitters are
useful in nuclear medicine because of the radiation produced when the positron is
annihilated. The total masses of the positron and the electron are converted into
energy according to the relationship

E = mc2.

The energy produced is 1.022 MeV emitted as a pair of photons, each with an
energy of 511 keV. Therefore, the radiation from a positron-emitting material is
photons with a characteristic energy of 511 keV. The pair of photons leave the site
traveling in opposite directions. This is useful in imaging, because it allows the
annihilation site to be precisely determined.

Proton \

Transition
Energy

Z-l Z

Figure 5-6 Diagram of a Transition That Produces Positron Radiation

76 Physical Principles of Medical Imaging

Electron Capture

A nucleus can also relieve a low neutron-proton ratio by

capturing and absorb¬
ing anelectron from a shell. Since most electrons are captured from the K shell,
this process is sometimes referred to as K-capture. Capture from the L and M
shells is possible under some conditions, but does not occur so frequently as from
the K shell. The electron capture process is illustrated in Figure 5-7. When the

negative electron enters the nucleus, the positive charge of one proton is canceled
and the proton is converted into a neutron. This results in the reduction of the
atomic number by one unit. Since the mass number does not change, electron

capture is an isobaric transition. Electron capture often competes with positron

emission; if a nuclide is a positron emitter, some nuclei will emit positrons and
some will capture electrons. The ratio between the two processes is specific for

each nuclide.
In an electron capture
transition, radiation is not emitted directly from the
nucleus but results from changes within the electron shells. Electron capture cre¬
ates a vacancy in one shell, which is quickly filled by an electron from a higher

energy location. As the electron moves down to the K shell, it gives off an amount
of energy equivalent to the difference in the binding energy of the two levels. This

energy is emitted from the atom in either characteristic x-ray photons or Auger
electrons. Auger electrons are produced when the energy given up by the electron

/
/

S*eX^.

iVv A.'*

Figure 5-7 Diagram of a Transition That Produces Electron Capture

 Radioactive Transitions 77

filling the K-shell vacancy is transferred to another electron, knocking it out of its
shell. Most Auger electrons have relatively low energies.

Many radionuclides that undergo electron capture are used in nuclear medicine
because the energy of characteristic x-ray photons is ideal for in-vivo studies.

ISOMERIC TRANSITIONS

After a radioactive nucleusundergoes an isobaric transition (beta emission,

positron emission, orelectron capture), it usually contains too much energy to be
in its final stable or daughter state. Nuclei in these intermediate and final states are
isomers, since they have the same atomic and mass numbers. Nuclei in the inter¬
mediate state will undergo an isomeric transition by emitting energy and dropping
to the ground state.

Gamma Emission

In most isomeric transitions, a nucleus will emit its excess energy in the form of
a gamma photon. A gamma photon is a small unit of energy that travels with the
speed of light and has no mass; its most significant characteristic is its energy. The
photon energies useful for diagnostic procedures are generally in the range of 100
keV to 500 keV.
The energy of a gamma photon is determined by the difference in energy be¬
tween the intermediate and final states of the nucleus undergoing isomeric transi¬
tion. This difference is the same for all nuclei of a specific nuclide. However,
many nuclides have more than one intermediate state or energy level. When this is
the case, a radionuclide might emit gamma photons with several different ener¬

gies. This is illustrated in Figure 5-8.

The nuclide used in this illustration has two intermediate states or energy levels.
One has energy 500 keV above the daughter level, and the other is 300 keV
an

higher than the first. When there are several different intermediate energy levels, it
is common for some nuclei to go to one level and other nuclei to go to another
level during isobaric transition. This is usually indicated on the transition diagram
by showing the percentage of nuclei that go to each energy level. In the illustration
considered, 80% of the nuclei go directly to intermediate energy level number 1,
and 20% go directly to level number 2. The gamma photons are emitted when the
nuclei move from these intermediate energy levels down to the daughter nuclide
level.
Nuclei that have gone to a specific intermediate energy level might then go
directly to the daughter level or to a lower intermediate level. With this in mind we
can predict the gamma photon energy spectrum produced by our example nuclide.

The spectrum will consist of three discrete energies as shown in Figure 5-8. Sixty
 78 Physical Principles of Medical Imaging

percent of the parent nuclei will go to intermediate energy level number 1 and then
directly to the daughter level 800 keV below. Therefore, 60% of the transitions
will give rise to an 800-keV photon. Twenty percent of the nuclei that go to energy
level 1 will then go to intermediate level number 2 by emitting a 300-keV photon.

Forty percent of the nuclei will go through intermediate energy level number 2,
either directly from the parent or from intermediate level number 1. When these
nuclei drop to the daughter energy level, a 500-keV gamma photon will be emit¬
ted. It is the combination of different energy levels and different transition routes
that gives rise to the different energies in the typical gamma spectrum. For most
radionuclides, one or two gamma energies will account for the vast majority of
transitions.
For most nuclides, the time spent by the nucleus in the intermediate state is

extremely short and the isomeric transition appears to coincide with the isobaric
transition. In some nuclides, however, the nuclei remain in the intermediate state
for a longer time. In this
case, the intermediate state is referred to as a metastable
state. Metastable states are of particular interest in nuclear medicine because
they
make possible the separation of electron and photon radiation. In a
diagnostic pro¬
cedure it is undesirable to have electron radiation in the
body because it contrib¬
utes to radiation dosage but not to
image formation. By using a nuclide that has
already undergone an isobaric (electron-emitting) transition and is in a metastable
state, it is possible to have a radioactive material that emits only gamma radiation.

(20%)

200 400 600 800

Photon Energy (kev)

Figure 5-8 Relationship of Nuclear Energy Levels to the Energy Spectrum of Gamma
Photons
 Radioactive Transitions 79

Technetium-99m is a nuclide used in the metastable state. The parent

nuclide is
molybdenum, which undergoes isobaric transition to technetium-99 in the
an
metastable state. The technetium-99m will later undergo an isomeric transition to
technetium-99.

Internal Conversion

Under some conditions, the energy from an isomeric transition can be trans¬
ferred to an electron within the atom. This energy supplies the
binding energy and
expels the electron from the atom. This process is known as internal conversion
(IC) and is an alternative to gamma emission. In many nuclides, isomeric transi¬
tions produce gamma photons and IC electrons. When an electron is removed
from the atom by internal conversion, a vacancy is created. When the
vacancy is
filled by an electron from a higher energy level, energy must be emitted from the
atom as a characteristic x-ray photon or an Auger electron.
The various isobaric and isomeric transitions give rise to a
combination of both
photon and particulate radiations. The radiations encountered in clinical proce¬
dures are summarized in Figure 5-9. Nuclei with a high N/P generally produce
beta radiation; those with a low N/P produce either positrons or electron capture.
All transitions are usually followed by either gamma or internal conversion elec-

High Low
N/P N/P

Gamma
< A/

Figure 5-9 Composite Diagram Showing the Various Nuclear Transitions That Produce
Radiation
 80 Physical Principles of Medical Imaging

tron emission. Internal conversion and electron capture lead to x-ray or Auger
electron emission.

ALPHA EMISSION

Some radioactive materials emit alpha particles during their transformation. An

alpha particle consists of two neutrons and two protons. Because of their size and
electrical charge, alpha particles are not good penetrators and deposit their
energy
very close to their origin. Because of this, and the fact that alpha particles gener¬
ally have more energy than other radiation forms, significant tissue doses can re¬
sult from an alpha emitter within the body. Alpha emitters are
generally not used
in clinical medicine. An exception is radium, which is often used in
therapeutic
procedures. In these procedures the radium is contained in sealed metal capsules
that absorb alpha radiation and let gamma radiation
through to the tissue.
The transitions and principal radiations emitted by
many nuclides used in clini¬
cal medicine are shown in Table 5-1.

Table 5-1 Radionuclides Used in Nuclear Medicine

Energy
Element A Z T1/2 Transition Radiation Yield (keV)

Hydrogen 3 1 12.3 yr Beta Beta 1.0 57

Carbon 11 6 20.3 min Positron Positron 1.0 394
Annihilation 2.0 511

Nitrogen 13 7 10 min Positron Positron 1.0 488

Annihilation 2.0 511

Carbon 14 6 5730 yr Beta Beta 1.0 49

Oxygen 15 8 2 min Positron Positron 1.0 721

Annihilation 2.0 511
Fluorine 18 9 109 min Positron Positron 0.97 250
EC (3%) Annihilation 1.94 511
Chromium 51 24 27.7 d EC Gamma 0.10 320
Cobalt 57 27 270 d EC Gamma 0.86 122
Gamma 0.10 136
Iron 59 26 45 d Beta Beta 0.52 150
Beta 0.46 81
Gamma 0.55 1099
Gamma 0.44 1292
Gallium 67 31 78.1 hr EC Gamma 0.38 93
Gamma 0.24 185
Gamma 0.16 300
IC Electron 0.28 84
 Radioactive Transitions 81

Table 5-1 continued

Energy
Element A Z T1/2 Transition Radiation Yield (keV)

Zinc 69m 30 13.8 hr Isomeric Gamma 0.95 440

Selenium 75 34 120 d EC Gamma 0.16 121

Gamma 0.54 136
Gamma 0.57 265
Gamma 0.24 280
Gamma 0.12 400

Strontium 85 38 65.1 d EC Gamma 0.99 514

Strontium 87m 38 2.8 hr EC and Gamma 0.83 388

isomeric IC electron 0.14 372

Techne¬ 99m 43 6.0 hr Isomeric IC electron 0.09 119

tium Gamma 0.88 141

Indium 111 49 2.8 d EC Gamma 0.90 172

Gamma 0.94 247

Iodine 123 53 13 hr EC IC electron 0.13 127

Gamma 0.84 159

X-Ray 0.71 27

Iodine 125 53 60.2 d EC X-Ray 1.15 27

Iodine 131 53 8.0 d Beta Beta 0.90 192

Gamma 0.82 364
Gamma 0.07 637

Xenon 133 54 5.31 d Beta Beta 0.98 101

IC electron 0.53 45
Gamma 0.36 81

Ytterbium 169 70 32 d EC IC electron 0.47 108

IC electron 0.15 196
Gamma 0.45 63
Gamma 0.11 130
Gamma 0.17 177
Gamma 0.26 198

X-Ray 0.78 51

197 80 65 hr EC IC electron 0.56 64

Mercury
IC electron 0.19 75
Gamma 0.25 77

X-Ray 0.36 69

Gold 198 79 2.69 d Beta Beta 0.99 316

Gamma 0.96 412

Note: EC, electron capture; IC, internal conversion.

82 Physical Principles of Medical Imaging

PRODUCTION OF RADIONUCLIDES

Some radionuclides in nature but are generally not suitable for clinical
occur

studies. Most are made

by bombarding a nucleus with a particle such as a neutron
or a proton. Beta emitters are created by neutron bombardment, and
positron emit¬
ters and nuclides that undergo electron capture are created by bombardment with

positive particles such as protons. Neutrons can be obtained from nuclear reactors
or accelerators. Positive particles are obtained from accelerators,
usually cyclo¬
trons.
 Chapter 6

Radioactivity

INTRODUCTION AND OVERVIEW

One of the most important quantities associated with a sample or collection of

radioactive material is its activity. Activity is the rate at which the nuclei within
the sample undergo transitions and can be expressed in terms of the number of
transitions per second (tps). Two units are used: the becquerel
(Bq), equivalent to
1 tps, and the curie (Ci), equivalent to 3.7 x 1010
tps. The becquerel is an SI unit.
The curie was first introduced as the activity of 1 g of radium. However, it was
later discovered that the activity of 1 g of radium is not
exactly 1 Ci, although the
number of transitions per second per curie remains the same. Some useful conver¬
sions are

1 Ci = 3.7 x 1010 Bq
1 mCi = 37 MBq
1 MBq = 27 pCi.
The activity of
sample is related to two quantities used in clinical nuclear
a
medicine. These are illustrated in
Figure 6-1 and are (1) the number of radioactive
(untransformed) nuclei in the sample and (2) the elapsed time. Both relationships
involve the lifetime of the radioactive material. The lifetime is the time between
the formation of a radioactive nucleus and its radioactive transition.

RADIOACTIVE LIFETIME

A fundamental characteristic of radioactivity is that all nuclei, even of the same

radioactive nuclide, do not have the same lifetime. This is illustrated in
Figure 6-2.
There is no way to determine or predict the lifetime of a nucleus. However, we can
determine the average lifetime of the nuclei of a specific radioactive nuclide. The

average lifetime is a unique characteristic of each specific nuclide.

83
84 Physical Principles of Medical Imaging

Activity (A)
+

Figure 6-1 Relationship of Activity to Number of Nuclei and Elapsed Time

Formation

Time (hrs)

Figure 6-2 Variations in Lifetimes of Radioactive Nuclei

 Radioactivity 85

Half-Life

It isgenerally more useful to express the lifetime of a radioactive material in

terms of the half-life. T1/2, rather than the
average life, Ta. The half-life is the time
required for one-half of the nuclei to undergo transitions. The half-life is shorter
than the average life. The specific
relationship is
T1/2 = 0.693 Ta
or

Ta= 1.44 T1/2.

Since half-life is proportional to the
average life, the value is specific for each
radionuclide. The half-lives for many nuclides of interest are
given in Table 5-1 of
Chapter 5.

Transformation Constant (Decay Constant)

Another way to express the lifetime characteristic of a radioactive substance is
by means of the transformation constant, X, often referred to as the decay constant.
The transformation constant actually expresses the
probability that a nucleus will
undergo a transition in a stated period of time. In the example in Figure 6-2, the
value of the transformation constant is 0.115 per hour. This means that a nucleus
has a probability of 0.115 or an 11.5% chance of
undergoing a transition in 1 hour.
The value of the transformation constant is
inversely related to lifetime. The prob¬
ability of undergoing a transition in 1 hour is obviously much less for a radionu¬
clide with a long lifetime (half-life). The actual
relationship between the transfor¬
mation constant and lifetime is:

T
11/2
_

-
0.693 •

The number, 0.693, is the naturallogarithm of the number two, and frequently
appears in relationships involving half-life. The transformation constant X is the
reciprocal of the average life, Ta:
X=±.
Ta

We can summarize the lifetime characteristics of a radioactive substance: The

lifetimes of nuclei within a sample vary tremendously. For a specific radioactive
substance or nuclide, however, a characteristic lifetime can be expressed in terms
of half-life, average life, or the transformation constant. If the value for one term is
known, the others can be derived using the simple relationships above.
86 Physical Principles of Medical Imaging

Quantity of Radioactive Material

Although activity does not express the amount of radioactive material present,
it isproportional to the amount present at a specific time. The amount can be
expressed by quantities such as mass, volume, or number of nuclei. We now con¬
sider the relationship of activity and the number of nuclei, N, in a specific sample.
We have just seen that transitions are spread over a longer time for some nu¬
clides than for others. In other words, for a given number of radioactive nuclei, the
rate of transition (activity) is inversely related to the lifetime of the nuclide. The

transformation constant, X, can be used to relate the activity to the number of

nuclei in a sample. When applied to a large number of nuclei, the value of the
transformation constant represents the fraction or percentage of the nuclei that will
undergo a transition during one unit of time. Suppose we have a sample containing
one million radioactive nuclei and the transformation constant has a value of 0.001
per second.
Activity = JixN
=
(0.00 l/s)(l,000,000)
=
1,000 transitions/second.

We should emphasize the difference between activity and amount of radio¬

active material, or number of nuclei. Both quantities are important when using
radionuclides for clinical purposes. The amount of radioactive material is the

quantity of radioactive nuclei or atoms in a sample, whereas the activity is the rate
at which they are undergoing transitions and emitting radiation. Although activity

is proportional to the number of nuclei, the proportion varies from one nuclide to
another depending on its lifetime. From the relationships above, it can be seen that
for a given quantity of radioactive material, activity is inversely related to half-
life:

Activity = .693 x JlL_

T./2

Number of nuclei = 1.44 x Activity x T\a.

A relatively small amount of radioactive material can have the same activity as a
larger amount if the smaller quantity has a shorter lifetime (half-life).

Cumulated Activity
Thequantity of radioactive nuclei that undergo transitions in a period of time is
usually designated the cumulated activity, A, and is expressed in the units of
microcurie-hours. 1 pCi-hr is equivalent to 133 million (13.3 x 107) transitions.
 Radioactivity 87

The relationship between cumulated activity, A, and the initial activity of a collec¬
tion of radioactive material, A, is

A (pCi-hr) = 1.44 x A (pCI) x Ti/2(hr).

The quality of nuclear radiation images is generally related to activity, whereas

patient dose is more dependent on the amount of radioactive material or cumu¬
lated activity. Therefore, the "ratio" of image quality to patient dose is inversely

proportional to radionuclide lifetime (half-life); a radionuclide with a short half-

life yields more activity from less radioactive material and is generally desirable
for clinical studies. The relationship of patient dose to half-life (and other factors)
is explored in a later chapter.

ACTIVITY AND TIME

One of the most important characteristics of a radioactive material is that the

quantity and activity constantly change with time. As each nucleus undergoes
transition, it no longer belongs to the radioactive material. In each transition one
atom is removed from the parent radioactive material and converted into the

daughter product. Because the activity is proportional to the quantity of radioac¬

tive material at any instant in time, both quantity and activity decrease continu¬
ously with elapsed time. This decrease is generally referred to as radioactive de¬
cay.
The nature of radioactive decay is such that during a given time interval the
same percent) of radioactive nuclei will undergo transitions. The im¬
fraction (or
portant point is that the fraction (but not the amount) per unit time remains con¬
stant. The fraction of nuclei that undergo transitions in a specified time period is

different for each nuclide and depends on the nuclide lifetime (transformation
constant or half-life). This characteristic of radioactive decay is illustrated in Fig¬
ure 6-3.
Let us assume that we have a radioactive material with a transformation con¬
stant hour. This means that approximately one-tenth of the nuclei will
of 0.1 per
undergo transitions during a 1-hour time interval. If we begin with 100 units of
radioactive material, 10 units will undergo transition during the first hour. At the
beginning of the second hour there will be 90 units of material. During the second
hour, one-tenth of 90 units will undergo transition which results in 81 units re¬
maining at the end of the second hour. The relationship between amount of radio¬
activity and time is not linear, but is exponential. This relationship is encountered
when the fraction of material undergoing change remains constant, but the amount
decreases with time.
88 Physical Principles of Medical Imaging

i 1 1 1 1 1 1 1 " ' «"

01 23456789 10
Elapsed Time (hrs)

Figure 6-3 Relationship between Amount of Radioactive Material and Elapsed Time

Remaining Fraction and Half-Life

It is often necessary to determine the fraction of radioactive material (or activ¬

ity) that remains after a specific elapsed time. If the elapsed time is one half-life,
the remaining fraction, f, is always 0.5 . If the elapsed time is not one half-life, the

remaining fraction is the fraction 0.5 multiplied by itself the number of times cor¬
responding to the number of half-lives. For example,
1 half-life, f = 0.5
2 half-lives, f = (0.5) x (0.5) = 0.25
3 half-lives, f= (0.5) x (0.5) x (0.5) = 0.125
4 half-lives, f = (0.5) x (0.5) x (0.5) x (0.5) = 0.0625.

This can be expressed as

f=(0.5),/r = (0.5)n
where t is the elapsed time, T is the half-life, and n is the number of half-lives.
When the elapsed time is an integral number of half-lives, the remaining fraction
can be easily calculated. If the elapsed time is not an integral number of half-lives,

the computation requires a calculator that can perform exponential functions or a

special mathematical table. Table 6-1 gives the remaining fractions for several
elapsed time intervals expressed in terms of the number of half-lives.
 Radioactivity 89

Let us see how this table can be used to find the activity remaining after some
elapsed time. Assume you have 100 pCi of a radioactive nuclide with a half-life of
6 hours. How much activity will remain after 33 hours? The first step is to express
the elapsed time in terms of half-lives:

n = 33 hr/6 hr = 5.5.

The remaining fraction is

f= (0.5)5-5 .

The value of this is obtained from Table 6-1 and is

f= 0.022 (2.2%).

Therefore, if we started with 100 pCi, 2.2 pCi would remain after an elapsed time
of 33 hours.

Table 6-1 Tabulation of Remaining Fraction (f) After an Elapsed Time of n Half-Lives

n f n f
n f

1.25 0.42 2.5 0.175

0.0 1.0
1.3 0.41 2.55 0.17
0.05 0.97
1.35 0.39 2.6 0.165
0.1 0.93
1.4 0.38 2.65 0.16
0.15 0.90
0.37 2.7 0.15
0.2 0.87 1.45
0.35 2.75 0.145
0.25 0.84 1.5
0.34 2.8 0.14
0.3 0.81 1.55
0.33 2.85 0.135
0.35 0.78 1.6
0.32 2.9 0.13
0.4 0.76 1.65
0.31 2.95 0.129
0.45 0.73 1.7
0.3 3.0 0.125
0.5 0.71 1.75
0.29 3.5 0.088
0.55 0.68 1.8
0.28 4.0 0.063
0.6 0.66 1.85
0.27 4.5 0.044
0.65 0.64 1.9
0.26 5.0 0.031
0.7 0.62 1.95
2.0 0.25 5.5 0.022
0.75 0.59
0.24 6.0 0.016
0.8 0.57 2.05
0.23 6.5 0.011
0.85 0.55 2.1
0.225 7.0 0.008
0.54 2.15
0.9
2.2 0.22 7.5 0.006
0.95 0.52
2.25 0.21 8.0 0.004
1.0 0.50
2.3 0.2 8.5 0.003
1.05 0.48
2.35 0.195 9.0 0.002
1.1 0.47
2.4 0.19 9.5 0.0014
1.15 0.45
2.45 0.18 10.0 0.001
1.2 0.44
90 Physical Principles of Medical Imaging

Another expression relating remaining fraction to elapsed time is

f= e_?lt
where X is the transformation constant and t is the elapsed time expressed in the
same time units(hours, days, etc.) as the transformation constant. To determine
the remaining fraction from this expression also requires a calculator that can per¬
form exponential functions or special exponential tables.

RADIOACTIVE EQUILIBRIUM

We have considered fixed quantities of radioactive material that decay with

elapsed time. If the radioactive material is being formed or replenished during the
decay process, however, the relationship between activity and elapsed time is
quite different from a simple exponential decay. The form of this relationship de¬
pends on the relationship of the rate of formation to the rate of decay. If we began
by forming radioactive material, we would expect the activity to increase with
elapsed time as illustrated in Figure 6-4. As the amount of radioactive material
(and activity) increases, however, the rate of loss of material by radioactive transi¬
tions also increases.
Consider filling a bucket with a hole in it. As the water level rises in the bucket,
the rate at which water flows out of the hole also increases. The water will usually

Formation
^4 Equilibrium
Level

V Radioactive
Transitions

Figure 6-4 Concept of Equilibrium

 Radioactivity 91

reach a level at which the rate of loss is

equal to the rate of filling, and the water
level will remain constant. This could be described as a state of
equilibrium be¬
tween the rate of
filling and rate of loss. The same process occurs with radioactive
material. As the amount of material or
activity builds up, the rate of loss by radio¬
active transitions can, under certain conditions, become the same as the rate of
formation, and a state of equilibrium will be established. When the radioactive
material being formed is the daughter of a radioactive parent, as illustrated in Fig¬
ure 6-5, the type of
activity-time relationship depends on the relationship of the
two half-lives. If the half-life of the
parent is shorter, no state of equilibrium will
be reached. If the half-life of the parent is longer, and
long enough that there is no
noticeable decay during the time interval of interest, a condition of secular equilib¬
rium will be reached. If the parent half-life is longer, but short
enough so that there
is a noticeable decay of the parent during the time interval of interest, a condition
of transient equilibrium will be reached.
When a state of equilibrium is reached, the activity of the radioactive daughter
is determined by the activity of the parent.

Secular Equilibrium
Assume that the radioactive material is forming at an almost constant rate. If, at
the beginning, no radioactive daughter material is present, no nuclei will be under¬
going transition. As soon as the radioactive material begins to accumulate, transi¬
tions will begin and some radioactive nuclei will be lost. As the number of radio¬
active nuclei increases, the activity and rate of loss increase. Initially, the rate of
loss is much less than the rate of formation. As the quantity of radioactive material

Parent Daughter

'f Parent
^^Transformation
Formation
of Daughter
Transformation

Figure 6-5 Factors Affecting Build-up of Daughter Activity

92 Physical Principles of Medical Imaging

builds, the activity or transition rate increases until it is equal to the rate of forma¬
tion as shown in Figure 6-6. In other words, radioactive nuclei undergo transitions
at exactly the same rate they are forming, and a condition of equilibrium is estab¬
lished. The amount of radioactive material will then remain constant regardless of
elapsed time. Under this condition, the activity is equal to the rate of formation and
is referred to as the saturation activity. The important point is that the maximum
activity of a radioactive material is determined by the rate (nuclei per second) at
which the material is being formed. Although it is true that the activity gradually
builds with time, a point is reached at which build-up stops and the activity re¬
mains at the saturation level.
The time required to reach a specific activity depends on the half-life of the
material being formed (daughter). After n half-lives the activity will be some frac¬
tion, f, of the rate of formation or saturation activity. The relationship is

Activity values after a specific elapsed time can be obtained for this relationship
by using Table 6-1 to find the value of (l/2)n. It should be observed that the build¬
up of radioactivity is a mirror image of radioactive decay. Just as a radioactive
material never decays to zero activity (at least theoretically), radioactive build-up
never practical purposes, saturation is reached in
reaches saturation. However, for
approximately 5 half-lives when the activity is more than 96% of the saturation
value.
activity reaches the saturation value it remains constant and is in a
After the
state of secularequilibrium. This occurs when the rate of formation does not
change during the time period of interest because either the parent material has a
very long half-life or the radioactive material is forming at a constant rate by an¬
other means such as a cyclotron or nuclear reactor.

Transient Equilibrium

When the half-life of the parentis only a few times greater than the half-life of
the daughter, the condition of transient equilibrium will occur. During the period
of interest the parent will undergo radioactive decay. Daughter activity will build
and establish a state of equilibrium with the parent activity. Transient equilibrium
differs from secular equilibrium in two respects.
First, the equilibrium or saturation activity of the daughter, Ad, is not equal to
the activity of the parent, AP. The relationship is

Tp
Ad — Ap
Tp—Td
 Radioactivity 93

Elapsed Time (half-lives)

Figure 6-6 Build-up of Activity to Saturation Level during Transient Equilibrium

When the half-life of the parent, TP, is much greater than that of the daughter, Td,
the term (TP/TP-Td) approaches a value of one, and daughter activity approaches
parent activity, as in secular equilibrium. However, as daughter and parent half-
lives become closer, this term becomes greater than one, which means that daugh¬
ter activity is actually greater than parent activity under equilibrium conditions.

The ratio of daughter to parent activity becomes greater as the half-lives become
closer.
Second, with transient equilibrium the equilibrium activity of the daughter
changes with time because the parent activity is changing. The relationship of
parent and daughter activity for a transient condition is shown in Figure 6-7. After
the condition of equilibrium is reached, the daughter appears to decay with the
half-life of the parent.
Technetium-99m and molybdenum-99 are good examples of transient equilib¬
rium. Technetium-99m is obtained from a generator that contains molybdenum-
99. The molybdenum-99 undergoes an isobaric transition into technetium-99m
(86%) and technetium-99 (14%). The technetium-99m is radioactive with a half-
life of 6 hours. Molybdenum-99 has a half-life of approximately 67 hours. The
relationship between technetium and molybdenum activity in a typical generator
 94 Physical Principles of Medical Imaging

Figure 6-7 Transient Equilibrium

is shown in Figure 6-8. In this example it is assumed that all technetium is re¬
moved from the generator every 24 hours.
If all molybdenum nuclei changed into technetium-99m
nuclei, the saturation
activity would be
ATc = A»
t
T"
mo 1 Tc

—1.1 Amo.

However, since only about 86% of the molybdenum-99 goes to technetium-99m,

the saturation
activity of technetium-99m will be only about 95% of the molybde-
num-99 activity. In a 24-hour period (4 half-lives), the activity of technetium-
99m will be approximately 94% of the saturation activity value. This would be
only 84% of the molybdenum activity at that particular time.
 Radioactivity 95

>- .5 _

Elapsed Time (days)

Figure 6-8 Molybdenum and Technetium Activity in a Generator

Radioactive Biologic
Decay Elimination

Tp = 5 hr Tk = 3hr

Effective Half-life
TpTb
(Te) = = l.9hr
Tp+Tb

T
2 3
Time (hours)

Figure 6-9 Relationship of Effective Lifetime to Rates of Radioactive Decay and

Biological Elimination
96 Physical Principles of Medical Imaging

EFFECTIVE LIFETIME

When a a living organism, the material can be re¬

radioactive material is in
moved from particular organ or location by two mechanisms, as illustrated in
a

Figure 6-9. One is the normal radioactive decay, and the other is biological trans¬
port or elimination from the specific site.
Half-life values can be used to express the rate of removal by both mechanisms.
The half-life associated with normal radioactive decay is generally designated the

physical half-life and has a characteristic value for each radionuclide. The rate of
biological removal can generally be expressed in terms of the biological half-life.
The value of the biological half-life is determined by such things as the chemical
form of the radionuclide and the physiological function of the organ or organism
considered.
When biological transport or elimination occurs, the lifetime of the radioactive
material in the organ is reduced. This is generally expressed in terms of an effec¬
tive half-life. The relationship between effective half-life (Te), physical half-life
(TP), and biological half-life (Tb) is given by

T
Te= _ Tp x Tb
VPfb"
When both radioactive decay and biological elimination are present, the effective
half-life will always be less than either the physical or biological half-life. If the
difference in the two half-life values is rather large, the effective half-life will be

slightly less than the shorter half-life of the two; if the two are equal, the effective
half-life will be one-half of the physical or biological half-life value.
 Chapter 7

X-Ray Production

INTRODUCTION AND OVERVIEW

X-radiation is created by taking energy from electrons and converting it into

photons with appropriate energies. This energy conversion takes place within the
x-ray tube. The quantity and quality of the x-radiation produced can be controlled
by adjusting the electrical quantities (KV, MA) and exposure time, S, applied to
the tube. In this chapter we first become familiar with the design and construction
of x-ray tubes, then look at the x-ray production process, and conclude by review¬
ing the quantitative aspects of x-ray production.

THE X-RAY TUBE

Function

An x-ray tube is an energy converter. It receives electrical energy and converts

it into two other forms: x-radiation and heat. The heat is an undesirable byproduct.

X-ray tubes are designed and constructed to maximize x-ray production and to
dissipate heat as rapidly as possible.
The x-ray tube is a relatively simple electrical device typically containing only
two elements: a cathode and an anode. As the electrical current flows through the

tube from cathode to anode, the electrons undergo an energy loss, which results in
the generation of x-radiation. A cross-sectional view of a typical x-ray tube is
shown in Figure 7-1.

Anode

The anode is the component in which the x-radiation is produced. It is a rela¬

tively large piece of metal that connects to the positive side of the electrical circuit.

97
98 Physical Principles of Medical Imaging

Glass

Cathode

Figure 7-1 Cross-section of a Typical X-Ray Tube

The anode has two primary functions: ( 1 ) to convert electronic energy into
in the process. The material for the
x-radiation, and (2) to dissipate the heat created
anode is selected to enhance these functions.
The ideal situation would be if most of the electrons created x-ray photons
rather than heat. The fraction of the total electronic energy that is converted into
x-radiation(efficiency) depends on two factors: the atomic number (Z) of the an¬
ode material and the energyof the electrons. Most x-ray tubes use tungsten, which
has an atomic number of 74, as the anode material. In addition to a high atomic
number, tungsten has several other characteristics that make it suited for this pur¬
pose. Tungsten is almost unique in its ability to maintain its strength at high tem¬
peratures, and it has ahigh melting point and a relatively low rate of evaporation.
For many years, pure tungsten was used as the anode material. In recent years an
alloy of tungsten and rhenium has been used as the target material but only for the
surface of some anodes. The anode body under the tungsten-rhenium surface on
many tubes is manufactured from a material that is relatively light and has good
heat storage capability. Two such materials are molybdenum and graphite. The
use of molybdenum as an anode base material should not be confused with its use

as an anode surface material. Most x-ray tubes used for mammography have
molybdenum-surface anodes. This material has an intermediate atomic number
(Z = 42), which produces characteristic x-ray photons with energies well suited to
 X-Ray Production 99

thisparticular application. Some mammography tubes also have a second anode

made of rhodium, which has an atomic number of 45. This produces a higher
energy and more penetrating radiation, which can be used to image dense breast.
The use of a rhenium-tungsten alloy improves the long-term radiation output of
tubes. With x-ray tubes with pure tungsten anodes, radiation output is reduced
with usage because of thermal damage to the surface.

Design
Most anodes shaped as beveled disks and attached to the shaft of an electric
are

motor that rotates them at

relatively high speeds during the x-ray production pro¬
cess. The purpose of anode rotation is to dissipate heat and is considered in detail

in Chapter 9.

Focal Spot
Not all of the anode is involved in x-ray production. The radiation is produced
in very small area on the surface of the anode known as the focal spot. The
a

dimensions of the focal spot are determined by the dimensions of the electron
beam arriving from the cathode. In most x-ray tubes, the focal spot is rectangular.
The dimensions of focal spots usually range from 0.1 mm to 2 mm. X-ray tubes
are designed to have specific focal spot sizes; small focal spots produce sharper
images, and large focal spots have a greater heat-dissipating capacity.
Focal spot size is one factor that must be considered when selecting an x-ray
tube for a specific application. Tubes with small focal spots are used when high
image quality is essential and the amount of radiation needed is relatively low.
Most x-ray tubes have two focal spot sizes (small and large), which can be se¬
lected by the operator according to the imaging procedure.

Cathode

The basic function of the cathode is to expel the electrons from the electrical
circuit and focus them into a well-defined beam aimed at the anode. The typical
cathode consists of a small coil of wire (a filament) recessed within a cup-shaped
region, as shown in Figure 7-2.
Electrons that flow through electrical circuits cannot generally escape from the
conductor material and move into free space. They can, however, if they are given
sufficient energy. In a process known as thermionic emission, thermal energy (or
heat) is used to expel the electrons from the cathode. The filament of the cathode is
heated in the same way as a light bulb filament by passing a current through it.
This heating current is not the same as the current flowing through the x-ray tube
 100 Physical Principles of Medical Imaging

Cathode

High Energy
• • 1 Electrons (100KeV)
Potential Energy L^\jKinetic Energy
100 • 0

50 • . 50

0 . 1QQ Anode

X-ray o ° ° ( ° Low Energy

O
Heat o \ 0 Electrons

Figure 7-2 Energy Exchanges within an X-Ray Tube

that produces the x-radiation.

During tube operation, the cathode is heated to a
glowing temperature, and the heat energy expels some of the electrons from the
cathode.

Envelope
The anode and cathode contained in
are an airtight enclosure, or envelope. The
envelope and its contents are often referred to as the tube insert, which is the part
of the tube that has a limited lifetime and can be
replaced within the
housing. The
majority of x-ray tubes have glass envelopes, although tubes for some applications
have metal and ceramic
envelopes.
The primary functions of the
envelope are to provide support and electrical in¬
sulation for the anode and cathode assemblies and to maintain a vacuum in the
tube. The presence of gases in the
x-ray tube would allow electricity to flow
through the tube freely, rather than only in the electron beam. This would interfere
with x-ray production and possibly
damage the circuit.

Housing
The x-ray tube housing provides several functions in addition to
enclosing and
supporting the other components. It absorbs radiation, except for the radiation that
 X-Ray Production 101

passes through the window as the useful x-ray beam. Its relatively large exterior
surface dissipates most of the heat created within the tube. The space between the
housing and insert is filled with oil, which provides electrical insulation and trans¬
fers heat from the insert to the housing surface.

ELECTRON ENERGY

The energy that will be converted into x-radiation (and heat) is carried to the
x-ray tube by a current of flowing electrons. As the electrons pass through the x-
ray tube, they undergo two energy conversions, as illustrated in Figure 7-2: The
electrical potential energy is converted into kinetic energy that is, in turn, con¬
verted into x-radiation and heat.

Potential

When the electrons arrive at the x-ray

tube, they carry electrical potential en¬
ergy.The amount of energy carried by each electron is determined by the voltage
or KV, between the anode and cathode. For each kV of voltage, each electron has

1 keV of energy. By adjusting the KV, the x-ray machine operator actually assigns
a specific amount of energy to each electron.

Kinetic

After the electrons are under the influence

emitted from the cathode, they come
of an electrical forcepulling them toward the anode. This force accelerates them,
causing an increase in velocity and kinetic energy. This increase in kinetic energy
continues as the electrons travel from the cathode to the anode. As the electron
moves from cathode to anode, however, its electricalpotential energy decreases as
it is converted into kinetic energy all along the way. Just as the electron arrives at
the surface of the anode its potential energy is lost, and all its energy is kinetic. At
this point the electron is traveling with a relatively high velocity determined by its
actual energy content. A 100-keV electron reaches the anode surface traveling at
more than one half the velocity of light. When the electrons strike the surface of

the anode, they are slowed very quickly and lose their kinetic energy; the kinetic

energy is converted into either x-radiation or heat.

The electrons interact with individual atoms of the anode material, as shown in

Figure 7-3. Two types of interactions produce radiation. An interaction with elec¬
tron shells produces characteristic x-ray photons; interactions with the atomic

nucleus produce Bremsstrahlung x-ray photons.

 102 Physical Principles of Medical Imaging

L electron
_ 10.2 ke V
■Q- -
^
Choracterislic pholon
\ — >
59 3 ke V

A # \
/ / ✓ K electron N
[ / 69 5 keV n \
HiQh Spe6d
electrons
I f *

Figure 7-3 Electron-Atom Interactions That Produce X-Ray Photons

BREMSSTRAHLUNG

Production Process

The interaction that produces the most photons is the Bremsstrahlung process.
Bremsstrahlung is German word for "braking radiation" and is a good descrip¬
a
tion of the process. Electrons that penetrate the anode material and
pass close to a
nucleus are deflected and slowed down by the attractive force from the nucleus.
The energy lost by the electron during this encounter appears in the form of an
x-ray photon. All electrons do not produce photons of the same energy.

Spectrum

Only a few photons that have energies close to that of the electrons are pro¬
duced; most have lower energies. Although the reason for this is complex, a sim¬
plified model of the Bremsstrahllung interaction is shown in Figure 7-4. First,
assume that there is
a space, or field, surrounding the nucleus in which electrons

experience the "braking" force. This field can be divided into zones, as illustrated.
This gives the nuclear field the appearance of a target with the actual nucleus
located in the center. An electron striking anywhere within the target experiences
 X-Ray Production 103

Nuclear Field

Figure 7-4 A Model for Bremsstrahlung Production and the Associated Photon Energy
Spectrum

some braking action and produces an x-ray photon. Those electrons striking near¬
est the center are subjected to the greatest force and, therefore, lose the most en¬
ergy and produce the highest energy photons. The electrons hitting in the outer
zones experience weaker interactions and produce lower energy photons. Al¬

though the zones have essentially the same width, they have different areas. The
area of a given zone depends on its distance from the nucleus. Since the number of

electrons hitting a given zone depends on the total area within the zone, it is obvi¬
ous that the outer zones capture more electrons and create more photons. From this

model, an x-ray energy spectrum, such as the one shown in Figure 7-4, could be
predicted.
The basic Bremsstrahlung spectrum has a maximum photon energy that corre¬

sponds to the energy of the incident electrons. This is 70 keV for the example
shown. Below this point, the number of photons produced increases as photon

energy decreases. The spectrum of x-rays emerging from the tube generally looks
quite different from the one shown here because of selective absorption within the
filter.
Asignificant number of the lower-energy photons are absorbed or filtered out
as they attempt to pass through the anode surface, x-ray tube window, or added
filter material. X-ray beam filtration is discussed more extensively in Chapter 11.
The amount of filtration is generally dependent on the composition and thickness
 104 Physical Principles of Medical Imaging

of material through which the x-ray beam passes and is generally what determines
the shape of the low-energy end of the spectrum curve.

KVP

The high-energy end of the spectrum is determined by the kilovoltage applied

to the x-ray tube. This is because the kilovoltage establishes the energy of the
electrons as they reach the anode, and no x-ray photon can be created with an
energy greater than that of the electrons. The maximum photon energy, therefore,
in kiloelectron volts is numerically equal to the maximum applied potential in
kilovolts. In some x-ray equipment, the voltage applied to the tube might vary
during the exposure. The maximum photon energy is determined by the maxi¬
mum, or peak, voltage during the exposure time. This value is generally referred to
as the kilovolt
peak (KVP) and is one of the adjustable factors of x-ray equipment.
In addition to establishing the maximum x-ray photon
energy, the KVP has a
major role in determining the quantity of radiation produced for a given number of
electrons, such as 1 mAs, striking the anode. Since the general efficiency of x-ray
production by the Bremsstrahlung process is increased by increasing the energy of
the bombarding electrons, and the electronic energy is determined
by the KVP, it
follows that the KVP affects x-ray production efficiency.

Changing the KVP will generally alter the Bremsstrahlung spectrum, as shown
in Figure 7-5. The total area under the spectrum curve
represents the number of
photons produced. If no filtration is present where the spectrum is essentially a
triangle, the amount of radiation produced is approximately proportional to the
KV squared. With the presence of filtration, however,
increasing the KV also in¬
creases the relative
penetration of the photons, and a smaller percentage is filtered
out. This results in an even greater increase in radiation
output with KVP.

CHARACTERISTIC RADIATION

Production Process

The type of interaction that produces characteristic radiation, also illustrated in

Figure 7-3, involves a collision between the high-speed electrons and the orbital
electrons in the atom. The interaction can occur only if the
incoming electron has
a kinetic
energy greater than the binding energy of the electron within the atom.
When this condition exists, and the collision occurs, the electron is
dislodged from
the atom. When the orbital electron is removed, it leaves a vacancy that is filled
by
an electron from a
higher energy level. As the filling electron moves down to fill
the vacancy, it gives up energy emitted in the form of an x-ray photon. This is
known as characteristic radiation because the energy of the photon is characteris-
 X-Ray Production 105

Photon Energy (keV)

Figure 7-5 Comparison of Photon Energy Spectra Produced at Different KVP Values

tic of the chemical element that serves as the anode material. In the example
shown, the electron dislodges a tungsten K-shell electron, which has a binding
energy of 69.5 keV. The vacancy is filled by an electron from the L shell, which
has a binding energy of 10.2 keV. The characteristic x-ray photon, therefore, has
an energy equal to the energy difference between these two levels, or 59.3 keV.
Actually, a given anode material gives rise to several characteristic x-ray ener¬
gies. This is because electrons at different energy levels (K, L, etc.) can be dis¬
lodged by the bombarding electrons, and the vacancies can be filled from different
energy levels. The electronic energy levels in tungsten are shown in Figure 7-6,
along with some of the energy changes that give rise to characteristic photons.
Although filling L-shell vacancies generates photons, their energies are too low
for use in diagnostic imaging. Each characteristic energy is given a designation,
which indicates the shell in which the vacancy occurred, with a subscript, which
shows the origin of the filling electron. A subscript alpha (a) denotes filling with
an L-shell electron, and beta ((3) indicates filling from either the M or N shell.

Tungsten Spectrum
The spectrum of the significant characteristic radiation from tungsten is shown
in Figure 7-6. Characteristic radiation produces a line spectrum with several dis¬
crete energies, whereas Bremsstrahlung produces a continuous spectrum of pho¬

ton energies over a specific range. The number of photons created at each charac¬

teristic energy is different because the probability for filling a K-shell vacancy is
different from shell to shell.
106 Physical Principles of Medical Imaging

Liu
Jiil.

Kau

Ka.
^r

—i—
p- •'
± ±± V 20 40 60 80
Photon Energy (keV)

Figure 7-6 Electron Energy Levels in Tungsten and the Associated Characteristic X-Ray
Spectrum

Molybdenum Spectrum

Molybdenum anode tubes produce two rather intense characteristic x-ray ener¬
gies: K-alpha radiation, at 17.9 keV, and K-beta, at 19.5 keV.

KYP

The KVP value also strongly influences the production of characteristic radia¬
tion. No characteristic radiation will be produced if the KVP is less (numerically)
than the binding energy of the K-shell electrons. When the kilovoltage is increased
above this threshold level, the quantity of characteristic radiation is generally pro¬

portional to the difference between the operating kilovoltage and the threshold
kilovoltage.
The x-ray beam that emerges from a tube has a spectrum of photon energies
determined by several factors. A typical spectrum is shown in Figure 7-7 and is
made up of photons from both Bremsstrahlung and characteristic interactions.
The relative composition of an x-ray spectrum with respect to Bremsstrahlung
and characteristic radiation depends on the anode material, kilovoltage, and filtra¬
tion. In a tungsten anode tube, no characteristic radiation is produced when the
KVP is less than 69.5. At some higher kilovoltage values generally used in diag¬
nostic examinations, the characteristic radiation might contribute as much as 25%
 X-Ray Production 107

Photon Energy (keV)

Figure 7-7 Typical Photon Energy Spectrum from a Machine Operating at KVP = 80

of the total radiation. In molybdenum target tubes operated under certain condi¬
tions of KVP and filtration, the characteristic radiation can be a major part of the
total output.

EFFICIENCY

Concept

Only a small fraction of the energy delivered to the anode by the electrons is
converted into x-radiation; most is absorbed and converted into heat. The effi¬
ciency of x-ray production is defined as the total x-ray energy expressed as a frac¬
tion of the total electrical energy imparted to the anode. The two factors that deter¬
mine production efficiency are the voltage applied to the tube, KV, and the atomic
number of the anode, Z. An approximate relationship is

Efficiency = KVxZ x Kb6.

KVP

The relationship between x-ray production efficiency and KVP has a specific
effect on the practical use of x-ray equipment. As we will see in Chapter 9, x-ray
tubes have a definite limit on the amount of electrical energy they can dissipate
108 Physical Principles of Medical Imaging

because of the heat produced. This, in principle, places a limit on the amount of
x-radiation that can be produced by an x-ray tube. By increasing KVP, however,
the quantity of radiation produced per unit of heat is significantly increased.

Anode Material

The relationship of x-ray production efficiency to anode material is only of aca¬

demic interest because most tubes use tungsten. The exception is molybdenum
and rhodium used in mammography. The x-ray production efficiency of these
tubes is significantly less than that of tungsten anode tubes.

kVp

Figure 7-8 Typical X-Ray Tube Efficacy (Exposure Output) for Different KVP Values
 X-Ray Production 109

EFFICACY (OUTPUT)

Concept
The x-ray efficacy of the x-raytube is defined as the amount of exposure, in
milliroentgens, delivered to point in the center of the useful x-ray beam at a
a
distance of 1 m from the focal spot for 1 mAs of electrons passing through the tube.
The efficacy value expresses the ability of a tube to convert electronic energy
into x-ray exposure. Knowledge of the efficacy value for a given tube permits the
determination of both patient and film exposures by methods discussed in later

chapters. Like x-ray energy output, the efficacy of a tube depends on a number of
factors including KVP, voltage waveform, anode material, filtration, tube age, and
anode surface damage. Figure 7-8 gives typical efficacy values for tungsten anode
tubes with normal filtration.

KVP

KVP is very useful in controlling the radiation output of an x-ray tube. Figure
7-8 shows a nonlinear relationship. It is normally assumed that the radiation out¬
put is proportional to the square of the KVP. Doubling KVP quadruples the expo¬
sure from the tube.

Waveform

Waveform describes the manner in which the KV changes with time during the

x-ray production process; several different KV waveforms are used. A general

principle is that the waveform with the least KV variation during the exposure is
the most effective x-ray producer. Single-phase, three-phase, and constant poten¬
tial are three of the most common waveform types. Constant potential has no fluc¬
tuation and produces more radiation per unit of MAS. Waveforms are described in
more detail in the next chapter.
 Chapter 8

Energizing and Controlling the

X-Ray Tube

INTRODUCTION AND OVERVIEW

To produce x-radiation, the x-ray tube must be supplied with electrical

energy.
The electrical energy provided by a power company is not in the correct form for
direct application to the x-ray tube. An x-ray machine has a number of compo¬
nents that rearrange, control, and perhaps store electrical energy before it is ap¬
plied to the x-ray tube. These components are collectively referred to as either the
power supply or the generator. The function of the generator is not to supply or
generate energy, but to transform it into an appropriate form for x-ray production.
The other major function of the generator is to permit the operator to control three

quantities: (1) KV, (2) MA, and (3) exposure time.

The more specific functions of the generator are identified in Figure 8-1. These
include:

• increase voltage (produce KV)

• convert AC to DC
•
change waveform (filter)
• store energy (for portable machines)
• control kilovoltage (KV)
• control tube current (MA)
• control exposure time.
A simplified circuit diagram of an x-ray machine is shown in Figure 8-2. We
now consider the functions of the components.

KV PRODUCTION

One requirement for x-ray production is that the electrons delivering energy to
the x-ray tube must have individual energies at least equal to the energy of the

111
 112 Physical Principles of Medical Imaging

From Generator To
Power Company X-Ray Tube
0

Low Voltage Increase •KV

High Current Decrease •MA

AC Rectify •DC

KV MA Time

Operator Controls

Figure 8-1 Functions Performed by an X-Ray Machine Generator

Auto High Voltage

Transformer Timer Transformer Rectifier

Figure 8-2 A Basic Circuit of an X-Ray Machine

x-ray photons; the x-ray photon energy (kiloelectron volts) is always limited by
the electron energy, or voltage (kilovolts).
The electrical energy from a power company is generally delivered at
120, 240,
or 440 V. This voltage must be increased to the range of 25,000 V to 120,000 V to
produce diagnostic-quality x-rays.
 Energizing and Controlling the X-Ray Tube 113

Transformer Principles
The device that increase
can
voltage is the transformer, which is one of the
major components of the generator. It is a relatively large device connected by
cables to the x-ray tube. The basic function of a transformer is illustrated in
Figure
8-3.
A transformer has two separate circuits. The input circuit, which receives the
electrical energy, is designated the primary, and the output circuit is designated
the secondary. Electrons do not flow between the two circuits; rather, energy is
passed from the primary circuit to the secondary circuit by a magnetic field.
As electrons flow into the transformer and through the primary circuit, they
transfer energy to the electrons in the secondary circuit. The voltage (individual
electron energy) increases because the transformer collects the energy from a
large number of primary-circuit electrons and concentrates it into a few secondary
circuit electrons. In principle, the transformer repackages the electron energy; the
total energy entering and leaving the transformer is essentially the same. It enters
in the form of high current, low voltage and leaves in the form of high voltage, low
current.

Transformers designed to produce specific changes in voltage. The trans¬

are

former described above increases voltage and is therefore designated a "step-up

transformer." For some applications, transformers are designed to decrease volt¬

age and are designated "step-down transformers."

Transformer Concept

0# m © © m
1—
High Current- Low Current

Low
t
Voltage ®
Energy High Voltage

o o o-o _o
Primary Magnetic Secondary
Field

Figure 8-3 Electron-Energy Transfer in a Transformer

114 Physical Principles of Medical Imaging

The High Voltage Transformer

Thehigh voltage transformer in most x-ray machines has a voltage step-up ratio
of approximately 1,000:1. The output of such a transformer would be 1,000 V
(1 kV) for each volt applied to the primary.
In a step-up transformer, the current (electron flow) must be larger in the pri¬

mary than in the secondary. The ratio of the currents is the same as the voltage
ratio, except it is reversed. The larger current is in the primary, and the smaller
current is in the secondary. For a transformer with a 1,000:1 ratio, the current

flowing through the primary must be 1 A (1,000 mA) per 1 mA of current flowing
through the secondary.
The high voltage transformer in an x-ray machine can be described in quantita¬
tive terms as a device that converts volts into kilovolts and converts amperes into
milliamperes.
A transformer physically consists of two coils of wire, as shown in Figure 8-2.
One coil forms the primary and the other the secondary circuit of the transformer.
Each coil contains a specific number of loops or turns. The characteristic of the
transformer that determines the voltage step-up ratio is the ratio of the number of
turns (loops) in the secondary coil to the number in the primary. The voltage step-

up ratio is determined by, and is the same as, the secondary-to-primary-turns ratio.
There is no direct flow of electrons between the primary and secondary coils;

they are coupled by the magnetic field produced by current passing through the
primary coil. The transformer is based on two physical principles involving the
interaction between electrons and magnetic fields: (1) when electrons flow
through a coil of wire, a magnetic field is created around the coil; (2) electrons
within a coil of wire will receive energy if the coil is placed in a changing mag¬
netic field.
Thekey to transformer operation is that the primary coil must produce a con¬
stantly changing, or pulsing, magnetic field to boost the energy of the electrons in
the secondary coil. This occurs when the primary of the transformer is connected
to an AC source. When AC is applied to the input of a transformer, the primary

coil produces a pulsing magnetic field. It is this pulsing magnetic field that pumps
the electrons through the secondary coil. An electron in the secondary coil gains a

specific amount of energy each time it goes around one loop, or turn, on the coil.
Therefore, the total energy gained by an electron as it passes through the second¬
ary coil is proportional to the number of turns on the coil. Since the energy of an
electron is directly related to voltage, it follows that the output voltage from a
transformer is proportional to the number of turns on the secondary coil.

The Autotransformer

In most x-ray apparatus, it is desirable to change the voltage (KV) applied to the
tube to accommodate clinical needs. This is generally done by using the type of
 Energizing and Controlling the X-Ray Tube 115

transformer illustrated in Figure 8-2, the autotransformer, which has a movable

contact on the
secondary coil that permits the effective number of turns to be
changed. Since the output voltage is proportional to the number of turns in the
secondary, it can be adjusted by moving the contact. The typical system has an
autotransformer that applies an adjustable voltage to the input of the
high voltage
(step-up) transformer. The autotransformer does not significantly increase volt¬
age; in fact, most slightly reduce voltage. Autotransformers often use a combined
primary-secondary coil, but the principle is the same as if the two coils were com¬
pletely separated.
The question is often raised as to the possibility of putting an adjustable contact
on the secondary of the
high voltage transformer for the purpose of KV selection.
Unfortunately, high voltage, such as that generated in the transformer, requires
extensive insulation normally achieved by placing the high voltage transformer in
an enclosed tank of oil. There is no
practical way to connect the KV selector
switch, located on the control console, to the high-voltage circuit without interfer¬
ing with the insulation.

RECTIFICATION

The output voltage from the high voltage transformer is AC and changes polar¬
ity 60 times
per second (60 Hz). If this voltage were applied to an x-ray tube, the
anode would be positive with respect to the cathode only one half of the time.

During the other half of the voltage cycle, the cathode would be positive and
would tend to attract electrons from the anode. Although the anode does not emit
electrons unless it is very hot, this reversed voltage is undesirable. A circuit is
needed that will take the voltage during one half of the cycle and reverse its polar¬
ity, as illustrated in Figure 8-4. This procedure is called rectification.

Rectifiers

The typical rectification circuit is made up of several rectifiers. A rectifier is a

relatively simple two-terminal device that permits electrons to flow through it in
one direction but not the other. It can be compared with the valves of the heart,

which permit blood to flow in one direction but not the other. In fact, in some
countries, rectifiers are referred to as valves. Earlier x-ray equipment used vacuum
tube rectifiers, but most rectifiers are now solid state.

Rectifier Circuits

Notice that the circuit in Figure 8-4 has two input points, to which the incoming
voltage from the transformer is applied, and two output points, across which the
voltage will appear and be applied to the tube. The circuit contains
rectified output
116 Physical Principles of Medical Imaging

Tube k.
Transformer kV * /
\ i
\ '

electron flow

Figure 8-4 A Typical Full-Wave Rectifier Circuit

four rectifiers, labeled a, b, c, and d. Electrons (current) can flow through a recti¬
fier only in the direction indicated by the arrow. The waveform shown indicates
the polarity of the lower terminals with respect to the upper. The operation of this
circuit can be easily understood by considering the following sequence of events.

During the first half of the voltage cycle, the upper transformer terminal is nega¬
tive, and the electrons flow into the rectifier circuit at that point. From there, they
flow only through rectifier a and on to the x-ray tube. They enter the tube at the
cathode terminal, leave by means of the anode, and return by the lower conductor
to the rectifier circuit. At that point, it would appear they have two possible path¬

ways to follow. They flow, however, only through rectifier d because the lower
transformer terminal is positive and is more attractive than the upper negative
terminal. During this part of the voltage cycle, rectifiers b and c do not conduct.

During the second half of the cycle, the polarity of the voltage from the trans¬
former is reversed, and the lower terminal is negative. The electrons leave the
transformer at this point and pass through rectifier c and on to the cathode.
Electrons leaving the x-ray tube by means of the lower conductor pass through
rectifier b because of the attraction of the upper transformer terminal, which is
then positive.

Full-Wave

In effect, the rectifier circuit takes an alternating polarity voltage and reverses
one half of it so that the outcoming voltage always has the same polarity. In this
 Energizing and Controlling the X-Ray Tube 117

particular circuit, the cathode of the x-ray tube always receives a negative voltage
with respect to the anode. This circuit,
consisting of four rectifier elements con¬
nected as shown, is known as a
bridge rectifier. Since it makes use of all of the
voltage waveform, it is classified as a full-wave rectifier.

Half-Wave
A rectifier circuit can have
only one rectifier element. The disadvantage is that
it conducts during only one half of the cycle. This type is classified as a half-wave
rectifier. This type of rectification is found in some smaller
x-ray machines, such
as those used in
dentistry. In such apparatus, the x-ray tube itself often serves as
the rectifier.

VOLTAGE WAVEFORM AND X-RAY PRODUCTION

Single-Phase and Constant Potential

Both the full-wave and half-wave circuits discussed up to this point use single
high voltage transformers and are classified as single-phase apparatus. The basic
disadvantage of single-phase operation is that the KV applied to the x-ray tube
constantly changes, or pulses, throughout the exposure, as shown in Figure 8-5.
This means that both the quantity and energy spectrum of the x-rays produced

change constantly with time throughout the cycle. The output from the tube is a
spectrum of photon energies that is an average of all instantaneous spectra.
Three principal KV values are associated with the typical single-phase wave¬
form. Each is related to an aspect of x-ray production. At any instant in time, the
pulsing KV has an instantaneous value (KVi), which determines the rate of x-ray
production at each specific instant. During each cycle, the KV reaches a maximum
or peak value (KVP). It is the KVP that is set by the operator as a control on x-ray

KVp (peak)

KVe (effective)
KV
KVi (instantaneous)

1/120 1/60 1/40

Time (sec)

Figure 8-5 Relationship of KV Peak, Effective, and Instantaneous Values for a Single-
Phase Generator
118 Physical Principles of Medical Imaging

production. The ability of a voltage to transfer energy is related to its effective

value (KVe), which reflects the fact that the voltage varies with time and does not
always produce energy at the peak value. For the typical sine-waveform voltage,
as shown in Figure 8-5, the KVe is 70.7% of the KVP. Our primary interest in the

KVe is that it determines the rate at which heat is produced in the x-ray tube.
Some x-ray generators produce a constant KV; in these cases the KVP, KVe, and
KVi have the same value. These generators are called constant potential apparatus.
The constant potential x-ray machine produces more photons with higher average
or effective energy than are produced by the single-phase machine, as shown in

Figure 8-6.
The rate at which exposure is delivered to the receptor varies significantly with
time for single-phase equipment, as shown in Figure 8-6. Most of the exposure is
produced during a small portion of the voltage cycle, when the voltage is near the
KVP value. Several factors contribute to this effect. One is that the efficiency of
x-ray production increases with voltage and gives more exposure per milliampere-
second at the higher voltage levels. Second, the photons produced at the higher
tube voltages have higher average energies and are more penetrating. Third, the
MA also changes with time during the voltage cycle.
When an x-ray machine is set at a certain MA value, the stated value is usually
the average throughout the exposure time. In single-phase equipment, the MA
value changes significantly during the voltage cycle. The effect is that the x-ray
exposure is delivered to the receptor in a series of pulses. Between the pulses is a
period of time during which no significant exposure is delivered. This means, gen¬
erally, that the total exposure time must be longer for single-phase than for con¬
stant potential x-ray equipment, which can deliver a given film exposure in a much
shorter total exposure time.

Single Phase Constant Potential

Time

Figure 8-6 Comparison of Single-Phase and Constant Potential X-Ray Production

 Energizing and Controlling the X-Ray Tube 119

Three-Phase

One of the most practical means of obtaining essentially constant voltage and
high average current is to use three-phase electrical power. The concept of three-
phase electricity can best be understood by considering it as three separate incom¬
ing power circuits, as shown in Figure 8-7. Although this illustration shows six
conductors coming in, this is not necessary in
reality because the power lines can
be shared by the circuits. Each circuit, or phase, delivers a
voltage that can be
transformed and rectified in the conventional manner. The important characteris¬
tic of a three-phase power system is that the waveforms or
cycles in one circuit are
out of step, or phase, with those in the other two. This means that the
voltage in the
three circuits peak at different times. In an actual circuit, the three
voltage wave¬
forms are combined, as shown in Figure 8-7. They are not added, but are com¬
bined so that the output voltage at any instant is equal to that of the highest
phase
at the time. Since the voltage drops
only a few percent before it is picked up by
another phase, the KVi at all times is quite close to the KVP.
The voltage variation over the period of a cycle is designated the ripple and is
expressed as a percentage. The typical ripple levels for several power supply types
are shown in Figure 8-8. One
way to classify power supply circuits is according to
the number of pulses they produce in the period of one cycle, ie, l/60th of a sec¬
ond. By using a complex circuit of transformers and rectifiers, it is possible to
produce a 12-pulse machine that has a ripple level of less than 4%.

Power
Supplies

Incoming
Power —

Lines

■/ '/
60 '*>
Time (Seconds)

Figure 8-7 Concept of a Three-Phase Generator

120 Physical Principles of Medical Imaging

'/60
SEC^j

Figure 8-8 Voltage Waveforms Encountered in X-Ray Production

CAPACITORS

Capacitors (sometimes referred to as condensers) are electrical components

used in many types of electronic equipment. They are used in some x-ray genera¬
tors for two purposes. In capacitor discharge (or condenser discharge) portable

x-ray machines, capacitors are used to accumulate and store electrical energy; in
other types of equipment, they are used as a filtering device to produce constant
potential KV.
A capacitor consists of two electrical conductors, such as metal foil, separated
by a layer of insulation.
 Energizing and Controlling the X-Ray Tube 121

Capacitor
Uncharged Charged

Voltage oc Charge

Figure 8-9 Concept of a Capacitor

Capacitor Principles
The basic function of a capacitor is illustrated in Figure 8-9. A capacitor can be
described as a storage tank for electrons. When it is connected to a voltage source,
electrons flow into the capacitor, and it becomes "charged. " As the electrons flow
in, the voltage of the capacitor increases until it reaches the voltage of the supply.
Energy is actually stored in the capacitor when it is charged; the amount stored is
proportional to the voltage and the quantity of stored electrons. If a charged ca¬
pacitor is connected to another circuit, the capacitor becomes the source, and the
electrons flow out and into the circuit.

Energy Storage
In the discussion of the high voltage transformer, it was pointed out that the
current flowing into the power supply circuit must be greater than the tube current
by a factor equal to the voltage step-up ratio. This is typically as high as 1,000:1,
which would require 1 A of power line current for every 1 mA of tube current. The

special circuits feeding permanently installed x-ray equipment can accommodate

these high currents. In other areas of the hospital where portable x-ray equipment
is used, the normal electrical circuits are limited to currents of about 15 A to 20 A.
Many portable x-ray machines are now designed to overcome this limitation by
using a capacitor as an electron-energy storage device.
A simplified capacitor storage-discharge power supply is shown in Figure
8-10. Step-up transformers and rectifiers are used to produce the high voltage and
to charge the capacitor. The electrons are pumped into the capacitor. Charging

times can be as long as 10 seconds to 20 seconds. The current flow into the capaci¬
tor is typically only a few milliamperes; when it is discharged to the tube over a
122 Physical Principles of Medical Imaging

Transformer Capacitor Exposure Tube

and Switch
Rectifiers

lyEnergy

O ■ ^t I

Charge Circuit Discharge Circuit

Low MA, Long Time High MA, Short Time

Figure 8-10 Basic Capacitor-Storage X-Ray Machine

short period of time, ie, the exposure time, the current can be several hundred
milliamperes.
The voltage across a capacitor is proportional to the quantity of electrons stored
(MAS); the actual relationship depends on the size, or capacity, of the capacitor.
Many machines use 1-microfarad (pF) capacitors, which produce a voltage of 1 kV
for each milliampere-second stored. As the electrons flow from the capacitor to
the tube, the voltage drops at the rate of 1 kV/mAs. For example, if a machine is

charged to 70 kV, and an exposure of 18 mAs is made, the voltage will have
dropped to 52 kV at the end of the exposure.
Capacitor-storage x-ray equipment has a high-voltage waveform, unlike other
power supplies. An attempt to obtain large milliampere-second exposures drops
the kilovolts to very low values by the time the exposure terminates. Since low
tube voltages produce very little film exposure, but increase patient exposure, this

type of operation should be avoided. The total MAS should generally be limited to
approximately one third of the initial KV value.
A means for turning the tube current on and off is included in the x-ray tube
circuit. Most machines use a grid-control x-ray tube for this purpose.

Filtration

When capacitor is used to produce a constant voltage, or potential, it is perma¬

a

nently connected between the rectifier circuit and the x-ray tube. As the voltage
rises toward its peak, electrons from the rectifier circuit flow both to the x-ray tube
and into the capacitor. When the voltage from the rectifier circuit begins to fall,
electrons flow out of the capacitor and into the x-ray tube. Within certain opera-
 Energizing and Controlling the X-Ray Tube 123

tional limits, this can maintain constant

a
potential across the tube. Capacitors can
be used on single-phase and
three-phase equipment. On single-phase equipment,
the maximum MA that can be used without introducing ripples is more limited.

HIGH-FREQUENCY POWER SUPPLIES

Another approach used for some machines producing

relatively constant KV is
to convert the
60-Hz (low frequency) electricity to a higher
frequency before it is
rectified. This function is performed by an electrical circuit known as an inverter.
After the high-frequency voltage is rectified, the short-duration pulses are much
easier to filter into an essentially constant potential.

MA CONTROL

The cathode is heated electrically by a current from a separate low-voltage

power supply. The output of this supply is controlled by the MA selector. Increas¬
ing the MA selector setting passes more heating current through the cathode; this,
in turn, increases the temperature, and the increased emission produces an in¬
crease in x-ray tube current. There are actually two currents
flowing through por¬
tions of the x-ray tube: one, the MA, flows from the cathode to the anode and
through the high voltage power supply; the other flows only through the filament
of the cathode. It is this second current that controls the cathode-to-anode current.
The cathode temperature required to produce adequate thermionic emission,
especially at high MA values, is relatively high. The temperature is sufficiently
high, in many cases, to produce some evaporation of the tungsten cathode. Be¬
cause of this, it is undesirable to keep the cathode at the high operating tempera¬

ture except for the duration of the x-ray exposure. Most x-ray equipment operates

with two levels of cathode heating. When the equipment is turned on, the cathode
is heated to a standby level that should not produce significant evaporation. Just
before the actual exposure is initiated, the cathode temperature is raised to a value
that will give the appropriate tube current. In most radiographic equipment, this
function is controlled by the same switch that activates the anode rotor. Unneces¬
sarily maintaining the cathode temperature at full operating temperature can sig¬
nificantly shorten the x-ray tube lifetime.
Although it is true that the x-ray tube current is primarily controlled by cathode
temperature, there are conditions under which it is influenced by the applied KV.
At low KV values, some of the electrons emitted from the cathode are not attracted
to the anode and form a space charge. In effect, this build-up of electrons in the

vicinity of a cathode repels electrons at the cathode surface and reduces emission.
Under this condition, the x-ray tube current is said to be space-charge limited. This
124 Physical Principles of Medical Imaging

can beespecially significant at low KV, such as are used in mammography. This
effect canbe reduced by locating the cathode and anode closer together.
As the KV is increased, the space charge decreases, and the x-ray tube current
rises to a value limited by the cathode emission. At that point the tube is said to be
saturated. Many x-ray machines contain a compensation circuit to minimize the
effect. The compensation is activated by the KV selector. As the KV is adjusted to
higher values, the compensation circuit causes the cathode temperature to be de¬
creased. The lower emission compensates for the decreased space charge.
The x-ray tube current can be read or monitored by a meter located in the high

voltage circuit; it must be placed in the part of the circuit that is near ground volt¬
age, or potential. This permits the meter to be located on the control console with¬
out extensive high-voltage insulation.

EXPOSURE TIMING

Another function of the generator is to control the duration of the x-ray expo¬
sure. In radiography, the exposure is initiated by the equipment operator and then
terminated either after preset time has elapsed or when the receptor has received
a

a specific level of exposure. In fluoroscopy, the exposure is initiated and termi¬

nated by the operator, but a timer displays accumulated exposure time and pro¬
duces an audible signal at the end of each 5-minute exposure increment.

Operator-controlled switches and timers turn the radiation on and off by activat¬
ing switching devices in the primary circuit of the x-ray generator.

Manual Timers

X-ray equipment with manual timers requires the operator to set the exposure
time before initiating the exposure. The time is determined by personal knowl¬
edge, or from a technique chart, after the size of the patient and the KV and MA
values being used are considered.

Exposure timers for single-phase equipment usually operate in increments of 1/

120th of a second, which is the duration of one half of a 60-Hz voltage cycle. This
is also the elapsed time between individual pulses of radiation. It is generally not

practical to terminate an exposure during the actual radiation pulse.

A potential problem with this type of timer is its inability to make relatively
small adjustments in exposure time. In a situation in which 1/120th of a second

produces a slight underexposure, the next possible exposure value, 1 /60th of a

second, would double the amount of radiation and probably result in an overex¬
posed film. This problem is especially significant for the shorter exposure times.
Three-phase and constant potential equipment produces radiation at a more
constant rate, and the exposures can be timed and terminated with more precision.
 Energizing and Controlling the X-Ray Tube 125

Automatic Exposure Control

Automatic exposure control (AEC) is an x-ray machine function that terminates
the exposure when a specific predetermined amount of radiation reaches the re¬
ceptor. This function is also referred to as phototiming. AEC is used frequently in
many general radiographic procedures and is always used in spot filming and
cineradiography.

QUALITY ASSURANCE PROCEDURES

With all x-ray equipment, the operator can control the quantity and quality

(penetrating ability) of the radiation with the KV, MA, and exposure-time con¬
trols. If the equipment is not properly calibrated, or is subject to periodic malfunc¬
tion, it will not be possible to control the radiation output. This can result in re¬
duced image quality and unnecessary patient exposure, especially when repeat

images are required.

X-ray equipment is required to meet certain federal standards at the time of
installation, and, in most states, periodic calibration and quality assurance inspec¬
tions are required.
 Chapter 9

X-Ray Tube Heating and Cooling

INTRODUCTION AND OVERVIEW

Toproduce x-radiation, relatively large amounts of electrical energy must be

transferred to the x-ray tube. Only a small fraction (typically less than 1 %) of the
energy deposited in the x-ray tube is converted into x-rays; most appears in the
form of heat. This places a limitation on the use of x-ray apparatus. If excessive
heat is produced in the x-ray tube, the temperature will rise above critical values,
and the tube can be damaged. This damage can be in the form of a melted anode or
a ruptured tube housing. In order to prevent this damage, the x-ray equipment

operator must be aware of the quantity of heat being produced and its relationship
to the heat capacity of the x-ray tube.

Figure 9-1 identifies the factors that affect both heat production and heat ca¬
pacity.

HEAT PRODUCTION

Heat is
produced in the focal spot area by the bombarding electrons from the
cathode. Since only a small fraction of the electronic energy is converted in
x-radiation, it can be ignored in heat calculations. We will assume all of the elec¬
tron energy is converted into heat. In a single exposure, the quantity of heat pro¬

duced in the focal spot area is given by

Heat (J) = KVe x MAS

or

Heat (J) = w x KVP x MAS.

In this relationship, w is the waveform factor; its value is determined by the wave¬
form of the voltage applied to the x-ray tube. Values for most waveforms encoun-

127
 128 Physical Principles of Medical Imaging

Figure 9-1 Factors That Determine the Amount of Heat Produced and the Three Areas of
an X-Ray Tube That Have
Specific Heat Capacities

tered in diagnostic x-ray machines are constant potential, 1.0; three-phase, 12-

pulse, 0.99; three-phase, 6-pulse, 0.96; single-phase, 0.71.

Although the joule is the basic unit for energy and heat, it is not always used to
express x-ray tube heat. The heat unit was introduced for the purpose of express¬
ing x-ray tube heat. The relationship between a quantity of heat expressed in heat
units and in joules is given by

Heat (HU) = 1.4 x heat (J).

Since the product of the joules-to-heat unit conversion factor (1.4) and the wave¬
form factor for single-phase (0.71 ) is equal to 1, the following relationship is
obtained:

Heat (HU) = KVP x MAS.

Here it is
seen that for
single-phase operation, the heat produced in heat units is the
product of the KVP and MAS. In fact, this is why the heat unit is used. In the earlier
days of radiology, when most equipment was single-phase, it was desirable to
calculate heat quantities without having to use a waveform factor. This was
achieved by introducing a new unit, the heat unit. For three-phase, six-pulse
equipment, the heat in heat units is given by
Heat (HU) = 1.35 x KVP x MAS.
The factor of 1.35 is the ratio of the waveform factors, 0.96/0.71.
 X-Ray Tube Heating and Cooling 129

The rate at which heat is produced in a tube is equivalent to the electrical power
and is given by
Power (watts) = w x KVP x MA.
The total heat delivered during an exposure, in joules or watt-seconds, is the prod¬
uct of the power and the exposure time.

HEAT CAPACITY

In order to evaluate the

problem of x-ray tube heating, it is necessary to under¬
stand the relationship of three physical quantities: (1) heat, (2) temperature, and
(3) heat capacity. Heat is a form of energy and can be expressed in any energy
units. In x-ray equipment, heat is usually expressed in joules (watt-seconds) or
heat units.

Temperature is the physical quantity associated with an object that indicates its
relative heat content. Temperature is specified in units of degrees. Physical
changes, such as melting, boiling, and evaporation, are directly related to an
object's temperature rather than its heat content.
For a given object, the relationship between temperature and heat content in¬
volves a third quantity, heat capacity, which is a characteristic of the object. The

general relationship can be expressed as follows:

Temperature = heat/heat capacity.
The heat capacity of an object is more or less proportional to its size, or mass, and
a characteristic of the material known as the specific heat. As heat is added to an
object, the temperature increases in proportion to the amount of heat added. When
a given amount of heat is added, the temperature increase is inversely proportional

to the object's heat capacity. In an object with a large heat capacity, the tempera¬

ture rise is smaller than in one with a small heat capacity. In other words, the

temperature of an object is determined by the relationship between its heat content

and its heat capacity. This is illustrated in Figure 9-2.
In x-ray tube operation, the goal is never to exceed specific critical temperatures
that produce damage. This is achieved by keeping the heat content below specified
critical values related to the tube's heat capacity.
In most x-ray tubes there are three distinct areas with critical heat capacities, as
shown in Figure 9-3. The area with the smallest capacity is the focal spot area, or
track, and is the point at which heat is produced within the tube. From this area, the
heat moves by conduction throughout the anode body and by radiation to the tube

housing; heat is also transferred, by radiation, from the anode body to the tube
housing. Heat is removed from the tube housing by transfer to the surrounding
 130 Physical Principles of Medical Imaging

Same Heat
-

Large Heat Small Heat

Capacity Capacity
Figure 9-2 Relationship Among Heat, Temperature, and Heat Capacity

atmosphere. When the tube is in operation, heat generally flows into and out of the
threeareas shown. Damage can occur if the heat content of
any area exceeds its
maximum heat capacity.

HEAT CAPACITY AND TRANSFER

rad/'at/on

Focal Spot Track

atmosphere

Figure 9-3 The Three Critical Heat Capacities in an X-Ray Tube

 X-Ray Tube Heating and Cooling 131

FOCAL SPOT AREA

The maximum heat capacity of the focal spot area, or track, is the major limiting
factor with single exposures. If the quantity of heat delivered during an individual
exposure exceeds the track capacity, the anode surface can melt, as shown in Fig¬
ure 9-4. The capacity of a
given focal spot track is generally specified by the
manufacturer in the form of a curve, as shown in Figure 9-5. This type of curve
shows the maximum power (KV and MA) that can be delivered to the tube for a

given exposure time without producing overload. Graphs of this type are generally
designated tube rating charts. From this graph, it is seen that the safe power limit
of a tube is inversely related to the exposure time. This is not surprising, since the
total heat developed during an exposure is the product of power and exposure
time. It is not only the total amount of heat delivered to the tube that is crucial, but
also the time in which it is delivered.

X-ray tubes are often given single power ratings. By general agreement, an ex¬
posure time of 0.1 second is used for specifying a tube's power rating. Although
this does not describe a tube's limitations at other exposure times, it does provide
a means of
comparing tubes and operating conditions.
A number of different factors determine the heat capacity of the focal spot track.
The focal spot track is the surface area of the anode that is bombarded by the
electron beam. In stationary anode tubes, it is a small area with dimensions of a
few millimeters. In the rotating anode tube, the focal spot track is much larger
because of the movement of the anode with respect to the electron beam. Fig¬
ure 9-6 shows a small section of a rotating anode.

Focal Spot Size

From the standpoint of producing x-ray images with minimum blur, a small
focal spot is desired. However, a small focal spot tends to concentrate heat and
give the focal spot track a lower heat capacity. The only advantage of a larger focal
spot is increased heat capacity. Many x-ray tubes have two focal spot sizes that
can be selected by the operator. The small focal spot is generally used at relatively

low power (KV and MA) settings. The large focal spot is used when the machine
must be operated at power levels that exceed the rated capacity of the small focal

spot. The specified size of an x-ray tube focal spot is the dimensions of the effec¬
tive or projected focal spot shown in Figure 9-6. Notice that the actual focal spot,
the area bombarded by the electron beam, is always larger than the projected, or
effective, focal spot. For a given anode angle, the width of the focal spot track is
directly proportional to the size of the projected spot. The relationship between
heat capacity and specified focal spot size is somewhat different. In many tubes,
doubling the focal spot size increases the power rating by a factor of about 3.
ObDAvaenmrhogydaetding
Rotaing
A9Fig-u4re
 X-Ray Tube Heating and Cooling

Single Exposure Ratings

Single-Phase Full-Wave Rectification
0.3 rrm Focal Spot

Hicji Speed Rotation

MAXIMUM EXPOSURE TIME IN SECONDS

0.3 rnn Focal Spot

Low Speed Rotation

MAXIMUM EXPOSURE TIME IN SECONDS

Figure 9-5 Rating Curves for an X-Ray Tube Operated under Different Conditions
134 Physical Principles of Medical Imaging

1.0 mm Focal Spot

Hi^i Speed Rotation

150
1
140

130

120

110 \
100
900 MA
\ \
90

80

70

60

50
.001 X302 .005 jOI .02 .05 .1 .2 .3 .5.7 I 2 3 5 7 10 20
MAXIMUM EXPOSURE TIME IN SECONDS

1.0 mn Focal Spot

Lou Speed Rotation
150

.001 OQZ j005 XX .02 .05 .1 .2 .3 .5 .7 I 2 3 5 7 10 20

MAXIMUM EXPOSURE TIME IN SECONDS

Figure 9-5 Continued

Anode Angle
The actual relationship between focal spot width (and heat capacity) and the
size of theprojected focal spot is determined by the anode angle. Anode angles
generally range from about 7° to 20°. For a given effective focal spot size, the
 X-Ray Tube Heating and Cooling 135

Figure 9-6 Section ofa Rotating Anode Showing Relationship of Focal Spot Track to
Electron Beam and Anode Angle

track width and heat capacity are inversely related to anode angle. Although an¬
odes with small angles give maximum heat capacity, they have specific limita¬
tions with respect to the area that can be covered by the x-ray beam. X-ray inten¬
sity usually drops off significantly toward the anode end because of the heel effect.
In tubes with small angles, this is more pronounced and limits the size of the useful
beam. Figure 9-7 shows the nominal field coverage for different anode angles. The
x-ray tube anode angle should be selected by a compromise between heat capacity
and field of coverage.

Anode Rotation Speed

Inrotating tubes, the anode assembly is mounted on bearings and actually forms
the rotor ofan electric motor. The x-ray tube is surrounded by a set of coils that

form the stator of the motor. When the coils are energized from the power line, the
rotor spins. The speed of rotation is determined by the frequency of the applied
current. When the stator coils are operated from the 60-Hz power line, the speed of
approximately 3,000 rpm. By using a power supply that produces 180-
rotation is
rotation speeds of approximately 10,000 rpm can be obtained. This is
Hz current,
commonly referred to as high-speed rotation.
136 Physical Principles of Medical Imaging

Figure 9-7 Variation of X-Ray Intensity Because of the Anode Heel Effect

The effective length of the focal spot track is proportional to the speed of rota¬
tion for given exposure time. High-speed rotation simply spreads the heat over a
a

longer track, especially in short exposure times. High-speed rotation generally

increases the power capacity of a tube by approximately 60%.

Kilovoltage Waveform

Another factor that affects the heat capacity of the focal spot track is the wave¬
form of the kilovoltage. Single-phase power delivers energy to the anode in
pulses, as shown in Figure 9-8. Three-phase and constant potential generators de¬
liver the heat at an essentially constant rate, as indicated. Figure 9-8 compares the

temperatures produced by a single-phase and a constant potential machine deliv¬

ering the same total heat. Because of the pulsating nature of single-phase power,
some points on the anode surface are raised to higher temperatures than others.

These hot spots exceed the temperature produced by an equal amount of three-

phase energy. When an x-ray tube is operated from a single-phase power supply,
the maximum power must be less than for constant potential operation to keep the
hot spots from exceeding the critical temperature. In other words, constant poten¬
tial operation increases the effective focal spot track heat capacity and rating of an
x-ray tube.
The effect of kilovoltage waveform on tube rating should not be confused with
the effect of waveform on heat production, which was discussed earlier. However,
 X-Ray Tube Heating and Cooling 137

Single Phase "Hot Spots

/ D~tential

Distance along focal spot track

Figure 9-8 Approximate Distribution of Temperature along the Focal Spot Track for
Single-Phase and Three-Phase Operation

both factors should be considered to determine if there is any

advantage, from the
standpoint of tube heating, to using three-phase or constant potential power. In
comparing three-phase or constant potential and single-phase operation, three fac¬
tors should be considered:

1. Constant potential operation permits a tube to be operated at a higher power

level because of the uniform distribution of heat.

2. Constant potential operation produces more x-radiation and increased pen¬

etration at a given KVP and MAS setting.

3. Constant potential operation produces more heat for a given KVP and MAS
setting.
The real advantage of constant potential operation is related to the first two fac¬
tors. Because of the increased efficiency of x-ray production, and the increased
penetrating ability of the radiation, a lower KVP or MAS value is required to pro¬
duce a given film exposure. This more than compensates for the increased heat

production associated with constant potential operation. The increased rating, or

maximum permissible power, associated with the constant potential waveform
also adds to the advantage. An x-ray tube can generally be operated at a higher

power level when the power is supplied from a three-phase or constant potential
power supply, and it will also produce radiation more efficiently.
A rating chart for an x-ray tube operated at different waveforms and rotation
speeds is shown in Figure 9-5. The highest power capacity is obtained by using
three-phase power and high-speed rotation; notice that the real advantage occurs
at relatively short exposure times. As exposure time is increased, overlapping of

the focal spot track and the diffusion of heat make the difference in power capacity
much less significant.
The actual rating charts supplied by an x-ray tube manufacturer are shown in
Figure 9-5. It is common practice for each of the four operating conditions (wave-
138 Physical Principles of Medical Imaging

form and speed) to be on a separate chart. Each chart contains a number of differ¬
ent curves, each representing a different MA value. The vertical scale on such a
rating chart is KVP. A chart of this type is still a power rating chart. Each combina¬
tion of KVP and MA represents a constant power value. Such a chart is easier to
use, since it is not necessary to calculate the power. The rating chart is used by the

operator to determine if the technical factors, KVP, MA, and exposure time, for a
given exposure will exceed the tube's rated capacity.
Most rotating anode tubes contain two focal spots. As mentioned previously,
the size of the focal spotsignificantly affects the heat capacity. Remember that a
given x-ray tube has a number of different rating values, depending on focal spot
size, rotation speed, and waveforms. Some typical values are shown in Table 9-1.

ANODE BODY

The heat capacity of the focal spot track is generally the limiting factor for
single exposures. In a series of radiographic exposures, CT scanning, or fluoros¬
copy, the build-up of heat in the anode can become significant. Excessive anode
temperature can crack or warp the anode disc. The heat capacity of an anode is
generally described graphically, as shown in Figure 9-9. This set of curves, de¬
scribing the thermal characteristics of an anode, conveys several important pieces
of information. The maximum heat capacity is indicated on the heat scale. The

heating curves indicate the build-up of heat within the anode for various energy
input rates. These curves apply primarily to the continuous operation of a tube,
such as in CT or fluoroscopy. For a given x-ray tube, there is a critical input rate
that can cause the rated heat capacity to be exceeded after a period of time. This is

generally indicated on the graph. If the heat input rate is less than this critical
value, normal cooling prevents the total heat content from reaching the rated
capacity.
The cooling curve can be used to estimate the cooling time necessary between
sets of exposures. Suppose a rapid sequence of exposures has produced a heat

Table 9-1 Heat Rating (in Joules) for Typical X-Ray Tube for Exposure Time of 0.1 sec and
Focal Spot Sizes of 0.7 mm and 1.5 mm

Single-phase Three-phase

3,600 rpm 700 (0.7 mm) 1,050 (0.7 mm)

2,300 (1.5 mm) 3,400 (1.5 mm)

10,800 rpm 1,100 (0.7 mm) 1,700 (0.7 mm)

3,900 (1.5 mm) 5,800 (1.5 mm)
 X-Ray Tube Heating and Cooling 139

150,000.
Rated Anode Capacity

£ 120,000-
o

X
90,000-
TJ

10
60,000.

30,000.

2 3 4 5 6 7 8
Time (Minutes)

Figure 9-9 Anode Heating and Cooling Curves

input of 90,000 HU. This is well over 50% of the anode storage capacity. Before a
similar sequence of exposures can be made, the anode must cool to a level at
which the added heat will not exceed the maximum capacity. For example, after
an initial heat input of 90,000 HU, a cooling time of approximately 3.5 minutes

will decrease the heat content to 30,000 HU. At this point, another set of exposures

producing 90,000 HU could be taken.

The cooling rate is not constant. An anode cools faster when it has a high heat
content and a high temperature. In CT scanning, when anode heating is a limiting

factor, a higher scan rate can be obtained by operating the anode with the highest
safe heat content since the cooling rate is higher for a hot anode and more scans
can be obtained in a specific time than with a cool anode. Most CT systems have a

display that shows the anode heat content as a percentage of the rated capacity.
The anodes in most radiographic equipment are cooled by the natural radiation
of heat to the surrounding tube enclosures. However, anodes in some high-

powered equipment, such as that used in CT, are cooled by the circulation of oil
through the anode to a heat exchanger (radiator).
Anode damage can occur if a high-powered exposure is produced on a cold
anode. It is generally recommended that tubes be warmed up by a series of low

energy exposures to prevent this type of damage.

TUBE HOUSING

The third heat capacity that must be considered is that of the tube housing. Ex¬
cessive heat in the housing can rupture the oil seals, or plugs. Like the anode, the
140 Physical Principles of Medical Imaging

housing capacity places a limitation on the extended use of the x-ray tube, rather
than on individual exposures. Since the housing is generally cooled by the move¬
ment of air, or convection, its effective capacity can be increased by using forced-

air circulation.
The housing heat capacity is much larger than that of the anode and is typically
over 1 million HU. The time required for a housing to dissipate a given quantity of
heat can be determined with cooling charts supplied by the manufacturer.

SUMMARY

The heat characteristics of x-ray tubes should be considered when tubes are
selected for specific applications and should be used as a guide to proper tube
operation.
 Chapter 10

Interaction of Radiation with

Matter

INTRODUCTION AND OVERVIEW

X-ray photons are created by the interaction of energetic electrons with matter
at the atomic level. Photons (x-ray and gamma) end their lives by transferring their

energy to electrons contained in matter. X-ray interactions are important in diag¬

nostic examinations for many reasons. For example, the selective interaction of

x-ray photons with the structure of the human body produces the image; the inter¬
action of photons with the receptor converts an x-ray or gamma image into one
that can be viewed or recorded. This chapter considers the basic interactions be¬
tween x-ray and gamma photons and matter.

INTERACTION TYPES

Photon Interactions

Recall that photons are individual units of energy. As an x-ray beam or gamma
radiation passes through an object, three possible fates await each photon, as
shown in Figure 10-1:
1. It can penetrate the section of matter without interacting.
2. It can interact with the matter and be completely absorbed by depositing its
energy.
3. It can interact and be scattered or deflected from its original direction and
deposit part of its energy.
There are two kinds of interactions through which photons deposit their energy;
both are with electrons. In one type of interaction the photon loses all its energy; in
it loses a portion of its energy, and the
the other, remaining energy is scattered.
These two interactions are shown in Figure 10-2.

141
142 Physical Principles of Medical Imaging

Figure 10-1 Photons Entering the Human Body Will Either Penetrate, Be Absorbed, or
Produce Scattered Radiation

Photoelectric

In the photoelectric (photon-electron) interaction, as shown in Figure 10-2, a

photon transfers all its energy to an electron located in one of the atomic shells.
The electron is ejected from the atom by this energy and begins to pass through the

surrounding matter. The electron rapidly loses its energy and moves only a rela¬
tively short distance from its original location. The photon's energy is, therefore,
deposited in the matter close to the site of the photoelectric interaction. The energy
transfer is a two-step process. The photoelectric interaction in which the photon
transfers its energy to the electron is the first step. The depositing of the energy in
the surrounding matter by the electron is the second step.
Photoelectric interactions usually occur with electrons that are firmly bound to
the atom, that is, those with a relatively high binding energy. Photoelectric interac¬
tions are most probable when the electron binding energy is only slightly less than
the energy of the photon. If the binding energy is more than the
energy of the
photon, a photoelectric interaction cannot occur. This interaction is possible only
when the photon has sufficient energy to overcome the binding energy and re¬
move the electron from the atom.
The photon's energy is divided into two parts by the interaction. A portion of
the energy is used to overcome the electron's binding energy and to remove it
 Interaction of Radiation with Matter 143

Electron
Kinetic
Photon
Energy

Strong j Binding
Energy
Nucleus
Kinetic
Energy^

Compton Interaction
Photon

Scattered
Weak Binding
Energy
"^Photon

Figure 10-2 The Two Basic Interactions between Photons and Electrons

from the atom. The remaining energy is transferred to the electron as kinetic en¬

ergy and is deposited near the interaction site. Since the interaction creates a va¬
cancy in one of the electron shells, typically the K or L, an electron moves down to
fill in. The drop in energy of the filling electron often produces a characteristic
x-ray photon. The energy of the characteristic radiation depends on the binding
energy of the electrons involved. Characteristic radiation initiated by an incoming
photon is referred to as fluorescent radiation. Fluorescence, in general, is a process
in which some of the energy of a photon is used to create a second photon of less

energy. This process sometimes converts x-rays into light photons. Whether the
fluorescent radiation is in the form of light or x-rays depends on the binding en¬
ergy levels in the absorbing material.

Compton
A Compton interaction is one in which only a portion of the energy is absorbed
and photon is produced with reduced energy. This photon leaves the site of the
a

interaction in a direction different from that of the original photon, as shown in

Figure 10-2. Because of the change in photon direction, this type of interaction is
classified scattering process. In effect, a portion of the incident radiation
as a

"bounces off' or is scattered by the material. This is significant in some situations

because the material within the primary x-ray beam becomes a secondary radia-
144 Physical Principles of Medical Imaging

tion source. The most significant object producing scattered radiation in an x-ray

procedure is the patient's body. The portion of the patient's body that is within the
primary x-ray beam becomes the actual source of scattered radiation. This has two
undesirable consequences. The scattered radiation that continues in the forward
direction and reaches the image receptor decreases the quality (contrast) of the
image; the radiation that is scattered from the patient is the predominant source of
radiation exposure to the personnel conducting the examination.

Coherent Scatter

There actually two types of interactions that produce scattered radiation.

are

One type, referred to by a variety of names, including coherent, Thompson,

Rayleigh, classical, and elastic, is a pure scattering interaction and deposits no
energy in the material. Although this type of interaction is possible at low photon
energies, it is generally not significant in most diagnostic procedures.

Pair Production

production is a photon-matter interaction that is not encountered in diag¬

Pair
nosticprocedures because it can occur only with photons with energies in excess
of 1.02 MeV. In a pair-production interaction, the photon interacts with the
nucleus in such a manner that its energy is converted into matter. The interaction

produces a pair of particles, an electron and a positively charged positron. These

two particles have the same mass, each equivalent to a rest mass energy of 0.51

MeV.

Electron Interactions

The interaction and transfer of energy from photons to tissue has two phases.
The first is the "one-shot" interaction between the photon and an electron in which
allor a significant part of the photon energy is transferred; the second is the trans¬

fer of energy from the energized electron as it moves through the tissue. This
occurs as a series of interactions, each of which transfers a relatively small amount

of energy.
Several types of radioactive transitions produce electron radiation including
beta radiation, internal conversion (IC) electrons, and Auger electrons. These ra¬
diation electrons interact with matter (tissue) in a manner similar to that of elec¬
trons produced by photon interactions.
In photoelectric interactions, the energy of the electron is equal to the energy of
the incident photon less the binding energy of the electron within the atom. In

Compton interactions, the relationship of the electron energy to that of the photon
depends on the angle of scatter and the original photon energy. The electrons set
free by these interactions have kinetic energies ranging from relatively low values
 Interaction of Radiation with Matter 145

to values slightly below the

energy of the incident photons.
As the electrons leave the interaction site,
they immediately begin to transfer
their energy to the surrounding material, as shown in
Figure 10-3. Because the
electron carries an electrical charge, it can interact with other electrons without
touching them. As it passes through the material, the electron, in effect, pushes the
other electrons away from its path. If the force on an electron is sufficient to re¬
move it from its atom, ionization results. In some cases, the atomic or molecular
structures are raised to a
higher energy level, or excited state. Regardless of the
type of interaction, the moving electron loses some of its energy. Most of the
ionization produced by x- and gamma radiation is not a result of direct
photon
interactions, but rather of interactions of the energetic electrons with the material.
For example, in air, radiation must expend an average energy of 33.4 eV per ion¬
ization. Consider a 50-keV
x-ray photon undergoing a photoelectric interaction.
The initial interaction of the photon ionizes one atom, but the resulting
energetic
electron ionizes approximately 1,500 additional atoms.

Electron Range
The total distance an electron travels in a material before
losing all its energy is
generally referred to as its range. The two factors that determine the range are (1)
the initial energy of the electrons and (2) the density of the material. One impor¬
tant characteristic of electron interactions is that all electrons of the same energy
have the same in a specific material, as illustrated in Figure 10-4. The gen¬
range
eral relationship between electron range and energy is shown in Figure 10-5. The
curve shown is the range for a material with a density of 1 g/cm3. This is the

Electrons attached to atoms

Radiation Electron

Figure 10-3 Ionization Produced by a Radiation Electron

146 Physical Principles of Medical Imaging

Matter

Same Initial
Energy

•Linear Energy Transfer (LET)

Figure 10-4 The Range of Electrons with the Same Initial Energies

density of water and the approximate density of muscle tissue.

The electron range in other materials can be determined by dividing the range

given in Figure 10-5 by the density of the material. Let us now apply this proce¬
dure to determine the range of 300-keV beta particles in air. (Air has a density of
0.00129 g/cm3.) From Figure 10-5 we see that a 300-keV electron has a range of
0.76 mm in a material with a density of 1 g/cm3. When this value is divided by the

density of air, we find the range to be 59 cm.

In general, the range of electron radiation in materials such as tissue is a fraction
of a millimeter. This means that essentially all electron radiation energy is ab¬
sorbed in the body very close to the site containing the radioactive material.

Linear Energy Transfer

The rate at which an electron transfers energy to a material is known as the
linear energy transfer (LET), and is expressed in terms of the amount of energy
transferred per unit of distance traveled. Typical units are kiloelectron volts per
micrometer (keV/pm). In a given material, such as tissue, the LET value depends
on the kinetic energy (velocity) of the electron. The LET is generally inversely
related to the electronvelocity. As a radiation electron loses energy, its velocity
decreases, and the value of the LET increases until all its energy is dissipated. LET
 Interaction of Radiation with Matter 147

Electron Energy (keV)

Figure 10-5 Relationship of Electron Range to Initial Energy in a Material with a Density
of 1g/cm3 (Soft Tissue)

values in soft tissue for several electron energies are given below.
Electron Energy LET
(keV) (keV/jim)
1000 0.2
100 0.3
10 2.2
1 12.0

The effectiveness of particular radiation in producing biological damage is

a

often related to the LET of the radiation. The actual relationship of the efficiency
in producing damage to LET values depends on the biological effect considered.
For some effects, the efficiency increases with an increase in LET, for some it
decreases, and for others it increases up to a point and then decreases with addi¬
tional increases in LET. For a given biological effect, there is an LET value that
produces an optimum energy concentration within the tissue. Radiation with
lower LET values does not produce an adequate concentration of energy. Radia-
 148 Physical Principles of Medical Imaging

tions with higher LET values tend to deposit more energy than is needed to pro¬
duce the effect; this tends to waste energy and decrease efficiency.

Positron Interactions

Recall that a positron is the same size as an electron, but has a positive charge.
It is also different from the electron in that it is composed of what is referred to as
antimatter. This leads to a type of interaction that is quite different from the inter¬
actions among electrons.
The interaction between a positron and matter is in two phases, as illustrated in

Figure 10-6. These are ionization and annihilation. As the energetic positron
passes through matter, it interacts with the atomic electrons by electrical attrac¬
tion. As the positron moves along, it pulls electrons out of the atoms and produces
ionization. A small amount of energy is lost by the positron in each interaction. In
general, this phase of the interaction is not too unlike the interaction of an ener¬
getic electron, but the positron pulls electrons as it races by and electrons push
electrons away from the path. Also, when the positron has lost most of its kinetic
energy and is coming to a stop, it comes into close contact with an electron and
enters into an annihilation interaction.
The annihilation process occurs when the antimatter positron combines with the
conventional-matter electron. In this interaction, the masses of both particles are
completely converted into energy. The relationship between the amount of energy

jr
*

^ $10X*V
Pcrs+ira/L *

lomzattofr y -flmrttvlatten

yC
/

Figure 10-6 A Positron Interaction That Produces Annihilation Radiation

 Interaction of Radiation with Matter 149

and mass is given by

E = mc2.

The energy equivalent of one electron or

positron mass is 511 keV. The energy
that results from the annihilation process is emitted from the interaction site in the
form of two photons, each with an energy of 511 keV. The pair of photons leave
the site in opposite directions. With special imaging equipment it is possible to
capture both photons and to determine the precise three-dimensional location of
the interaction site. Since the range of a positron, like that of an electron, is rela¬

tively short, the site of interaction is always very close to the location of the radio¬
active nuclei.

PHOTON INTERACTION RATES

Attenuation

As a photon makes its way through matter, there is no way to predict precisely
either how far it will travel before engaging in an interaction or the type of interac¬
tion it will engage in. In clinical applications we are generally not concerned with
the fate of an individual photon but rather with the collective interaction of the

large number of photons. In most instances we are interested in the overall rate at
which photons interact as they make their way through a specific material.
Let us observe what happens when a group of photons encounters a slice of
material that is 1 unit thick, as illustrated in Figure 10-7. Some of the photons
interact with the material, and some pass on through. The interactions, either pho-

Linear Attenuation Coefficient (fi)

ji = 0.1 /cm
/ \

100 Photons 90 Phot*

1 cm-
J
Photon Material
Energy Density
Atomic Number

Figure 10-7 Linear Attenuation Coefficient

150 Physical Principles of Medical Imaging

toelectric or Compton, remove some of the photons from the beam in a process
known as attenuation. Under specific conditions, a certain percentage of the pho¬
tons will interact, or be attenuated, in a 1-unit thickness of material.

Linear Attenuation Coefficient

The linear attenuation coefficient (p.) is the actual fraction of photons interact¬

ing per 1-unit thickness of material. In our example the fraction that interacts in the
1-cm thickness is 0.1, or 10%, and the value of the linear attenuation coefficient is
0.1 per cm.
Linear attenuation coefficient values indicate the rate at which
photons interact
as they move through material and are inversely related to the average distance
photons travel before interacting. The rate at which photons interact (attenuation
coefficient value) is determined by the energy of the individual photons and the
atomic number and density of the material.

Mass Attenuation Coefficient

In some situations it is more desirable to express
the attenuation rate in terms of
the mass of the material encountered by the photons rather than in terms of dis¬
tance. The quantity that affects attenuation rate is not the total mass of an object
but rather the area mass. Area mass is the amount of material behind a 1-unit sur¬

face area, as shown in Figure 10-8. The area mass is the product of material thick¬
ness and density:
Area Mass (g/cm2) = Thickness (cm) x Density (g/cm3).
The mass attenuation coefficient is the rate of photon interactions per 1-unit (g/
cm2) area mass.

Figure 10-8 compares two pieces of material with different thicknesses and
densities but the same area mass. Since both attenuate the same fraction of pho¬
tons, the mass attenuation coefficient is the same for the two materials. They do
not have the same linear attenuation coefficient values.
The relationship between the mass and linear attenuation coefficients is
Mass Attenuation Coefficient (m/p) =
Linear Attenuation Coefficient (m) /Density (r).
Notice that the symbol for mass attenuation coefficient (|i/p) is derived from the
symbols for the linear attenuation coefficient (p.) and the symbol for density (p).
We must be careful not to be misled by the relationship stated in this manner.
Confusion often arises as to the effect of material density on attenuation coeffi¬
cient values. Mass attenuation coefficient values are actually normalized with re¬

spect to material density, and therefore do not change with changes in density.
Material density does have a direct effect on linear attenuation coefficient values.
 Interaction of Radiation with Matter 151

The total attenuation ratedepends on the individual rates associated with photo¬
electric and Compton interactions. The respective attenuation coefficients are re¬
lated as follows:

p. (total) = p (photoelectric) + p (Compton).

Let us now consider the factors that affect attenuation rates and the competition
between photoelectric and Compton interactions. Both types of interactions occur
with electrons within the material. The chance that a photon will interact as it
travels a 1-unit distance depends on two factors.
One factor is the concentration, or density, of electrons in the material. Increas¬
ing the concentration of electrons increases the chance of a photon coming close
enough to an electron to interact. In Chapter 4 we observed that electron concen¬
tration was determined by the physical density of the material. Therefore, density
affects the probability of both photoelectric and Compton interactions.
All electrons are not equally attractive to a photon. What makes an electron
more or less attractive is its binding energy. The two general rules are:

1. Photoelectric interactions occur most frequently when the electron binding

energy is slightly less than the photon energy.
2. Compton interactions occur most frequently with electrons with relatively
low binding energies.

In Chapter 4 we observed that the electrons with binding energies within the en¬
ergy range of diagnostic x-ray photons were the K-shell electrons of the intermedi¬
ate- and high-atomic-number materials. Since an atom can have, at the most, two
152 Physical Principles of Medical Imaging

electrons in the K shell, the majority of the electrons are located in the other shells
and have relatively low binding energies.

Photoelectric Rates

The probability, and thus attenuation coefficient value, for photoelectric inter¬
actions depends on how well the photon energies and electron binding energies
match, as shown in Figure 10-9. This can be considered from two perspectives.
In a specific material with a fixed binding energy, a change in photon energy
alters the match and the chance for photoelectric interactions. On the other hand,
with photons of a specific energy, the probability of photoelectric interactions is
affected by the atomic number of the material, which changes the binding energy.

Dependence on Photon Energy

In a given material, the probability of photoelectric interactions occurring is

strongly dependent on the energy of the photon and its relationship to the binding
energy of the electrons. Figure 10-10 shows the relationship between the attenua¬
tion coefficient for iodine (Z = 53) and photon energy. This graph shows two
significant features of the relationship. One is that the coefficient value, or the
probability of photoelectric interactions, decreases rapidly with increased photon
energy. It is generally said that the probability of photoelectric interactions is in¬
versely proportional to the cube of the photon energy (1/E3). This general relation¬
ship can be used to compare the photoelectric attenuation coefficients at two dif-

Atomic Number-Z

20 30 40 50 60 70

Photon
Energy
Increase
Photoelectric
Interactions

0 10 20 30 40 50 60 70 80 90
Energy (keV)

Figure 10-9 The Relationship between Material Atomic Number and Photon Energy That
Enhances the Probability of Photoelectric Interactions
 Interaction of Radiation with Matter 153

55 keV

45 keV
yes + +

35 keV

25 keV

15 keV

Figure 10-10 Relationship between the Probability of Photoelectric Interactions and

Photon Energy

ferent photon energies. The significant point is that the probability of photoelec¬
tric interactions occurring in a given material drops drastically as the photon en¬
ergy is increased.
The other important feature of the attenuation coefficient-photon energy rela¬

tionship shown in Figure 10-10 is that it changes abruptly at one particular energy:
the binding energy of the shell electrons. The K-electron binding energy is 33 keV
for iodine. This feature of the attenuation coefficient curve is generally designated
as the K, L, or M edge. The reason for the sudden change is apparent if it is re¬

called that photons must have energies equal to or slightly greater than the binding

energy of the electrons with which they interact. When photons with energies less
than 33 keV pass through iodine, they interact primarily with the L-shell electrons.
They do not have sufficient energy to eject electrons from the K shell, and the
probability of interacting with the M and N shells is quite low because of the
relatively large difference between the electron-binding and photon energies.
However, photons with energies slightly greater than 33 keV can also interact with
154 Physical Principles of Medical Imaging

the K shell electrons. This means that there are now more electrons in the material
that are produces a sudden increase in the attenua¬
available for interactions. This
tion coefficient at the K-shell energy. In the case of iodine, the attenuation coeffi¬
cient abruptly jumps from a value of 5.6 below the K edge to a value of 36, or
increases by a factor of more than 6.
A similar change in the attenuation coefficient occurs at the L-shell electron

binding energy. For most elements, however, this is below 10 keV and not within
the useful portion of the x-ray spectrum.
Photoelectric interactions occur at the highest rate when the energy of the x-ray

photon is just above the binding energy of the electrons.

Material Atomic Number

The probability of photoelectric interactions occurring is also dependent on the

atomic number of the material. An explanation for the increase in photoelectric
interactions with atomic number is that as atomic number is increased, the binding

energies move closer to the photon energy. The general relationship is that the
probability of photoelectric interactions (attenuation coefficient value) is propor¬
tional to Z3. In general, the conditions that increase the probability of photoelec¬
tric interactions are low photon energies and high-atomic-number materials.

Compton Rates

Compton interactions can occur with the very loosely bound electrons. All elec¬
trons in low-atomic-number materials and the majority of electrons in high-
atomic-number materials are in this category. The characteristic of the material
that affects the probability of Compton interactions is the number of available
electrons. It was shown earlier that all materials, with the exception of hydrogen,
have approximately the same number of electrons per gram of material. Since the
concentration of electrons in a given volume is proportional to the density of the
materials, the probability of Compton interactions is proportional only to the
physical density and not to the atomic number, as in the case of photoelectric
interactions. The major exception is in materials with a significant proportion of

hydrogen. In these materials with more electrons per gram, the probability of
Compton interactions is enhanced.
Although the chances of Compton interactions decrease slightly with photon
energy, the change is not so rapid as for photoelectric interactions, which are in¬
versely related to the cube of the photon energy.

Direction of Scatter

It is possible for photons to scatter in any direction. The direction in which an

individual photon will scatter is purely a matter of chance. There is no way in
 Interaction of Radiation with Matter 155

which the angle of scatter for a specific photon can be predicted. However, there
are certain directions that are more
probable and that will occur with a greater
frequency than others. The factor that can alter the overall scatter direction pattern
is the energy of the original
photon. In diagnostic examinations, the most signifi¬
cant scatter will be in the forward direction. This would be an
angle of scatter of
only afew degrees. However, especially at the lower end of the energy spectrum,
there is a significant amount of scatter in the reverse direction, ie, backscatter. For
the diagnostic photon energy range, the number of
photons that scatter at right
angles to the primary beam is in the range of one-third to one-half of the number
that scatter in the forward direction.
Increasing primary photon energy causes a
general shift of scatter to the forward direction. However, in diagnostic proce¬
dures, there is always a significant amount of back- and sidescatter radiation.

Energy of Scattered Radiation

When photon undergoes a Compton interaction, its energy is divided between
a

the scattered secondary photon and the electron with which it interacts. The
electron's kinetic energy is quickly absorbed by the material along its path. In
other words, in a Compton interaction, part of the original photon's energy is ab¬
sorbed and part is converted into scattered radiation.
The manner in which the energy is divided between scattered and absorbed
radiation depends on two factors—the angle of scatter and the energy of the origi¬
nal photon. The relationship between the energy of the scattered radiation and the

angle of scatter is a little complex and should be considered in two steps. The
photon characteristic that is specifically related to a given scatter angle is its
change in wavelength. It should be recalled that a photon's wavelength (X) and
energy (E) are inversely related as given by:

Since photons lose energy in a Compton interaction, the wavelength always in¬
creases. The relationship between the change in a photon's wavelength, A X, and
the angle of scatter is given by:

AX, = 0.024(1 - cosO).

For example, all photons scattered at an angle of 90 degrees, where the cosine has
a undergo a wavelength change of 0.024 A. Photons that scatter
value of 0, will
back at an angle of 180 degrees where the cosine has a value of-1 will undergo a
wavelength change of 0.048 A. This is the maximum wavelength change that can
occur in a scattering interaction.

It is important to recognize the difference between a change in wavelength and

a change in energy. Since higher energy photons have shorter wavelengths, a
156 Physical Principles of Medical Imaging

change of say 0.024 A represents a larger energy change than it would for a lower
energy photon. All photons scattered at an angle of 90 degrees will undergo a
wavelength change of 0.0243 A. The change in energy associated with 90-degree
scatter is not the same for all photons and depends on their original energy. The

change in energy can be found as follows. For a 110-keV photon, the wavelength
is 0.1127 A. A scatter angle of 90 degrees will always increase the wavelength by
0.0243. Therefore, the wavelength of the scattered photon will be 0.1127 plus
0.0243 or of a photon with this wavelength is 91 keV. The 110
0.1370. The energy
keVphotons will lose 19 keV or 17% of their energy in the scattering process.
Lower energy photons lose a smaller percentage of their energy.

COMPETITIVE INTERACTIONS

As photons pass through matter, they can engage in either photoelectric or

Compton interactions with the material electrons. The photoelectric interaction

captures all photon energy and deposits it within the material, whereas the
Compton interaction removes only a portion of the energy, and the remainder con¬
tinues as scattered radiation. The combination of the two types of interactions

produces the overall attenuation of the x-ray beam. We now consider the factors
that determine which of the two interactions is most likely to occur in a given
situation.
The energy at which interactions change from predominantly photoelectric to
Compton is function of the atomic number of the material. Figure 10-11 shows
a
this crossover energy for several different materials. At the lower photon energies,

photoelectric interactions are much more predominant than Compton. Over most
of the energy range, the probability of both decreases with increased energy. How¬
ever, the decrease in photoelectric interactions is much greater. This is because the

photoelectric rate changes in proportion to 1/E3, whereas Compton interactions are

much less energy dependent. In soft tissue, the two lines cross at an energy of
about 30 keV. At this energy, both photoelectric and Compton interactions occur
in equal numbers. Below this energy, photoelectric interactions predominate.
Above 30 keV, Compton interactions become the significant process of x-ray at¬
tenuation. As photon energy increases, two changes occur: the probability of both
types of interactions decreases, but the decrease for Compton is less, and it be¬
comes the predominant type of interaction.

In higher-atomic-number materials, photoelectric interactions are more prob¬

able, in general, and they predominate up to higher photon energy levels. The
conditions that cause photoelectric interactions to predominate over Compton are
the same conditions that enhance photoelectric interactions, that is, low photon

energies and materials with high atomic numbers.

 Interaction of Radiation with Matter 157

Figure 10-11 Comparison of Photoelectric and Compton Interaction Rates for Different
Materials and Photon
Energies

The total attenuation coefficient value for materials involved in x-ray and
gamma interactions can vary tremendously if photoelectric interactions are in¬
volved. A minimum value of approximately 0.15 cm2/g is established by Compton
interactions. Photoelectric interactions can cause the total attenuation to increase
to very high values. For example, at 30 keV, lead (Z = 82) has a mass attenuation
coefficient of 30 cm2/g.
 Chapter 11

Radiation Penetration

INTRODUCTION AND OVERVIEW

One of the characteristics of x- and gamma radiation that makes them useful for
medical imaging is their penetrating ability. When they are directed into an object,
some of the photons are absorbed or scattered, whereas others
completely pen¬
etrate the object. The penetration can be expressed as the fraction of radiation

passing through the object. Penetration is the inverse of attenuation. The amount
of penetration depends on the energy of the individual photons and the atomic
number, density, and thickness of the object, as illustrated in Figure 11-1.
The probability of photons interacting, especially with the photoelectric effect,
is related to their energy. Increasing photon energy generally decreases the prob¬

ability of interactions (attenuation) and, therefore, increases penetration. As a

rule, high-energy photons are better penetrators than low-energy photons, al¬
though there are limits and exceptions to this, which we discuss later.

PHOTON RANGE

It might be helpful in understanding the characteristics of radiation penetration

to firstconsider the range, or distance, traveled by the individual photons before
they are absorbed or scattered. When photons enter an object, they travel some
distance before interacting. This distance can be considered the range of the indi¬
vidual photons.
A characteristic of radiation is that photons do not have the same range, even
when they have the same energy. In fact, there is no way to predict the range of a

specific photon. Let us consider a group of monoenergetic photons entering an

object, as shown in Figure 11-2. Some of the photons travel a relatively short
distance before interacting, whereas others pass through or penetrate the object. If
we count the number of photons penetrating through each thickness of material,

159
 160 Physical Principles of Medical Imaging

Object

Density
Atomic Number (Z)

Figure 11-1 Factors That Affect the Penetration of Radiation through a Specific Object

we begin to see a fundamental characteristic of photon penetration. The relation¬

ship between the number of photons reaching a specific point and the thickness of
the material to that point is exponential.
The nature of the exponential relationship is that each thickness of material
attenuates the same fraction of photons entering it. This means that the first
layer
encountered by the radiation beam attenuates many more photons than the suc¬

ceeding layers.
In a given situation a group of photons have different individual
ranges which,
when considered together, produce an average range for the group. The average

range is the average distance traveled by the photons before they interact. Very
few photons travel a distance exactly equal to the
average range. The average
range of a group of photons is inversely related to the attenuation rate. Increasing
the rate of attenuation by changing photon energy or the type of material decreases
the average range of photons. Actually, the average photon range is
equal to the
reciprocal of the attenuation coefficient (|a):
Average Range (cm) = 1/Attenuation Coefficient (cm"1)
Therefore, the average distance (range) that photons penetrate a material is deter¬
mined by the same factors that affect the rate of attenuation: photon energy, type
of material (atomic number), and material density.
Average photon range is a useful concept for visualizing the penetrating charac¬
teristics of radiation photons. It is, however, not the most useful parameter for
measuring and calculating the penetrating ability of radiation.
 Radiation Penetration 161

HALF VALUE LAYER

Half value layer (HVL) is the most frequently used factor for describing both
the penetrating ability of specific radiations and the penetration through specific
objects. HVL is the thickness of material penetrated by one half of the radiation
and is expressed in units of distance (mm or cm).

Increasing the penetrating ability of a radiation increases its HVL. HVL is re¬
lated to, but not the same as, average photon range. There is a difference between
the two because of the exponential characteristic of
x-ray attenuation and penetra¬
tion. The specific relationship is

HVL = 0.693 x Average Range = 0.693/p.

(/a = 0.1/cm)
Photons interacting in each one cm layer
100 90 81 73 65 59 53 47 43 38 34 31

rsj-
-rJ.

1000
Photons Photons

-nJ-

1000

10 12

Thickness (cm)

Figure 11-2 Penetration Range of Individual Photons

162 Physical Principles of Medical Imaging

This shows that the HVL is inversely proportional to the attenuation coefficient.
The number, 0.693, is the exponent value that gives a penetration of 0.5
(e-0.693 = 0.5).

Any factor that changes the value of the attenuation coefficient also changes the
HVL. These two quantities are compared for aluminum in Figure 11-3. Aluminum
has two significant applications in an x-ray system. It is used as a material to filter

x-ray beams and as a reference material for measuring the penetrating ability
(HVL) of x-rays. The value of the attenuation coefficient decreases rather rapidly
with increased photon energy and causes the penetrating ability to increase.

Figure 11-4 illustrates an important aspect of the HVL concept. If the penetra¬
tion through a thickness of 1 HVL is 0.5 (50%), the penetration through a thick¬
ness of 2 HVLs will be 0.5 x 0.5 or 25%. Each succeeding layer of material with a

thickness of 1 HVL reduces the number of photons by a factor of 0.5. The relation¬

ship between penetration (P) and thickness of material that is n half value layers
thick is

P = (0.5 )n.

10 20 30 40 50 60
Photon Energy (keV)

Figure 11-3 Relationship between Attenuation Coefficient and HVL for Aluminum
 Radiation Penetration 163

50%

PENETRATION
25%

w-^12.5%
-5
O"
O
O

6.25%

3.13%

0 1 4
Thickness (HVLs)

Figure 11-4 Relationship between Penetration and Object Thickness Expressed in HVLs

An
example using this relationship is determining the penetration through lead
shielding. Photons of 60 keV have an HVL in lead of 0.125 mm. The problem is to
determine the penetration through a lead shield that is 0.5 mm thick. At this par¬
ticular photon energy, 0.5 mm is 4 HVLs, and the penetration is

n = thickness/HVL = 0.5/0.125 = 4
p = (0.5)4 = 0.0625.

Figure 11-5 summarizes two important characteristics of HVL. In a specific

material, the HVL is affected by photon energy. On the other hand, for a specific
photon energy, the thickness of 1 HVL is related to characteristics of the material,
density, and/or atomic number.
The general procedure for determining the HVL value of an x-ray beam is illus¬
trated in Figure 11-6. Two items are required. One is an instrument for measuring
radiation exposure, and the second is a set of aluminum absorbers. Typically, the
set includes absorbers with thicknesses of both 0.5 mm and 1 mm.
The exposure meter is positioned as shown, and a reading is made. Aluminum
absorbers are then placedin the beam, typically in 0.5- or 1-mm increments, and an
exposure reading is made. Dividing each exposure reading by the exposure with
no absorber gives the penetration for each thickness of absorber. The penetration
164 Physical Principles of Medical Imaging

values are plotted as a function of aluminum-absorber thickness. The ab¬

then
sorber thickness corresponding to a penetration value of 0.5 is the HVL. This
value is referred to as the first HVL. The second HVL value is the additional
thickness required to reduce the penetration to 0.25. Generally, it is larger than the
first value because the first aluminum absorbers added to the beam act as a filter
and produce an increase in the equivalent energy and corresponding HVL value.
In actual practice, it is usually more desirable to plot the penetration values on a

logarithmic scale (by using semilogarithmic graph paper) so that the resulting
graph is essentially a straight line.

X-RAY BEAM QUALITY

The general term "quality" refers to an x-ray beam's penetrating ability. It has
been shown that, for a given material, the penetrating ability of an x-ray beam
depends on the energy of the photons. Up to this point, the discussion has related

Low
Energy
—
r^J —
-50%

l HVL1!
High
Energy
-

—rJ— -50o/o Exposure

meter

High
Density

rJ- -50%

Same
Energy
/ 1 1
! HVL

-rJ. -50%

Low
Density

Figure 11-5 Factors That Affect the Figure 11-6 Procedures for Determining
Thickness of 1 HVL the HVL of an X-Ray Beam
 Radiation Penetration 165

penetration to specific photon energies. For x-ray beams that contain a spectrum
of photon energies, the penetration is different for each
energy. The overall pen¬
etration generally corresponds to the penetration of a
photon energy between the
minimum and maximum energies of the
spectrum. This energy is designated the
effective energy of the x-ray spectrum as shown in Figure 11-7. The effective
energy of an x-ray spectrum is the energy of a monoenergetic beam of photons that
has the same penetrating ability (HVL) as the spectrum of
photons.
The effective energy is generally close to 30% or 40% of
peak energy, but its
exact value depends on the shape of the spectrum. For a
given KVP, two factors
that can alter the spectrum are the amount of filtration in the beam and the
high
voltage waveform used to produce the x-rays.

FILTRATION

As an x-ray beam made up of different photon energies passes through many

materials, photons of certain energies penetrate better than others. This selective

100 kVp

Effective Energy
50 kVp

0 20 40 60 80 100 120
Photon Energy (keV)

Figure 11-7 Effective Energy of X-Ray Spectra

166 Physical Principles of Medical Imaging

attenuation of photons, according to their energy, is referred to asfiltration. Figure

11-8 shows the penetration through two materials of special interest, a 1-cm thick¬
ness of muscle and a 1-mm thickness of aluminum. The penetration through the
muscle, or soft tissue, is considered first. For photons with energies less than 10
keV, there is virtually no penetration; all the photons are attenuated by the tissue.
The low penetration in tissue by photons of this energy is because of the high
value for the attenuation coefficient. Recall that the high attenuation coefficient
value is the result of photoelectric interactions, which are highly probable at this

energy. In the range of 10 keV to 25 keV, penetration rapidly increases with en¬
ergy. As photon energy increases to about 40 keV, penetration increases, but much
more gradually. Of special interest is the very low penetrating ability of x-ray

photons with energies below approximately 20 keV. At this energy, the penetra¬
tion through 1 cm of tissue is 0.45, and the penetration through 15 cm of tissue is

P = (0.45)15 = 0.0000063.

Figure 11-8 Penetration of Soft Tissue and Aluminum for Various Photon Energies
 Radiation Penetration 167

On the other hand, the penetration

through 15 cm of tissue for photons with an
energy of 50 keV is
P = (0.8)15 = 0.035.
A significant portion (3.5%) of photons with an energy near 50 keV penetrate a
15-cm-thick patient, whereas virtually no photons with energies of 20 keV or less
make it through. This means that low-energy photons in an
x-ray spectrum do not
contribute to image formation; they contribute only to patient exposure. In other
words, the tissue of the body selectively filters out the low-energy photons.
An obvious solution is to place some material in the x-ray beam, before it enters
the patient, to filter out the low-energy photons. In diagnostic x-ray equipment,
aluminum is normally used for this purpose. Figure 11-8 shows the penetration
through a 1-mm thickness of aluminum. Typically, most x-ray machines contain
the equivalent of several millimeters of aluminum filtration. This might not al¬

ways be in the form of aluminum because several objects contribute to x-ray beam
filtration: the x-ray tube window, the x-ray beam collimator mirror, and the table
top in fluoroscopic equipment. The total amount of filtration in a given x-ray ma¬
chine is generally specified in terms of an equivalent aluminum thickness.
The addition of filtration significantly alters the shape of the x-ray spectrum, as
shown in Figure 11-9. Since filtration selectively absorbs the lower energy pho¬
tons, it produces a shift in the effective energy of an x-ray beam. Figure 11-9
compares an unfiltered spectrum to spectra that passed through 1-mm and 3-mm
filters. It is apparent that increasing the filtration from 1 mm to 3 mm of aluminum

produces a noticeable decrease in the number of x-ray photons. It should be ob¬

served, however, that most of this decrease is in photons with energies less than
approximately 40 keV. These are the photons with a low probability of penetrating
a typical patient and contributing to image formation. They do, however, contrib¬

ute to patient exposure.

Adding filtration increases the penetration (HVL) of an x-ray beam by remov¬

ing the low-energy photons. HVL values are used to judge the adequacy of the
filtration. Regulations that specify filtration requirements generally state a mini¬
mum acceptable HVL value. Typical values are shown in Table 11-1. It is as¬

sumed that if an x-ray beam has the minimum specified HVL value at a stated
KVP, the filtration is adequate.

PENETRATION WITH SCATTER

Up to this point, the x-ray photons that penetrate an object were assumed to be
those that had escaped both photoelectric and Compton interactions. In situations
in which Compton interactions are significant, it is necessary to modify this con¬

cept because some of the radiation removed from the primary beam by Compton
168 Physical Principles of Medical Imaging

Photon Energy (KeV)

Figure 11-9 X-Ray Spectra After Filtration

interactions is scattered in the forward direction and creates the appearance of

increased penetration. A prime example is an x-ray beam passing through the
larger portions of the human body,as illustrated in Figure 11-10. When significant
forward-scattered radiation combines with the penetrated portion of the primary
beam, the effective penetration, Pe, is given by:

Pe = P x S

where S is the scatter factor. Its value ranges from 1 (no scatter) to approximately
6 for conditions encountered in some diagnostic examinations.
Several factors contribute to the amount of radiation scattered in the forward
direction and hence to the value of S. One of the most significant factors is the
x-ray beam area, or field size. Since the source of the scattered radiation is the
volume of the patient within the primary x-ray beam, the source size is propor¬
tional to the beam area. Within limits, the value of S increases from a value of 1,
 Radiation Penetration 169

Table 11-1 Recommended Minimum Penetration (HVL) for Various KVP Values

KVp Minimum penetration (HVL) for aluminum (mm)

30 0.3
50 1.2
70 1.5
90 2.5
110 3.0

>r

Primory Source

.> , » Primary ♦ Scatter

- y.

Figure 11-10 Scattered Radiation Adds to the Primary Radiation That Penetrates an
Object

more or less, in proportion to field size. Another important factor is body section
thickness, which affects the size of the scattered radiation source. A third signifi¬
cant factor is KVP. As the KVP is increased over the diagnostic range, several
changes occur. A greater proportion of the photons that interact with the body are
involved in Compton interactions, and a greater proportion of the photons created
in Compton interactions scatters in the forward direction. Perhaps the most sig¬
nificant factor is that the scattered radiationproduced at the higher KVP values is
more penetrating. A larger proportion of it leaves the body before being absorbed.
When the scattered radiation is more penetrating, there is a larger effective source
within the patient. At low KVP values, most of the scattered radiation created near
the entrance surface of the x-ray beam does not penetrate the body; at higher KVP
values, this scattered radiation contributes more to the radiation passing through
the body.
170 Physical Principles of Medical Imaging

Table 11-2 HVL Values for Certain Materials

Material HVL (mm)

30 keV 60 keV 120 keV

Tissue 20.0 35.0 45.0

Aluminum 2.3 9.3 16.6
Lead 0.02 0.13 0.15

PENETRATION VALUES

We have seen that the amount of radiation that penetrates

through a specific
thickness of material is determinedby the energy of the individual photons and the
characteristics (density and atomic number) of the material. HVL values provide
useful information about the penetration of a specific radiation in a specific mate¬
rial. When an HVL value is known, the penetration through other thicknesses can
be easily determined. Table 11-2 gives HVL values for several materials related to

diagnostic imaging.
 Chapter 12

X-Ray Image Formation and

Contrast

INTRODUCTION AND OVERVIEW

There are two basic ways to create images with x-radiation. One method is to
pass an x-ray beam through the body section and project a shadow image onto the
receptor. The second method, used in CT, employs a digital computer to calculate
(reconstruct) an image from x-ray penetration data. CT image formation is dis¬
cussed in Chapter 23. At this time, we consider only projection imaging, which is
the basic process employed in conventional radiography and fluoroscopy.
The contrast that ultimately appears in the image is determined by many factors,
as indicated in Figure 12-1. In addition to the penetration characteristics to be

considered, image contrast is significantly affected by scattered radiation (Chapter

13) and the contrast characteristics of the film (Chapter 16). The contrast of small
objects within the body and anatomical detail are reduced by image blurring
(Chapters 18 and 19). As the x-ray beam emerges from the patient's body, as
shown in Figure 12-2, it contains an image in the form of variations in exposure
across the image area. A significant characteristic of this invisible x-ray image is

the amount of contrast it contains. Contrast is represented by the amount of varia¬

tion in x-ray exposure between points within the image; the amount of contrast

produced in a specific examination is determined by both the physical characteris¬

tics of the body section and the penetrating characteristics of the x-ray beam.
In this chapter we explore the characteristics of both the objects within a body
and the x-ray beam and show how optimum image contrast can be achieved.

CONTRAST TYPES

Several types of contrast are encountered during x-ray image formation. The
formation of a visible image involves the transformation of one type of contrast to
another at two stages in the image-forming process, as shown in Figure 12-2.

171
172 Physical Principles of Medical Imaging

Radiographic
Contrast

PENETRATION SCATTER FILM

Object Photon Energy Source Grid Characteristic Exposure

Curve
Atomic Number KV Field Size Ratio • Design
Density Filter Thickness •
Processing
Thickness Anode KV

Figure 12-1 Factors That Affect Radiographic Contrast

Object Contrast
For an object to be visible in an x-ray image, it must have physical contrast in
relationship to the tissue or other material in which it is embedded. This contrast
can be a difference in physical density or chemical composition (atomic number).

When an object is physically different it absorbs either more or less x-radiation

than an equal thickness of surrounding tissue and casts a shadow in the x-ray
beam. If the object absorbs less radiation than the surrounding tissue (ie, gas sur¬
rounded by tissue), it will cast a negative shadow that appears as a dark area in a

radiograph. The third factor that affects object contrast is its thickness in the direc¬
tion of the x-ray beam. Object contrast is proportional to the product of object

density and thickness. This quantity represents the mass of object material per unit
area (cm2) of the image. For example, a thick (large diameter) vessel filled with

diluted iodine contrast medium and a thin (small diameter) vessel filled with undi¬
luted medium will produce the same amount of contrast if the products of the
diameters and iodine concentrations (densities) are the same.
The chemical composition of an object contributes to its contrast only if its
effective atomic number (Z) is different from that of the surrounding tissue. Rela¬
tively little contrast is produced by the different chemical compositions found in
soft tissues and body fluids because the effective atomic number values are close
together. The contrast produced by a difference in chemical composition (atomic
number) is quite sensitive to photon energy (KVP).
Most materials that produce high contrast with respect to soft tissue differ from
the soft tissue in both physical density and atomic number. The physical character¬
istics of most materials encountered in x-ray imaging are compared in Table 12-1.
 O
a. u>
3 a a a a a a a a a
S3
><
-j

- - Number(Z) Charcteis Energy

if
Density Thicknes -Atomic -Object
♦

-Photn
Filter
KV

rType Procesing LExposure

Pentraion
Charcteis
Film

Contras
Object Contras
Subject Radiogrphc Image Contrast

iRDCaeovndnoilootpgrmarsfpthy
EAxproesuare
Object

Patient Exposure
Background Recptor Image S1t2ag-es
Figure
174 Physical Principles of Medical Imaging

Table 12-1 Physical Characteristics of Contrast-Producing Materials

Materia! Effective Atomic Number Density

(Z) (g/cm3)

Water 7.42 1.0

Muscle 7.46 1.0

Fat 5.92 0.91

Air 7.64 0.00129

Calcium 20.0 1.55

Iodine 53.0 4.94

Barium 56.0 3.5

Subject Contrast

The contrast in the invisible image emerging from the patient's body is tradi¬
tionally referred to as subject contrast. Subject contrast is the difference in expo¬
sure between various points within the image area.
For an object, the significant contrast value is the difference in expo¬
individual
sure between the object area and its surrounding background. This exposure dif¬

ference is generally expressed as a percentage value relative to the background

exposure level. Contrast will be present if the exposure in the object area is either
more or less than in the surrounding background.

Subject contrast is produced because x-ray penetration through an object differs

from the penetration through the adjacent background tissue. For objects that at¬
tenuate more of the radiation than the adjacent tissue, contrast is inversely related

to object penetration. Maximum (100%) contrast is produced when no radiation

penetrates the object. Metal objects (lead bullets, rods, etc.) are good examples.
Contrast is reduced as x-ray penetration through the object increases. When object
penetration approaches the penetration through an equal thickness of surrounding
tissue, contrast disappears.
The amount of subject contrast produced is determined by the physical contrast
characteristics (atomic number, density, and thickness) of the object and the pen¬

etrating characteristics (photon energy spectrum) of the x-ray beam.

Image Contrast

The third type of contrast is

the contrast that appears in the visible image. The
contrast is in the form of differences in optical density be¬
in a radiograph (film)
tween various points within the image, such as between an object area and the

surrounding background. The amount of visible radiographic contrast produced in

a specific procedure depends on the amount of x-ray beam exposure (subject) con-
 X-Ray Image Formation and Contrast 175

trast delivered to the receptor and the contrast transfer characteristics of the film,
which are discussed in
Chapter 16.
The contrast in a visible
fluoroscopic image is in the form of brightness ratios
between various points within the image area. The amount of contrast in a fluoro¬
scopic image depends on the amount of subject contrast entering the receptor sys¬
tem and the characteristics and adjustments of the
components (image intensifier
tube, video, etc.) of the imaging system. The contrast transfer characteristics of a
fluoroscopic system are discussed in Chapter 20.

EFFECTS OF PHOTON ENERGY (KVr)

Object penetration and the resulting contrast often depend on the photon energy
spectrum. This, in turn, is determined by three factors: (1) x-ray tube anode mate¬
rial, (2) x-ray beam filtration, and (3) KV. Since most x-ray examinations are
performed with tungsten anode tubes, the first factor cannot be used to adjust con¬
trast. The exception is the use of molybdenum anode tubes in mammography.

Most x-ray machines have essentially the same amount of filtration, which is a few
millimeters of aluminum. Two exceptions are molybdenum filters used with mo¬
lybdenum anode tubes in mammography and copper or brass filters, sometimes
used in chest radiography.
In most procedures, KVP is the only photon-energy controlling factor that can
be changed by the operator to alter contrast. Radiographic examinations are per¬
formed with KVP values ranging from a low of approximately 25 kVP, in
mammography, to a high of approximately 140 kVP, in chest imaging. The selec¬
tion of a KV for a specific imaging procedure is generally governed by the contrast
requirement, but other factors, such as patient exposure (Chapters 17 and 33) and
x-ray tube heating (Chapter 9), must be considered.
Both photoelectric and Compton interactions contribute to the formation of im¬

age contrast. It was shown in Chapter 10 that the rate of Compton interactions is
primarily determined by tissue density and depends very little on either tissue
atomic number or photon energy. On the other hand, the rate of photoelectric in¬
teractions is very dependent on the atomic number of the material and the energy
of the x-ray photons. This means that when contrast is produced by a difference in
the atomic numbers of an object and the surrounding tissue, the amount of contrast
is very dependent on photon energy (KVP). If the contrast is produced by a differ¬
ence in density (Compton interactions), it will be relatively independent of photon

energy. Changing KVP produces a significant change in contrast when the condi¬
tions are favorable for photoelectric interactions. In materials with relatively low
atomic numbers (ie, soft tissue and body fluids), this change is limited to relatively
low KVP values. However, the contrast produced by higher atomic number mate¬
rials such as calcium, iodine, and barium, has a KVP dependence over a much
wider range of KVP values.
176 Physical Principles of Medical Imaging

Soft Tissue Radiography

Two basic factors tend to limit the amount of contrast that can be produced
between types of soft tissue and between soft tissue and fluid. One factor is the
small difference in the physical characteristics (density and atomic number)
among these materials, as shown in Table 12-1, and the second factor is the rela¬
tively low number of photoelectric interactions because of the low atomic num¬
bers.

Mammography is a procedure that uses soft tissue contrast. The production of

significant contrast requires the use of relatively low energy photons.
Mammography is typically performed with equipment that uses the characteristic
radiation produced in a molybdenum anode x-ray tube and filtered by a molybde¬
num filter. The spectrum of this radiation is shown in Figure 12-3. The range of

photon energies contained within this spectrum represents a reasonable compro¬

mise between contrast production and overall breast penetration (patient exposure
and machine loading).

Calcium

Calcium produces significant contrast relative to soft tissue because it differs in

both density and atomic number. Because of its higher atomic number, photoelec¬
tric interactions predominate over Compton interactions up to a photon energy of
approximately 85 keV. Above this energy, the photoelectric interactions contrib¬
ute less to image contrast.

Figure 12-4 shows the relationship between calcium penetration (contrast) and
photon energy. In principle, the optimum photon energy range (KVP) for imaging
calcium depends, to some extent, on the thickness of the object. When imaging
very small (thin) calcifications, as in mammography, a low photon energy must be
used or the contrast will be too low for visibility. When the objective is to see
through a large calcified structure (bone), relatively high photon energies (KVP)
must be used to achieve adequate object penetration.

Iodine and Barium Contrast Media

The two chemical elements iodine and barium produce high contrast with re¬
spect to soft tissue because of their densities and atomic numbers. The signifi¬
cance of their atomic numbers (Z = 53 for iodine, Z = 56 for barium) is that they

cause the K-absorption edge to be located at a very favorable energy relative to the

typical x-ray energy spectrum. The K edge for iodine is at 33 keV and is at 37 keV
for barium. Maximum contrast is produced when the x-ray photon energy is

slightly above the K-edge energy of the material. This is illustrated for iodine in
 X-Ray Image Formation and Contrast 177

•*—
K shell binding energy

10 15 20 25 30 35

Photon Energy (keV)

Figure 12-3 The X-Ray Spectrum Used in Mammography

Figure 12-5. A similar relationship exists for barium but is shifted up to slightly
higher photon energies.
Since the typical x-ray beam contains a rather broad spectrum of photon ener¬
gies, all of the energies do not produce the same level of contrast. In practice,

Photon Energy (keV)

Figure 12-4 Relationship of Calcium Penetration and Contrast to Photon Energy

 178 Physical Principles of Medical Imaging

Photon Energy (keV)

Figure 12-5 Relationship of Iodine Penetration and Contrast to Photon

Energy; The
Values Shown Are for a 1-mm Thickness of Iodine Contrast Medium

maximum contrast is achieved by adjusting the KVP so that a major part of the
spectrum falls just above the K-edge energy. For iodine, this
generally occurs
when the KVP is set in the
range of 60-70.

AREA CONTRAST

We have considered a single

object embedded in tissue. In this simple case an
increase in contrast generally increases the
visibility of the object. However, in
most clinical
applications one image contains many objects or anatomical struc¬
tures. A problem arises when the different
objects are located in different areas of
the body and the thickness or
density of the different areas is significantly differ¬
ent. A chest image that contains
lung and mediastinal areas is a good example; a
simple representation is shown in Figure 12-6. Because of the large difference in
tissue density between the lungs and the
mediastinum, the contrast is significant
between these two areas in the image. In this
typical radiograph, the area of the
mediastinum is very light (low film density), and the
lung areas are much darker.
Any objects within the mediastinum are imaged on a light background, and ob¬
jects within the lung areas are imaged on dark backgrounds.
 X-Ray Image Formation and Contrast 179

MEDIASTINUM

LUNGS

1/8 1/4 1/21 248

Relative Exposure

Figure 12-6 Physical Conditions That Produce Area Contrast

A characteristic of radiographic film is that its ability to display object contrast

is reduced in areas that are either very light (mediastinum) or relatively dark

(lungs). If there is a relatively high level of contrast between areas within an im¬
age, then the contrast of objects within these areas can be reduced because of film
limitations. Three actions can be taken to minimize the problem. One is to use a
wide latitude film that reduces area contrast and improves visibility within the
individual areas in many situations; this is described in Chapter 16. A second ap¬
proach is to place compensating filters between the x-ray tube and the patient's
body. The filter has areas with different thicknesses and is positioned so that its
thickest part is over the thinnest, or least dense, part of the body. The overall effect
is a reduction in area contrast within the image. The third action is to use a very
penetrating x-ray beam produced by high KV.
Figure 12-7 compares chest radiographs made at two KVP values. The image on
the left was made at 60 KVP. Although it has high contrast between the mediasti-
180 Physical Principles of Medical Imaging

Figure 12-7 Radiographs Illustrating a Difference in Area Contrast Produced by Changing

from 60 kVP (left image) to 140 kVP

num and lung areas, visibility of structures within these areas is diminished. The
high-KV radiograph, which has less area contrast, has increased object contrast,
especially within the lung areas.
 Chapter 13
Scattered Radiation and Contrast

INTRODUCTION AND OVERVIEW

When an x-ray beam enters a patient's body, a large portion of the photons
engage in Compton interactions and produce scattered radiation. Some of this
scattered radiation leaves the body in the same general direction as the primary
beam and exposes the image receptor. The scattered radiation reduces image con¬
trast. The degree of loss depends on the scatter content of the radiation emerging
from the patient's body. In most radiographic and fluoroscopic procedures, the
major portion of the x-ray beam leaving the patient's body is scattered radiation.
This, in turn, significantly reduces contrast.
Subject contrast was previously defined as the difference in exposure to the
object area on a film expressed as a percentage of the exposure to the surrounding
background. Maximum contrast, ie, 100%, is obtained when the object area re¬
ceives no exposure with respect to the background. A previous chapter discussed
the reduction of subject contrast because of x-ray penetration through the object

being imaged. This chapter describes the further reduction of contrast by scattered
radiation.

CONTRAST REDUCTION

The basic concept of contrast reduction by scattered radiation is illustrated in

Figure 13-1. For simplicity, it is assumed that the object is not penetrated and, if it
were not for scattered radiation, would produce 100% subject contrast. The object

is assumed to be embedded in a larger mass of material, such as the human body,

that produces the scattered radiation. The exposure to the background area of the

receptor, or film, is produced by radiation that penetrates the body adjacent to the
object plus the scattered radiation. For a given x-ray machine setting, the back¬
ground area exposure is proportional to PS, the product of the penetration through

181
With

)
Scater FSacctaotr=e4r
(

2105=%%/4
Contras=

Scater )FSaccatotr=e1r
Without (

1100=%%/ RSbCaIcmRdoietnodaeurroagycntsiefn
Contras=
1F3ig-u1re
 Scattered Radiation and Contrast 183

the patient and the scatter factor. For the same exposure conditions, the exposure
to the
object area is proportional to P (S - 1 ). By combining these expressions for
relative background and object area exposure, it can be shown that the contrast is
inversely related to the value of the scatter factors, as follows:
Cs (%) = 100/S.
Thisrelationship shows that as the proportion of scattered radiation in the x-ray
beam increases, contrast proportionally decreases. For example, if the scatter fac¬
tor has a value of 4, the contrast between the object and background areas will be

reduced to 25%. In other words, the object area exposure is 75% of the exposure
reaching the surrounding background. The contrast can also be determined as fol¬
lows. The ratio of scattered to primary radiation is always S - 1. For a scatter
factor value of 4, the scatter-primary ratio is 3. The background area exposure is,
therefore, composed of one unit of primary and three units of scattered radiation.
The object area receives only the three units of scattered radiation. This yields an

object area exposure of 75% of background and a contrast of 25%.

With respect to image contrast, the scatter factor, S, is also the contrast reduc¬
tion factor. For example, if the scatter (contrast reduction) factor has a value of 2,
the resulting contrast will be 50%. This is a reduction of 100% contrast by a factor
of 2. A scatter factor value of 5 reduces contrast by a factor of 5, or down to 20%.

Figure 13-2 shows the general relationship between contrast and scatter factor.
The value of the scatter factor is primarily a function of patient thickness, field
size, and KVP. In examinations of relatively thick body sections, contrast reduc¬
tion factors of 5 or 6 are common.

Figure 13-2 Relationship between Contrast Reduction and the Amount of Scatter
184 Physical Principles of Medical Imaging

We developed our discussion of contrast reduction using an unpenetrated object

that would produce 100% contrast in the absence of scatter. Most objects within
the body are penetrated to some extent. Therefore, contrast is reduced by both

object penetration and scattered radiation. For example, if an object is 60% pen¬
etrated (40% contrast), and the scatter factor, S, has a value of 4, the final contrast
will be 10%.
Since scattered radiation robs an image of most of its contrast, specific
x-ray
actions must be taken to regain of the lost contrast. Several methods can be
some
used to reduce the effect of scattered radiation but none is capable of restoring the
full image contrast. The use of each scatter reduction method usually involves

compromises, as we will see below.

COLLIMATION

The amount of scattered radiation is generally proportional to the total mass of

tissue contained within the primary x-ray beam. This is, in turn, determined by the
thickness of the patient and the area or field size being exposed. Increasing the
field size increases the total amount of scattered radiation and the value of the
scatter contrast-reduction factors. Therefore, one method of reducing scattered
radiation and increasing contrast is to reduce the field size with x-ray beam colli¬
mators, cones, or other beam-limiting devices, as illustrated in Figure 13-3. This
method is limited by the necessity to cover a specific anatomical region. However,
in most situations, contrast can be improved by reducing the field size to the small¬
est practical value.

Figure 13-3 Contrast Improvement by Reducing X-Ray Beam Size

 Scattered Radiation and Contrast 185

AIR GAP

The quantity of scattered radiation in an x-ray beam reaching a receptor can be

reduced by separating the patient's body and receptor surface, as shown in Figure
13-4. This separation is known as an air
gap. Scattered radiation leaving a
patient's body is more divergent than the primary x-ray beam. Therefore, scattered
radiation spreads out of the primary beam area. The reduction of scattered radia¬
tion in proportion to primary radiation increases with
air-gap distance. Several
factors must be considered when
using this method of scatter reduction. Patient
exposure is increased because of the inverse-square effect. The use of an air gap
introduces magnification. Therefore, a larger
receptor size is required to obtain the
same patient area
coverage. If the air gap is obtained by increasing the tube-to-
receptor distance, the x-ray equipment must be operated at a higher output to ob¬
tain adequate receptor exposure.
Also, increasing the separation distance between the patient and the receptor
increases focal spot blurring. It is usually necessary to use
relatively small focal
spots with an air-gap technique.

Figure 13-4 Contrast Improvement by Using an Air Gap

186 Physical Principles of Medical Imaging

GRIDS

In most examinations, the most effective and practical method of removing a

portion of the scattered radiation is to use a grid. The grid is placed between the
patient's body and the receptor, as shown in Figure 13-5. It is constructed of alter¬
nate strips of an x-ray-absorbing material, such as lead, and a relatively

nonabsorbing interspace material, such as fiber, carbon, or aluminum. Under nor¬

mal operating conditions, the grid strips are aligned with the direction of the pri¬
mary x-ray beam. In most grids, the interspaces are angled so as to align with a
specific point in space. These are designated focused grids. The focal point of the
grid should coincide with the focal spot of the x-ray tube, which is the source of
the primary radiation. In an unfocused grid, the interspaces and strips are parallel
and are not aligned with a single point in space. Because the x-ray beam direction
is aligned with the grid, much of the primary radiation passes through the
interspaces without encountering the lead strips. Scattered radiation, on the other
hand, leaves the patient's body in a direction different from that of the primary
beam, as shown in Figure 13-6. Since scattered radiation is not generally lined up
with the grid strips, a large portion of it is absorbed by the grid. The ideal grid
would absorb all scattered radiation and allow all primary x-rays to penetrate to
the receptor. Unfortunately, there is no ideal grid, because all such devices absorb
some primary radiation and allow some scattered radiation to pass through.

*•- Receptor

Figure 13-5 Contrast Improvement by Using a Grid

 Scattered Radiation and Contrast 187

The penetration characteristics for scattered radiation are largely determined by

the dimensions of the lead
strips and the interspaces. The significant dimensions
are illustrated in
Figure 13-5. The height of the strips, t, is the thickness of the grid
and is typically in the range of 2 mm to 5 mm. Another
significant dimension is the
width of the interspace, d. This dimension varies with
grid design, but generally
ranges from 0.25 mm to 0.4 mm. With respect to grid performance, the important
variable is the ratio of these two dimensions, which is
designated the grid ratio, r.
Most grids have ratios ranging from 5:1 to 16:1. The selection of the
appropriate
grid ratio for a given examination involves the consideration of a number of fac¬
tors. Although grids with higher ratios eliminate more scattered
radiation, they
tend to increase patient exposure and x-ray tube
loading and require more precise
positioning.

GRID PENETRATION

A knowledge of the total penetration of primary and scattered radiation through

a grid is necessary to select appropriate exposure factors for the x-ray machine.

X-ray Tube
Grid

H\

Primary Penetration Scatter

Scatter Penetration
Pern

Figure 13-6 Selective Absorption of Scattered Radiation by a Grid

 188 Physical Principles of Medical Imaging

The total grid penetration is a function of scattered-radiation penetration and pen¬

etration of primary radiation. The relationship also involves the proportion of scat¬
tered radiation in the beam, S. Figure 13-7 shows the general relationship between
the two components (primary radiation and scatter) of grid penetration and
grid
ratio. In general, the penetration of both types of radiation decreases as the grid
ratio is increased.
Primary penetration does not change with the amount of scattered radiation, but
does change with grid ratio. On the other hand, scattered-radiation penetration is
strongly dependent on grid ratio and the amount of scattered radiation in the beam.
Because the typical grid removes more scattered than
primary radiation, total pen¬
etration decreases as the scattered-radiation content of the beam increases. The
two major factors, therefore, that determine total grid penetration are the grid ratio
and the scatter factor, S.
It is common to express grid penetration in terms of the Bucky factor, named
after Dr. Gustave Bucky, who constructed the first grid in 1913. The Bucky factor
is the reciprocal of the total grid penetration, or

1/Bucky factor = Grid penetration.

Grid penetration and Bucky factor values are shown in Figure 13-8 for various
grid ratios and scatter factors.
It should be recalled that, in most cases, there is a correlation between S and
KVP. Since high KVP values are generally used for thick body sections, and both

ideal grid
1.0 i

§ 0.8"
(0

% 0.6-
c

0.2-

\
——
ideal
~l |1 =t—
1 T ^-7™- 1 I 1

24 6 8 10 12 14 16
Grid Ratio

Figure 13-7 General Relationship between Radiation Penetration and Grid Ratio
 Scattered Radiation and Contrast 189

Figure 13-8 Grid Penetration and Bucky Factor Values

factors increase S, grid penetration appears to decrease as KVP increases. This is

because scatter radiation content at the higher KVP values is generally greater than
for primary radiation.
The amount of radiation delivered to a patient's body must be increased to com¬

pensate for the radiation absorbed by the grid. Patient exposure is directly propor¬
tional to the Bucky factor. For example, if a grid with a Bucky factor of 3 is re¬
placed by onewith a Bucky factor of 6, the exposure to the patient must be
doubled to compensate for the additional grid absorption.

Scatter Penetration

The relationship between the quantity of scattered radiation that passes through
the grid and the grid ratio can be visualized by referring to Figure 13-9. Consider
the exposure that reaches a point on the receptor located at the bottom of an

interspace. Since no radiation penetrates the lead strips, radiation can reach the
point on the receptor only from the directions indicated. The amount of radiation
reaching this point is generally proportional to the volume of the patient's body in
direct "view" from this point. As grid ratio is increased, this volume becomes
smaller, and the amount of radiation reaching this point is reduced. In effect, with
a high-ratio grid, each point on the receptor surface is exposed to a smaller portion

of the patient's body, which is the source of scattered radiation. Using basic geo¬
metrical relationships, the theoretical penetration of scattered radiation through

grids of various ratios can be determined. This is shown graphically in Fig¬

ure 13-7. In actual usage, the relationship can differ from the one shown, espe¬

cially for certain grid ratio-KVP combinations.

190 Physical Principles of Medical Imaging

16 to I Grid

Figure 13-9 Relationship of Receptor Exposure to Grid Ratio

Primary Penetration
Because of the presence of the lead strips, grids attenuate part of the primary
radiation. The penetration of primary radiation through the grid is generally in the
range of 0.6 to 0.7. This value depends on grid design and is generally inversely
related to grid ratio.

Contrast Improvement

It has been shown that as the

grid ratio is increased, a greater proportion of the
scattered radiation is removed from the beam. By using the scattered-radiation
penetration shown in Figure 13-7 and an average primary penetration of 0.65, it is
possible to calculate the expected contrast for various combinations of grid ratio
and scatter factors, S. Some values are shown in Figure 13-10.
For a grid ratio of 0, that is, no grid, the contrast percentage is equal to 100
divided by S. As grid ratio is increased and scatter penetration decreases, contrast
 Scattered Radiation and Contrast 191

Figure 13-10 Relationship of Image Contrast to Scatter and Grid Ratio

improves. For relatively small amounts of scattered radiation, that is, S = 2, a grid
ratio of 8:1 restores the contrast to 90%. The additional improvement in contrast
with higher grid ratios is relatively small. It should be noticed, however, that even
with high grid ratios, all contrast is not restored. When the proportion of scattered
radiation in the beam is higher, for example, when S has a value of 6, the situation
is significantly different. At each grid ratio value, the contrast is much less than for
lower scatter factor values. Even with a high-ratio grid such as 16:1, the contrast
,

is restored to only about 76%. This graph illustrates that contrast is not only a
function of grid ratio, but is also determined by the quantity of scattered radiation
in the beam, the value of S.
It might appear that the data in Figure 13-10 indicate that grids do not remove as
much scattered radiation when the amount of scattered radiation in the beam is

relatively large, such as for a value of S of 5 or 6. The relatively lower contrast

obtained with large amounts of scattered radiation is because of the very low con¬
trast values present without the grid. Actually, grids improve contrast by larger
factors when the proportion of scattered radiation in the beam is higher. This can
be illustrated by observing values of the contrast improvement factor, K, as shown
in Figure 13-11. The contrast improvement factor is the ratio of the contrast when
a specific grid is used compared with the contrast without the grid. It is a function

of the grid penetration characteristics and the amount of scattered radiation, S.

The value of the contrast improvement factor, K, generally increases both with

grid ratio and with the quantity of scattered radiation in the beam, S. Although it is
true that grids improve contrast by larger factors under conditions of high levels of

scattered radiation, one significant fact should not be overlooked: the total restora-
 192 Physical Principles of Medical Imaging

-
c
51
0)

4^ CO
<0 U.

c
o
O 1-

2 4 6 8 10 12 14 16
Grid Ratio

Figure 13-11 Relationship of Contrast Improvement Factor to Scatter Factor and Grid
Ratio

tion of contrast for a given grid is always less for the higher values of scattered
radiation. This becomes apparent by comparing the value of the contrast
improve¬
ment factor to the value of the contrast reduction factor, which is
equal to the value
of S. This expresses the ability of a grid under various scatter conditions to recover
lost contrast. For example, in Figure 13-11 it is shown that when S is
equal to 5
(contrast reduced to one fifth) a 16:1-ratio grid produces a contrast improvement
factor of 4. The contrast recovery, K/S, is four fifths, or 80%. Flowever, at a lower
level of scattered radiation, such as S = 3, the same
grid produces a contrast im¬
provement factor of 2.7, which represents a contrast recovery of 2.7/3, or 90%.
The relationship between the improvement in contrast and
grid ratio strongly
depends on the proportion of scattered radiation in the beam emerging from the
patient's body. This, in turn, is a function of patient thickness, field size, and KVP.
Under conditions that produce high scatter radiation values, a
given grid improves
contrast by a greater factor, but cannot recover as much contrast
as is possible at
lower scattered radiation levels.

Artifacts

Since the grid is physically located between the patient and the receptor, there is
always possibility that it will interfere with the formation of the image. This
a
interference can be in the form of an image of the grid strips
(lines) on the film, or
the abnormal attenuation of radiation in certain portions of the field.
 Scattered Radiation and Contrast 193

Grid Lines

To some extent, the appearance of grid

lines in the image depends on the thick¬
ness of the strips and the interspaces. This is usually specified in terms of the
number of strips, or lines, per unit distance. The
spacing of lines in grids normally
encountered ranges from approximately 24 lines to 44 lines per centimeter (60 to
110 lines per inch). The grid lines are generally less
distracting for the higher
spacing densities.
A method frequently used to eliminate grid lines in the image is to blur them
by
moving the grid during the exposure. The mechanism for accomplishing this was
first introduced by Dr. Hollis Potter, and a moving grid system is often referred to
as a Potter-Bucky
diaphragm. In a Potter-Bucky system the grid moves at right
angles to the grid lines. The speed at which the grid moves determines the shortest
exposure time that will not produce grid lines.
Grid motion during exposure also helps eliminate image patterns created by the
irregular spacing of grid strips. This type of interference is generally less when
grids with aluminum interspaces are used.
Grid Cutoff
The basic function of grid is to absorb radiation that is moving along a path
a

that is not aligned with the grid interspaces. It is desirable that the primary radia¬
tion from the x-ray tube focal spot pass through the grid with a minimum of ab¬

sorption. Maximum grid penetration by primary radiation can occur only if the
x-ray tube focal spot is located at the grid focal point. If these two points are not
properly aligned, as shown in Figure 13-12, the direction of the primary radiation
might be such that the radiation does not adequately penetrate certain sections of
the grid.

Misalignment of the x-ray tube focal spot with respect to the focal point of the
grid can be either lateral or vertical, or a combination of both. Lateral misalign¬
ment causes the x-ray beam to be misaligned with all interspaces, and grid pen¬

etration is decreased over the entire beam area. The amount of penetration reduc¬
tion is related to the amount of misalignment and the grid ratio. Alignment
becomes more critical for higher ratio grids. That is, the loss of grid penetration
because of a specific misalignment is much greater for a high-ratio grid.
Vertical misalignment does not alter penetration in the center of the grid, but
decreases penetration near the edges. The loss of penetration is related to the de¬

gree of misalignment and the grid ratio. The reduction in penetration for a given
degree of misalignment increases with grid ratio. Focused grids are labeled with
either a focal distance or a focal range, which should be carefully observed to

prevent this type of grid cutoff. Cutoff toward the edges of the image area will also
occur if a focused grid is turned upside down because the primary radiation will be
194 Physical Principles of Medical Imaging

X-ray Tube
Focal Spot Grid Focal Point

Figure 13-12 Two Forms of Grid Misalignment That Can Produce Artifacts

unable to penetrate except near the center. This produces an artifact similar to
vertical misalignment but usually much more pronounced.

GRID SELECTION

A number of factors must be considered when selecting a grid for a specific

application. In most cases, agrid is selected that provides a reasonable compro¬
mise between contrast improvement and patient exposure, machine loading, and
positioning.
The advantages of a 5:1-ratio grid are that it is easy to use and does not require
critical positioning. Its use must be restricted, however, to situations in which the
amount of scattered radiation is relatively small (thin body section, low KVP) or in

which maximum image contrast is not necessary. On the other hand, a 16:1-ratio

grid produces high-contrast recovery but significantly increases patient exposure.

With a high-ratio grid of this type, there is very little latitude in positioning. Many

applications are best served by grid ratio values between these two extremes. Such
 Scattered Radiation and Contrast 195

grids generally represent compromises between image quality and the other fac¬
tors discussed.
Some grids have strips running at right angles to each other, generally desig¬
nated crossed grids. This design generally increases contrast improvement but
cannot be used in examinations in which the
x-ray tube is tilted.
In stationary grid applications in which lines in the
image are undesirable, grids
with a high spacing density (lines per centimeter) can be used. An increase in the
spacing density generally requires a higher ratio grid to produce the same contrast
improvement.
 Chapter 14

Radiographic Receptors

INTRODUCTION AND OVERVIEW

There are three basic types of radiographic receptors. In addition to the conven¬
tional type described in this chapter there are the digital radiographic receptors
described in Chapter 22 and the fluoroscopic systems that can also produce radio¬

graphs as described in Chapter 20.

In conventional radiography, the receptor consists of the film mounted in con¬
tact with either one or two intensifying screens, as shown in Figure 14-1. Intensi¬

fyingscreens are thin sheets, or layers, of fluorescent materials. The screen-film

combination is housed in either a cassette film changer. The x-ray energy is
or a

absorbed by the intensifying screen material, and a portion of it is converted into

light. The light, in turn, exposes the film. Intensifying screens are used because
film is much more sensitive to light than to x-radiation; approximately 100 times
as much x-radiation would be required to expose a film without using intensifying

screens. Unfortunately, intensifying screens introduce blurring into the imaging

process.
A variety of intensifying screens is available for clinical use. The selection of a
screen for specific procedure is usually based on a compromise between the
a

requirements for image detail and patient exposure.

The receptor used for most radiographic procedures contains two intensifying
screens mounted on each side of double-emulsion film. Using two screens in this

manner increases x-ray absorption and receptor sensitivity. In some procedures

that require high image detail, such as mammography, one intensifying screen is
used in conjunction with a single-emulsion film.

SCREEN FUNCTIONS

X-Ray Absorption
The first function performed by the intensifying screen is to absorb the x-ray
beam (energy) emerging from the patient's body. The ideal intensifying screen

197
198 Physical Principles of Medical Imaging

EXPOSURE SENSITIVITY

► IMAGE QUALITY

Figure 14-1 A Conventional Radiographic Receptor

would absorb all x-ray energy that enters it; real intensifying screens are generally
notthick enough to absorb all of the photons. As we discuss later, increasing the
thickness of an intensifying screen to increase its absorption capabilities degrades
image quality.
In most cases, a significant portion of x-ray energy is not absorbed by the screen
material and penetrates the receptor. This is wasted radiation since it does not
contribute to image formation and film exposure. The absorption efficiency is the
percentage of incident radiation absorbed by the screen material. An ideal screen
would have a 100% absorption efficiency; actual screens generally have absorp¬
tion efficiencies in the range of 20 to 70%. Absorption efficiency is primarily
determined by three factors: (1) screen material, (2) screen thickness, and (3) the
photon energy spectrum.

Light Production

The second function performed by the intensifying screen is to convert a por¬

tion of the absorbed x-ray energy into light. This is the fluorescent process. Fluo¬
rescence is the property of a material that enables it to absorb radiation
energy in
one portion of the photon-energy spectrum and emit some of the energy in the
form of lower energy photons. Materials that glow, or emit visible light, when
exposed to high-photon energy ultraviolet light have this property. Figure 14-2
illustrates what happens to the x-ray energy that is absorbed by an intensifying
screen. In the intensifying screen, the fluorescent process creates visible
light
when such material is exposed to high-energy x-ray photons. The intensifying
screen is an
energy converter; it converts approximately 5 to 20% of the absorbed
x-ray energy into light. This percentage is the conversion efficiency of the screen,
and depends on the type of material used in the screen.
 Radiographic Receptors 199

Film

/-N_y
r^j
r-u X-ray r^j
r^J r^j n*J r-vj
_____

High
Same
Exposure Density

Low P
I

X-ray *0 Light

v&S*

Screen Film

Figure 14-2 Conversion of X-Ray Energy in an Intensifying Screen

Although the total energy of the light emitted by a screen is much less than the
total x-ray energythe screen receives, the light energy is much more efficient in
exposing film because it is "repackaged" into a much larger number of photons. If
we assume a 5% energy conversion efficiency, then one 50-keV x-ray photon can

produce 1,000 blue-green light photons with an energy of 2.5 eV each.

Exposure Reduction

Since film is more sensitive to

light than to x-ray exposure, film can be exposed
with much less radiation if anintensifying screen is used. Conventional x-ray film
has an x-ray exposure sensitivity in the range of 50 mR to 150 mR. When the film
is combined with intensifying screens, the sensitivity ranges from approximately
0.1 mR to 10 mR, depending on the type of screen and film used.

RECEPTOR SENSITIVITY

The sensitivity of a receptor, such as an intensifying screen-film combination, is

expressed in terms of the exposure required to produce a film density of 1 unit

200 Physical Principles of Medical Imaging

above the base plus fog level. Some manufacturers do not provide sensitivity val¬
ues for their receptor systems,but most provide speed values such as 100, 200,
400, etc. The speed scale compares the relative exposure requirements of different
receptor systems. Most speed numbers are referenced to a so-called par speed
system that is assigned a speed value of 100. Whereas sensitivity is a precise re¬
ceptor characteristic that expresses the amount of exposure the receptor requires,
speed is a less precise value used to compare film-screen combinations. There is,
however, a general relationship between exposure requirements (sensitivity) and
receptor speed values:

Sensitivity (mR) = 128/speed.

For example, a receptor with a true speed value of 100 requires an exposure of
1.28 mR to produce a 1-unit film density. Sensitivity and speed values are in¬
versely related. A more sensitive receptor has a higher speed value than a less
sensitive receptor. The range of receptor sensitivity and speed values used in radi¬
ography is shown below.
Speed Sensitivity (mR)
1200 0.1

800 0.16

400 0.32

200 0.64

100 1.28

50 2.56

25 5.0

12 10.0

Most receptors are given a nominal speed rating by the manufacturer. The actual
speed varies, especially with KVP and film processing conditions.
The sensitivity (speed) of an intensifying screen-film receptor depends on the

type of screen and film used in addition to the conditions under which they are
used and the film is processed.
We now consider characteristics of the screen that contribute to its sensitivity.

Materials

Several compounds are used to make intensifying screens. The two major char¬
acteristics the material must have are (1) high x-ray absorption and (2) fluores¬
cence. Because of their fluorescence, intensifying screen materials are often re¬
ferred to as phosphors.
 Radiographic Receptors 201

Soon after the discovery of x-rays, calcium tungstate became the principal ma¬
terial in intensifying screens and continued to be until the 1970s. At that time, a
variety of new phosphor materials were developed; many contain one of the rare
earth chemical elements. Phosphor
compounds now used as intensifying screen
materials include:

• barium lead sulfate

• barium strontium sulfate

• barium fluorochloride

•
yttrium oxysulfide
• lanthanum oxybromide
• lanthanum oxysulfide
•
gadolinium oxysulfide.

Each compound contains element that is the primary x-ray absorber.

one
You will recall that the probability of x-ray absorption is higher when the pho¬
ton energy is just slightly higher than the K energy of the absorbing material. The

K-edge energy is, in turn, determined by the atomic number of the material.
Calcium tungstate, the most common screen material for many years, uses tung¬
sten as the absorbing element. The K edge of tungsten is at 69.4 keV. For most

x-ray examinations, a major portion of the x-ray beam spectrum falls below this
energy. For this reason, screens containing tungsten are limited with respect to
x-ray absorption. Today, most intensifying screens contain either barium, lantha¬
num, gadolinium, or yttrium as the absorbing element. The K edge of these ele¬
ments is below a major portion of the typical x-ray beam spectrum. This increases

the chance of x-ray interaction and absorption.

Spectral Characteristics

The other elements in the compound contribute to the fluorescent properties of

the material. Each compound produces light of a color (wavelength) that is spe¬
cific to the particular material. The light from intensifying screens is produced in
either the blue or green portion of the light spectrum, and intensifying screens are

generally classified as either blue or green emitters. The significance of this is that
a screen must be used with a film that has adequate sensitivity to the color of light

the screen emits. Some radiographic films are sensitive only to blue light; others
(orthochromatic) are also sensitive to green light. If screen and film spectral char¬
acteristics are not properly matched, receptor sensitivity is severely reduced.
202 Physical Principles of Medical Imaging

Thickness

The selection of a screen is generally a compromise between exposure and im¬

age quality, as illustrated in Figure 14-3. Thin screens absorb a relatively small
fraction of the x-ray photons; thicker screens absorb a greater fraction and thus
require less x-radiation to produce the same film exposure. Unfortunately, in¬
creasing screen thickness also increases image blur.

Photon Energy (KVP)

The sensitivity of intensifying screens varies with x-ray photon energy because
sensitivity is directly related to absorption efficiency. Absorption efficiency and
screen sensitivity are maximum when the x-ray photon energy is just above the K

edge of the absorbing material. Each intensifying screen material generally has a
different sensitivity-photon energy relationship because the K edge is at different
energies.
The spectrum of photon energies within an x-ray beam is most directly affected
and controlled by the KVP; the sensitivity and speed of a specific intensifying
screen is not constant but changes with KVP.

Significant exposure errors can occur if technical factors (KVP and MAS) are
not adjusted to compensate for the variation in screen sensitivity. This often oc¬

curs when the same technique charts are used with screens composed of different

materials. Also, the KVP response characteristics of automatic exposure control

(AEC) sensors should be matched to those of the intensifying screens.

Small Objects

X-ray
Fast Medium Detail

Screens

Light

Blur (mm)

Figure 14-3 Effect of Screen Thickness on Image Blur

 Radiographic Receptors 203

IMAGE BLUR

The most significant effect of intensifying screens on image quality is that they
produce blur. The reason for this is illustrated in Figure 14-3. Let us consider the
imaging of a very small object, such as a calcification. The x-ray photons passing
through the object are absorbed and produce light along the vertical path extend¬
ing through the intensifying screen. Before exiting the screen, the light spreads out
of the absorption path, as illustrated. The light image of the object that
appears on
the surface of the intensifying screen is therefore blurred; the degree of blurring
by
this process is related to the thickness and transparency of the intensifying screen.
The major issue in selecting intensifying screens for a particular clinical appli¬
cation is arriving at an appropriate compromise between patient exposure and im¬

age quality or, more specifically, between receptor sensitivity (speed) and image
blurring (visibility of detail). Screens that produce maximum visibility of detail
generally have a low absorption efficiency (sensitivity) and require a relatively
high exposure. On the other hand, screens with a high sensitivity (speed) cannot
produce images with high visibility of detail because of the increased blurring.
Intensifying screens are usually identified by brand names, which do not always
indicate specific characteristics. Most screens, however, are of five generic types:

1. mammographic
2. detail

3. par speed
4. medium speed
5. high speed.

Figure 14-4 shows how these general screen types fit into the relationship be¬
tween image blur and required exposure.

Screen-Film Contact

If the film and intensifying screen surfaces do not make good contact, the light
will as shown in Figure 14-5, and will produce image blurring. This is an
spread,
abnormal condition that occurs when a cassette or film changer is defective and
does not apply sufficient pressure over the entire film area. Inadequate film-screen
contact usually produces blurring in only a portion of the image area.
The conventional test for film-screen contact is to radiograph a wire mesh. Ar¬
eas within the image where contact is inadequate will appear to have a different

density than the other areas. This variation in image density is most readily seen
when the film is viewed from a distance of approximately 10 ft and at an angle.
204 Physical Principles of Medical Imaging

SPEED

Figure 14-4 General Relationship between Image Blur and Sensitivity (Speed)

Crossover

If the film emulsion does not completely absorb the light from the intensifying
screen,the unabsorbed light can pass through the film base and expose the emul¬
sion on the other side. This is commonly referred to as crossover. As the light

passes through the film base, it can spread and introduce image blur, as illustrated
in Figure 14-5. Many modern film-screen receptor systems are designed to mini-

Screen i . . Double
T
Emulsion Film
V V V
I I I
l g r
# m
ML v— *
M t< 1 H—H
Screen Poor Contact Crossover

Figure 14-5 Sources of Blur in Screen-Film Receptors

 Radiographic Receptors 205

mize crossover
blurring. Crossover can be decreased by placing a light-absorbing
layer between the film emulsion and film base, using a base material that selec¬
tively absorbs the light wavelengths emitted by the intensifying screens, and de¬
signing the film emulsion to increase light absorption.

Halation

When light encounters a boundary between materials, reflection can occur at

the boundary surface. Reflections at boundaries between film emulsion, film base,
intensifying screens, and cassette surfaces are known as halation and contribute to
image blur. Single-emulsion films generally have a light-absorbing layer coated
on the other side of the base to prevent halation.

IMAGE NOISE

The amount of noise in radiographic images is affected, to some extent, by the

characteristics of the intensifying screen; the crystal structure of the screen mate¬
rial produces a relatively small amount of image noise. Quantum noise is gener¬

ally the most significant type of noise in radiographs. Intensifying screens with
high conversion efficiencies generally produce more quantum noise than other
screens for reasons discussed in Chapter 21. Also, the visibility of noise is de¬

creased, to some extent, by the blurring created within screens.

ARTIFACTS

Intensifying screens can be significant sources of image artifacts. Artifacts can

be produced by scratches, stains, and foreign objects, such as hair, dust, and ciga¬
rette ashes, on the screen surface.

Intensifying screens should be cleaned periodically according to the

manufacturer's instructions.
 Chapter 15
The Photographic Process
and Film Sensitivity

INTRODUCTION AND OVERVIEW

Most medical images are recorded on photographic film. The active component
of film is emulsion of radiation-sensitive crystals coated onto a transparent base
an

material. The production of an image requires two steps, as illustrated in Figure

15-1. First, the film is exposed to radiation, typically light, which activates the
emulsion material but produces no visible change. The exposure creates a so-
called latent image. Second, the exposed film is processed in a series of chemical
solutions that convert the invisible latent image into an image that is visible as
different optical densities or shades of gray. The darkness or density of the film
increases as the exposure is increased. This general relationship is shown in Figure
15-2.
The specific relationship between the shades of gray and exposure depends on
the characteristics of the film emulsion and the processing conditions. The basic
principles of the photographic process and the factors that affect the sensitivity of
film are covered in this chapter.

FILM FUNCTIONS

Film performs several functions in the medical imaging process. A knowledge

of these functions and how they are affected by the characteristics of different
types of film aids in selecting film for a specific clinical procedure and in perfect¬
ing radiographic techniques.

Image Recording

In principle, film is an image converter. It converts radiation, typically light,

into various shades of gray. An important characteristic of film is that it records, or

207
208 Physical Principles of Medical Imaging

EXPOSURE

Figure 15-1 The Two Steps in the Formation of a Film Image

retains, animage. An exposure of a fraction of a second can create a permanent

image. The amount of exposure required to produce an image depends on the
sensitivity, or speed, of the film being used. Some films are more sensitive than
others because of their design or the way they are processed. The
sensitivity of
radiographic film is generally selected to provide a compromise between two very
important factors: patient exposure and image quality. A highly sensitive film re¬
duces patient exposure but decreases image quality.

•OPTICAL DENSITY >

Figure 15-2 The General Relationship between Film Density (Shades of Gray) and
Exposure
 The Photographic Process and Film Sensitivity 209

Image Display

Most medical images are recorded as

transparencies. In this form they can be
easily viewed by transillumination from a viewbox. The overall appearance and
quality of a radiographic image depends on a combination of factors, including the
characteristics of the particular film used, the way in which it was
exposed, and the
processing conditions. When a radiograph emerges from the film processor, the
image is permanent and cannot be changed. It is, therefore, important that all fac¬
tors associated with the production of the
image are adjusted to produce optimum
image quality.

Image Storage

Film has been the traditional medium for medical image storage. If a film is
properly processed it will have lifetime of many years and will, in most cases,
a
outlast its clinical usefulness. The major disadvantages of storing images on film
are bulk and inaccessibility. Most clinical facilities must devote considerable

space to film storage. Retrieving films from storage generally requires manual
search and transportation of the films to a viewing area.
Because film performs so many of the functions that make up the radiographic
examination, it will continue to be an important element in the medical imaging
process. Because of its limitations, however, it will gradually be replaced by digi¬
tal imaging media in many clinical applications.

OPTICAL DENSITY

Optical density is the darkness, or opaqueness, of a transparency film and is

produced by film exposure and chemical processing. An image contains areas
with different densities that are viewed as various shades of gray.

Light Penetration

The optical density of film is assigned numerical values related to the amount of
light that penetrates the film. Increasing film density decreases light penetration.
The relationship between density values and light penetration is exponential, as
illustrated in Figure 15-3.
A clear piece of film that allows 100% of the light to penetrate has a density
value of 0. Radiographic film is never completely clear. The minimum film den¬

sity is usually in the range of 0.1 to 0.2 density units. This is designated the base
plus fog density and is the density of the film base and any inherent fog not asso¬
ciated with exposure.
DENSITY
OPTICAL P1(%) ENTRAIO
LIGHT

Density
10(%)

LPFeingaitrlhmod
Rbeeltawionsnhp
V

0.5

15-3
(%) Figure
0

100
 The Photographic Process and Film Sensitivity 211

Each unit of density decreases light penetration by a factor of 10. A film area
with a
density value of 1 allows 10% of the light to penetrate and generally ap¬
pears as a medium gray when placed on a conventional viewbox. A film area with
a density value of 2 allows 10% of 10% (1.0%) light penetration and appears as a
relatively dark area when viewed in the usual manner. With normal viewbox illu¬
mination, it is possible to see through areas of film with density values of up to
approximately 2 units.
A density value of 3 corresponds to a
light penetration of 0.1% (10% of 10% of
10%). A film with a density value of 3 appears essentially opaque when
transilluminated with a conventional viewbox. It is possible, however, to see
through such a film using a bright "hot" light. Radiographic film generally has a
maximum density value of approximately 3 density units. This is
designated the
Dmax of the film. The maximum density that can be
produced within a specific film
depends on the characteristics of the film and processing conditions.

Measurement

The density of film is measured with a densitometer. A light source passes a

small beam of light through the film area to be measured. On the other side of the
film, a light sensor (photocell) converts the penetrated light into an electrical sig¬
nal. A special circuit performs a logarithmic conversion on the signal and displays
the results in density units.
The primary use of densitometers in a clinical facility is to monitor the perfor¬
mance of film processors.

FILM STRUCTURE

Conventional film islayered, as illustrated in Figure 15-4. The active compo¬

nent is an emulsion
layer coated onto a base material. Most film used in radiogra¬
phy has an emulsion layer on each side of the base so that it can be used with two
intensifying screens simultaneously. Films used in cameras and in selected radio-

EMULSION—- 10/xm

150 /u.m
BASE—-

EMULSION—-

Figure 15-4 Cross-Section of Typical Radiographic Film

212 Physical Principles of Medical Imaging

graphic procedures, such as mammography, have one emulsion layer and are
called single-emulsion films.

Base

The base of typical radiographic film is made of a clear polyester material

a

about 150 jam thick. It provides the physical support for the other film components
and does not participate in the image-forming process. In some films, the base
contains a light blue dye to give the image a more pleasing appearance when illu¬
minated on a viewbox.

Emulsion

The emulsion is the active component in which the image is formed and con¬
sists of many small silver halide crystals suspended in gelatin. The gelatin sup¬
ports, separates, and protects the crystals. The typical emulsion is approximately
10 |Ltm thick.
Several different silver halides have photographic properties, but the one typi¬
cally used in medical imaging films is silver bromide. The silver bromide is in the
form of crystals, or grains, each containing on the order of 109 atoms.
Silver halide grains are irregularly shaped like pebbles, or grains of sand. Two
grain shapes are used in film emulsions. The conventional form approximates a
cubic configuration with its three dimensions being approximately equal. More
recently, tabular-shaped grains were developed. The tabular grain is relatively thin
in one direction, and its length and width are much larger than its thickness, giving
it a relatively large surface area. The primary advantage of tabular grain film in

comparison to cubic grain film is that sensitizing dyes can be used more effec¬
tively to increase sensitivity and reduce crossover exposure.

THE PHOTOGRAPHIC PROCESS

Theproduction of film density and the formation of a visible image is a two-

step process. The first step in this photographic process is the exposure of the film
to light, which forms an invisible latent image. The second step is the chemical

process that converts the latent image into a visible image with a range of densi¬
ties, or shades of gray.
Film density is produced by converting silver ions into metallic silver, which
causes processed grain to become black. The process is rather complicated
each
and is illustrated by the sequence of events shown in Figure 15-5.
Each film grain contains a large number of both silver and bromide ions. The
silver ions have a one-electron deficit, which gives them a positive charge. On the
other hand, the bromide ions have a negative charge because they contain an extra
 The Photographic Process and Film Sensitivity 213

0
G
©
Unexposed Film
© ^-Sensitivity Speck

© ©

Figure 15-5 Sequence of Events That Convert a Transparent Film Grain into Black
Metallic Silver

electron. Each grain has a structural "defect" known as a sensitive speck. A film
grain in this condition is relatively transparent.

Latent Image Formation

The first step in the formation of the latent image is the absorption of light

photons by the bromide ions, which frees the extra electron. The electron moves to
the sensitivity speck, causing it to become negatively charged. The speck, in turn,
attracts one of the positively charged silver ions. When the silver ion reaches the

speck, its positive charge is neutralized by the electron. This action converts the
silver ion into an atom of black metallic silver. If this process is repeated several
times within an individual grain, the cluster of metallic silver at the sensitive speck
will become a permanent arrangement. The number of grains in the emulsion that
214 Physical Principles of Medical Imaging

reach this statusdepends on the overall exposure to the film. The grains that re¬
ceived sufficient exposure to form a permanent change are not visually distin¬
guishable from the unexposed grains, but are more sensitive to the action of the
developer chemistry. The distribution of these activated, but "invisible," grains
throughout the emulsion creates the latent image.

Development

The invisible latent image is converted into a visible image by the chemical
process of development. The developer solution supplies electrons that migrate
into the sensitized grains and convert the other silver ions into black metallic sil¬
ver. This causes the grains to become visible black specks in the emulsion.

Radiographic film is generally developed in an automatic processor. A sche¬

matic of a typical processor is shown in Figure 15-6. The four components corre¬

spond to the four steps in film processing. In a conventional processor, the film is
in the developer for 20 to 25 seconds. All four steps require a total of 90 seconds.
When a film is inserted into a processor, it is transported by means of a roller

system through the chemical developer. Although there are some differences in
the chemistry of developer solutions supplied by various manufacturers, most
contain the same basic chemicals. Each chemical has a specific function in the
development process.
Reducer

Chemical reduction of the exposed silver bromide grains is the process that
converts typically provided by two
them into visible metallic silver. This action is
chemicals in the solution: phenidone and hydroquinone. Phenidone is the more

Film Path

Developer Fixer Wash Dryer

Figure 15-6 A Film Processor

 The Photographic Process and Film Sensitivity 215

active andprimarily produces the mid to lower portion of the gray scale. Hydro-
quinone produces the very dense, or dark, areas in an image.

Activator

The primary function of the activator, typically sodium carbonate, is to soften

and swell the emulsion so that the reducers can reach the
exposed grains.
Restrainer

Potassium bromide is generally used as a restrainer. Its function is to moderate

the rate of development.

Preservative

Sodium sulfite, a typical preservative, helps protect the reducing agents from
oxidation because of their contact with air. It also reacts with oxidation products to
reduce their activity.

Hardener

Glutaraldehyde is used as a hardener to retard the swelling of the emulsion. This

is necessary in automatic processors in which the film is transported by a system
of rollers.

Fixing

After leaving the developer the film is transported into a second tank, which
contains the fixer solution. The fixer is a mixture of several chemicals that perform
the following functions.

Neutralizer

When a film is removed from the developer solution, the development contin¬
ues because of the solution soaked up by the emulsion. It is necessary to stop this
action to prevent overdevelopment and fogging of the film. Acetic acid is in the
fixer solution for this purpose.

Clearing
The fixer solution also clears the undeveloped silver halide grains from the film.
Ammonium sodium thiosulfate is used for this purpose. The unexposed grains
or

leave the film and dissolve in the fixer solution. The silver that accumulates in the
fixer during the clearing activity can be recovered; the usual method is to electro¬
plate it onto a metallic surface within the silver recovery unit.
216 Physical Principles of Medical Imaging

Preservative

Sodium sulfite is used in the fixer as a preservative.

Hardener

Aluminum chloride is typically used as a hardener. Its primary function is to

shrink and harden the emulsion.

Wash

Film is next passed through a waterbath to wash the fixer solution out of the
emulsion. It is especially important to remove the thiosulfate. If thiosulfate (hypo)
is retained in the emulsion, it will eventually react with the silver nitrate and air to
form silver sulfate, a yellowish brown stain. The amount of thiosulfate retained in
the emulsion determines the useful lifetime of a processed film. The American
National Standard Institute recommends a maximum retention of 30 pg/in2.

Dry

The final step in processing is to dry the film by passing it through a chamber in
which hot air is circulating.

SENSITIVITY

One of the most important characteristics of film is its sensitivity, often referred
to as film speed. The sensitivity of a particular film determines the amount of
exposure required to produce an image. A film with a high sensitivity (speed)
requires less exposure than a film with a lower sensitivity (speed).
The sensitivities of films are generally compared by the amount of exposure

required to produce an optical density of 1 unit above the base plus fog density.
The sensitivity of radiographic film is generally not described with numerical val¬
ues but rather with a variety of generic terms such as "half speed," "medium

speed," and "high speed." Radiographic films are usually considered in terms of
their relative sensitivities rather than their absolute sensitivity values. Although it
is possible to choose films with different sensitivities, the choice is limited to a

range of not more than four to one by most manufacturers.

Figure 15-7 compares two films with different sensitivities. Notice that a spe¬
cific exposure produces a higher density in the high sensitivity film; therefore, the

production of a specific density value (ie, 1 density unit) requires less exposure.
High sensitivity (speed) films are chosen when the reduction of patient expo¬
sure and heat loading of the x-ray equipment are important considerations.
 a
s a a
1 a- On n>
s-

0 "lC r>

sx
to
•o
-o

OQ

64

32

->

■>

16

F(SSielpnmesitvd)y F(SSeipnlmseitvdy)
1

DENSITY 1
2 DENSITY
4
1

SeDnFisfTtwvirlomthsf
Low 8
High
1

1
16

1
32

1
64

C1om5pari-s7n
Figure
218 Physical Principles of Medical Imaging

Low sensitivity (speed) films are used to reduce image noise. The relationship
of filmsensitivity to image noise is considered in Chapter 21.
The sensitivity of film is determined by a number of factors, as shown in Figure
15-8, which include its design, the exposure conditions, and how it is processed.

Composition
The basic sensitivity characteristic of a film is determined by the composition
of the emulsion. The size and shape of the silver halide grains have some effect on
film sensitivity. Increasing grain size generally increases sensitivity. Tabular-

shaped grains generally produce a higher sensitivity than conventional grains. Al¬
though grain size may vary among the various types of radiographic film, most of
the difference in sensitivity is produced by adding chemical sensitizers to the
emulsion.

Processing
The effective sensitivity of film depends on several factors associated with the
development:
• the type of developer
•
developer concentration
•
developer replenishment rates
•
developer contamination

Film Sensitivity
(Speed)

FILM PROCESSING EXPOSURE

CHEMISTRY CONDITIONS

Type Wavelength of light

Time

Type Activity Temperature Time

•
Replenishment
•
Contamination

Figure 15-8 Factors That Affect Film Sensitivity

 The Photographic Process and Film Sensitivity 219

•
development time
•
development temperature.
In most medical imaging applications, the objective is not to use these factors to
vary film sensitivity, but rather to control them to maintain a constant and predict¬
able film sensitivity.

Developer Composition
The processing chemistry supplied by different manufacturers is not the same.
It isusually possible to process a film in a variety of developer solutions, but they
will not all produce the same film sensitivity. The variation in sensitivity is usually
relatively small, but must be considered when changing from one brand of devel¬
oper to another.

Developer Concentration
Developer chemistry is usually supplied to a clinical facility in the form of a
concentrate that must be diluted with water before it is pumped into the processor.
Mixing errors that result in an incorrect concentration can produce undesirable
changes in film sensitivity.

Developer Replenishment
The film development process consumes some of the developer solution and
causes the solution to become less active. Unless the solution is replaced, film
sensitivity will gradually decrease.
Inradiographic film processors, the replenishment of the developer solution is
automatic. When a sheet of film enters the processor, it activates a switch that

causes fresh solution to be pumped into the development tank. The replenishment

rate can be monitored by means of flow meters mounted in the processor. The

appropriate replenishment rate depends on the size of the films being processed. A
processor used only for chest films generally requires a higher replenishment rate
than one used for smaller films.

Developer Contamination
developer solution becomes contaminated with another chemical, such as
If the
abrupt changes in film sensitivity can occur in the form of either
the fixer solution,
an increase or decrease in sensitivity, depending on the type and amount of con¬

tamination. Developer contamination is most likely to occur when the film trans¬
port rollers are removed or replaced.
Development Time
When an exposed film enters the developer solution, development is not instan¬
taneous. It is agradual process during which more and more film grains are devel-
220 Physical Principles of Medical Imaging

oped, resulting in increased film density. The development process is terminated

by removing the film from the developer and placing it in the fixer. To some ex¬
tent, increasing development time increases film sensitivity, since less exposure is
required to produce a specific film density. In most radiographic film processors,
the development time is usually fixed and is approximately 20-25 seconds. How¬
ever, there are two exceptions. So-called rapid access film is designed to be pro¬
cessed faster in special processors. Some (but not all) mammographic films will

produce a higher contrast when developed for a longer time in an extended cycle
processor.

Development Temperature
The activity of the developer changes with temperature. An increase in tem¬
perature speeds up the development process and increases film sensitivity because
less exposure is required to produce a specific film density.
The temperature of the developer is thermostatically controlled in an automatic
processor. It is usually set within the range of 90-95°F. Specific processing tem¬
peratures are usually specified by the film manufacturers.

Light Color (Wavelength)

Film is equally sensitive to all wavelengths (colors) of light. The spectral

not

sensitivity is characteristic of film that must be taken into account in selecting

a
film for use with specific intensifying screens and cameras. In
general, the film
should be most sensitive to the color of the light that is emitted by the intensifying
screens, intensifier tubes, cathode ray tubes (CRTs), or lasers.

Blue Sensitivity
A basic silver bromide emulsion has its maximum
sensitivity in the ultraviolet
and blue regions of the light spectrum. For many years most intensifying screens
contained calcium tungstate, which emits a blue
light and is a good match for blue
sensitive film. Although calcium tungstate is no
longer widely used as a screen
material, several contemporary screen materials emit blue light.

Green Sensitivity
Several image light sources, including
image intensifier tubes, CRTs, and some
intensifying screens, emit most of their light in the green portion of the spectrum.
Film used with these devices must, therefore, be sensitive to
green light.
Silver bromide can be made sensitive to
green light by adding sensitizing dyes
to the emulsion. Users must be careful not to use the
wrong type of film with
intensifying screens. If a blue-sensitive film is used with a green-emitting intensi¬
fying screen, the combination will have a drastically reduced sensitivity.
 The Photographic Process and Film Sensitivity 221

Red Sensitivity
Many lasers produce red light. Devices that transfer images to film by means of
a laser beam must,therefore, be supplied with a film that is sensitive to red light.

Safelighting
Darkrooms in which film is loaded into cassettes and transferred to processors
are usually illuminated with safelight. A safelight emits a color of light the eye
a
can see but that will not
expose film. Although film has a relatively low sensitivity
to the light emitted by
safelights, film fog can be produced with safelight illumina¬
tion under certain conditions. The safelight should
provide sufficient illumination
for darkroom operations but not produce significant
exposure to the film being
handled. This can usually be accomplished if certain factors are controlled. These
include safelight color, brightness, location, and duration of film
exposure.
The color of the safelight is controlled by the filter. The filter must be selected
in relationship to the spectral sensitivity of the film being used. An amber-brown

safelight provides a relatively high level of working illumination and adequate

protection for blue-sensitive film; type 6B filters are used for this application.
However, this type of safelight produces some light that falls within the sensitive
range of green-sensitive film.
A red safelight is required when working with green-sensitive films. Type GBX
filters are used for this purpose.

Selecting the appropriate safelight filter does not absolutely protect film be¬
cause film has some sensitivity to the light emitted by most safelights. Therefore,
the brightness of the safelight (bulb size) and the distance between the light and
film work surfaces must be selected so as to minimize film exposure.
Since exposure is an accumulative effect, handling the film as short a time as
possible minimizes exposure. The potential for safelight exposure can be evalu¬
ated in a darkroom by placing a piece of film on the work surface, covering most
of its area with an opaque object, and then moving the object in successive steps to

expose more of the film surface. The time intervals should be selected to produce
exposures ranging from a few seconds to several minutes. After the film is pro¬
cessed, the effect of the safelight exposure can be observed. Film is most sensitive
to safelight fogging after the latent image is produced but before it is processed.

Exposure Time
In radiography it is usually possible to deliver a given exposure to film by using
many combinations of radiation intensity (exposure rate) and exposure time. Since
radiation intensity is proportional to x-ray tube MA, this is equivalent to saying
that a given exposure (in milliampere-seconds) can be produced with many com-
222 Physical Principles of Medical Imaging

binations of MA and time. This is known as the law of reciprocity. In effect, it

means that it is
possible to swap radiation intensity (in milliamperes) for exposure
time and produce the same film exposure. When a film is directly exposed to
x-radiation, the reciprocity law holds true. That is, 100 mAs will produce the same
film density whether it is exposed at 1,000 mA and 0.1 seconds or 10 mA and 10
seconds. However, when a film is exposed by light, such as from intensifying
screens or image intensifiers, the reciprocity law does not hold. With
light expo¬
sure, as opposed to direct x-ray interactions, a single silver halide grain must ab¬
sorb more than one photon before it can be developed and can contribute to image

density. This causes the sensitivity of the film to be somewhat dependent on the
intensity of the exposing light. This loss of sensitivity varies to some extent from
one type of x-ray film to another. The clinical
significance is that MAS values that
give the correct density with short exposure times might not do so with long expo¬
sure times.

PROCESSING QUALITY CONTROL

There are many variables, such as temperature and chemical activity, that can
affect the level of processing that a film receives. Each type of film is
designed and
manufactured to have specified sensitivity (speed) and contrast characteristics.

Underprocessing

If a film isunderprocessed its sensitivity and contrast will be reduced below the
specified values. The loss of sensitivity can usually be compensated for by in¬
creasing exposure but the loss of contrast cannot be recovered.

Overprocessing

Overprocessing can increase sensitivity. The contrast of some films might in¬
crease with overprocessing, up to a point, and then decrease. A
major problem
with overprocessing is that it increases
fog (base plus fog density) which contrib¬
utes to a decrease in contrast.

Processing Accuracy

The first step in processing quality control is to set up the correct processing
conditions and then verify that the film is being correctly processed.
 The Photographic Process and Film Sensitivity 223

Processing Conditions
A specification of recommended processing conditions (temperature, time, type
of chemistry, replenishment rates, etc.) should be obtained from the manufacturers
of the film and chemistry.

Processing Verification
After the recommended
processing conditions are established for each type of
film, should be performed to verify that the film is producing the
a test
design
sensitivity and contrast characteristics as specified by the manufacturer. These
specifications are usually provided in the form of a film characteristic curve that
canbe compared to one produced by the processor
being evaluated.

Processing Consistency
The second step in processing quality control is to reduce the variability over
time in the level of processing.
Variations in processing conditions can produce significant differences in film
sensitivity. One objective of a quality control program is to reduce exposure errors
that cause either underexposed or overexposed film. Processors should be checked
several times each week to detect changes in processing. This is done
by exposing
a test film to a fixed amount of
light exposure in a sensitometer, running the film
through the processor, and then measuring its density with a densitometer. It is not
necessary to measure the density of all exposure steps. Only a few exposure steps
are selected, as shown in Figure 15-9, to
give the information required for proces¬
sor
quality control. The density values are recorded on a chart (Figure 15-10) so
that fluctuations can be easily detected.

Base Plus Fog Density

One density measurement is made in an area that receives no exposure. This is

a measure of the base plus fog density. A low density value is desirable. An in¬
crease in the base plus fog density can be caused by overprocessing a film.

Speed
A single exposure step that produces a film density of about 1 density unit
(above the base plus fog value) is selected and designated the "speed step." The
density of this same step is measured each day and recorded on the chart. The
density of this step is a general indication of film sensitivity or speed. Abnormal
variations can be caused by any of the factors affecting the amount of develop¬
ment.
224 Physical Principles of Medical Imaging

SENSITOMETER
EXPOSED DENSITY
FILM
Base + Fog

Speed Index
2.20 - 1.20 = 1.0 - Contrast Index

Figure 15-9 Density Values from a Sensitometer Exposed Film Strip Used for Processor
Quality Control

Contrast

Two other steps are selected, and the difference between them is used as a mea¬
sureof film contrast. This is the contrast index. If the two sensitometer
steps that
are selected represent a two-to-one exposure ratio (50% exposure contrast), the
contrast index is the same as the contrast factor discussed earlier. This value is

recorded on the chart to detect abnormal changes in film contrast produced by

processing conditions.
If abnormal variations in film density are observed, all
possible causes, such as
developer temperature, solution replenishment rates, and contamination, should
be evaluated.
If more than one processor is used for films from the same imaging device, the
level of development by the different processes should be matched.
3

O o O S 3
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226 Physical Principles of Medical Imaging

Artifacts

A variety of artifacts can be produced during the storage, handling, and process¬
ing of film.
Bending unprocessed film can produce artifacts or "kink marks," which can
appear as either dark or light areas in the processed image. Handling film, espe¬
cially in a dry environment, can produce a build-up of static electricity; the dis¬
charge produces dark spots and streaks.
Artifacts can be produced during processing by factors such as uneven roller

pressure or the accumulation of a substance on the rollers. This type of artifact is

often repeated at intervals corresponding to the circumference of the roller.
 Chapter 16
Film Contrast Characteristics

INTRODUCTION AND OVERVIEW

Contrast isperhaps the most significant characteristic of an image recorded on

film. Contrast is the variation in filmdensity (shades of gray) that actually forms
the image. Without contrast there is no image. The amount of contrast in an image

depends on a number of factors, including the ability of the particular film to

record contrast.
Film can be considered as a contrast converter. One of its functions is to convert
differences in exposure (subject contrast) into film contrast (differences in den¬
sity), as shown in Figure 16-1. The amount of film contrast resulting from a spe¬
cific exposure difference can vary considerably.
The exposure contrast between two areas can be expressed as a ratio or percent¬

age difference, as illustrated in Figure 16-1. The film contrast between two areas is
expressed as the difference between the density values. The ability of the film to
convert exposure contrast into film contrast can be expressed in terms of the con¬

trast factor. The value of the contrast factor is the amount of film contrast resulting

from an exposure contrast of 50%. The amount of contrast produced by medical

imaging films depends on four basic factors: (1) type of emulsion, (2) amount of
exposure, (3) processing, and (4) fog.
In this chapter we consider the basic contrast characteristics of film, how these
characteristics are affected by the factors listed above, and how contrast character¬
istics relate to clinical applications.

CONTRAST TRANSFER

The ability of a film to produce contrast can be determined by observing the

difference in density between two areas receiving a specified difference in expo¬
sure, as shown in Figure 16-1. However, since the amount of contrast is affected

by the level of exposure, a range of exposure values must be delivered to a film to

demonstrate fully its contrast characteristics.

227
 228 Physical Principles of Medical Imaging

Exposure Contrast
i-50% -|

Relative Exposure

0.8 1.4 Density Units

A i i

0.6

Film Contrast

Figure 16-1 The General Relationship between Exposure Contrast and Film Contrast

One method of doing this is illustrated in Figure 16-2; this type of exposure
pattern is usually produced by a device known as a sensitometer. In this method, a
strip of film is divided intoa number of individual areas, and each area is
exposed
to a different level of radiation. In this
particular illustration, the exposure is
changed by a factor of 2 (50% contrast) between adjacent areas. When considering
contrastcharacteristics, we are usually not interested in the actual exposure to a
film but rather the relative
exposure among different areas of film. In Figure 16-2
the exposures to the different areas are
given relative to the center area, which has
been assigned a relative
exposure value of 1. We will use this relative exposure
scale throughout our discussion of film contrast
characteristics. Note that each
interval on the scale represents a 2:1 ratio. This is a characteristic
of a logarithmic
scale. When the film is
processed, each area will have density values, as shown
directly below the area. The amount of contrast between any two adjacent areas is
the difference in
density, as shown. In this illustration we can observe one of the
very important characteristics of film contrast. Notice how the contrast is not the
 A

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I3.0
I222..49.118
I1.8
A
A

A
.4

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EXPOSUR
A

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CONTRAS
RELATIVE A
35

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4s iCVTaonrwnhtritaeohs Exposure
.05
16 15

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230 Physical Principles of Medical Imaging

same between each pair of adjacent areas throughout the exposure range: there is
no contrast between the first two areas, but the contrast gradually increases with
exposure, reaches a maximum, and then decreases for the higher exposure levels.
In other words, a specific type of film does not produce the same amount of con¬
trast at all levels of exposure. This important characteristic must be considered
when using film to record medical images.
All films have alimited exposure range in which they can produce contrast: if
areas of a film receive exposures either below or above the useful exposure range,

contrast will be diminished, or perhaps absent. Image contrast is reduced when a

film is either underexposed or overexposed.

The Characteristic Curve

The relationship between film density and exposure is often presented in the
form of a graph, as shown in Figure 16-3. This graph shows the relationship be¬

tween the density and relative exposure for the values shown in Figure 16-2. This

type of graph is known as either a film characteristic curve or an H and D (Hurter

and Driffield) curve. The precise shape of the curve depends on the characteristics
of the emulsion and the processing conditions. The primary use of a characteristic
curve is to describe the contrast characteristics of the film throughout a wide expo¬

sure range. At any exposure value, the contrast characteristic of the film is repre¬

sented by the slope of the curve. At any particular point, the slope represents the
density difference (contrast) produced by a specific exposure difference. The
same interval anywhere on the relative exposure scale represents the same expo¬

sure ratio and amount of contrast delivered to the film during the exposure pro¬

cess. An interval along the density scale represents the amount of contrast that

actually appears in the film. The slope of the characteristic curve at any point can
be expressed in terms of the contrast factor because the contrast factor is the den¬
sity difference (contrast) produced by a 2:1 exposure ratio (50% exposure con¬
trast).
A film characteristic curve has three distinct regions with different contrast
transfer characteristics. The part of the curve associated with relatively low expo¬
sures is designated the toe, and also corresponds to the light or low density por¬

tions of an image. When an image is exposed so that areas fall within the toe
region, little or no contrast is transferred to the image. In the film shown in Figure
16-2, the areas on the left correspond to the toe of the characteristic curve.
A film also has a reduced ability to transfer contrast in areas that receive rela¬

tively high exposures. This condition corresponds to the upper portion of the char¬
acteristic curve in which the slope decreases with increasing exposure. This por¬
tion of the curve is traditionally referred to as the shoulder. In Figure 16-2 the dark
areas on the right correspond to the shoulder of the characteristic curve. The two

significant characteristics of image areas receiving exposure within this range are
 Film Contrast Characteristics 231

1 1 1 1 1 i i i i i i I l
_J 1 2 2 2 — 1 2 4 8 16 32 64
64 32 16 8 4 2

RELATIVE EXPOSURE

Figure 16-3 A Film Characteristic Curve Showing the Relationship between Density and
RelativeExposure

that the film isquite dark (dense) and contrast is reduced. In many instances, im¬
age contrast is present that cannot be observed on the conventional viewbox be¬
cause of the high film density. This contrast can be made visible by viewing the

film with a bright "hotlight."

232 Physical Principles of Medical Imaging

The highest level of contrast is produced within a range of exposures falling

between the toe and the shoulder. This portion of the curve is characterized by a
relatively straight and very steep slope in comparison to the toe and shoulder re¬
gions. In most imaging applications, it is desirable to expose the film within this
range so as to obtain maximum contrast.
The minimum density, in the toe, is the residual density, which is observed after
processing unexposed film, and is typically in the range of 0.1 to 0.2 density units.
This density is produced by the inherent density of the film base material and the
low-level fog in the film emulsion; it is therefore commonly referred to as the base
plus fog density. The maximum density, in the shoulder, is determined by the
design of the film emulsion and the processing conditions and is typically referred
to as the Dmax.

Contrast Curve

It is easier to see the relationship between film contrast and exposure by using a
contrast curve, as shown in Figure 16-4. The contrast curve corresponds to the
slope of the characteristic curve. It clearly shows that the ability of a film to trans¬
fer exposure contrast into film contrast changes with exposure level, and that
maximum contrast is produced only within a limited exposure range.
The exposure range over which a film produces useful contrast is designated the
latitude. An underexposed film area contains little or no image contrast. Exposure
values above the latitude range also produce areas with very little contrast and
have the added disadvantage of being very dark or dense.
Since the contrast transfer characteristics of film change with exposure, a spe¬
cific film characteristic can be described only by using either a characteristic curve
or contrast curve, as illustrated in Figure 16-4. There are occasions, however,

when it would be desirable to use a single-parameter value to describe the general

contrast characteristics of a film. Two parameters are often used for this purpose:
the average gradient expresses the average contrast transferring ability, and the

gamma expresses the maximum contrast.

Gamma

The gamma value of a film is the maximum slope of the characteristic curve, as
shown in Figure 16-5. By tradition, the gamma value is the slope expressed in
terms of the density difference associated with an exposure ratio of 10:1. The

relationship between the film gamma value and the maximum contrast factor is
given by
Gamma = 3.32 Maximum contrast factor.
 Film Contrast Characteristics 233

RELATIVE EXPOSURE

Figure 16-4 The Relationship of Film Contrast (Solid Line) to Relative Exposure and the
Line)
Characteristic Curve (Dotted

The factor 3.32 converts a slope based on an exposure ratio of 2:1 to a slope ex¬
pressed with respect to a 10:1 exposure ratio.
234 Physical Principles of Medical Imaging

Average Gradient

The average gradient is the average slope between two designated density val¬
ues, asillustrated in Figure 16-5. For medical imaging film the density values of
0.25 and 2.0 above the base plus fog density are used to determine average gradi¬
ent. Average gradient values, like gamma values, are based on an exposure ratio of

8 4 2 1 ^

RELATIVE EXPOSURE

Figure 16-5 The Relationship of Average Gradient and Gamma to the Characteristic Curve
 Film Contrast Characteristics 235

10:1. The relationship between the average gradient and the average contrast fac¬
tor is therefore:

Average gradient = 3.32 Average contrast factor.

FILM LATITUDE

InFigure 16-4 we saw that film contrast is limited to a specific range of expo¬
surevalues. The exposure range in which a film can produce useful contrast is
known as its latitude. The latitude of a specific film is determined primarily by the

composition of the emulsion and, to a lesser extent, by processing conditions. The

significance of film latitude is that it represents the limitations of the exposure
range that will yield useful image contrast.
The exposure to any given area of a film falls within one of three general ranges,
as shown in Figure 16-4. Two general conditions can cause film
exposure to fall
outside the latitude range: an incorrect exposure setting of the equipment, which
can produce either an underexposure or an
overexposure, and an anatomical struc¬
ture, which produces a wide range of exposure values within an image that exceed
the latitude range.

Exposure Error

In every
imaging procedure it is necessary to set the exposure to match the
sensitivity (speed) of the film being used. This is not always an easy task.
Exposure error is generally a much more significant problem in radiography
than in other imaging procedures. It is not always possible to predict the amount of

x-ray exposure required in every procedure because of subtle variations in body

size and composition. In any radiographic practice, a significant number of films
must be repeated because of exposure error.

Subject Contrast Range

When an x-ray beam passes through certain body areas, the penetration of the
areas varies considerably because of differences in tissue thickness and composi¬
tion. Under these conditions it is possible for the range of exposures from the
patient's body (subject contrast range) to exceed the latitude of the film. This typi¬
cally produces a high level of area contrast, as discussed in a previous chapter.
When the exposure to some image areas falls outside the film latitude, details
within the recorded with reduced contrast, as illustrated in Figure 16-6.
areas are

Notice that the objects located within the very thick and thin body sections are not
recorded because they are located in areas outside the film latitude. Radiography
 236 Physical Principles of Medical Imaging

if)
if)
<D
C

o
if)
C
I- <D
+-» a
c
a>

<S
Q.
1 1 1 i i i i
1 1 1 i i i i

tit
'
'
■
V

r' r
1/8 1/4 1/2 1 2 4 8
Relative Exposure
Figure 16-6 Loss of Contrast in Both Thick and Thin Body Sections when Using High
Contrast Film

of the chest illustrates thisproblem: the area of the mediastinum receives a rela¬
tively low exposure whereas the lung areas receive a much higher level.
One possible solution to the problem is to decrease the
subject contrast range by
using increased KVP, spacial filtration, bolus, or compression. Another possible
solution is to use a film with a
longer latitude.

FILM TYPES

The overall contrast characteristic of a film

(shape of characteristic curve and
latitude) is determined by the composition of the emulsion. Radiographic film is
usually designated as either high contrast or medium contrast film. Medium con¬
trast film is often referred to as latitude film.
When selecting film for
a a particular medical imaging application, contrast
characteristics should be considered. Figure 16-7
compares the contrast character¬
istics of two general types of
radiographic film. The high contrast film can pro¬
duce higher contrast. Notice the contrast of 0.6 between the
areas with relative
FCOINLTRMAS CONTRAS CONTRAS
FLAITLIUMDE
FLCMCHaooetinalndiumtgriurdmsehs
CAomparisfn
16-7
Figure
238 Physical Principles of Medical Imaging

exposure values of 1 and 2. The contrast is limited, however, to a relatively small

exposure range, or latitude. The medium contrast, or latitude, film produces less
contrast but can produce contrast over a much larger range of exposure values.
The corresponding characteristic and contrast curves are shown in Figures 16-8
and 16-9.

1 I I I I I I T

-5T -s—^—i i 5- 1 2 4 8 16 32 64
RELATIVE EXPOSURE
Figure 16-8 Characteristic Curves for the High Contrast and Latitude Films Illustrated in
Figure 16-7
 Film Contrast Characteristics 239

RELATIVE EXPOSURE
Figure 16-9 Contrast Curves for the High Contrast and Latitude Films Illustrated in
Figure 16-7 (Compare with Characteristic Curves in Figure 16-8 )

Figure 16-10 illustrates how using a medium contrast, or latitude, film actually
increasesobject contrast within certain areas because of the overall reduction in
area contrast.

EFFECTS OF PROCESSING

Both the sensitivity and the contrast characteristics of a given film type are
affectedby processing. The degree of processing received by film generally de¬
pends on three factors: (1) the chemical activity of the developer solution, (2) the
temperature of the developer, and (3) the period of immersion in the developer. In
most applications it is usually desirable to maintain a constant developer activity
by replenishment and to control the degree of development by varying the tern-
 240 Physical Principles of Medical Imaging

I i

1/8 1/4 1/21 248

Relative Exposure
Figure 16-10 Increase in Object Contrast in Thick and Thin Body Sections with a Latitude
Film (Compare with Figure 16-6)

perature or, in some cases, the amount of development time. Varying the amount
of development by changing either the chemical activity, the time period, or the
temperature produces a shift in the characteristic curve.
Theoptimum performance of most film types is obtained by using the recom¬
mended degree of development. Deviation in either direction
generally results in a
loss of contrast. Although the
sensitivity of film can usually be increased by over¬
developing, this is usually accompanied by an increase in undesirable fog.

Overprocessing

Increasing development will cause the curve to shift to the left with a rise in the
toe. The movement of the curve to the left indicates increase in
an
sensitivity be¬
cause a given density value is produced with a lower exposure. As the toe of the
curve rises, the
general slope of the curve decreases, which results in less contrast.
The increased density value of the toe also indicates an increased
fog level. This
 Film Contrast Characteristics 241

fog density occurs because more of the unexposed silver grains are developed by
the excess processing.

Underprocessing

Underprocessing causes the curve to shift to the right, indicating a decrease in

sensitivity. The shoulder also begins to drop, and the slope of a curve decreases.
This results in less contrast and less
density.

FILM FOG

Any density in a film that is not produced as part of the image-forming exposure
is generally referred to as fog. There are several potential sources of film fog.

Inherent

All film, even under the best conditions, showsdensity even if it has re¬
some
ceived no radiation exposure.
This density comes from the film base and from the
unexposed emulsion, and is the density observed if a piece of unexposed film is
processed. This is typically referred to as the base plus fog density and is generally
in the range of 0.15 to 0.2 density units for radiographic film.

Chemical

If a film is
overprocessed, abnormally high densities will be developed by
chemical action in image areas that received little or no exposure. This results
from chemicals in the developer solution interacting with some of the film grains
that were not sensitized by exposure.

Heat and Age

Fog will gradually develop in unprocessed film with age; therefore, film should
not be stored for long periods of time. Each box of film is labeled with an expira¬
tion date by the manufacturer. When stored under proper conditions, film should
not develop appreciable fog before the expiration date. When film is stored in a

clinical facility, the stock should be rotated on a first-in, first-out basis.

The development of film fog with age is accelerated by heat; therefore, film
should not be stored in hot areas. Refrigeration can extend the useful life of un¬
processed film.
242 Physical Principles of Medical Imaging

Radiation Exposure
It is not uncommon for film to be fogged by accidental exposure to either
x-radiation light. Light-exposure fogging can result from light leaks in a dark¬
or

room, the use of incorrect safelights, and cassettes with defective light seals
around the edges.
Film darkrooms and storage areas should be properly shielded from
nearby
x-ray sources.
 Chapter 17

Radiographic Density Control

INTRODUCTION AND OVERVIEW

Maximum visibility in a radiograph requires that the optical density be within a

range that produces adequate contrast, as discussed in Chapter 16. This is
achieved by setting the exposure to fit the conditions established by the
receptor
system and the patient. The exposure can be selected by either manually adjusting
the KV, MA, and exposure time or using the AEC circuit of the
x-ray machine.
Neither method produces a perfect exposure each time. A number of sources of
exposure error must be considered during the production of a radiograph.
A proper film density is obtained when the radiation exposure
penetrating the
patient's body (receptor exposure) matches the sensitivity (speed) requirements of
the receptor system. Both receptor sensitivity and receptor exposure are affected

by many factors, as shown in Figure 17-1. Film density is optimal when all of
these factors are properly balanced.
After a radiographic system is installed, the films, screens, and grids are se¬
lected, and the processor is adjusted, the major task is selecting KVP and MAS
values to compensate for variations in patient thickness and composition. If the
KVP and MAS are to be selected manually, technique charts should be used for
reference. The most common chart form gives KVP and MAS values in relation to
the thickness of different parts of the body. It should be emphasized that a given

technique chart should be used only if it has been calibrated for the specific ma¬
chine and film-screen-grid combination being used.
Exposure errors are produced by variations in any of the factors listed in Figure
17-1 that are not properly compensated for. When it is necessary to change certain
factors, such as focal-film distance (FFD) or KVP, to meet a specific examination
objective, the change can usually be compensated for by changing another factor
according to established relationships, such as the inverse-square law and the 15%
rule.

243
244 Physical Principles of Medical Imaging

Radiographic
Density

RECEPTOR SENSITIVITY RECEPTOR EXPOSURE

Screen Film Patient Machine Other

•
Thickness •
KV •
Grid
•
Material •
Type
• MA • FFD
• Thickness •
Spectral Sens. •
Density
• Time •
Field Size
• KV •
Processing
•
Waveform

Figure 17-1 Factors That Affect Radiographic Density

In this chapter we consider the specific factors that relate to exposure (density)
control, exposure error, and technique compensation.

THE X-RAY GENERATOR

The exposure delivered by an x-ray generator can be controlled by selecting

appropriate values for KVP, MA, and exposure time. In principle, several combi¬
nations of these three parameters produce the same film density; therefore, other
factors, such as patient exposure, x-ray tube heat production, generator capa¬
bilities, image contrast, and image blur, must be considered in setting technical
factors.

MA

The intensity (exposure rate) of an x-ray beam is directly proportional to the

MA value. The typical radiographic generator provides several MA values (25,
50, 100, 200, 500, etc.) to choose from. The selection of an MA value is usually
coupled with the selection of focal spot size. The use of the small focal spot (for
better image detail) is typically limited to the lower MA values. The highest avail¬
able MA value on a particular machine is determined by the capacity of the gen¬
erator, as discussed in Chapter 8.
No one specific MA value must be used for a given procedure; the MA value
must be selected in conjunction with the exposure time and KVP. Some
general
rules governing the selection of MA are:

• Select low MA values to permit use of the small focal spot when image detail
is important.
 Radiographic Density Control 245

• Selectlarge MA values to reduce exposure time when motion blurring is a

problem.
• Selecthigh MA values when it is desirable to reduce the KVP to increase
image contrast.
Two types of exposure errors are associated with the MA selection: one is pri¬
marily a human error and the other is an error associated with the calibration of the
x-ray generator.
An exposure error can occur when the operator selects an MA value that is
inappropriate in relation to the exposure time and KVP value. This can occur if
patient size and condition are not properly evaluated or if the technique charts are
not correctly calibrated for the specific
x-ray generator.
Exposure errors will occur if the output exposure rate of the x-ray machine is
not proportional to the indicated MA value at a particular
setting. It is not uncom¬
mon for the actual MA value to be different from the value indicated
by the MA
selector. This error source can be minimized by the periodic calibration of the

x-ray generator. Calibration consists of measuring the x-ray exposure rate at each
MA value that can be selected.

Exposure Time

Since the exposure produced by an x-ray tube is directly proportional to expo¬

sure time, it be controlled by selecting an appropriate exposure time value. In
can

radiography, exposure times are selected either by the operator, who sets the timer
before initiating the exposure, or by the AEC circuit, which terminates the expo¬
sureafter the selected exposure has reached the receptor.
As with MA, no one exposure time value is correct for a specific procedure.
Remember that it is the combination of exposure time, MA, and KVP that deter¬
mines exposure. Some general rules for selecting an appropriate exposure time
are:

• Select short exposure times to minimize motion blurring and improve image
detail.
• Select longer exposure time when motion is not a problem and it is necessary
to reduce either MA or KVP.

Exposure errors can result from the selection of an inappropriate exposure time
by the operator or from the failure of the generator to produce the exposure time
indicated on the time selector.
X-ray machine timers should be calibrated periodically to determine if the ma¬
chineproduces an exposure that is proportional to the indicated exposure time.
Timers can be calibrated by several methods including the use of an electronic
246 Physical Principles of Medical Imaging

timer or the measurement and

comparison of actual exposure output produced by
each timer setting.
Exposure errors encountered in the use of AEC are discussed later.

KVP

Film exposure is more sensitive to changes in KVP than to changes in either MA

orexposure time. This is because the KVP affects several independent factors that
contribute to film exposure. In Chapter 7 we saw that x-ray beam intensity in¬
creased exponentially with an increase in KVP. A good approximation is that dou¬
bling the KVP increases exposure from an x-ray tube by a factor of 4. In Chapter 11
we observed that the penetration of radiation
through an object, such as a patient's
body, increases with KVP. The increase in both x-ray production and penetration
with KVP means that a relatively small change in KVP produces a relatively
large
change in the exposure penetrating the patient's body and reaching the receptor. It
should be recalled (Chapter 14) that the sensitivity of intensifying screens changes
with KVP. Both the direction and amount of change depend on the specific screen
material.
Ageneral rule of thumb in radiography is that a 15% increase in KVP will
double the exposure to the film. In other words, it takes only a 15% increase in
KVP to produce the same increase in film exposure as a 100% increase in either
MA or exposure time. The 15% rule is useful for comparing
change in KVP and
MAS, but it by no means expresses a precise relationship.
Figure 17-2 shows the approximate relationship between MAS and KVP values
that would produce the same film exposure. The KVP-MAS values
represented by
points along this curve apply to a specific x-ray generator, patient, and receptor
system. If either of these factors is changed, the position of the curve would be
shifted.

Although it is true that KVP-MAS values represented by any point along the
curve produce the same film exposure, they will not produce the same image qual¬
ity, patient exposure, and demands on the x-ray equipment. Moving down the
curve (higher KVP values)
generally decreases patient exposure, x-ray tube heat¬
ing, and motion blurring when the MAS is decreased by a shorter exposure time.
The major reason for moving up the curve
(higher MAS values) is to increase
image contrast with the lower KVP values, as discussed in Chapter 12.
The range of KVP values for a
specific procedure is selected on the basis of
contrast requirements, patient
exposure, and the limitations of the x-ray generator.
However, small changes in KVP within each range can be used to adjust film expo¬
sure.

Exposure errors can occur if the actual KVP produced by an x-ray generator is
different from the value indicated by the KVP selector. Periodic calibration of an
x-ray generator helps reduce this potential source of error.
 Radiographic Density Control 247

60 "i

50

40
UT
<
30

(/>
<
2 20

10
15%

0_j ! , , p-
60 70 80 90 100

KVP (kV)

Figure 17-2 Relationship of KVP and MAS to Control of Film Density

Waveform

An x-ray generator that produces a relatively constant KV (ie, three-phase) re¬

quires less KVP and/or MAS than a single-phase generator to produce the same
film exposure. The constant potential, or three-phase, generator produces more
radiation exposure per unit of MAS, as discussed in Chapter 7. For a specific KVP
value, the radiation is more penetrating because of the higher average KV during
the exposure.

Technique charts designed for use with a single-phase generator would lead to
considerable overexposure if used with a constant potential, or three-phase, gen¬
erator.

X-Ray Tubes
All x-ray tubes do not produce the same exposure (for a specific KVP-MAS

value), and the exposure output sometimes decreases with aging. A difference in
tube output among tubes is often caused by variations in the amount of filtration.
The significance of the tube-to-tube variation is that technique factors for one
x-ray machine might not produce proper film exposure if used with another
machine.
248 Physical Principles of Medical Imaging

RECEPTOR SENSITIVITY

The overall sensitivity (speed) of the radiographic receptor is determined by the

characteristics of both the film and the intensifying screens. The sensitivity of a
specific film-screen combination is usually specified in terms of a speed value, as
described in Chapter 14. If either the film or screen type is changed so that the
combined sensitivity (speed) changes, it will be necessary to change either the
MAS or KVP to compensate. If the speed is increased, less radiation will be re¬

quired, so MAS or KVP must be reduced. The relationship is

MAS (new) = (Speed (old)/Speed (new)) x MAS (old).
For example, if we change from a 200- to a 400-speed system,
MAS (new) = 200 (old)/400 (new) x MAS (old) = 1/2 x MAS (old).
A change in KVP can also be selected to compensate for changes in receptors by
using the 15% rule.
Many exposure errors are caused by undetected variations in receptor sensitiv¬
ity from examination to examination, or over a period of time. When a receptor is
described as having a specific speed value, such as 200, 400, etc., the value is
nominal and applies to specific exposure and processing conditions. When these
conditions change, so does the receptor sensitivity, as discussed in Chapters 14
and 15.
One of the major factors that produce variations in receptor sensitivity and,
therefore, exposure error is variation in developer temperature and activity. The
inherent sensitivity of film varies somewhat from one batch to another, but this is

usually not sufficient to produce significant exposure error. Variations in screen

sensitivity with KVP can be a problem, especially when techniques appropriate for
one type of screen (phosphor material) are used for another type.

Grids

When a grid is changed, the exposure factors must be changed. The approxi¬
mate relationship between the old and new MAS values depends on the Bucky
factors, B, or penetration values of the grids and is

MAS (new) = (B (new)/B (old)) x MAS (old).

The grid penetration is the reciprocal of the Bucky factor. If the condition being
considered does not involve a grid, then the value of the Bucky factor or grid
penetration will be 1. The value of these factors generally depends on grid ratio
and the quantity of scattered radiation in the beam, as discussed in Chapter 13.
Values of grid penetration range from 1 (no grid) to approximately 0.2 for a high-
 Radiographic Density Control 249

ratio grid. Changing from an examination condition without a grid to one with a
grid penetration of 0.2 (Bucky factor of 5) requires the MAS to be increased by a
factor of 5. Approximate grid penetration and
Bucky factor values for different
grids are given in Chapter 13.

PATIENT

For a given type of examination, the factor

subject to the greatest variation from
patient to patient is the penetration of the body section. For a given x-ray beam
quality, or KVP, the penetration depends on the thickness of the body part being
examined and the composition of the body section.
Changes in body thickness
from one patient to another can be compensated for
by changing either KVP or
MAS. An approximate relationship between KVP and body thickness, t, is
given
by

KVP = 50 -J- 2t (cm).

For example, a 15-cm thickness would require a KVP of approximately 80,

whereas a 20-cm thickness would require a KVP of 90.
When a change in patient thickness is compensated for by changing MAS, a
change of a factor of 2 is generally required for a thickness difference of approxi¬
mately 5 cm. This varies, however, with KVP. A given thickness difference re¬
quires a smaller MAS change when higher KVP values are used.
The presence of various pathological conditions can also alter body penetration
and require appropriate exposure adjustments. Muscular patients generally require
an additional increase in exposure factors, whereas elderly patients require a

reduction.

DISTANCE AND AREA

As the areacovered by the x-ray beam, or field size, is increased, more scattered
radiation is produced and contributes to film exposure. Although much of the scat¬
tered radiation is removed by the grid, it is often necessary to change exposure
factors to get the same density with different field sizes.
Because of the inverse-square effect, the exposure that reaches the receptor is
related to the focal spot-receptor distance, d. If this distance is changed, the new
MAS value required to obtain the same film exposure will be given by

MAS (new) = (d2 (new)/d2 (old)) x MAS (old).

A characteristic of the relationship is that if the distance is doubled, the required
MAS will increase by a factor of 4. Long focal spot-receptor distances generally
decrease image blur, patient exposure, and distortion; however, a significantly
higher MAS is required.
250 Physical Principles of Medical Imaging

AUTOMATIC EXPOSURE CONTROL

Many radiographic systems are equipped with an AEC circuit. The AEC is of¬
ten referred to as the phototimer. The basic function of an AEC is illustrated in
Figure 17-3.
The principal component of the AEC is a radiation-measuring device, or sensor,
located near the receptor. A common type of sensor contains an intensifying
screen that converts the x-ray
exposure into light. The sensor also contains a com¬
ponent, typically a photomultiplier tube, that converts the light into an electrical
signal. Another type of sensor is an ionization chamber (described in Chapter 34)
that also converts x-ray exposure into an electrical signal.
Within the AEC circuit, the exposure signal is compared to a reference value.
When the accumulated exposure to the sensor (receptor) reaches the predeter¬
mined reference value, the exposure is terminated when the x-ray tube automati¬
cally turns off.
The reference exposure level is determined by two variables: one is the calibra¬
tion of the AEC. A service engineer must adjust the basic reference level to match
the sensitivity (speed) of the receptor. If either the intensifying screen or film is

changed so that the overall receptor sensitivity changes, it will usually be neces¬
sary to recalibrate the AEC.

3
Backup
_
2 Timer
-1

/ \
/ *
'
' \
/ \
/ \
/ \
/ \ ■

+ 1
/ *
l-1/2
<
Receptor Density
Exposure
Value
_
N Setting
Radiation Sensor
1/2

AEC Calibration

Figure 17-3 Basic Automatic Exposure Control System

 Radiographic Density Control 251

The other variable found on most systems is the

density control, which can be
adjusted by the operator. In general, the density control can be used to vary recep¬
tor exposure (film
density) within a limited range. The density control is usually
marked with the factors by which the nominal
(zero setting) exposure will be
changed.
The AEC contains a back-up timer, which will terminate an
exposure if there is
a malfunction in the normal
operation and is a safety feature to prevent excessive
patient exposure. In most systems, the manual timer also serves as the back-up
timer for the AEC. The back-up timer should be set to a value somewhat
larger
than the expected exposure time. If it is set at a value that is too
low, it will termi¬
nate the exposure before
adequate receptor exposure has accumulated. The result
will be an underexposed film.
When using AEC, the location of the sensor with
respect to patient anatomy
must be considered. The sensitive area of the sensor has a definite size and
shape.
Typically, different sensor areas can be selected by the operator. The function of
the AEC is to control the average density within the sensitive area of the sensor. If
the sensitive area is incorrectly positioned relative to the
patient's anatomy, expo¬
sure errors can be
significant. For example, if, in chest radiography, the sensor
field is placed over the mediastinum, the AEC will attempt to produce a density of
approximately 1 unit (medium gray) in that area. Under this condition, the lung
areas will be overexposed.

The use of AEC does not eliminate exposure error. Some possible sources of
error that must be considered are the
following:
• AEC not calibrated for a specific receptor
•
Density control not set to proper value
•
Back-up timer not set to proper value
• Sensor field incorrectly positioned with respect to anatomy.
 Chapter 18

Blur, Resolution, and Visibility

of Detail

INTRODUCTION AND OVERVIEW

An important characteristic of any medical imaging method is its ability to

show the anatomical detail of the human body. Detail, as used here, refers to the
small structures, features, and objects associated with normal anatomy and vari¬
ous pathological conditions. The smallest detail that can be visualized is deter¬

mined, to a large extent, by the amount of blur produced by the imaging proce¬
dure. There is some blur in all medical images. Some methods, however, produce

images with significantly less blur than others, and the result is images that show
much greater detail. Each imaging method also has certain associated factors that
control the amount of blurring and the ultimate visibility of detail.
In this chapter we consider the general characteristics of image blur and its

relationship to other image characteristics.

BLUR

Blurring is present, to some extent, in all imaging processes, including vision,

photography, and medical imaging methods. The basic concept of blur is illus¬
trated in Figure 18-1. An image is a visual representation of a specific physical

object, such as a patient's body. In an ideal situation, each small point within the
object would be represented by a small, well-defined point within the image. In
reality, the "image" of each object point is spread, or blurred, within the image.
The amount of blurring can be expressed as the dimension of the blurred image of
a very small object point. Blur values range from approximately 0.15 mm, for

mammography, to approximately 15 mm, for imaging with a gamma camera.

The blur of a small object point can have a variety of shapes, as shown in Figure
18-2. The shape generally depends on the source of blur. Some x-ray system com¬

ponents, such as intensifying screens and image intensifier tubes, generally pro-

253
 254 Physical Principles of Medical Imaging

Small Object
Point
Patient

Blur .

Image

B (mm)

Figure 18-1 The Blur of an Individual Object Point

duce round blur patterns. Most imaging methods that

produce digital images (digi¬
tal subtraction angiography (DSA), CT, MRI, etc.)
produce square blur patterns
that correspond to the dimensions of the image pixel or tissue voxel. Motion dur¬

ing the imaging process typically produces an elongated blur pattern. X-ray tube
focal spots produce a variety of blur shapes.
In addition to a size and shape, the blur
produced by a specific factor has a
specific intensity distribution. This characteristic is related to the manner in which
the point image is spread, or distributed, within the blur area. Two blur distribution

patterns are illustrated in Figure 18-3. The actual distribution of the image inten¬
sity within the blur area is often illustrated by means of an intensity profile. Some
sources of blur uniformly distribute the
object-point image intensity within the
blur area. This gives the blur pattern a precise dimension, as illustrated in
Figure
18-3. Many sources of blur, however, do not
uniformly distribute blur. Common
examples are intensifying screens and defocused optical systems. A common dis-

Blur Shapes

Round Square Elongated

Figure 18-2 Blur Shapes Encountered in Medical Imaging

 Blur, Resolution, and Visibility of Detail 255

Blur Distribution

Figure 18-3 Blur Distribution Patterns

tribution patternis one with a relatively high intensity near the center with a
gradual reduction of intensity toward the periphery. The profile of this type of
distribution is often a Gaussian curve, as illustrated. The full dimension (diameter)
of Gaussian blur pattern is not used to express the amount of blur because
a it
would tend to overstate the blur in relation to blur that is uniformly distributed. A
more appropriate value is the dimension of a uniform distribution that would pro¬
duce the same general image quality as the Gaussian distribution. This is desig¬

nated the equivalent blur value. For example, the two blur patterns shown in Fig¬
ure 18-3 have the same general effect on image quality even though the total

dimension of the Gaussian distribution is larger.

VISIBILITY OF DETAIL

The most significant effect of blur in an imaging process is that it reduces the

visibility of details such as small objects and structures. In every imaging process,
blur places a definite limit on the amount of detail (object smallness) that can be
visualized.
is to reduce the contrast of small objects and features, as
The direct effect of blur
18-4. In effect, blur spreads the image of small objects into the
illustrated in Figure
surrounding background area. As the image spreads, the contrast and visibility are
reduced.
 RCeolnattriavs
50% 20%
100%

Image

CImonatrges
o

Blur

Object Point
o
o
o

EGBefonleurncartl
1Fi8gu-r4e
 Blur, Resolution, and Visibility of Detail 257

The visibility of specific

objects is very dependent on the relationship between
object size and the blur value. If the blur value is less than the dimension of an
object, the reduced contrast will generally not affect visibility. When the amount
of blur approaches the dimensions of the
object, the blurring process can signifi¬
cantly reduce contrast. In some situations, especially in which small objects al¬
ready have a low inherent contrast, the blur can significantly affect visibility. As a
general rule, the blur value can be considered as an approximate detail-visibility
threshold. In most situations, body structures much smaller than the blur value
will not be visible.
The basic concept we need to emphasize is that the blur that is present as part of
an imaging procedure reduces the contrast, and the resulting visibility, of small
objects (detail) within the body. The extent to which the contrast is reduced de¬
pends on the relationship between the amount of blur and the size of the object, as
illustrated in Figure 18-5. This diagram shows how the contrast of objects is af¬
fected by blur. The maximum value on the relative contrast scale (100%) repre¬
sents the contrast of each object in the absence of blur; it does not mean that all

objects, both small and large, have the same amount of inherent contrast. In pro¬
jection x-ray imaging, small objects tend to produce much less contrast than large
objects because of their increased penetration. The contrast and visibility of small
objects are actually reduced by two factors: the increased x-ray penetration and the
effects of blur, which we are considering here.
No medical imaging method produces images that are free of blur; the no-blur
line is included in the illustration as a point of reference. In this particular ex¬
ample, the blur values are described only in the relative terms of low, medium, and
high.
Let us now consider the effect of a small amount of blur on the imaging process.
The contrast of the larger objects is not affected. The loss of contrast because of
blur increases with decreasing object size (detail). The contrast is eventually re¬
duced to zero at some point along the detail scale, and no smaller objects will be
visible. For objects that produce relatively low contrast, even without blur, the
threshold of visibility might occur at object sizes larger than the point at which
blur produces zero contrast. The visibility threshold is related to, but not necessar¬
ily equal to, the object size at which blur produces zero relative contrast.
As blur is increased in the imaging process, the loss of contrast increases for all

objects, and the visibility threshold moves to the left.

UNSHARPNESS

An image that shows much detail and distinct boundaries is often described as
being sharp. The presence of blur produces unsharpness. Image unsharpness, as
the term is commonly used, and blur refer to the same general image characteris-
 258 Physical Principles of Medical Imaging

No Blurring (Ideal)

\
\
\
\

8 4 2 0.4 0.2 0

Detail Object Size (mm)

Figure 18-5 Effect of Blur on the Contrast of Objects of Different Size

tic. In a more however, image unsharpness is one of several visual

exact sense,
effects produced by the basic process of blurring.
Unsharpness is especially noticeable at the boundaries and edges within an
image.
In the early days of radiography, the term
penumbra was often used to describe
the unsharpness, or blur, produced by x-ray tube focal
spots. Penumbra is prima¬
rily an astronomical name for the unsharp shadow boundaries created by the moon
because of its finite size. Because a number of different sources of blur in x-ray
imaging produce the same visual effects and are not true penumbras, use of the
term should be discouraged.

RESOLUTION

Resolution describes the ability of an imaging system to

distinguish or separate
(ie, resolve) objects that are close together. The resolving capability of a particular
imaging process is determined by the amount of blur. When blur is present, the
images of individual objects begin to run together until the separate objects are no
longer distinguishable. For objects to be resolved, their separation distance must
be increased in proportion to the amount of blur
present.
The resolving ability, or resolution, of an
imaging system is relatively easy to
measure and is often used to evaluate
system blur. Figure 18-6 shows one type of
test object used for this purpose; it consists of
parallel lead strips separated by a
distance equal to the width of the strips. The common
practice is to describe the
 Blur, Resolution, and Visibility of Detail 259

Figure 18-6 A Test Pattern Used To Measure the Resolution of an X-Ray Imaging System

line width and separation distance in terms of line pairs (lp) per unit distance (mil¬
limeters or centimeters). One line pair consists of one lead strip and one adjacent
separation space. The number of line pairs per millimeter is actually an expression
of spatial frequency. As the lines get smaller and closer together, the spatial fre¬
quency (line pairs per millimeter) increases. A typical test pattern contains areas
with different spatial frequencies. An imaging system is evaluated by imaging the
test object and observing the highest spatial frequency (or minimum separation) at

which the separation of the lines is visible.

Figure 18-7 illustrates the effect of blur on resolution. When no blur is present,
all of the line-pair groups can be resolved. As blur is increased, however, resolu¬
tion is decreased, and only the lines with larger separation distances are visible.
260 Physical Principles of Medical Imaging

No Blurring (Ideal)
100-

80-

</>
ra
i: 60-
c
o
o ^ V *5 \
a> 40-

a> \ V
CC 20-
\ \ \
\
\

1—i 1 1 1 r— i i i—i ■ i i 1—

0.25 0.5 1 2.5

Spatial Frequency (Ip/mm)

Figure 18-7 Effect of Blur on Resolution

Figure 18-8 compares how the contrast within the various line-pair groups is
reduced by various levels of blur. Note the similarity between this illustration and
Figure 18-5. Increasing spatial frequency corresponds to increasing image detail

100-1 —
O— — -0 — o~ -0 O— -0 O— -0 —~o

*
— — — — — — — — —- -

90-

h
</> 80- NO BLUR
<
OS 70-
H
Z 60-
O
o 50-

U1 40-
>
30-
i-
< 20-
-j
LU
10-
OS

T6 1I 7
7 1I ft
8 1I a
9 1I in
10
SPATIAL FREQUENCY (Ll>/mit!)
Figure 18-8 The General Relationship between Blur and Resolution
 Blur, Resolution, and Visibility of Detail 261

100-

w
90-

h* 0. MEDIUM BLUR
H) 80'
<
OS 70-
t-
z 60-
o
o 50-

LU 40-
>
r" 3o-
\
< 20-
-j
u
10-
cc

1 ' 2 ' 3 ' 4 1 5 » 6 1 7 1 8 1 9

SPATIAL FREQUENCY (LP/mm)

100-n
#
90-

H HIGH BLUR
(/> 80-
<
0S 70-
H
Z 60-
O
o 50-

u 40-
>
30-
H
< 20-
-1
U
10-
OS

1 ' 2 » 3 ' 4 1 5 1 6 1 7 ' 8 1 9

SPATIAL FREQUENCY (Liymm)

Figure 18-8 continued

 262 Physical Principles of Medical Imaging

and reducing object size. Curves like those shown in Figure 18-8 are
generally
designated contrast transfer functions (CTF). They show the ability of an imaging
system to transfer contrast of objects of different sizes in the presence of blur.
The shape of the curve depends, to some extent, on the
major source and distri¬
bution of blur within the system, as shown in Figure 18-9. For example, the
typical
CTF curve associated with focal spot blur usually has a
specific point at which the
contrast becomes zero. This is commonly referred to as the
disappearance fre¬
quency and represents the resolution limit, or resolving ability, of the system.
When the major source of blur is the receptor, ie, the
intensifying screen or image
intensifier tube, the curve might not show a distinct zero-contrast point. Criteria
must be established for
defining the maximum resolution point. It is common
practice to specify the resolution of such a system in terms of the spacing fre¬
quency, in line pairs per millimeter, at which the contrast falls to a relatively low
value, typically 3%. When comparing the resolution values of different systems,
this practice should be taken into consideration. For
example, if a manufacturer
arbitrarily uses a 3% contrast, the resolution values for its equipment will be
higher than for equipment from a company that uses 10%, even if the systems are
identical.

Figure 18-9 The Contrast Transfer Function Associated with Two Types of Blur. The
Solid Line ( ) Is Characteristic of Motion and Focal Spot Blur. The Broken line ( ) Is
Generally Characteristic of Receptor Blur.
 Blur, Resolution, and Visibility of Detail 263

Theapproximate blur and resolution values encountered with various imaging

methods are shown in
Figure 18-10, which illustrates why some imaging methods
are much better than others in
visualizing anatomical detail.

MODULATION TRANSFER FUNCTION

The modulation transfer function (MTF) is a graphical description of the blur,

or resolution characteristics, of animaging system or its individual components.
In many respects, the MTF is similar to the CTF shown in
Figure 18-9. The differ¬
ence is that the CTF describes a
system's ability to image line pairs, whereas the
MTF describes its ability to image sine-wave
shapes, or spatial frequencies.
Rather than lines and spaces, as in the CTF test object, a true MTF test
object has
peaks and valleys. Actually, the MTF is seldom determined by using such a test
object, but the idea is useful in understanding the concept of MTF. One peak and
valley make up 1 cycle of the object. Such a test object is characterized by its
spatial frequency, which is the number of cycles (peaks and valleys) per millime¬
ter of length. In other words, an MTF test object has a certain number of peaks and

valleys (cycles) per millimeter, whereas a CTF test object has a certain number of
lines and spaces (line pairs) per millimeter. The ability of a system to image the
various spatial frequencies is related to the amount of blur present.
A large flat object of relatively uniform thickness contains low frequency com¬

ponents. At the edge of such an object, however, high frequency components are
created by the sudden change in thickness. Generally speaking, small objects of a

given cross-sectional shape have higher frequency components than larger

objects.

Gamma Camera

Ultrasound

MRI

CT

Fluoroscopy

Radiography
Maximum Resolution (lp/mm) —
.3 .4 .5 1 2 3 4 5 6 7 8 910
1 1 1 I I II I 1 1 1 I I II I I
10 2 1 .5 .2 .1
Blur (mm)

Figure 18-10 Comparison of Blur and Resolution Values for the Different Imaging
Methods
 264 Physical Principles of Medical Imaging

In order to form an unblurred

image of the object, the x-ray imaging system
must be able toproduce sufficient contrast for all spatial frequencies contained in
the object. If some of the frequency components are lost in the
imaging process,
the image will not be a true representation of the object. For example, if the
high
frequency components are not present in the image, the image will be blurred. The
spatial frequency content of the image that reaches the film is determined by the
frequency content of the object being imaged and the MTF of the imaging system.
This is illustrated in Figure 18-11. The image content at a
specific frequency is
found by multiplying the object content by the MTF. For
example, in Fig¬
ure 18-11, the
object contains 0.8 (80%) at a frequency of 2 cycles per mm. The
MTF at this frequency is 0.7. Multiplying these two quantities shows that the im¬
age will contain only 0.56 (56%) at this frequency. The shaded area is the portion
of the object's spatial frequency spectrum that is lost because of the MTF of the

imaging system. Any frequency components of the object that are above the reso-

Object Spectrum

Figure 18-11 The Relationship of an Image Spatial Frequency Spectrum to the Object
Spectrum and the MTF of the Imaging System
 Blur, Resolution, and Visibility of Detail 265

Figure 18-12 The Composite MTF

lution limit of the system are completely lost. In effect, the MTF of the imaging
system can cut out the higher frequency components associated with an object,
and the image will be made up only of lower frequency components. Since low

frequency components are associated with large objects with gradual changes in
thickness, as opposed to sharp edges, the image will be blurred.
A property of MTFs that is not possessed by CTFs is their ability to be cas¬
caded. Consider an imaging system in which the sources of blur are the focal spot
and receptor. The blur characteristics of each of these can be described by an MTF
curve, as shown in Figure 18-12. The MTF of the total system is found by multi¬

plying the two MTF values at each frequency. For example, if at 2 cycles per mm
the MTF for the focal spot is 62%, and for the receptor is 72%, the total system
will have an MTF value of 44%. It should be observed that a system cannot have

frequency components that are higher than the resolution limit of either the recep¬
tor or the focal spot. This is equivalent to saying that the total system blur cannot

be less than the blur from either of the two sources. If the MTFs of the different
blur (focal spot, motion, or receptor) are significantly different, the one
sources

with the lowest limiting frequency (the largest blur) will generally determine the
MTF of the total system. In other words, if one source is producing significantly
larger blur than the other sources, the total system blur will be essentially equal to
the largest blur value.
 Chapter 19

Radiographic Detail

INTRODUCTION AND OVERVIEW

Of all medical imaging systems, radiography has the ability to produce images
with the greatest detail. All radiographs, however, contain some blur. The three
basic sources of radiographic blurring and loss of detail are indicated in Fig¬
ure 19-1 and are (1) the focal
spot, (2) motion during film exposure, and (3) the
receptor. Most receptor blur is produced by the spreading of light within the inten¬
sifying screen, as described in Chapter 14. Light crossover between the two film
emulsions can add to receptor blur. If the intensifying screen and film surfaces do
not make good contact, additional blurring is produced.

The amount of blur in radiographs is generally in the range of 0.15 mm to ap¬

proximately 1 mm. The blur value for a specific radiographic procedure depends
on a combination of factors including focal spot size, type of intensifying screen,

location of the object being imaged, and exposure time (if motion is present). The
general objective is not to produce a radiograph with the greatest possible detail
but to produce one with adequate detail within the confines of x-ray tube heating
and patient exposure.
We begin by considering the characteristics of the three basic blur sources, and
then show how they combine to affect image quality.

OBJECT LOCATION AND MAGNIFICATION

Before proceeding with a discussion of the various types of blur, it is necessary

to establish the relationship of several distances within the imaging system. Figure
19-2 shows the three basic distances. The focal-spot-to-receptor distance, FRD, is
always the sum of the focal-spot-to-object distance, FOD, and the object-to-recep-
tor distance, ORD. With respect to image formation and image quality, the signifi¬
cant values are not the actual distances, but certain distance ratios.

267
268 Physical Principles of Medical Imaging

Radiographic
Detail
(Blurring)

FOCAL SPOT

Exposure Velocity Screen CContact^ Film

Time Type Crossover

■
Object Location

Figure 19-1 The Sources of Blur in Radiographs

In the formation of an x-ray image, the image will always be

larger than the
object if the object is separated from the receptor. The amount of enlargement, or
magnification, is equal to the FRD:FOD ratio. Magnification, m, is increased ei¬
ther by increasing the FRD or bringing the object closer to the
x-ray tube, which
decreases the FOD.

Focal Spot
—n— —r 1.0
i \
i \ 0.9

FOD
i \ -

0.8

0.7

0.6 O
Object ro ORD
FRD 0.5 O S
I \ CO FRD
i \ 0.4 w
I \\
FRD 1- 0.3
ORD / FOD \
0.2

0.1

J L 0

Receptor

Figure 19-2 Distance Relationships in Radiographic Imaging

 Radiographic Detail 269

Another useful relationship is the ORD:FRD ratio. This

quantity, s, is used to
specify the distance between the object and receptor (ORD) in relation to the total
distance between focal spot and receptor (FRD). It is
helpful to think of a scale
running from the receptor to the focal spot: The receptor would be at the zero-end,
and the focal spot at the other end, which has a value of 1. The
position of the
object being radiographed can be specified with respect to this scale; for example,
if it is located at s = 0.2 on the scale, the ORD is 20% of the FRD. For certain types
of blurring, the blur value is dependent on s, rather than on the actual distance
between object and receptor.
When blur is given a specific value, the location within the imaging system
must be specified. Blur values are generally specified for either the
receptor input
surface (plane) or the location of the object being radiographed. If an x-ray system
has a blur value of 0.3 mm when measured in the object plane, and a magnification
factor of 1.2, the image at the receptor location will have a blur value of 0.3 x 1.2
or 0.36 mm. Conversely, if an imaging system has a blur value
specified at the
receptor, the amount of blur with respect to the object size is found by dividing by
the magnification factor. In all cases, as shown in Figure 19-3, the relationship
between the blur with respect to the size of the object, and as measured at the
receptor surface, is just the magnification, m.
The visibility of detail within a radiograph is determined by the relationship of
the blur to the size of the objects being imaged. As blur values begin to exceed
object dimensions, contrast and visibility are greatly diminished. Therefore, the

Object Plane

Receptor Plane

Blur (Magnified)

Figure 19-3 Magnification of Blur

 270 Physical Principles of Medical Imaging

most appropriate location for evaluating blur is at the location of the object where
the blur values have meaning with respect to image detail. Another major reason
for evaluating blur at the location of the
object, rather than at the receptor, is that
the relationship of blur values to all
contributing factors is a simple linear relation¬
ship, as described below.

MOTION BLUR

Blurring will if the object being imaged moves during the exposure. The
occur
amount of blur in theobject plane is equal to the distance moved during the expo¬
sure. As shown in
Figure 19-3, the blur value at the receptor is larger and is in
proportion to the magnification factor, m. The effect of motion on each point
within the object is to reduce contrast and
spread the image over a larger area, as
indicated. If motion of body parts cannot be
temporarily halted, motion blur can be
minimized by reducing exposure time.
A misconception
regarding motion blur is that it is increased by magnification.
Although it is true that the blur at the receptor surface is increased, image quality
generally depends on the amount of blur with respect to the object size. This value
is not affected by magnification.

FOCAL SPOT BLUR

All x-ray tube focal spots have a finite size, and this contributes to image blur.
Consider the example shown in Figure 19-4.
X-ray photons passing through each
point of the object from the focal spot diverge and form a blurred image of the
object point. The blur value with respect to the object size (in the object plane) is
given by
Bf = F x s

where F is the dimension of the focal

spot. Note that the value of focal spot blur,
for agiven focal size, is directly related to the position of the object on the s scale.
If the object is in direct contact with the
receptor (s = 0), focal-spot blur vanishes.
As the object is moved away from the
receptor, the blur increases in direct propor¬
tion to the value of s. The significance of this is illustrated in
Figure 19-5. When
the object is moved away from the
receptor, both the image and blur are magni¬
fied, but the blur increases faster than the size of the image. Therefore, the blur
value is increased in proportion to the
object size, causing a deterioration in image
quality.
Figure 19-5 shows the relationship of focal-spot blur to object size as it is af¬
fected by object location(s). The amount of blur relative to the size of
the object in
the object plane increases in proportion to the relative
distance(s) between the
 Radiographic Detail 271

Effective Focal Spot Size

Object Point

Blur(B,J

Figure 19-4 Focal Spot Blur

object and the receptor. The maximum blur occurs at the focal spot where the
blur value becomes equal to the actual size of the spot.
The effect of focal spot size on the visibility of a specific object depends on
three factors: (1) the size of the object, (2) the size of the focal spot, and (3) the
location of the object.

Focal Spot Size

The most significant characteristic of a focal spot is its size. Most x-ray tubes
have labels that specify the size of the focal spot. The size specified by the manu¬
facturer on the label is generally referred to as the nominal size. The dimension
that determines the blur characteristics of the focal spot is the effective blur size.
The relationship between these two sizes is illustrated in Figure 19-6.
A distinction must be made between the focal spot dimension, which deter¬
mines its blur characteristics, and the focal spot size, as specified by the tube
manufacturer. Because of several factors, the generally stated size of a focal spot
and its blur-producing size are significantly different. Blur is related to the equiva¬
lent size of a focal spot, rather than to its actual dimensions. The equivalent size is
defined as the size of a rectangular focal spot with uniform x-ray emission over its
surface that will produce the same blur as the focal spot in question.
 Physical Principles of Medical Imaging

1.5 1.5
1.4 1.4

1.3 1.3

1.2 1.2

1.1 1.1

1.0 1.0
0.9 0.9
0.8 0.8

0.7 0.7

0.6 0.6
0.5 0.5
0.4 0.4

0.3 0.3

0.2 0.2

0.1 0.1

Object

I 1 1 1 1 1 1 1 1 1 1
0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1
I-Receptor Object Location(s) Focal Spot—t
Figure 19-5 Relationship of Focal Spot Blur to Focal Spot Size and Object Location

Manufacturer's Tolerance

It is a general practice to allow a discrepancy between the manufacturer's stated

nominal size and the actual measured size of focal
spots. In almost all cases, the
allowed tolerance is such that the stated nominal size is less than the measured
size. The allowed tolerance generally depends on the size of the focal
spot but is as
large
as 50% for the smaller focal spot sizes. For example, focal spot that has a
a
measured size of 0.9 mm could be labeled as a 0.6-mm focal spot because it falls
within the accepted tolerance values.

Blooming
A common characteristic of many focal spots is that they undergo a
change in
size with changes in MA and KVP. This effect is known as blooming. If the size of
 Radiographic Detail 273

Nominal Measured Operating Effective Blur

Size Size Size Size

Figure 19-6 Different Focal Spot Sizes

a focal spotis measured at a relatively low tube current, the size during operation
at higher tube current values can be significantly larger. The amount of blooming
with an increase in tube current varies from tube to tube. In some tubes, the bloom¬
ing of the focal spot in one direction is more than in the other. Blooming is gener¬
ally greater for small focal spots.
KVP generally has less effect on focal spot size than current. Some focal spots
undergo a slight reduction in size with increased KVP.

Intensity Distribution

Most focal spots do not have a uniform distribution of radiation over their entire
area. A non-uniform distribution of x-ray intensity causes a focal spot to have an
effective blur size different from its actual physical size. The variation in x-ray
emission can be
represented by an intensity profile, as shown in Figure 19-7. The
focal spot with a rectangular intensity distribution (center) has an effective blur
size identical with the dimensions of the spot. A focal spot with a double peak
distribution (top) has an effective blur size significantly larger than the actual di¬
mension of the spot. This double-peak distribution is characteristic of many focal

spots produced by a line focus cathode.

The intensity distribution shown at the bottom of the illustration has a Gaussian

shape. A focal spot with this type of intensity distribution has an effective blur size
less than its actual physical size. Gaussian-shaped focal spots are highly desirable
because they have a relatively low effective blur size in comparison to their heat
capacity. A focal spot with an approximate Gaussian distribution can be produced
in line focus tubes by applying a bias voltage between the cathode elements.

Anode Angle

The size of the focal spot is usually specified with reference to the center of the
x-ray beam area, or field. Because of the angle of the anode surface, the effective
focal spot size changes with position in the field. It becomes smaller for points
274 Physical Principles of Medical Imaging

Equivolent
Size

Figure 19-7 Three Focal-Spot Intensity Distributions

with Approximately the Same Effective Blur Size

toward the anode end and larger toward the cathode end of the field. The variation
in effective focal spot size with position within the field is more significant in
tubes with small anode angles.

Measurement of Focal Spot Sizes

Two methods are used to determine the size of focal spots. The principles of the
two methods are entirely different and generally produce different dimensions for
the same focal spot. The pin-hole camera can be used to determine the actual di¬
mensions of a focal spot, whereas the star test pattern is used to determine the
effective blur size.

Pin-Hole Camera

The principle of the pin-hole camera is illustrated in Figure 19-8. The pin-hole
camera consists of a very small hole in a sheet of metal, such as gold or lead. The
pin-hole is positioned between the focal spot and a film receptor, as shown. When
 Radiographic Detail 275

Focal Spot

Pin Hole

Figure 19-8 Pin-Hole Method of Determining Focal Spot Size

the x-ray tube is energized, an image of the focal spot is projected onto the film.
The size of the focal spot can be determined by measuring the size of the image
and applying a correction factor if there is any geometric magnification present. If
the pin-hole is located at the midpoint between the focal spot and film, no correc¬
tion factor will be required.

Star Test Pattern

The effective blur size of a focal spot can be measured by using a test object that
measures blur or resolution. The most common object used for this purpose has

alternating lines and spaces arranged in a star pattern, as shown in Figure 19-9.
The first step in determining focal spot size is to make a radiograph with the test
object located at approximately the midpoint between the focal spot and receptor.
An image is obtained in which there is a zone of blurring at some distance from the
center of the object. The distance between the blur zones is measured and used to

calculate the size of the focal spot by using the following formula:

P_ k8D
180(M - 1)
276 Physical Principles of Medical Imaging

Figure 19-9 The Image of a Star Test Pattern Used To Determine Focal Spot Size

where F is the effective focal spot size, D is the diameter of the blur circle illus¬
trated in Figure 19-9, M is the magnification factor, and t9 is the angle of one test-
pattern segment.

RECEPTOR BLUR

If the receptor input surface that absorbs the x-ray beam has significant thick¬
ness, blur will be introduced
at this point. Blurring of this type generally occurs in

intensifying screens and in the input phosphor layers of image intensifies. Blur
production was illustrated in Figure 14-5. X-ray photons that pass through a point
 Radiographic Detail 277

within the object are absorbed by the phosphor layer and converted into light. The
light created along the x-ray "path" spreads into the surrounding portion of the
phosphor layer. When the light emerges from the screen it covers an area that is
larger than the object point. In other words, the x-rays that pass through each point
within an object form an image that is blurred into the
surrounding area.
Because this type of blur is caused by the
spreading, or "diffusing," of light, the
blur profile generally has a shape different from that of motion blur. In most
cases,
the blur profile is "bell-shaped" or Gaussian in nature. Because it is somewhat
difficult to specify an exact blur dimension,
receptor blur is more appropriately
described in terms of an effective blur value. The amount of blur is
primarily de¬
pendent on the thickness of the phosphor layer.
Intensifying screens generally have effective blur values in the range of 0.15
mm to 0.6 mm. The
approximate breakdown for the basic screen types is as
follows:

•
mammographic, 0.15-0.2 mm
•
detail, 0.2-0.35 mm

• medium speed, 0.5-0.6 mm

•
high speed, 0.6-0.7 mm.

Since there must be a compromise between image detail and patient

exposure, the
objective is not always to use intensifying screens that produce maximum detail
but to select screens that provide adequate detail with the lowest possible

exposure.
In a given imaging system, the receptor blur value with respect to the size of the
object can be decreased by introducing magnification. This is illustrated in Figure
19-10, in which a small object is being imaged. The presence of receptor blur
produces a zone of unsharpness around the object. The actual blur dimension at
the receptor surface is fixed by the receptor characteristics and is unaffected by

magnification. When magnification is relatively small, the blur is large in com¬

parison to the object. When magnification is increased, the relative blur-to-image
size is decreased. What actually happens is that magnification causes the image of
a specific object to be enlarged at the receptor. This changes the relationship be¬

tween the amount of blur and the size of the object image because the blur value at

the receptor remains fixed. However, the amount of receptor blur projected back
to the location of the object is reduced by magnification. Receptor blur in the

object plane, Br, is related to the position of the object, s, by

Br = Bro (1 - s)

where Bro is the equivalent blur value of the receptor measured at the receptor
surface. Although magnification can be used to reduce receptor blur with respect
278 Physical Principles of Medical Imaging

1.0 -

0.9 -

^ 0.8 -

0 .1 .2 .3 .5 .6 .7 .8 .9

Figure 19-10 Relationship between Receptor Blur and Object Location for Three Types of
Intensifying Screens

to object size, it must be approached with caution. Since focal spot blur increases
with magnification, the two blur sources must be considered together.

COMPOSITE BLUR

The total blur in an image is a composite of the three different

types of blur: (1)
motion, (2) receptor, and (3) focal spot. In some situations one source of blur
might predominate. When this occurs, the total blur is essentially equal to the
largest blur value.
In order to determine the total, or composite, blur in a system, it is necessary to
combine the three blur values. Although the exact relationship may vary, depend¬
ing on conditions, it is generally accepted that the total value is given by
Bt = V Br2 + Bf- + Bin2.
 Radiographic Detail 279

1 4
—I r14
1.3- -
1.3
1.2- -
1.2

0 .1 .2 .3 .4 .5 .6 .7 .8 .9

Receptor Object Location(s) Focal Spot-t

Figure 19-11 A Nomogram Used To Determine Radiographic Blur at Different Object
Locations

For example, if receptor blur, Br, is 0.3 mm; focal spot blur, Bf, is 0.2 mm; and
motion blur, Bm, is 0.2 mm; the total blur, Bt, would be found by substituting in
the equation above as follows:

Bt = V 0.32 + 0.22 + 0.22 = 0.41 mm.

It was shown earlier that blur from two sources, the receptor
and the focal spot,
depends the position of the object with respect to the s scale. As an object is
on
moved away from the receptor, focal spot blur increases and receptor blur de¬
creases. This means that the position of the object must be taken into account

when considering the blur characteristics of a specific x-ray system. For most sys¬
tems, there is an object position on the s scale that produces the minimum blur.
Moving the object in either direction, toward or away from the receptor, in¬
creases the blur.
The relationship between blur and object position is easy to visualize by using a
blur nomograph, as shown in Figure 19-11. The nomograph has three scales: (1)
blur, (2) focal spot size, and (3) the position of the object, or s scale. The lines
representing the blur from the three sources are drawn on the diagram according to
the following simple rules.
The line representing receptor blur is drawn between a point on the blur scale
that represents the equivalent blur of the particular receptor being used and a point
located at a value of 1 on the s scale.
 280 Physical Principles of Medical Imaging

Figure 19-12 Blur Produced by High Speed Screens and a 0.5-mm Focal Spot

Figure 19-13 Blur Produced by Detail Screens and a 1-mm Focal Spot
 Radiographic Detail 281

The line
representing focal spot blur is drawn between the zero (0) point on the
s scale and a point on the focal
spot scale that corresponds to the size of the focal
spot.
The line for motion blur is drawn
horizontally and intersects the blur scale at a
value equal to the distance the object moved during the exposure interval. The
significance of the horizontal line for motion blur is that its value relative to the
size of an object does not change with
magnification. In most applications, the
actual value for motion blur is difficult to estimate. It is included in this illustration

primarily for the sake of completeness.

The three lines represent the blur of an
object from the three blur sources. The
composite, total blur, is found for any point on the s scale by combining the
or
three blur values, using the equation given above. It is of
special significance that
the total system blur usually has a minimum value at a
point on the s scale. An
exception is when the major source of blur is motion, in which case the total blur is
essentially the same at any point along the s scale. However, when most of the blur
arises from either the receptor or the focal spot, a minimum point is
usually
present. The position of the minimum blur point along the s scale depends on the
characteristics of the receptor and the focal spot. If the receptor has a relatively
low characteristic blur value, the minimum point will be located in the lower
por¬
tion of the s scale, which represents a position close to the receptor surface. Either

increasing receptor blur or decreasing focal spot size shifts the minimum blur
point to higher values on the s scale. Inspection of the diagram leads to two signifi¬
cant observations:

1. When an object is located near the receptor surface (low s scale value), the
total blur is essentially a function of the receptor.
2. As an object is moved away from the receptor surface (high s scale value),
the focal spot becomes the major determining factor in overall system blur.

Figure 19-12 shows the composite blur for a radiographic system using high¬
speed screens and a 0.5-mm focal spot. With this combination, the intensifying
screen is the most significant blur source. Notice that the blur decreases with mag¬

nification over the useful range of object locations.

Figure 19-13 illustrates the blur produced when using detailscreens and a 1-mm
focal spot. With this combination, the focal spot is the predominant blur source for
most object locations.

These two examples show how either the receptor or the focal spot can be the
predominant source of blur in a specific radiographic system. The dominating blur
source is determined by the relationship of receptor blur to focal spot size and the

location of the object; these are the factors that must be considered when setting up
a radiographic system.
 Chapter 20

Fluoroscopic Imaging Systems

INTRODUCTION AND OVERVIEW

The fluoroscope produces an instantaneous and continuous image that is espe¬

cially useful for guiding a procedure, searching through a body section, or observ¬
ing a dynamic function. Fluoroscopic examinations began soon after the discovery
of x-radiation. Since that time, however, the fluoroscopic imaging system has un¬
dergone several major changes that have improved image quality, reduced patient
exposure, and provided much more flexibility and ease of use.
The receptor for the first-generation fluoroscope was a flat fluorescent screen,
which intercepted the x-ray beam as it emerged from the patient's body. The x-ray
beam carrying the invisible image was absorbed by the fluorescent material and
converted into a light image. In fact, it is the fluorescent screen receptor that gives
the name "fluoroscopy" to the procedure.
Under normal operating conditions, the image had a relatively low brightness
level. Because of the low light intensity, it was usually necessary to conduct ex¬
aminations in a darkened room with the eyes dark-adapted by wearing red goggles
or remaining in the dark for approximately 20 minutes. The contrast sensitivity

and visibility of detail were significantly less than what can be achieved with con¬

temporary fluoroscopic systems.

The first major advancement was the introduction of the image intensifier tube.
The intensifier tube produces a much brighter image than the fluorescent screen,
and its images can be viewed in a lighted room. The quality of the image produced

by the intensifier tube was generally an improvement over the fluoroscopic screen
image. An examination was performed by viewing the image from the intensifier
tube through a system of mirrors. The viewing was generally limited to one person
unless a special attachment was used.
The next step in the evolution of the fluoroscope was the introduction of a video

(TV) system to transfer the image from the output of the image intensifier tube to
a large screen.

283
284 Physical Principles of Medical Imaging

Distributor Video Camera

Figure 20-1 Components of a Fluoroscopic Receptor System

The receptor system of a contemporary fluoroscope is shown in Figure 20-1. It

consists of image intensifier tube, an optical image distribution system, and a
an

closed-circuit video system containing a camera, monitor, and associated elec¬

tronics. A spot film or cine camera is often included as part of the receptor system.

INTENSIFIER TUBES

In any x-ray imaging process, it is necessary to convert the invisible x-ray im¬
age into a visible image. There are two major reasons for this conversion. A light
image can be visualized by the human eye, and film is generally more sensitive to
light than it is to x-radiation. We have already seen that certain fluorescent materi¬
als are used in intensifying screens to convert the x-rays into light images. Al¬

though intensifying screens are used in a wide range of radiographic applications,

the brightness of the light produced by the screen is relatively low. The brightness
is sufficient to expose film placed in direct contact with the screen, but the light

output is generally too low for direct visualization, photographing with a camera
(cine or spot film), or viewing with a television camera. In many applications, a
device is needed that will convert the x-ray into light and intensify, or increase the

brightness of, the light in the process. The image intensifier tube is such a device.
 Fluoroscopic Imaging Systems 285

GAIN
-75/0.014 = 5360

I
(0.014 nit)
1
(75 nits) ^

Light Light
t
t
CONVERSION FACTOR
75 nits =
75
1 mR/sec

X-ray X-ray
(1 mR/sec) (1 mR/sec)

Figure 20-2 Gain Characteristics of an Image Intensifier Tube

Before considering the details of intensifier tube function, let us compare its
overall function to that ofa fluorescent screen, shown in
Figure 20-2. The tube is
exposed to the x-ray beam, and light is emitted from the other end. One of the
important characteristics of a specific intensifier tube is its ability to produce a
bright light image.

Gain

Gain is one factor used to describe the ability of a tube to produce a bright
image. As illustrated in Figure 20-2, the gain value of a specific tube is the ratio of
its light brightness to that of a reference fluorescent screen receiving the same

x-ray exposure. Contemporary intensifier tubes have gains of 5,000 or more.

Conversion Factor

A factor that is easier to measure,especially in the clinical setting, is the conver¬

sion factor. The conversion factor of a specific tube is the ratio of the output light

brightness to the input x-ray exposure rate. Gain and conversion factor are merely
two terms used to describe the same general characteristic of an intensifier tube:

its ability to convert an x-ray exposure into a bright image. The approximate rela¬

tionship between the gain value and the conversion factor value is
Gain = 70 x Conversion factor.

The brightness of the light from the intensifier tube is several thousand times
brighter than from a fluorescent screen. This is achieved in two ways.
 286 Physical Principles of Medical Imaging

A fluorescent screen is a passive device that converts a portion of the absorbed

x-ray energy into light energy. On the other hand, an image intensifier tube is an
active device that adds energy to the process. This additional energy enters the
tube in the form of electrical energy from a high-voltage
energy source.
The second factor that contributes to the increase in image brightness, or inten¬
sity, is the minification of the image as it passes through the tube. The output light
image from an intensifier tube appears on a small screen with a diameter of ap¬
proximately 1 in. The input field of view of the intensifier tube generally has a
diameter in the range of 4 in. to 14 in. The maximum input image size is deter¬
mined by the size of the tube. Tubes can be adjusted to receive
input images
smaller than the tube diameter. The amount of minification
gain is the ratio of the
areas of the
input image to the output image.
The method by which electrical
energy is used to intensify the image is illus¬
trated in Figure 20-3. The intensifier tube
body is essentially an evacuated glass
bottle. The large area forming the bottom of the bottle is the
input screen, and the
small area that forms the "cap" on the bottle is the
output screen.
The input surface, or screen, of the intensifier tube is in two
layers. The first
layer encountered by the x-ray beam is a fluorescent material, typically cesium
iodide. In direct contact with the fluorescent screen is a
layer of material that func¬
tions as a photocathode.
The x-ray photons entering the tube are absorbed
by the fluorescent input
screen. A portion of the absorbed
energy is converted into light. Since light pho-

Intensifier Tube

Figure 20-3 The Events That Produce Electronic Gain in an Image Intensifier Tube
 Fluoroscopic Imaging Systems 287

tons contain much less energy than

x-ray photons, one x-ray photon can produce a
light flash consisting of many light photons. The light photons are, in turn, ab¬
sorbed by the photocathode layer by the
photoelectric process, which results in the
emission of electrons into the tube. At this
point, the electrons possess very little
kinetic energy.
The intensifier tube is connected to an electrical
energy source (power supply)
that applies relatively high voltage between the cathode surface and an anode
a
located near the output end of the tube The electrical energy accelerates the clus¬
.

ter of electrons toward the output end of the tube where

they strike the output
screen. The output screen absorbs the electron
energy and converts it into a rela¬
tively bright flash of light.
In a simple fluorescent screen, the x-ray energy is converted
directly into light
energy. In the intensifier tube three steps are added to the process. These are:

1. Transferring energy from light to electrons in the photocathode

2. Adding electrical energy to the electrons
3. Converting electron energy back to light within the output screen.

These additional steps are necessary to add energy, or intensify the image. It is not
possible to increase the energy of photons. It is possible, however, to increase the
energy of electrons. The result of this process is that an x-ray photon can produce
a much brighter light at the
output of an intensifier tube than in a fluorescent
screen.

Along the length of the tube is a series of electrodes that focus the electron
image onto the output screen. The voltage applied to the focusing electrodes can
be switched to change the size of the input image, or field of view, as shown in

Figure 20-4. The maximum field of view is determined by the diameter of the
tube.
In most tubes, the input image area can be electrically reduced. When the tube is
switched from one mode to another, the factors that change include field of view,

image quality, and receptor sensitivity (exposure). The tube should be operated in
the large field mode when maximum field of view is the primary consideration. In
this mode, the tube has the highest gain and requires the lowest exposure because
the minification gain is proportional to the area of the input image. The small field
mode is used primarily to enhance image quality. As an image passes through an
intensifier tube, its quality is usually reduced.

Contrast

We know that the contrast in an image delivered to the film is reduced by both
object penetration and scattered radiation. When image intensifier tubes are used,
there is an additional loss of contrast because of events taking place within the
288 Physical Principles of Medical Imaging

Small mode Large mode

Figure 20-4 A Dual-Mode (FOV)

Field of View Image Intensifier Tube

tube. Some of the radiation that penetrates the input screen can be absorbed by the
output screen and can produce an effect similar to scattered radiation. Also, some
of the light produced in the output screen travels back to the photocathode and
causes electrons to be emitted. These electrons are accelerated to the output screen

where they contribute additional exposure to the image area and further reduce
contrast. The contrast reduction in modern intensifier tubes is generally in the
range of 5 to 15%.

Blur

There are potential sources of blur within the system. The spreading of
several
light in the input and output screens of the image intensifier tube produces blur as
it does in intensifying screens. In many image intensifier tubes, both screens are

significant sources of blur. Actually, the blur in the output screen is quite small
and becomes significant only when it is referred back to the input screen. The
minification of the image within the tube has the effect of magnifying the blur of
most image intensifier tubes so that blur increases with the size of the input image.

With dual-mode tubes, the larger field generally produces more blur than the
 Fluoroscopic Imaging Systems 289

smaller field. In most tubes, the blur varies over the

image area; it is generally the
smallest near the center of the field and increases toward the
periphery.
Blur is also produced by improper focusing of the electrons in the tube. Most
intensifier systems have controls that can adjust the electron focus.

Noise

The problem of quantum noise in intensified systems is discussed in Chapter

21. If it
were not for the limitations of
quantum noise, modern intensifier systems
could operate at much lower input exposure values.

VIDEO SYSTEMS

The
primary function of a video system is to transfer an image from one loca¬
tion to another.During the transfer process, certain image characteristics, such as
size, brightness, and contrast, can be changed. However, as an image passes
through a video system, there can be a loss of quality, especially in the form of blur
and loss of detail visibility.

Video Principles

The two major components of a video system are the camera and the monitor, or
receiver. Conventional broadcast television systems transmit the image from the
camera to the receiver by means of radio frequency (RF) radiation. In a closed

circuit system, the image is transmitted between the two devices by means of elec¬
trical conductors or cables. However, other than for the means of image transmis¬
sion, the basic principles of the two systems are essentially the same.
A basic video system is illustrated in Figure 20-5, which shows the major func¬
tional components contained in the camera and the monitor. The "heart" of each is
an electronic tube that converts the image into an electrical signal or vice versa.
The function of the camera tube is to convert the light image into an electronic
signal. Broadcast television systems use camera tubes known as image orthicons.
Fluoroscopic systems generally use either vidicon or plumbicon tubes; they are
smaller and less complex than image orthicons. They also require brighter input

images, but this is not a problem in fluoroscopy. The significant difference be¬
tween the vidicon and plumbicon is one of image persistence, or lag.

The typical camera tube is cylindrical with a diameter of approximately 25 mm

and a length of 15 cm. The image to be transmitted is projected onto the input
screen of the tube by a lens like that in a conventional film camera. The other end

of the tube contains a heated cathode and other electrodes that form an electron

gun. The electron gun shoots a small beam of electrons down the length of the
 290 Physical Principles of Medical Imaging

CAMERA SWEEP CIRCUIT

±.
"GUN"

PICTURE TUBE IMAGE OUT

(CRT)

Figure 20-5 Basic Components and Function of a Fluoroscopic Video System

evacuated tube. The electron beam strikes the rear of the screen surface on which
the input image is projected.
Electrical signals are applied to the camera tube, which causes the electron
beam to be swept over the surface of the
input screen. One signal moves the beam
in a horizontal direction, and the other
signal moves it vertically. The two signals
are synchronized so that they work together to move the beam in a specific pattern.
Although the input screen is round, the area covered by the scanning electron
beam is generally rectangular. The beam
begins in the upper left-hand corner and
moves across the screen
horizontally, as shown in Figure 20-6. In the conventional
American 525-line video system, lines are scanned at the rate of
15,750 per sec¬
ond. When the beam reaches the
right-hand side, it is quickly "snapped back" to
the left and deflected downward
by approximately one beam width. It then sweeps
across to form a second scan line. This
process is repeated until the beam reaches
the bottom of the screen, which
usually requires l/60th of a second. After reaching
the bottom, the beam returns to the
top and resumes the scanning process. This
time, however, the scan lines are slightly displaced with respect to the first set so
that they fall between the lines created in the first scan field. This is
known as
interlacing.
 Fluoroscopic Imaging Systems 291

INTERLACED SCAN

1st Field

START (odd lines)

FINISH

1 IMAGE FRAME - SEC

Figure 20-6 An Interlaced Scan Format

Interlacing is used to prevent flicker in the picture. If all lines were scanned
consecutively, it would take twice as long (l/30th of a second) for the beam to
reach the bottom of the screen. This delay would be detectable by the human eye
and would appear as flicker. With interlacing, the face of the screen is scanned in
two sets of lines, or fields. The pattern of scan lines produced in a video system is

known as raster. The conventional video system is generally set to contain 525
lines. The raster, however, contains approximately 485 lines. The remaining lines
are lost during the return of the electron beam to the left side of the screen. In a

525-line system, 30 complete raster frames (60 fields) are formed per second.
The screen of the camera tube is made of a material with light-sensitive electri¬
cal properties. Several types of tubes are used, but the general concept of tube
function can be described as follows.
The electrical conductivity of the screen surface depends on its illumination.
When an image is projected onto the screen, the conductivity varies from point to
point. A dark area is essentially nonconductive, and a brightly illuminated area is
the most conductive. As the electron beam sweeps over the surface, it encounters
areas with various levels of conductivity, which depend on the brightness at each

point. When the beam strikes a bright spot, it is "conducted through" and creates a
relatively high signal voltage at the output terminal of the tube. As the spot moves
across the screen, it creates a signal that represents the brightness of the image at

each point along its path.

The heart of the receiver, or monitor, is the picture tube. The picture tube differs
from the camera tube in size and shape. One end of the tube is the screen on which
 292 Physical Principles of Medical Imaging

the video image is displayed. Like the camera tube, the picture tube has an electron
gun located in the end opposite to the screen. The electron gun produces a beam of
electrons that strike the rear of the screen in the
picture tube. The electron beam
scans the surface of the picture tube screen just as it scans the camera tube screen.
In fact, the scanning in the two tubes is synchronized
by a signal transmitted from
the camera to the monitor. If the scanning becomes
unsynchronized, the image
will roll in the vertical direction or become distorted
horizontally. The horizontal
and vertical controls on a video monitor are used to
adjust the scan rates so that
they are identical with those of the camera and can maintain synchronization.
When the electron beam in the picture tube strikes the screen, it
produces a
bright spot. The brightness of the spot is determined by the number of electrons in
the beam, which is controlled by the signal from the camera tube. In other
words,
the brightness of a spot on the picture tube screen is determined
by the brightness
of the corresponding point on the camera tube screen. As the two electron beams
scan the two screens, the
image is transferred from the camera tube to the picture
tube. In the 525-line system, complete
images are transferred at the rate of 30 per
second.

Contrast

In the typical video system, image contrast canbe changed by adjusting a con¬
trol located in the monitor. The contrast control
changes the amplification of the
video signal. The brightness of each point within the
image on the picture tube
screen is determined
by the voltage of the video signal associated with the point.
The contrast of an image on the screen is the
brightness difference between two
points, such as background and object area, and is determined by the voltage dif¬
ference in the video signal for the two areas. When a video
signal is amplified, the
voltage difference between two points is increased. This, in turn, produces a larger
difference in brightness, or more contrast. At first, it
might appear that amplifica¬
tion of the video signals not
only increases contrast, but also produces a brighter
image. Most circuits are designed, however, so that changing the contrast control
does not appreciably
change the average signal level. The average video signal
level is changed by
adjusting the brightness control.
Although the contrast and brightness controls are essentially separate and inde¬
pendent, they must generally be adjusted together for optimum image
quality. The
typical picture tube has a maximum brightness level that cannot be exceeded, re¬
gardless of the value of the incoming video signal. If the average signal level is
pushed toward this upper limit by turning up the brightness control, contrast will
generally decrease. This is because the bright (white) areas have reached a limit¬
ing value, and the darker areas are increasing in brightness. Since the bright areas
cannot increase above the maximum limit, the contrast between the two areas is
reduced.
 Fluoroscopic Imaging Systems 293

Blur

One generally undesirable characteristic of a video imaging system is that it

introduces blur into theimage. One source produces blur in the vertical direction,
and the other in the horizontal. Although the blur values can be different for the
two directions, the overall image quality is usually best when they are approxi¬

mately equal.
Vertical Blur

Vertical blur is caused by the finite size of the electron beam and the scan lines.
The effect of vertical blur is illustrated in
Figure 20-7. If a small-line-type object is
oriented at a slight angle to the scan lines, the images of the object will appear to
be wider because of blur. At any instant, the width of a line in the image cannot be
less than the width of one scan line. An object is normally not perfectly aligned
with a single scan line. Therefore, the width of the image of the line is slightly

larger than the width of a single scan line. The approximate relationship between
blur (image line width), Bv, and scan line width, w, is given by

Bv = 1.4 w.

The width of a scan line, w, is, in turn, related to the vertical field of view (FOV)
and the number of actual scan lines. These factors can be incorporated into the
relationship above to give the following:
Bv= 1.4 FOV/n

where FOV is the vertical dimension of the image, and n is the number of useful
scan lines within that dimension. For an image containing a given number of scan
lines, vertical blur is directly proportional to the dimension of the image, or FOV.
Where within the system is the image dimension determined? Should it be on the
monitor screen, at the camera tube, or at some other point? The appropriate loca-

Image on Image on
Camera Tube Picture Tube

Figure 20-7 Vertical Blur Produced by Scan Lines

294 Physical Principles of Medical Imaging

tion fordetermining image size is in the plane through the object being imaged, as
illustrated inFigure 20-8.
The blur value determined by using this image dimension is properly scaled to
the size of the object and can be easily compared to blur values for the focal spot
and receptor. In the plane of the object, the image diameter, FOV, is equal to the
FOV of the image at the input to the image intensifier divided by the geometric
magnification factor, m. Substitution of this expression for image size gives an
expression for image blur that is related to three specific factors:
Bv = 1.4 FOV (image tube)/nm.

Special attention is called to the fact that video blur is directly proportional to
the FOV at the input to the image intensifier tube, as illustrated in Figure 20-9. A
small FOV produces better detail. For example, assume that a system has 485
useful lines and a magnification factor, m, of 1.2. For a 15-cm (6-in.) input image
size, the blur is 0.36 mm. If the image size is switched to 23 cm (9 in.), the blur will
increase to 0.55 mm. When the size of the image at the input of the image intensi¬
fier is increased, the video lines are spread over a larger object area. Since the
number of lines is not changed, the width of the lines must increase. Since blur is
directly related to line width, it is obvious that it must increase with an increase in
image size.
Blur can be decreased by increasing the number of lines used to form the video

image. Figure 20-10 illustrates two of the most common video formats used in

Figure 20-8 The Factors That Affect Line Width and Vertical Detail in a Video Image
 Fluoroscopic Imaging Systems 295

fluoroscopy. Most are classified as 525-line systems. In special applications that

require more image detail, 1,050-line systems are used.

Horizontal Blur

Blur in the horizontal direction is determined

by the response time of the elec¬
tronic circuitry through which the video signal passes in going from the camera to
the picture tube. The response time of a video circuit is generally
specified in
terms of a frequency bandwidth. The bandwidth is in the units of
megahertz
(MHz). In most cases, the bandwidth can be readily changed by the circuit

SMALL FIELD OF VIEW LARGE FIELD OF VIEW

Figure 20-9 Improvement in Image Detail Using a Small Field of View

525 LINES 1050 LINES

Figure 20-10 Improvement in Image Detail by Increasing the Number of Scan Lines
296 Physical Principles of Medical Imaging

designer and is usually the factor used to adjust the horizontal blur value. In most
systems, the horizontal blur is adjusted to be approximately equal to the vertical
blur. There is probably no advantage in having significantly more or less blur in
one direction than the other.

Noise

The two types of noise in a fluoroscopic system are electronic and quantum.
Electronic noise produces "snow," which is familiar to most television viewers. It
is usually significant only when the video signals are extremely weak. Since signal

strength is not a problem in the typical closed circuit video system, the presence of
significant "snow" or electronic noise usually indicates problems within the video
system.
Quantum noise depends on the number of photons used to form the image. The
number of photons involved in image formation is directly related to the receptor
input exposure. The input exposure, for a specific image brightness, can be ad¬
justed by changing the automatic brightness control circuit reference level, as dis¬
cussed in Chapter 21. An input exposure rate of approximately 0.025 mR/sec (1.5
mR/min) is usually required to reduce quantum noise to an acceptable level in
fluoroscopy.
The noise level is related to the total number of photons used to form an image,
not the rate. The human eye has an effective "collection" time of approximately

0.2 seconds. In some video systems, the time during which photons are collected
to form an image is longer because of the persistence, or lag, inherent in the cam¬

era tube. Vidicon tubes generally have more

lag than plumbicons. Because of this,
they average photons over a longer period of time and produce less quantum noise
for the same input exposure rate.

THE OPTICAL SYSTEM AND CAMERAS

An optical system is used to transfer the image from the output screen of the
intensifier tube to the input screen of the video camera tube or to the film in the
spot or cine camera. The components of the total optical system are contained in
the image distributor and the individual cameras, as shown in Figure 20-11, and
are lenses,
apertures, and mirrors. Before we consider the operation of the optical
system, we will review the basic characteristics of two of these components,
lenses and apertures.

Lens

A lens is the basic element that can transfer animage from one location to
another. The curvature of the lens focuses the light that passes through the lens.
 Fluoroscopic Imaging Systems 297

TUBE

VIDEO
CAMERA

SPOT-FILM CAMERA

LENS
APERTURE FILM

O COLLIMATOR LENS

INTENSIFIER TUBE

Figure 20-11 Basic Optical System for a Fluoroscope

A fundamental characteristic of a lens is its focal length, which expresses its

focusing power. The focal length is the distance between the lens and the point at
which all parallel light rays that enter the lens are brought together, or focused.
The focal length is determined by the curvature of the lens and is typically ex¬

pressed in millimeters. The focal length of eyeglasses is expressed in the units of

diopters, which is the reciprocal of the actual focal length in meters. For example,
a
2-diopter lens has a focal length of 50 cm.
The focal length of a lens is a major factor in determining the size of an image

projected onto a film or screen.

Aperture
Another important characteristic of a lens is its size (diameter, or aperture). This
determines the amount of light that is captured by the lens. This, in turn, affects the
efficiency of light transfer through the optical system and the exposure to film in
the camera. Actually, the factor that determines the efficiency of a lens is the ratio
of its size to its focal length, which is generally expressed in terms of the f number,
which is

f number = focal length of lens/diameter of lens.

298 Physical Principles of Medical Imaging

It should be noted that the f number is inversely related to the diameter of the lens.
In other words, as the size of the lens is increased, the value of the f number is
decreased. The efficiency of a lens is given by
Efficiency = 1/4 f2
Certain f number values are commonly used and correspond to the different
multiples of two of the lens areas. This relationship between f number and relative
lens area is shown in Table 20-1.
The difference between any two adjacent standard f numbers is referred to as
one stop. A change of one stopcorresponds to changing the relative area, or effi¬
ciency, of the lens (and film exposure) by a factor of two.
In many applications, it is desirable to adjust the aperture size, or light-gather¬

ing efficiency, of a lens. This is accomplished by covering a portion of the lens

with a circular mask with a hole in the center. In conventional photographic cam¬
eras, the aperture can usually be adjusted to different sizes. In many radiographic

systems, the size of the aperture is changed by replacing one mask (aperture) with
another.

Image Distributor

When intensifying screens are used in radiography, the light is transferred di¬
rectly to the film because the film is in direct contact with the screen. This results
in a film image that is the same size as the image from the intensifying screen. The

output image from the typical intensifying tube, however, is only about 20 mm in
diameter and must be enlarged before it is applied to the film. In order to be en¬

larged, the film must be separated from the output screen. The transfer of the im¬
age from the image intensifier output to the film surface is the main function of the
optical system. If only one camera is to be used, it will be a relatively simple
process to mount the camera so that it views the image from the intensifier tube.

Table 20-1 Standard f Number Values and Relative Lens Areas

f number Relative lens area (efficiency)

16
11 2
8 4
5.6 8
4 16
2.8 32
2.0 64
1.4 128
1.0 256
 Fluoroscopic Imaging Systems 299

With many fluoroscopic systems, however, it is desirable to transfer the image to

spot film or cine cameras in addition to the video camera. This is the function of
the part of the optical system known as the image distributor.

Collimator Lens

The first component of the optical system encountered by the light from the
intensifier output screen is the collimator lens. Its function is to collect the light
from the output screen and focus it into a beam of parallel light rays, as shown in
Figure 20-11. The parallel rays are produced by positioning the lens so that the
image intensifier screen is located near the focal point of the lens. One of the
fundamental characteristics of a converging lens is that light originating at its
focal point forms a beam of parallel rays after passing through the lens. Light

originating from points at distances other than the focal length from the lens forms
into either a diverging or converging beam after passing through the lens. The
formation of the image into a parallel beam makes it possible to distribute the

image to two or more devices, such as a spot film camera and a video camera, for
fluoroscopy.
Mirrors

The next element in the path of the light is a beam splitter. A splitter is usually
a mirror that is
only partially reflective. A portion of the light is reflected by the
mirror to one camera. The remaining light passes through the mirror to a second
camera. In some systems, the mirror is attached to a rotating mechanism so that it

can be shifted from one camera to another. The mirrors are generally designed to

divide the light unevenly between two devices. For example, a 70-30 mirror sends
70% of the light to a film camera and 30% to a video camera to form the fluoro¬
scopic image.

Vignetting
A potential problem with a two-lens optical system is vignetting. Vignetting is
the loss of film exposure around the periphery of the image. Light that leaves a
point near the center of the intensifier output screen passes through the collimator
lens and forms a beam that is parallel to the axis running through the two lenses.

Light that originates from points near the periphery of the image also passes
through the collimator lens but is projected in a beam that is not parallel to the
axis. In order for a camera lens to capture light from the periphery of the image, it
must be located in an area where the beams overlap. Vignetting usually occurs

when the camera lens is mounted too far from the collimator, or the camera lens is
too large to be contained in the overlap area. Since the effective diameter of the
camera lens is often determined by the size of the aperture, changing the aperture

setting to a larger value (smaller f number) might introduce vignetting.

300 Physical Principles of Medical Imaging

Camera

After passing through the aperture, a second lens focuses the light onto the sur¬
face of the film to form the final image. This lens is part of the camera and serves
the same function as a conventional camera lens. The most significant characteris¬
tic of this lens is its focal length.

Image Size and Framing

The amount of enlargement, or magnification, in the image between the image
intensifier output and the film is given by:

Magnification (m) = total length of camera lens/focal length of collimator lens.

The camera lens must be selected to give the desired image size on the film, as
shown in Figure 20-12. Four film sizes are generally used in intensified radiogra¬
phy: 35 mm, 70 mm, 90 mm, and 105 mm. These are the dimensions of the film.
The size of the image area is somewhat less because of sprocket holes and borders.
For example, 35-mm film typically has an image area of 25 mm x 18 mm. The

image at the intensifier output screen is circular, but all films have either square or
rectangular image areas. Because of this, it is impossible to get exact coverage on
the film.
For agiven film size, it is possible to obtain different degrees of coverage, or
framing. With underframing, all of the image appears on the film but is circular;
the corners of the film area are not exposed. On the other hand, with overframing,
all of the film is used, but some portions of the image are lost.

Figure 20-12 Relationship of Image and Film Size for Different Degrees of Framing
 Fluoroscopic Imaging Systems 301

Unless the optical system is properly focused, it will also be a source of image
blur. Both the collimator and camera lens can be out of focus. Proper
focusing of
the collimator lens requires special equipment and should be attempted only by

qualified personnel.
Film Exposure

Only afraction of the light emitted by the image intensifier reaches the film.
The reasonsfor this are that the optical system does not capture all of the light, and
a significant portion of the light is absorbed by the lenses and mirrors within the

system or is stopped by the aperture. Only a fraction of light captured by the colli¬
mator lens and passed through the aperture reaches the film because of absorption

in the lens. This fraction is typically about 0.8. If the light that reaches the film is

spread over an area that is larger than the output screen, the intensity, but not the
total number of light photons, will be reduced.

RECEPTOR SENSITIVITY

Fluoroscopy

The sensitivity during fluoroscopic operations is set by the equipment engineer

through an adjustment of the video camera sensitivity or the video camera aper¬
ture. The sensitivity and exposure also change with the field of view (mode), as

described above. The fluoroscope is most sensitive when operated with the maxi¬
mum field of view. Increasing field of view increases sensitivity and decreases

required exposure. Because the x-ray beam then covers more of the patient's body,
however, the total radiation energy to the patient is not significantly reduced.
Some fluoroscopic systems have a control that allows the operator to change the

sensitivity. This is used to control the level of quantum noise in the fluoroscopic
image. The low sensitivity (low noise) settings are used to improve visibility in
certain demanding procedures, such as angioplasty.

Radiography

The overallsensitivity of an intensified radiography receptor system depends

on major factors: (1) the gain or conversion factor of the image tube, (2) the
three
efficiency of the optical system, and (3) the sensitivity of the film. The input expo¬
sure increases as the squareof the magnification, which is, in effect, the film im¬
age size. If all other factors remain unchanged, four times as much x-ray exposure
will be required if the film size is doubled. This is because doubling the size (di¬
ameter) of the film increases the image area by a factor of 4.
302 Physical Principles of Medical Imaging

Image size usually changes twice in an intensified system. The image is

reduced, or minified, in the image intensifier and then magnified in the optical

system. Minification increases image intensity, whereas magnification produces a

decrease. Much of the gain in the image intensifier tube obtained from
minification will be lost if the image is remagnified on the film. In fact, if the film
size is the same as the input phosphor size, these two factors will cancel each
other.
Within a given system, the receptor sensitivity can usually be changed by ad¬
justing the aperture. If the film is changed to one with a different sensitivity, the
aperture can be used to compensate for the change and to maintain the same recep¬
tor sensitivity, if desired. The aperture is also used to compensate for image inten¬

sifier tubes with different conversion factors.

The two factors used by the equipment engineer to set the sensitivity level are
the film sensitivity and the aperture of the camera lens. The gain (conversion fac¬
tor) of the intensifier tube has a major effect on overall receptor sensitivity. The
only way the gain of the specific tube can be changed is by changing the field of
view, or mode of a multi-mode tube. Tube gain, and therefore receptor sensitivity,
is proportional to the area of the field of view. Therefore, a tube operating in a

large field mode is more sensitive and requires less radiation exposure than when
it is operated in the small field mode. The sensitivity is usually set in relationship
to the size of the film being used. In general, maximum sensitivity (minimum

exposure) is obtained with the smallest film size.

 Chapter 21

Image Noise

INTRODUCTION AND OVERVIEW

It is generally desirable for film density, image brightness, to be uniform

or
except where it changes to form an image. There are factors, however, that tend to
produce variation in film density even when no image detail is present. This varia¬
tion is usually random and has no particular pattern. In many cases, it reduces

image quality and is especially significant when the objects being imaged are
small and have relatively low contrast. This random variation in film density, or

image brightness, is designated noise.

All medical images contain some visual noise. The presence of noise gives an

image a mottled, grainy, textured, or snowy appearance. Figure 21-1 compares

two images with different levels of noise. Image noise comes from a variety of

sources, as we will soon discover. No imaging method is free of noise, but noise is
much more prevalent in certain types of imaging procedures than in others.
Nuclear images are generally the most noisy. Noise is also significant in MRI,
CT, and ultrasound imaging. In comparison to these, radiography produces im¬
ages with the least noise. Fluoroscopic images are slightly more noisy than radio¬
graphic images, for reasons explained later. Conventional photography produces
relatively noise-free images except where the grain of the film becomes visible.
In this chapter we consider some of the general characteristics of image noise

along with the specific factors in radiography and fluoroscopy that affect noise.

EFFECT ON VISIBILITY

Although noise gives an image a generally undesirable appearance, the most

significant factor is that noise can cover and reduce the visibility of certain fea¬
tures within the image. The loss of visibility is especially significant for low-con¬

trast objects. The general effect of noise on object visibility was described in

303
(LITNMHm(RtAohehaoBiaiggsnfrhe))t
IT2mtho1haeg-ne
Figure
 Image Noise 305

Chapter 1 and illustrated in Figure 1-7. The visibility threshold, especially for
low-contrast objects, is very noise dependent. In
principle, when we reduce image
noise, the "curtain" is raised somewhat, and more of the low-contrast objects
within the body become visible.
If the noise level can be
adjusted for a specific imaging procedure, then why not
reduce it to its lowest possible level for maximum visibility? Although it is true
that we can usually change imaging factors to reduce noise, we must
always com¬
promise. In x-ray imaging, the primary compromise is with patient exposure; in
MRI and nuclear imaging, the primary compromise is with
imaging time. There
are also compromises between noise and other
image characteristics, such as con¬
trast and blur. In principle, the user of each
imaging method must determine the
acceptable level of noise for a specific procedure and then select imaging factors
that will achieve it with minimum exposure, imaging time, or effect on other im¬

age quality characteristics.

QUANTUM NOISE

X-ray photons impinge on a surface in a random pattern. No force can cause

them to be evenly distributed over the surface. One area of the receptor surface
might receive more photons than another area, even when both are exposed to the
same average x-ray intensity.

In all imaging procedures using x-ray or gamma photons, most of the image
noise is produced by the random manner in which the photons are distributed
within the image. This is generally designated quantum noise. Recall that each
individual photon is a quantum (specific quantity) of energy. It is the quantum
structure of an x-ray beam that creates quantum noise.

Let us use Figure 21-2 to refresh our concept of the quantum nature of radiation
to see how it produces image noise. Here we see the part of an x-ray beam that

forms the exposure to one small area within an image. Remember that an x-ray
beam is a shower of individual photons. Because the photons are independent,

they are randomly distributed within an image area somewhat like the first few
drops of rain falling on the ground. At some points there might be clusters of
several photons (drops) and, also, areas where only a few photons are collected.
This uneven distribution of photons shows up in the image as noise. The amount
of noise is determined by the variation in photon concentration from point to point
within a small image area.

Fortunately we can control, to some extent, the photon fluctuation and the re¬
sulting image noise. Figure 21-2 shows two 1-mm square image areas that are
subdivided into nine smaller square areas. The difference between the two areas is
the concentration of photons (radiation exposure) falling within the area. The first
has an average of 100 photons per small square, and the second a concentration of
306 Physical Principles of Medical Imaging

X-ray Beam

100 Photons 1000 Photons

Average per Area Average per Area
108 90 103 1026 1007 980

102 95 114 1 mm 967 984 1016

94 105 89 1010 1046 964

Standard Deviation Standard Deviation

± 10 photons - 10% ± 33 photons - 3.3%

Figure 21-2 The Concept of Quantum Noise

1,000 photons per small square. For a typical diagnostic x-ray beam, this is
equivalent to receptor exposures of approximately 3.6 jiR and 36 pR, respectively.
Notice that in the first large area none of the smaller areas has
exactly 100
photons. In this situation, the number of photons per area ranges from a low of 89
photons to a high of 114 photons. We will not, however, use these two extreme
values as a measure of photon fluctuation. Because most of the small areas have
photon concentrations much closer to the average value, it is more appropriate to
express the photon variation in terms of the standard deviation. The standard de¬
viation is a quantity often used in statistical analysis (see Chapter 31 ) to
express
the amount of spread, or variation, among quantities. The value of the standard
deviation is somewhat like the "average" amount of deviation, or variation,
among
the small areas. One of the characteristics of photon distribution is that the amount
of fluctuation (standard deviation value) is related to the
average photon concen¬
tration, or exposure level. The square root of the average number of photons per
area provides a close estimate for the value of the standard deviation. In
this ex-
 Image Noise 307

ample the standard deviation has a value of ten photons per area. Since this is 10%
of the average value, the quantum noise
(photon fluctuation) at this exposure has a
value of 10%.
Let us now consider the image area on the
right, which received an average of
1,000 photons per area. In this example, we also find that none of the small areas
received exactly 1,000 photons. In this case, the
photon concentrations range from
964 photons to 1,046 photons per area.
Taking the square root of the average pho¬
ton concentration (1,000) gives a standard deviation value of 33.3 photons. It ap¬
pears we have an evenhigher photon fluctuation, or noise, than in the other area.
However, when we express the standard deviation as a percentage of the average
photon concentration, we find that the noise level has actually dropped to 3.3%.
We have just observed what is perhaps the most
important characteristic of
quantum noise; it can be reduced by increasing the concentration of photons (ie,
exposure) used to form an image. More specifically, quantum noise is inversely
proportional to the square root of the exposure to the receptor.
The relationship between image noise and required exposure is one of the issues
that must be considered by persons setting up specific x-ray procedures. In most
situations, patient exposure can be reduced, but at the expense of increased quan¬
tum noise and, possibly, reduced visibility. It is also
possible, in most situations, to
decrease image noise, but a higher exposure would be required. Most x-ray proce¬
dures are conducted at a point of reasonable compromise between these two very
important factors.

RECEPTOR SENSITIVITY

The photon concentration, or exposure, that is required to form an image is

determined by the sensitivity of the receptor. The sensitivities of the receptors
used in x-ray projection imaging (radiography and fluoroscopy) vary over a con¬
siderable range, as shown in Figure 21-3. This chart shows the approximate values
used for specific imaging applications.

Screen-Film Radiography
The sensitivity of a radiographic receptor (cassette) is determined by character¬
istics of the screen and the film and the way they are matched. The factors that

affect receptor sensitivity do not necessarily alter the quantum noise characteris¬
tics of the receptor. The major factors that affect radiographic receptor sensitivity
are film sensitivity, screen conversion efficiency, and screen absorption effi¬

ciency. The quantum noise level is determined by the concentration of photons

actually absorbed by the receptor, rather than the concentration of photons deliv-
308 Physical Principles of Medical Imaging

Speed

P
1200 800 400 200 100 50
I I I I l_
Radiography Mammography

Spot film
—

■J
Regular
j Fluoroscopy
-i—i i i i 111 1 1 i i r i 11 r i i f 11 1—i—! i i 1111 r

1 p.R 10p.R 100p.R 1mR 10mR 100mR

Receptor Sensitivity

Figure 21-3 Receptor Sensitivity Values Used in X-Ray Imaging

ered to it.Increasing receptor sensitivity by changing any factor that decreases the
number of photons actually absorbed will increase the quantum noise.
The receptor exposure required to form an image (receptor sensitivity) can be

changed by modifying several factors, as indicated in Figure 21-4. Film sensitiv¬

ity, which is shown to the right in the illustration, determines the amount of light
required to produce the desired film density. If film sensitivity is increased to
reduce the amount of light required, this, in turn, will reduce the number of x-ray

photons that must be absorbed in the screen. The result would be an image with
increased quantum noise. Recall that the effective sensitivity of a particular film
and screen combination depends on the matching of the spectral sensitivity char¬
acteristics of the film to the spectral characteristics of the light produced by the
screen. When the two characteristics are
closely matched, maximum sensitivity
and maximum quantum noise are produced. In radiography,
changing the film
sensitivity (ie, changing type of film) is the most direct way to adjust the quantum
noise level in images. Quantum noise is usually the factor that limits the use of

highly sensitive film in radiography.

Conversion efficiency is the characteristic of an intensifying screen that is, in
effect, the fraction of absorbed x-ray energy actually converted into light. The
conversion efficiency value for a particular screen is determined by its composi¬
tion and design. It cannot be changed by the user. In principle, a high conversion

efficiency increases receptor sensitivity and reduces patient exposure. Unfortu¬

nately, an increase in conversion efficiency decreases the quantity of x-radiation
that must be absorbed in the screen, and this, in turn, increases quantum noise.

Therefore, a high conversion efficiency is not always a desirable characteristic for

 Image Noise 309

1.5 mR-i

1 mR-

Decrease Noise
Absorption_^
Efficiency
0.5 mR- Increase Noise

Conversion
Efficiency" Film
Sensitivity

Receptor Absorbed Emitted Film

Exposure Radiation Light Density

Figure 21-4 Relationship of Radiation Quantities within an Intensifying Screen-Film Re¬

ceptor

intensifying screens. It should be adjusted by the manufacturer to a value that

produces a proper balance between receptor sensitivity and quantum noise.
The only way to increase radiographic receptor sensitivity without
increasing
quantum noise is to increase the absorption efficiency. An increase in absorption
efficiency does not change the amount of radiation that must be absorbed to pro¬
duce an image. It does, however, reduce the required incident exposure since a
greater proportion of the radiation is absorbed.
Recall that several factors determine absorption efficiency: namely, screen
composition, screen thickness, and photon energy spectrum. The relationship be¬
tween radiographic receptor sensitivity and quantum noise can be summarized as
follows. The amount of quantum noise in a properly exposed image is directly
related to the amount of x-ray energy actually absorbed in the intensifying screen.
Changing factors, such as type of screen material, screen thickness, and KVP (pho¬
ton energy spectrum), that affect absorption efficiency will alter the overall recep¬
tor sensitivity in relation to the quantum noise level. On the other hand, changing

film sensitivity, spectral matching, and the conversion efficiency of the intensify¬
ing screen generally changes quantum noise and receptor sensitivity.
Two screen-film combinations with the same sensitivity are shown in Figure
21-5. One system uses a relatively thick high-speed screen and a film with conven¬
tional sensitivity. The other system uses a thinner detail-speed screen and a more
 310 Physical Principles of Medical Imaging

Sensitive Film

^ Same Density ^
N /
< More Noise
Image Image
More Blur >

Figure 21-5 Comparison of Image Quality between Two Screen-Film Combinations

sensitive film. The images produced by these two systems differ in two respects.
The system using the thicker screen has more blur but less quantum noise than the
system using the more sensitive film. The reduction in noise comes from the in¬
creases in absorption
efficiency and blur.

Intensified Radiography
Quantum noise is sometimes more significant in intensified radiography (cine
and spot films) than in screen-film radiography because of generally higher recep¬
tor sensitivity values (ie, lower
receptor exposures). With such systems, the quan¬
tum noise level can be
adjusted.
Absorption efficiency of image intensifier tubes has gradually improved over
the years. Like intensifying screens,
absorption efficiency depends on the compo¬
sition of the input screen, its thickness, and the
photon energy spectrum. However,
a manufacturer
generally does not offer choices. Most modern intensifier tubes
have input screens designed to provide a reasonable
compromise between absorp¬
tion efficiency (sensitivity) and image blur.
The variations in intensifier
tube-receptor system sensitivity are related to char¬
acteristics of the intensifier tube, the optical system, and the film. The
gain (con¬
version factor) of an image intensifier tube cannot be
adjusted by the user except
by changing the input field of view (mode).
Changing the size of the optical aperture is the most common method of adjust¬
ing the receptor sensitivity and quantum noise level. This adjustment can usually
be made in the clinical facility by a service engineer. The other factors associated
with the optical system that affect overall receptor
sensitivity, such as magnifica-
 Image Noise 311

tion (film size) and light transmission through the lens and distributor compo¬
nents, are not generally adjustable by the user and cannot be used to modify the
quantum noise level.
The sensitivity of the film has a direct effect on the overall receptor system

sensitivity. If the film is changed to one with a greater sensitivity, images can be
produced with less x-radiation, but the amount of quantum noise will be increased.
However, the aperture size can be decreased to compensate for the increase in film
sensitivity and prevent an increase in noise.
Whenever film sensitivity or the aperture is changed, the AEC system must be

readjusted to produce a properly exposed film.

The basic x-ray system illustrated in Figure 21-6 is used to illustrate how the

input exposure to the image intensifier can be adjusted to obtain a specified quan¬
tum noise level. In most systems, the input to the AEC circuit is a light sensor that

monitors the output of the image intensifier. The intensifier output luminance, or
exposure (luminance multiplied by time), is electronically compared with a pre-
established reference level. The output signal from the control circuit adjusts the
x-ray machine exposure factors until the desired luminance, or exposure, is ob¬
tained. In most spot film and some cine systems, the KVP and MA are preset, and
the AEC circuit adjusts the exposure time to achieve proper film exposure. In
some cine systems, the AEC circuit adjusts the KVP, MA, or both, and the expo¬

sure time is preset. In some systems, the control circuit can adjust all three expo-

Aperture

in.
Luminance Density
^*H=CZf Control

t7 - -

Reference
<
:: Level

Engineers
Control

Input Exposure

kVp,m As
<r

Figure 21-6 Factors That Determine the Input Exposure (and Quantum Noise) of an Inten¬
sified Radiography System
312 Physical Principles of Medical Imaging

sure factors. Generally, the time is changed within certain limits. If the desired
exposure is not obtained when time reaches a limit, either KVP or MA will be
changed.
The reference level for the luminance output of the intensifier is generally ad¬
justed by two controls: the operator's control, which is used to adjust film density,
and the engineer's control, which is used to set the approximate intensifier light

output. This second control is usually located within the equipment and is not
accessible to the equipment operator. The operator's control is essentially a fine
adjustment of the engineer's control. For a given setting of the reference level, the
AEC circuit produces a fixed value of intensifier input exposure. The readjust¬
ment of this reference level by means of the engineer's control is used to alter the

input exposure and control quantum noise.

The reference level cannot be changed without making other adjustments, or
film exposure will be incorrect. The relationship of film density to light output
from the image intensifier is determined by the film sensitivity and the size of the

aperture within the optical system. The aperture and reference level are usually
adjusted together to obtain the desired film exposure and image intensifier input
exposure.
Assume that a cine system is producing properly exposed films, but the quan¬
tum noise is considered to be too high. A measurement of the input exposure
shows that it is 10 pR per frame. It might be desirable to increase this to at least
25 pR to reduce quantum noise. This can be achieved by
changing the output light
reference level to a higher value by means of the engineer's control. It is then
necessary to reduce the size of the aperture to prevent the film from being overex¬
posed.
In considering the image intensifier input
exposure, the relationship between
the size of the image intensifier input and film must be considered. In most
sys¬
tems, the size of the image on the film is less than the size of the image at the
image intensifier input. When minification is present, an image can be formed
with a given noise level by using less radiation. The
significant factor is the con¬
centration of x-ray photons with respect to a given film area.

Many imaging systems use intensifier tubes with selectable input image sizes,
or fields of view, as illustrated in
Figure 21-7, in which three image intensifier
inputs, or modes, are compared with a 100-mm film. Intensifier input exposure
values that give approximately the same quantum noise on the film are also indi¬
cated. The relationship among the exposure values is determined
by the ratios of
the respective areas. In all three cases, the number of
photons forming the image is
the same. This is because the total photon number is related to the
product of the
exposure and the image area.
When an image intensifier can be operated with different
input image sizes,
there is a different sensitivity value for each size. Sensitivity
changes because the
gain of the intensifier tube is proportional to the area of the input.
 Image Noise 313

Intensifier Input

0. lmR

Film

100mm

0.23 mR

0.5 mR

Figure 21-7 Relationship of Intensifier Tube Input Diameters to Film Size and Exposure
Values Required To Produce the Same Image Quality

Fluoroscopy
The same basic
principles apply to a fluoroscopic imaging system except that
the sensitivity of the video camera, rather than the film, is a determining factor.
The sensitivity of a video camera is generally not fixed but can be varied through

adjustments in the internal amplification, or gain. The quantum noise level for a
fluoroscope is generally set to an acceptable level by adjusting either the video
camera or aperture, or both.

The receptor sensitivity of a conventional fluoroscope is typically in the range

of 1 (J.R to 10 pR per image frame. This relatively low exposure produces images
with considerable quantum noise. In normal fluoroscopic viewing, however, we
do not see one image frame at a time but an average of several frames, as discussed
below.
Some fluoroscopic systems can be switched into a low-noise mode, which will

improve the visibility of low-contrast detail. In the low-noise mode, the receptor
sensitivity is reduced, and more exposure is required to form the image.
It is possible to develop receptor systems that would have greater sensitivity
and would require less exposure than those currently used in x-ray imaging. But,
there is no known way to overcome the fundamental limitation of quantum noise.
The receptor must absorb an adequate concentration of x-ray photons to reduce
noise to an acceptable level.

GRAIN AND STRUCTURE NOISE

Although the quantum structure of the x-ray beam is the most significant noise
source in most x-ray imaging applications, the structure of the film, intensifying
screens, or intensifier tube screens can introduce noise into images.
314 Physical Principles of Medical Imaging

An
image recorded on film is composed of many opaque silver halide crystals,
or grains. The grains in radiographic film are quite small and are not generally
visible when the film is viewed in the conventional manner. The grainy structure
sometimes becomes visible when an image recorded on film is optically enlarged,
as when projected onto a screen. Whenever it is visible, film
grain is a form of
image noise.
Film-grain noise is generally a more significant problem in photography than in
radiography, especially in enlargements from images recorded on film with a rela¬
tively high sensitivity (speed).
Image-intensifying screens and the screens of intensifier tubes are actually lay¬
ers of small crystals. An
image is formed by the production of light (fluorescence)
within each crystal. The crystal structure of screens introduces a slight variation in
light production from point to point within an image. This structure noise is rela¬
tively insignificant in most radiographic applications.

ELECTRONIC NOISE

Video
images often contain noise that comes from various electronic sources.
Video image noise is often referred to as snow. Some of the electronic components
that make up a video system can be sources of electronic noise. The noise is in the
form of random electrical currents often produced by thermal activity within the
device. Other electrical devices, such as motors and fluorescent
lights, and even
natural phenomena within the atmosphere generate electrical noise that can be

picked up by video systems.

The presence of noise in a video system becomes especially noticeable when
the image signal is weak. Most video receivers have an automatic
gain (amplifica¬
tion) circuit that increases the amount of amplification in the presence of a weak
signal. This amplifies the noise and causes it to become quite apparent within the
image. This effect can be easily observed by tuning a TV (video) receiver to a
vacant channel or a channel with a weak
signal. The presence of excessive elec¬
tronic noise in a fluoroscopic image is often the result of a weak video
signal
because of system failure or misadjustment.

EFFECT OF CONTRAST ON NOISE

The noise in animage becomes more visible if the overall contrast transfer of
the imaging system is increased. This must be considered when using image dis¬
plays with adjustable contrast, such as some video monitors used in fluoroscopy,
and the viewing window in CT, MRI, and other forms of
digital images. High
contrast film increases the visibility of noise.
 Image Noise 315

EFFECT OF BLUR ON NOISE

The
visibility of image noise can often be reduced by blurring because noise has
a rather
finely detailed structure. The blurring of an image tends to blend each
image point with its surrounding area; the effect is to smooth out the random struc¬
ture of the noise and make it less visible.
The use of image
blurring to reduce the visibility of noise often involves a com¬
promise because the blurring can reduce the visibility of useful image detail.
High-sensitivity (speed) intensifying screens generally produce images show¬
ing less quantum noise than detail screens because they produce more image blur.
The problem is that no screen gives both maximum noise
suppression and visibil¬
ity of detail.
A blurring process is sometimes used in digital
image processing to reduce im¬
age noise, as described in Chapter 22.

IMAGE INTEGRATION

Integration is the process of averaging a series of images over a period of time.

Since most types of image noise have a random distribution with respect to time,
the integration of images can be quite effective in smoothing an image and reduc¬

ing its noise content. Integration is, in principle, blurring an image with respect to
time, rather than with respect to space or area. The basic limitation of using this
process is the effect of patient motion during the time interval.
Integration requires the ability to store or remember images, at least for a short
period of time. Several devices are used for image integration in medical imaging.

Human Vision

The human eye (retina) responds to average light intensity over a period of

approximately 0.2 seconds. This integration, or averaging, is especially helpful

when viewing fluoroscopic images.
The conventional fluoroscopic display is a series of individual video images.
Each image is displayed for one thirtieth of a second. Because a relatively low

receptor exposure (less than 5 pR) is used to form each individual image, the
images are relatively noisy. However, since the eye does not "see" each individual
image, but an average of several images, the visibility of the noise is reduced. In
effect, the eye is integrating, or averaging, approximately six video images at any
particular time. The noise actually visible to the human eye is not determined by
the receptor exposure for individual fluoroscopic images but by the total exposure
for the series of integrated images.
316 Physical Principles of Medical Imaging

Video Camera Tubes

Certain types of video camera tubes have an inherent lag, or slow response, to
changes in an image. This lag is especially significant in vidicon tubes. The effect
of the lag is to average, or integrate, the noise fluctuations and produce a smoother
image. The major disadvantage in using this type of tube for fluoroscopy is that
moving objects tend to leave a temporary trail in the image.

Digital Processing

When a series of images is acquired and stored in a digital memory, the

images
can be averaged to reduce the noise content. This process is frequently used in
DSA and MRI.

IMAGE SUBTRACTION

There are several

applications in which one image is subtracted from another. A
specific example is DSA. A basic problem with any image subtraction procedure
is that the noise level in the resulting image is
higher than in either of the two
original images. This occurs because of the random distribution of the noise
within each image.

Relatively high exposures are used to create the original images in DSA. This
partially compensates for the increase in noise produced by the subtraction
process.
 Chapter 22

Digital Imaging Systems and

Image Processing

INTRODUCTION AND OVERVIEW

Digital computers are now an integral part of the medical imaging process. In
some applications, such as CT, PET, and MRI, general purpose digital computers
are part of the system. In other
applications, such as digital radiography, digital
fluoroscopy, and ultrasound imaging, special purpose digital processors (comput¬
ers) are built into the equipment. Nuclear imaging systems use both general pur¬
pose and specialized computer systems.
In these applications, the computer, or digital processor, performs a variety of
functions including:

•
image acquisition control
•
image reconstruction
•
image storage and retrieval
•
image processing
•
image analysis
In this chapter we will consider some of the common characteristics of digital

images that apply to all modalities and then give special emphasis to radionuclide
imaging and several digital x-ray imaging methods that are not considered in other
chapters.

DIGITAL IMAGES

Images must be in a digital form to be processed by a computer. A digital image

consists of a matrix in which each element, or pixel, is represented by a numerical

value, as shown in Figure 22-1.

317
 318 Physical Principles of Medical Imaging

6 6 4 6 6
6 6 2 6 6
4 2 0 2 4
6 6 2 6 6
6 6 4 6 6
Figure 22-1 A 25-Pixel Digital Image

Matrix Size

The matrix size (number of rows and columns) for a

particular image generally
depends on the specific application and capabilities of the system that creates the
image. The most common format is a square, although it is possible to have rectan¬
gular digital images.
The number of rows and columns in an
image is usually a multiple of the num¬
ber 2 because of the binary characteristics of
digital systems. Matrix sizes encoun¬
tered in medical imaging include 64 x 64, 128 x 128, 256 x 256, 512 x
512, and
1,024 x 1,024. The number of pixels contained in an image is the product of the
number of rows and columns. For the square matrix, the number of
pixels is pro¬
portional to the square of the matrix size. When a matrix dimension is increased by
a factor of 2 (ie, from 256 to
512), the number of pixels increases by a factor of 4.
The selection of a matrix size has two
important consequences.

Image Detail
Matrix size is the principal factor that determines the size of the individual pix¬
els. Pixel size affects image detail. Since each pixel has only one numerical value
or shade of gray (brightness), it is not
possible to see any anatomical detail within
a pixel. All structures within the area covered
by a pixel are blurred together and
represented by one value. Digitizing an image adds this additional blurring. If it is
large relative to the level of blur from other sources (focal spot, receptors, etc.), it
becomes the limiting factor with respect to visibility of detail. Good
visibility of
detail requires small pixels that are produced by selecting a
large matrix size.
 Digital Imaging Systems and Image Processing 319

The other factor that must be considered with

respect to digital image detail is
the field of view (FOV) with respect to the patient's body. The effective pixel size
that limits visibility of detail is:
Pixel Size = FQV .

Matrix

For a large FOV, a large matrix is required to produce the same detail as a small
matrix in a smaller FOV.

Storage Capacity
The storage capacity required for a digital
image is related to the number of
pixels. Therefore, a large matrix that contains many pixels requires more storage
capacity and processing time than images in a small matrix format. Figure 22-2
shows the effect of matrix and pixel size on image detail. In the bottom row we see
that as the matrix size is decreased the image becomes more blurred. This is be¬
cause the pixel size is increased. Another
important factor is the number of bits
(binary digits) used to represent each pixel. This affects the number of shades of
gray or brightness levels that can be displayed. In the top row we see that as the
number of bits per pixel is decreased there are fewer shades of gray in the dis-

512x512
4 bits

Detail
Figure 22-2 The Effect of Matrix and Pixel Size on Image
320 Physical Principles of Medical Imaging

played image, this is because the number of bits per pixel determines the range of
pixel values and possible shades of gray.

Pixel Values

Devices that process and store digital images operate with binary numbers
rather than decimal numbers. The difference is that digits in a binary number al¬

ways express multiples of the base number 2, whereas digits in a decimal number
express multiples of the base number 10. A basic knowledge of the binary number
format is especially helpful in understanding the storage requirements for digital

images.
When a computer, or digital processor, writes a number in memory, it does so
by filling in, or marking, specific spaces. This is somewhat analogous to what
humans do when they fill out forms where a space is designated for each digit (or
letter of the alphabet). Let us use Figure 22-3 to develop this analogy. Consider the
decimal number first. Each digit in a decimal number represents a multiple of 10.

9 9 9 9
8 8 8 8
7 7 7 7
6 6 6 6
10 decimal 5 5 5 5 1 0,000
4 4 4 4
digits 3 3 3 3
combinations
2 2 2 2

0 0 0 0

0 0 E 6 - 1,956
1000 100 10

digit values

2 binary 16
digits (0) Q O O O combinations
o • 0 = 10
8 4 2

digit values

Figure 22-3 Comparison of Binary and Decimal Numbers

 Digital Imaging Systems and Image Processing 321

The specific multiple value is determined by the position, or order, of the digit
within the total number. When humans fill in decimal number,
a
they do so by
writing 1 of 10 different numbers (0-9). The total value of the number is deter¬
mined by the digit selected and the position in which it is entered. For
example, the
digit 3 entered into the space to the extreme right has the value of 3, whereas if it is
entered into the third space from the right, it has a value of 300. The value of a
number is simply the sum of its individual digit values.
In the binary number format shown here, each digit
position is indicated by a
circle. Notice that the value of each digit position is a multiple of the number 2.
When a computer fills in a binary number, it has a choice of
only two values, 0 and
1. A 0 is indicated by leaving the position blank, and a 1 is indicated
by placing a
mark in the position. Each space represents one binary digit, or bit. A bit can have

only two different values, whereas a decimal digit can have 10 different values.
Most digital devices work with groups of bits. A group of 8 bits is often used,
and it is known as a byte. Within a byte, each blank, or unmarked bit, has a value
of 0. Each marked bit has a value determined by its position within the byte. When
the bit on the extreme right is marked, it has a value of 1; the bit on the extreme left
would have a value of 128, etc. The total value of a byte is the sum of the values for
the marked bits.
One byte can represent 256 different values. A byte with all blank bits (all bits

equal to 0) has a value of 0. The other extreme is when all bits are marked, which
gives a total value of 255. There are 254 other combinations that can be formed
with marked and unmarked bits.
The number of different values a binary number can represent is much less than
with a decimal number of the same number of digits. This is because a binary digit
canhave only one of two possible values, whereas a decimal digit can have one of
tendifferent values. We have just seen that an 8-bit binary number, or 1 byte, can
have only 256 different values. By comparison, a three-digit decimal number can
have 1,000 different values, 0 to 999.
primary interest in binary numbers, bits and bytes, is that they are used to
Our

represent the pixels in digital images. Different byte configurations represent dif¬
ferent shades of gray in the pixels. Figure 22-4 shows the general relationship of

byte configurations, pixel values, and shades of gray. Here we see how four bits
per pixel can have 16 different combinations and represent 16 shades of gray. The
relationship between the number of bits per pixel and the number of shades of gray
is shown at the top.
The required number of bits per pixel for medical images is generally in the
range of 8-16 bits (1-2 bytes). Digital systems typically process and store infor¬
mation in byte increments. Whereas an 8-bit pixel can be stored in one byte, a 12-
bit pixel would require 2 bytes, the same as a 16-bit pixel.
 322 Physical Principles of Medical Imaging

PIXEL VALUES
266
or
16
SHADES OF GRAY

a*
i
o,
o

01 o-
BITS

PIXEL VALUES AND SHADES OF GRAY

0 1 2 3 4 6 6 7 8 9 10 11 12 13 14 16
■ ■■■«□□□□□□□□□□
|eOOOOOOOOi#«#ifii
%a000099990000%%99
>200iioo»«oot»oo««
aiOiOiOfOiOtOtOtOi
Four Bits Per Pixel

Figure 22-4 Relationship between Pixel Values and Image Gray Scale

Within a computer the number of bits processed as a single unit is known as a

word. This is determined by design of the computer. Examples are: 16-bit, 32-bit,
and 64-bit words.
An important consideration is the number of bits or bytes required to represent
one
image. As we have seen, this is determined by a combination of two factors:
the number of pixels in the image and the number of bits
required for each pixel.
The numerical size of an image (number of
bytes) determines how many images
can be stored in a
specific storage device such as a disk. The storage capacity of
such devices is typically rated in
megabytes or gigabytes.
There is a considerable variation in the numerical size of the
images produced
by the various modalities. This in turn affects the number of images that can be
stored in a specific device. Typical values are shown in Table 22-1.
However, for
several modalities the matrix size will be
adjusted by the operator to optimize
image quality and factors such as acquisition and processing time.

DIGITAL IMAGE PRODUCTION AND CONVERSION

Since digital images are not formed

directly, like conventional radiographs,
they must be created by a conversion process. The specific conversion process
 Digital Imaging Systems and Image Processing 323

depends on the source and form of the acquired image or data, which varies from
one imaging
modality to another.

Image Reconstruction
Most of the imaging modalities that produce tomographic image (CT, MRI,
SPECT, and PET) do so by an image reconstruction process. This is a mathemati¬
cal process that converts acquired data into a digital image. The details of the
image reconstruction process for each modality is described in the respective
chapters describing the modalities. Although the methods are somewhat different,
the results are essentially the same: a digital image.

Radionuclide Image Acquisition

In many nuclear medicine procedures, the computer has an important role in the

acquisition of the image. The computer is inserted between the gamma camera and
the display device and, in most applications, controls the acquisition, or flow, of
data from the gamma camera. The acquired data is stored in the computer memory
for later processing and display. The processing is usually of two types: the pro¬
cessing of an image to improve its quality and the processing, or abstraction of
quantitative information from the stored data. The computer also controls the
manner in which images and data are displayed.

The two major functions of the computer during the acquisition phase are to
collect data only during specific time intervals and to arrange the data into specific
formats for storage.
The formatting of the data during the acquisition phase is often referred to as the
mode of acquisition. The two most common formats (modes) are the frame (or
matrix) and the list. The selection between these two modes depends on the type of
processing to be performed.

Table 22-1 Typical Matrix Size Used with Specific Imaging Modalities

Modality Typical Matrix Size

Gamma Camera 128x 128

Magnetic Resonance Imaging 256 x 256

Ultrasound 512x512

Computed Tomography 512x512

Digital Fluoroscopy 1024x1024

2048 x 2048
Digital Radiography
324 Physical Principles of Medical Imaging

Frame Mode

In the frame, or matrix, mode the image area is divided into an array of pixels, as
shown in Figure 22-5. Typically the computer can be instructed to divide an image
into pixels of different sizes. The selection of a specific matrix format depends, to
some extent, on the type of study being conducted.
The formatting of an image into discrete pixels is, in effect, a blurring process.
The image of a small object point can be no smaller than one pixel. Therefore,
when it is necessary to visualize small objects, or to determine the size and shape
of structures with a reasonable degree of precision, small pixel sizes must be used.
If,on the other hand, the study is concerned with the build-up and elimination of
activity in relatively large areas, large pixels can be used to an advantage.
In the matrix mode, each pixel is represented by a specific location (address) in
the computer memory. Recall that when each photon is detected by the gamma
camera, an electrical signal (set of pulses) is created that represents its location
within the image area. These signals are processed by the computer to determine
the pixel in which the photon is located. It then goes to the corresponding memory
location for that pixel and adds one count to the number stored there. In effect,
each memory location is like a scoreboard that is continuously updated during the

acquisition of data. The final number in the location represents the number of
photons that originated within the corresponding pixel.
Let us consider the specific example illustrated in Figure 22-5. If a photon origi¬
nates from a specific point in an organ, its vertical and horizontal coordinates will

be sent to the computer. The computer then uses this information to identify the

specific pixel that corresponds to the photon location. The computer goes to the
memory location (address) that corresponds to the specific pixel and increases the
stored count value by 1 unit. The image stored in the computer memory is in a
numerical form. This is desirable because it can then be readily processed and
analyzed.
Many studies require a series of images, as illustrated in Figure 22-6. To
achieve this, the computer collects and stores counts for a series of specified time
intervals. These data are stored as separate images, or frames.
In some studies, it is desirable to have data collected only during specific phases
of a physiological function, such as the cardiac cycle. This is achieved by obtain¬

ing a signal from the patient's body, in this case, an electrocardiogram (EKG), and
using it to gate the acquisition process. For example, frames can be created to
correspond to the different segments of the cardiac cycle, as illustrated in Figure
22-7. In this type of acquisition, the count data can be collected over several car¬
diac cycles. The counts in each interval are added together to form a series of

images that are actually composites of several cycles.

 Digital Imaging Systems and Image Processing 325

Image
15 65 86 84 79 65 12

25 61 83 92 99 95 78 68 .Pixel
43 67 80 88 95 91 82 '71 12

25 61 75 91 98 92 85 73 45

48 68 80 87 96 88 79 65

52 77 80 83 81 72 63

60 73 78 76 71 60

60 68 70 65 57

51 58 49

Horizontal Location

Figure 22-5 The Creation of a Numerical Image. A Photon Is Recorded by Increasing the
Count Value in the Corresponding Pixel
326 Physical Principles of Medical Imaging

Frames

Figure 22-6 A Series of Images (Frames) as Recorded in the Matrix Mode

List Mode

In the list mode of data

acquisition, the data are arranged in memory according
to the sequence in which the photons are detected by the camera. Each time a
photon is detected, a pair of numbers representing its vertical and horizontal loca¬
tion is stored in the computer memory, as illustrated in Figure 22-8. In addition to
the position information, time marks and gate signals from the patient are also
stored.
The
major advantage in storing data in the list mode is that it can later be ar¬
ranged in a variety of formats at the user's discretion. It is also usually faster. A
disadvantage of the list mode is that it generally requires a larger computer
memory because a memory location is required for each photon in the frame
mode, and a memory location is required for each pixel (which can accommodate
many photons).

Analog to Digital Conversion

radiographic and fluoroscopic images are in an analog form. This

Conventional
means they are continuous, at least in one dimension, as compared to a digital
that
image, which is divided into individual discrete pixels. An analog image of this
type can be converted into a digital image by using a three-step process. The first
two steps are to divide the analog image into lines and then into individual pixels.
 Digital Imaging Systems and Image Processing 327

Figure 22-7 Relationship between a Series of Images and the EKG Signal As Created in a
Gated Study

The third step is to convert the brightness or film density of each pixel into a
digitized numerical value. This general process is illustrated in Figure 22-9.

Scanning
The first stepis to scan the image line by line as shown in Figure 22-9. A laser
beam is typically used to scan images that have been recorded on film or are on
stimulable-phosphor screens, as described later. Fluoroscopic images are scanned
continuously as part of the video process by an electron beam within the video
camera and monitor display tubes. For digitizing purposes the scan typically starts
328 Physical Principles of Medical Imaging

Figure 22-8 The Storage of Count Data in the List Mode

at one corner of the image and then scans it line by line. This scanning process
divides the image into discrete lines. The number of scan lines will generally de¬
termine the number of pixels across one dimension of the image.

Sampling
As each line is a continuous analog signal is created, which shows the
scanned,
variation in image brightness or film density along the line. This signal is then
sampled and measured at discrete intervals along the lines. Each sample interval
will correspond to one pixel. The number of sample intervals along the line will
determine the number of pixels across the image.

Conversion

The value of the analog signal during a specific sample interval is measured and

electronically converted into a digital value. This process is performed by an elec-

 Digital Imaging Systems and Image Processing 329

Converter

Analog Image Digital Image

Figure 22-9 The Process of Converting a Continuous Analog Image into Digital Values

tronic circuit which is known analog-to-digital (A-to-D) converter. The re¬

as an

sulting binary digital number becomes the value for the corresponding pixel.

Digital Scan Conversion

Most ultrasound systems produce digital images. This is done by the process of
scan conversion. As the ultrasound beam scans the patient's body an image is
formed by the reflected echoes along each beam pathway. The scanned image
format is determined by the orientation and number of scan lines. Several different
scan patterns are possible as described in Chapter 26. A digital scan converter

changes the scanned image format into a digital matrix.

IMAGE PROCESSING

When image data are stored in computer memory, they are available for various
kinds of processing. The processing is usually for the purpose of either altering a
 330 Physical Principles of Medical Imaging

characteristic of the image or obtaining quantitative data from an image or series

of images.

Contrast Modification

Image contrast is represented by the differences in the values among pixels.

This can be changed by
digital processing using one of several different methods.
Calculations

Animage with different contrast characteristics can be mathematically calcu¬

lated from an original digital
image. Multiplication of pixel values by a constant
factor greater than one and subtractions of background pixel values
generally in¬
creases contrast as shown in
Figure 22-10.

Lookup Tables
Many image processors use lookup tables to change the contrast. A lookup table
is programmed to provide a new pixel value for each pixel in the original image.
The values in the table can be selected to give a choice of
image contrast charac¬
teristics as shown in Figure 22-11.

Windowing
Most systems for viewing digitized images allow the observer to select the
range of pixel values that will be converted into the full gray scale, or brightness
range. This function is known as windowing. The two selectable variables associ¬
ated with the window are its width, or range of
pixel values, and its position along
the pixel value scale. The windowing
concept is illustrated in Figure 22-12.
When the window is set at a specific location on the
pixel value scale, all pixels
with values greater than the upper window limit are
displayed as white, all pixels
below the lower window limit are
displayed as black, and pixel values between the
two limits are spread over the full scale of
gray. In principle, the window setting
functions as a contrast control.
Decreasing window width increases image
contrast.

Detail Enhancement

It is possible todigital processing to enhance the visibility of anatomical

use
detail or other small
objects within an image. There are several different process¬
ing methods that can be used for this purpose. We recall that visibility of detail is
limited by the amount of blurring during the formation of an
image. It is not pos¬
sible to process an image later and reduce the blurring. However, it is
possible to
enhance the visibility of anatomical detail by first reducing
large area contrast so
Digital Imaging Systems and Image Processing 331
332 Physical Principles of Medical Imaging

New Gray Scale

(High Contrast)

0000024 68 10 12 16 16 16 16 16 16
AAA AAA A A A A A A AAA

t k_
Table Lookup t
0 1 2 3 4 5 6 7 8 9 10 12 13|l4|l5

Original Gray Scale

(Low Contrast)

Figure 22-11 Graph Illustrating the Contrast Enhancement Process

that the contrast of small objects becomes more predominant. One of these meth¬
ods is the blurred-mask subtraction technique. It is illustrated in Figure 22-13. The
original image is first blurred to create a so-called mask image. Digital image
blurring is generally done by replacing each pixel value with an average of the
pixel values in its immediate vicinity. This is, in effect, a smearing or blurring
process. The blurring of the image reduces the contrast and visibility of small
objects and detail, leaving an image in which only large areas of contrast are vis¬
ible. The next step is to subtract the blurred image from the original image. This
creates an image in which the large area contrast is reduced by the subtraction

process. However, the visibility of small objects and details can be enhanced be¬
cause they are now displayed on a relatively uniform background which permits

the total image contrast to be increased as described above. This technique is espe¬

cially useful in digital radiography of the chest.

 Digital Imaging Systems and Image Processing 333

Image Gray Scale

Figure 22-12 The Window Establishes the Relationship between Pixel Values and Bright¬
ness in the Display Image

Noise Reduction

Digitized images can be processed to reduce the noise produced by the statistical
fluctuation in photon concentration (quantum noise), as described in Chapter 21
and low signal-to-noise conditions in MRI. The apparent noise can be reduced by

blending or blurring the value for an individual pixel with the values for adjacent
pixels. Several mathematical approaches can be used for this, but a specific one,
the nine-point smoothing process, is illustrated in Figure 22-14. In this procedure,
the computer calculates a new image from the old. The value for each new pixel is
a weighted average value of the old pixel and the eight pixels surrounding it.

We can calculate a new value for each pixel shown in Figure 22-14. First, the

original value is multiplied by 4. The values for the four pixels located on the four
sides of the pixel being processed are multiplied by 2, and the values in the comer

pixels are multiplied by 1. The results of these multiplications are then added, and
the total is divided by 16 to give a weighted average. This process is repeated for
each pixel within the image area. When this process is applied to the image section
shown in Figure 22-14, the noise (1 standard deviation) is decreased from 10% to
334 Physical Principles of Medical Imaging

Enhanced Image

Detail

Original Image Blurred Image

Figure 22-13 The Blurred-Mask Process for Enhancing Visibility of Detail

1.8%. Image smoothing to reduce noise is generally a blurring process that re¬
duces the sharpness and visibility of small structures and detail.

IMAGE STORAGE AND RETRIEVAL

Provisions must be provided for storing and then retrieving digital images for
later use. There are several differenttechnologies and storage media that can be
used for this purpose. This storage capability is also referred to as memory. Figure

95 101 87 112 108 92 Values 101 100 98 101 97 100

113 97 110 10$ .97 110 104 1 2 1 100 97 102 103 99 101
k— 3—
102 122 88 98 125 75 122 88 98 X 2 4 2 4- 16 = 101 99 102 101 101 98 100

99 iii 100 84 113 101 iii 100 84 1 2 1 98 100 99 99 102 97

88 94 97 102 105 86 101 97 103 97 101 100

96 105 79 116 98 100 101 99 98 100 102 99

Noise ( 1 0-) = 10% Noise (1(M = 1.8%

Figure 22-14 The Reduction of Image Noise by the Use of the Nine-Point Smoothing
Process
 Digital Imaging Systems and Image Processing 335

22-15 gives an overview of the storage and retrieval process. At this point we will
consider the basic characteristics that should be considered when
selecting a stor¬
age media for a specific application. As we will see later, it is the differences in
these specific characteristics that distinguishes one
storage medium or method
from another.

Writing and Reading

The first step in storing an image or other digital data is to transfer it to the

storage medium. This transfer process is known as writing to the medium. The
writing process records the image by assigning binary values (0-1) to a long series
of digital bits. How this is done depends on the specific medium. With a magnetic
medium (disk or tape) the individual bits are magnetized to represent a value of
one and demagnetized to represent a value of zero. With
optical disk technology a
small laser beam is used to "punch" or mark the individual bit locations.
The storage or memory area is organized so that each byte has a specific ad¬
dress. When an image is stored a directory is also created in which the addresses
for each image are stored. The directory will associate the specific image storage
location or address to the patient name or ID number.
At a later time the image can be retrieved or read from the storage medium. The
first step is to consult the appropriate directory and find the patient's name or
number. The computer then looks at the assigned address and reads the digital data
representing the image. It is then transferred to the appropriate processor or dis¬
play device.
Storage or memory devices are characterized by their ability to write and read
data.

Bits
Q

Figure 22-15 The General Process for Storing and Retrieving Digital Data
336 Physical Principles of Medical Imaging

Random Access Memory (RAM)

A random memory device (RAM) is one in which data can be quickly
access

written to read from any address. This is achieved by electronic switching from
or

one address to another as opposed to mechanically moving from one area to an¬

other on disk or tape. All computers or digital processors contain RAM. This is the
active memory in which images and data are stored while they are actually being
processed or displayed. The size of a computer's RAM determines the size and
complexity of programs that it can run efficiently.

Erasable Reusable Memory (ERM)

Most magnetic storage media, disk, and tapes, are easily erasable and reusable.
When images or data are no longer needed they can be erased and new information
stored in the same locations.

Read Only Memory (ROM)

As the name implies, data cannot be written into ROM. Computers generally
contain some ROM in which their basic operating programs are stored. The data
are written into the memory by the manufacturer and cannot be altered by the user.

Write Once Read Many (WORM)

A WORM device is one in which data are written
permanently and cannot be
erased. However, it is possible to read the information many times. An optical disk
in which a laser produces a permanent mark in a bit location is an example of
WORM memory.

Capacity
The capacity of a specific memory device determines the number of images that
can be stored. As we recall, there is a considerable variation in the number of bytes
required to store an individual image. It depends on the matrix size and the number
of bytes per pixel. Memory size or storage capacity is
generally expressed in
megabytes or gigabytes.

Table 22-2 Digital Image Storage Capacity Requirements

Matrix Size Images per Megabyte

(8 bits/pixel) (16 bits/pixel)

256 x 256 16 8
512 x 512 4 2
1024 x 1024 0.5
 Digital Imaging Systems and Image Processing 337

Table 22-2 shows the number of

images that can be stored in one megabyte for
the different matrix sizes. It is
important to note that the storage requirements are
proportional to the square of the image matrix size. It takes four times the capacity
to store a 512 square image as it does a 256
square image.

Speed
An important characteristic of
digital storage media is the speed with which
a
data can be written and read. This is
especially important because it determines the
time required to retrieve and display stored images. There is generally an inverse

relationship between speed and capacity. This is illustrated by the following three
general types of storage media.

Random Access Memory (RAM)

RAM is characterized
by very fast writing and reading speeds. Images can be
retrieved from RAM and displayed in a fraction of a second. However, a typical
RAM within a computer can store just a few images. It is the memory that is used
to hold images only while they are being reconstructed, processed, or displayed.

Disk

Retrieval of
images from disk is somewhat slower than from RAM. One reason
is that the read head (sensor) must move to the location on the disk where the
image data is stored. It then reads the individual bits from the spinning disk.
Some disk systems for long-term storage (archiving) use a so-called "juke-box"
design. It contains many disks located in a storage rack. When a specific image is
requested the computer locates the disk on which it is stored, mounts it on the
spinning disk drive, and then reads the image data. This design increases total
storage capacity but at the cost of the reduced retrieval speed.

Tape
The retrieval of
images from magnetic tape is relatively slow because the tape
must be run location containing the desired image. Tape can be used for
to the

image archiving because tapes can be manually stored and retrieved when neces¬
sary. In principle, the total storage capacity is limited by a facility's space for
storing tapes.

IMAGE DISPLAY AND ANALYSIS

Digital images are not suitable for direct viewing. In most applications, the digi¬
talimage is converted into a video image, which can then be observed or recorded
on film. This conversion is performed by an electronic device: a digital to analog

(video) converter.
338 Physical Principles of Medical Imaging

The transfer of digital image to film is usually made by a laser camera. In this
a

device a scans over the film. The brightness of the beam is controlled
laser beam
by the pixel value that determines the exposure to the film in each pixel location.

Color

Some systems use a color display. In such a system, the computer translates

pixel values into specific colors. Color spectra are generally used to represent
characteristics such as levels of radioactivity in SPECT and PET and flow velocity
in Doppler ultrasound imaging.

Analysis
Profiles
The ability to compare a characteristic, such as density, activity, or signal inten¬

sity of various areas within an image, is often improved by generating a profile.

Typically, the computer is instructed to select a specific row of pixels and to create
a graphic display of the pixel values.

Regions of Interest
Computers can be instructed to outline a region of interest (ROI) in an image.
Then data such as the average and standard deviation of values within the region
can be obtained. A useful function for many dynamic studies is to produce a

graphic display of the change within the ROI as a function of elapsed time. Time-
activity curves are useful for observing the build-up and elimination of contrast
media or radioactive materials within a specific body region or organ.

DIGITAL X-RAY IMAGING SYSTEMS

Digital image processing is incorporated into many x-ray imaging systems.

Three specific applications are described below.

Computed Radiography

Although there are several different ways to produce computed radiographs, the
most prevalent method is illustrated in Figure 22-16. Here the general concept of
computed radiography is compared to conventional radiography that uses a film in
direct contact with intensifying screens. In principle, computed radiography in¬
serts an image processing computer between the receptor screen and the film. The

digital processor can perform a number of functions including:

•
Compensate for exposure errors
•
Change contrast characteristics
 Digital Imaging Systems and Image Processing 339

Stimulable-Phosphor Film
Screen
(After X-Ray Exposure)
Figure 22-16 The Concept of Computed Radiography Compared to a Conventional
Cassette

• Enhance image detail

• Store and distribute images in digital form

STIMULABLE PHOSPHOR RECEPTOR

The receptorin this type of computed radiography system consists of a screen

or plate of a stimulable phosphor material. It is typically contained in a cassette
and is exposed like conventional film-screen radiographic cassettes. However, the

stimulable-phosphor screen differs from the conventional intensifying screen in

this way. Whereas an intensifying screen produces light at the time of exposure,
the stimulable-phosphor screen does not produce light until it is scanned with a
laser beam at some time after the x-ray exposure.
The sequence of events in producing a computed radiograph is as follows. The
cassette containing the stimulable-phosphor screen is exposed and then inserted

into the processing equipment. In the processor the exposed screen is scanned with
a laser beam. The laser beam stimulates the phosphor material
causing each point
on the surface to emit light with a brightness proportional to the x-ray
exposure.
This general process is illustrated in Figure 22-16. The light is measured, con¬
verted into a digital value, and stored in the computer's memory.
After reading an image from the screen as described above, the processor erases
and restores the screen and then reloads it into a cassette ready for the next patient.

IMAGE PROCESSING

The computer that is part of the processing equipment can be programmed to

change the characteristics of the image in several different ways. In principle, the
 340 Physical Principles of Medical Imaging

computer creates the effective characteristic curve for the radiograph. This is illus¬
trated in Figure 22-17. The stimulable-phosphor screen has a linear response over
a wide range of
exposures. This is represented by the straight line in Figure 22-17.
When the receptor is exposed, a latent image is formed as a relatively small
range
of exposures somewhere within the range. Images created with three different lev¬
els of x-ray exposure are indicated. During the processing the equipment deter¬
mines where the exposure is located within the range. It then adjusts the effective

receptor sensitivity (speed) to match the actual exposure condition. This proce¬
dure is a compensation for errors in the initial x-ray exposure. It will
produce a
radiograph with appropriate density values regardless of the receptor exposure.
However, low receptor exposures will increase the quantum noise in the image
and high receptor exposure will produce unnecessary
exposure to the patient.
The computer can be programmed to produce contrast characteristics
appropri¬
ate to the specific clinical examination. This is
represented by characteristic
curves with different
shapes.

Computer Processing To Produce

High Contrast High Exposure
Low Exposure Low Contrast (Low Noise)

c/3
c
cd
Q

* I I I I I I I I I I I I I I I I I I I I I
Relative Receptor Exposure

Figure 22-17 Radiographic Exposure and Contrast Characteristics That Can Be Changed
by the Computer
 Digital Imaging Systems and Image Processing 341

Image Display

The digitally processed

image can be recorded on film with a laser camera or

displayed on a video monitor.

Digital Fluoroscopy

A digital image processor is sometimes included in a

fluoroscopy system. It is
located between the video camera and the video
display monitor. The digital pro¬
cessor and the associated memory can be used to perform several desirable func¬
tions.
Image noise can be reduced by averaging together or integrating several frames
of video image. We recall that video produces 30 images (frames) per second.
Each has a relatively high quantum noise level because it is created with a low
exposure. When these images are averaged together to form one image, the noise
is reduced because the new image represents a higher total
exposure. This tech¬
nique is especially useful for creating "freeze frame" or spot images with the fluo-
roscope.
Because of the memory capability selected, "spot" images can be stored for
display at a later time.

Digital Subtraction Angiography (DSA)

The basic principle of DSA is illustrated in Figure 22-18. The first image is
acquired before the injection of contrast medium. This image (the mask) contains

Bones
Bones and Vessels (mask) Vessels

After Injection Before Injection

of of
Contrast Media Contrast Media

Figure 22-18 The Basic Principles of Digital Subtraction Angiography

342 Physical Principles of Medical Imaging

all anatomical structures normally revealed in an x-ray image. The second image
is acquired after the contrast medium is injected into the vessel being imaged. If a
dilute concentration of contrast medium is used, the vessels will have
very little
contrast in comparison to many other structures,
especially bone. If the second
image is subtracted from the first under ideal conditions, an image showing only
the vessel containing the contrast medium will be obtained.

Image subtraction is used to increase contrast sensitivity with respect to con¬

ventional angiographic procedures, so that vascular structures with lower concen¬
trations of contrast medium can be imaged. The
improvement in contrast sensitiv¬
ity is, however, often accompanied by an increase in image noise and artifacts.
As discussed in Chapter 21, image subtraction
always increases image noise. In
DSA the two original images are usually
acquired with relatively high exposure
levels to minimize quantum noise.
The primary of artifacts in DSA is patient motion during the interval
source
between the images. If the anatomical structures are not in the same position
two
for the two images, the subtraction
process will produce an image of the move¬
ment or displacement. This
appears in the image as an artifact. Several methods
can beused to reduce the effect of motion artifacts. Some
imaging systems have a
reregistration capability that allows the user to shift one image with respect to the
other in an effort to compensate for the motion. Another
procedure is to acquire a
series of mask images, and then try different combinations to find one that
pro¬
duces the least artifact.
 Chapter 23

Computed Tomography Image

Formation

INTRODUCTION AND OVERVIEW

Computed tomography differs from conventional projection x-ray imaging in

several respects. A major difference is the way in which
the image is formed. The
formation of the CT image is a multi-step process.

Image production begins with the scanning phase, as shown in Figure 23-1.
During this phase, a thin fan-shaped x-ray beam is projected through the edges of
the body section (slice) being imaged. The radiation that penetrates the section is
measured by an array of detectors. The detectors do not "see" a complete image of
the body section, only a profile from one direction. The profile data are measure¬
ments of the x-ray penetration along each ray extending from the x-ray tube to the

individual detectors. In order to produce enough information to create a full im¬

age, the x-ray beam is rotated, or scanned, around the body section to produce
views from many angles. Typically, several hundred views are taken, and the pro¬
file data for each view are stored in the computer memory. The total number of

penetration measurements made during a scan is the product of the number of

views and the number of rays within each view. The total scanning time for one
slice can range from approximately 1 to 15 seconds, depending on the design of
the scanner mechanism and the selection of scanning variables by the operator. In

general, the quality of the image can be improved by using longer scanning times.
The second phase of image production is known as image reconstruction, as
illustrated in Figure 23-2. This is performed by the digital computer, which is part
of the CT system. Image reconstruction is a mathematical procedure that converts
the scan data for the individual views into a numerical, or digital, image. The

image is structured in an array of individual picture elements, or pixels. Each pixel

is represented by a numerical value, or CT number. The specific value for each

pixel is related to the density of tissue in the corresponding volume element, or

voxel. Reconstruction usually takes several seconds, depending on the complexity

343
344 Physical Principles of Medical Imaging

Penetration Measurements
unumuum
I I I I I II I I I I I I I I I l-Computer Memory

Figure 23-1 The Scanning Phase of CT Image Formation

Scan Data Digital Image

Reconstruction

Rays
M
CT
number

Figure 23-2 The Reconstruction of a CT Image from Scan Data

of the image and the capabilities of the computer. The digital image is then stored
in the computer memory.
The final phase is the conversion
of the digital image into a video display so that
it can be viewed
directly or recorded on film. This phase is performed by elec¬
tronic components that function as a digital-to-analog (video) converter. The rela¬

tionship between the pixel CT number values and the shades of gray, or bright-
 i
umugi ujjny irriugt r urmuiwn

ness,in the displayed image is determined by the window levels selected

by the
operator, as shown in Figure 23-3. Through the manipulation of the
upper and
lower window levels, it is possible to
adjust the brightness and contrast of the
displayed image. The window setting determines the range of CT numbers that are
spread over the entire image gray scale.
In this chapter we consider the basic construction and
operation of a CT scan¬
ner. In the next
chapter we consider, in more detail, the image quality characteris¬
tics of CT imaging.

THE X-RAY SYSTEM

The x-ray beam in a CT system must have an

appropriate shape, intensity distri¬
bution, and the ability to be rotated around the patient's body.

Tube and Gantry

The x-ray tube is mounted on a circular gantry
assembly, which rotates it
around the patient's body. Supplying electrical power to the tube while it is rotat-

CT number
Gray
scale scale
•+1000

Digital Image Viewed Image

L-1000

Figure 23-3 The Conversion of a Digital Image into a Gray Scale Image
 346 Physical Principles of Medical Imaging

ing is awkward. Most scanners use cables that wrap around the gantry while it is
rotating. This design allows only a few rotations; the gantry must then be stopped
and rotated in the other direction to uncoil the cables. Another design uses sliding
electrical contacts, or slip rings, that permit continuous high-speed rotation.

Collimation

The x-ray tube assembly contains collimating devices that determine the physi¬
cal size and shape of the x-ray beam. One set of collimators determines the angular
span of the beam, and another set determines its thickness. This latter set can usu¬
ally be adjusted to vary slice thickness.
With current technology it is not possible to create an x-ray beam with
sharply
defined edges. This is because of the finite size of the x-ray tube focal spot, which
results in a penumbra, or "partial shadow," along the beam
edges, as shown in
Figure 23-4. The radiation has the greatest intensity at the center of the slice and
reduced intensity near the edges. Some radiation exposes the tissue
adjacent to the
slice being imaged.

Filtration

The x-ray tube assembly also contains metal filters through which the x-ray
beam passes. CT x-ray beams are filtered for two purposes.

Beam Hardening
Beam hardening refers to the process of
increasing the average photon energy,
ie, hardening, that occurs when the lower-energy photons are absorbed as the
beam passes through any material. This will normally occur when an x-ray beam
passes through the human body if the beam contains a wide range of photon ener¬
gies. In CT imaging, this hardening of the beam creates an image artifact because
the peripheral tissue is exposed to a lower
average photon energy than the inner
portion of the slice. This can be minimized by hardening the beam with the filter
material before it enters the body. This filtration reduces
patient exposure by se¬
lectively removing the low-energy, low-penetrating part of the x-ray beam spec¬
trum.

Compensation
A filter with a non-uniform thickness is often placed in the x-ray beam to com¬
pensate for the non-uniform thickness of the human body. This type of filter is
thicker near the edges and is sometimes referred to as a bow-tie filter. When it is
used, the thick center section of the body is exposed to a higher radiation
intensity
than the thinner sections near the edges. The use of this type of compensation filter
 Computed Tomography Image Formation 347

—Focal Spot

™ m '
Collimator
Slice
Thickness

CD
W
O
Q

Figure 23-4 A Profile Showing the Distribution of Radiation Dose through a Slice

generally reduces patient exposure while maintaining a specified level of image

quality.

Power Supply
The generator, or power supply, for a CT system is typically a constant potential
type that can produce relatively high KV and MA values for a sustained period of
time.

DETECTORS

In a CT system, the radiation receptor is an array of many small detectors. Sev¬

eral types of detectors are in use today. The way in which they are mounted within
the gantry assembly can vary from one scanner type to another.

Function

The function of a detector element is to absorb the radiation it intercepts, and

then to produce an electrical signal proportional to the radiation intensity. In prin-
348 Physical Principles of Medical Imaging

ciple, each detector measures the radiation that penetrates the body section in the
direction of the detector.

Construction

Several materials are used for CT detectors. Solid-state detectors are made of
solid scintillation crystals that convert the x-ray energy into light. The light is then
converted into an electrical signal by either a photodiode or photomultiplier (PM)
tube. In another design, each detector is a small chamber filled with a high pres¬
sure gas, typically xenon. The radiation absorbed within the chamber ionizes the

gas, which, in turn, changes its electrical conductivity.

Two of the most important characteristics of an individual detector are its size
and its efficiency for absorbing radiation. The most significant dimension is its
width in the plane of the x-ray beam. This dimension is the detector aperture.
Small detectors are necessary to achieve high detail in CT images.
The efficiency of a detector is the percentage of radiation in its "space" that it

actually absorbs. Two factors affect detector efficiency, as shown in Figure 23-5.
The geometric efficiency is determined by the ratio of the individual detector aper¬
ture to the total space associated with each detector. This space includes the detec¬

tor itself and the inactive collimator or the interspace between it and the next de¬

tector. Radiation that enters the interspace is not absorbed by the detector and does

not contribute to image formation. The ideal situation would be a large detector

area in comparison to the dimensions of the interspace.

The other component of detector efficiency is determined by the percentage of

radiation entering the detector that is absorbed. This depends on detector thickness
and, to some extent, on the energy of the x-ray photons. The total detector effi¬
ciency is the product of the geometric and absorption efficiency values. High de¬
tector efficiency is desirable because it reduces patient dose for a
specific level of
image quality.

Sensitivity Profile
In the ideal situation, each detector would be uniformly sensitive to all radiation
passing through the body section being imaged and would be insensitive to radia¬
tion coming from outside the slice. This would permit the imaging of well-defined
slices with good detail. The slice thickness that is within the view of each detector
is determined by the position of the collimating elements. The typical collimator

geometry produces a variation in detector sensitivity along the axis passing

through the body section. A typical detector sensitivity profile is shown in Figure
23-6. The significance of this is that a CT image can contain features produced by
objects outside the nominal slice.
 Computed Tomography Image Formation 349

Absorbed in Detector

Detector Aperture Penetrate Detector

\
N
N | Absorbed in Interspace

?
I
Figure 23-5 Factors That Determine Detector Efficiency

Detector Configurations
The way in which the detectors are arranged and moved during the scanning
process has changed during the evolution of the CT scanner and is different among
scanners used today. It is common practice to designate various detector
configu¬
rations as either first, second, third, or fourth generation. The generation designa¬
tions correspond to the order in which the various configurations were developed.
Performance was improved in going from the first to the second and then on to the
third and fourth generations. The concept of generation with respect to the third
and fourth types, however, must be used with caution. They represent two differ¬
ent approaches to detector design. Each has its own operating characteristics, but

one is not inherently superior to the other.

First and Second Types

The first two detector configurations are discussed for the sake of historical
reference. The first CT scanner used a single detector element that was moved,
along with the x-ray tube, in a straight line across the patient's body to form one
view. The entire x-ray tube and detector assembly was then rotated approximately
1° and scanned across the body to form the second view. This combination of
translate-rotate motions was continued until the number of views was adequate.

Typical scanning time was approximately 4 minutes. The scanning time was re¬
duced with the development of the second type of detector configuration, which
350 Physical Principles of Medical Imaging

Figure 23-6 A Profile Showing the Variation in Detector Sensitivity within a Slice

used multiple detectors and reduced the number of rotations required to achieve a
full scan.The second type also used a combined translate-rotate motion.

Third Type
The third type of detector configuration is shown in Figure 23-7. An array of
individual detector elements that is just large enough to form one view is mounted
on the gantry so that it rotates along with the x-ray tube. This is often referred to as

a rotating detector configuration.

Fourth Type
The fourth type of detector configuration is a ring of detector elements that
completely encircles the patient's body, as shown in Figure 23-8. The detectors
are stationary and do not rotate. This arrangement has many more detector ele¬

ments than the third type, but they are not all in use at the same time. Different

segments of the detector array are exposed as the x-ray tube rotates. The functional
difference between the third and fourth types is the way in which the individual
views are created.

COMPUTER

The digital computer, which is a major component of a CT system, performs

several functions.
 Computed Tomography Image Formation 351

Stationary Detectors

Figure 23-8 A Type 4, or Stationary-Rotate, Scanner

352 Physical Principles of Medical Imaging

Control

After the operator selects the appropriate scanning factors and initiates the scan,
the procedure progresses under the control of the computer. The computer coordi¬
nates and times the sequence of events that occur during the scan, which includes

turning the x-ray beam and detectors on and off at the appropriate time, transfer¬
ring data, and monitoring the system operation.

Processing

The digital computer is directly involved in the formation of CT image through

processing of the profile data to reconstruct the image. This function is made up of
many steps that are written into the computer program. The reconstruction of one
CT image requires millions of mathematical operations by the computer; the se¬

quence of the mathematical operations makes up the reconstruction algorithm.

Storage and Retrieval

A third major function of the computer in the CT system is the transfer, storage,
and retrieval of images and data. Data and images that are being processed are
temporarily stored in the computer's electronic memory. Since this memory has a
rather limited capacity, most of the images within the system are stored on mag¬
netic disk. They can be recalled from the disk for processing or display very

quickly. The disk also has a limited capacity, although it is much larger than the
electronic memory. The long-term, or archival, storage of images requires the
transfer to a storage medium that can be removed from the computer and stored

independently. Magnetic tape and floppy disks are used for this purpose.

DISPLAY UNIT AND CAMERA

The two other units that make up a CT system are the display unit (viewing
console) and the camera, which records the images onto film. Most CT systems
use a multi-format camera.

The viewing unit is the interface between the CT system and the physician or
operator. The image display is a CRT or video monitor. Before the digital images
are transferred to the
viewing unit by the computer, they are converted from a
digital to a video form.
The viewer can communicate with the computer through a keyboard, joystick,
or tracker ball. This allows the viewer to select
specific images for display, control
brightness and contrast, implement display functions such as zoom and rotation,
and analyze region of interest (ROI).
 Computed Tomography Image Formation 353

SCANNING

The scanning process is the first step in the formation of a CT

image. During the
scanning phase, the data are collected that will be used as a basis for reconstruct¬
ing the image. The scanning process consists of rotating the x-ray beam around the
patient's body and making measurements of the penetration through the body
from various directions. One scan will result in hundreds of thousands of indi¬
vidual penetration measurements, or samples.

Rays

A ray is the portion of an x-ray beam that is projected onto an individual detec¬
tor, as shown in Figure 23-9. Typically, a ray passes through the body slice as
shown. The radiation within the ray is absorbed by the tissue in the pathway. The
rate of absorption at each point along the way is determined by the value of the

linear attenuation coefficient. For the purpose of this discussion, let us divide the
tissue into a line of individual blocks. Each block of tissue has an attenuation
coefficient value that depends on the type of tissue and the energy of the photons
within the x-ray beam. In principle, each block of tissue attenuates the x-ray beam
by an amount equal to the value of the attenuation coefficient. The total attenua¬
tion (or penetration) along a ray is related to the sum of the individual attenuation
coefficients of points along the ray.
The projection of one ray through a body section produces a measurement of
the total attenuation, or penetration, along its path; the measurement represents the
sum of the individual attenuation coefficient values for each voxel of tissue within

the ray. With a single measurement, there is no way to determine the individual
voxel attenuation coefficient values. However, by projecting many rays through a

body section, making measurements for each, and then reconstructing the image,
the attenuation coefficient value for each voxel within the slice can be calculated.

Views

A view consists of a collection of rays that share a common point. The common
point can be either a focal spot location or an individual detector, depending on the
specific detector configuration.
Third Type
In systems with the third type of detector configuration (Figure 23-7), a view is
created by exposing all of the detectors from one focal spot location. All of the
rays within the view are projected simultaneously. The time required to create one
view is relatively short and is controlled by turning either the x-ray tube or the
354 Physical Principles of Medical Imaging

Focal Spot ^

detectors on and off. Additional views are created as the x-ray tube (focal spot)
and detector array rotate around the body.

Fourth Type
In views created by CT scanners with the fourth type of detector configuration

(Figure 23-8), one detector is common to all rays within one view. Individual rays
are created as the focal spot moves along its circular path. The rays are not pro¬

jected simultaneously, as in the third type, but are produced sequentially as the
x-ray tube moves along.
During each scan, many views are being developed at the same time. This is
possible because the x-ray beam exposes many detectors simultaneously. For ex-
 Computed Tomography Image Formation 355

ample, when the focal spot is in a specific position, it can project the first ray of one
view, the second ray of another view, and the third ray of yet another view, etc.

Measurements and Samples

The total number of measurements, or data samples, obtained during one scan is
the product of the number of views and the number of rays per view. The actual
number varies from one type of scanner to another; it also depends on the selection
of scanning factors by the operator. In principle, increasing the number of mea¬
surements improves image quality but often increases scanning time. The number

of measurements per scan is typically within the range of 500,000 to 1.5 million.
A typical scan is created by rotating the x-ray beam through an angle of 360°.
Some systems can be set to scan through a smaller angle, to reduce time, or to scan

through angles larger than 360°, to increase the number of measurements and im¬
age quality. The number of measurements per scan is generally not set directly by
the operator but is affected by the examination type (or mode) and the scanning
time.

IMAGE RECONSTRUCTION

CT image reconstruction is the process of transforming the x-ray penetration

measurements into a digital image of the body section. It is a mathematical process
performed by the computer using one of several mathematical methods of image
reconstruction.

Image Format
The image is reconstructed in the form of an array of individual picture ele¬
ments, or pixels. The number of pixels making up the image is typically in the
range of 64 x 64 pixels to 512 x 512 pixels. The matrix size (number of pixels per
image) is selected by the operator before the scan procedure. Pixel size has a sig¬
nificant effect on image quality and must be selected to fulfill the needs of the

specific clinical procedure.

Each pixel in the image corresponds to a volume element, or voxel, of tissue in
the body section being imaged. The size of the individual tissue voxel has a sig¬
nificant effect on image quality. Three examination variables affect the size of a
voxel, as shown in Figure 23-10: (1) matrix size, (2) field of view, and (3) slice
thickness. The slice thickness corresponds to the depth of a voxel. The dimension
of a voxel area is the field of view divided by the matrix size. For example, a 25.4-
cm (10-in.) field of view with a 256 matrix produces tissue voxels with dimensions
356 Physical Principles of Medical Imaging

FOV (mm) Voxel

i \
/// / / // / (llf! TTl

d =
Matrix Size

Matrix Size (voxels)

(64, 128, 256, 512)

Figure 23-10 The Relationship of Voxel Size to FOV, Matrix Size, and Slice Thickness

(length and width) of 1 mm. Changing either the field of view or the matrix size
alters the dimensions of the individual voxels.

CT Numbers

In the reconstructed image, each pixel is represented by a numerical value re¬

lated to the linear attenuation coefficient value of the tissue in each voxel, as
shown in Figure 23-11. In principle, the reconstruction process first calculates the

Tissue Voxel Image Pixel

MTissue juH?o X 1000

—

CT number =
Mh,0

/ \
Tissue Photon
Density Energy

Figure 23-11 The Relationship of Pixel (CT) Number and Tissue Voxel Attenuation Coef¬
ficient Value (p.)
 Computed Tomography Image Formation 357

attenuation coefficient value for each voxel and then transforms it into an appro¬
priate image pixel value. The pixel values are generally designated CT numbers.
Most systems express CT numbers in Hounsfield units. The
relationship be¬
tween a CT number and the
corresponding attenuation coefficient value is given
by
CT number =
((ji Tissue - p. h2o)/|1 h2o) x 1,000.
Water is used as a reference material for determining CT numbers. By defini¬
tion, water has a CT number value of 0. Materials that have attenuation coefficient
values greater than that of water have positive CT number values, and materials
with coefficient values less than that of water have negative CT numbers. CT scan¬
ners generally operate at relatively high KVs when Compton interactions pre¬
dominate in the soft tissue. The linear attenuation coefficient values for Compton
interactions are primarily determined by material density. Therefore, at least in the
soft tissues, the CT numbers are closely related to tissue density. Tissue with a

density less than that of water (specific gravity less than 1) generally has negative
CT number values. Positive CT number values indicate a tissue density greater
than that of water.
The same tissue will not produce the same CT numbers if scanned with differ¬
ent machines because of differences in x-ray beam energy (KV and filtration) and

system calibration procedures. CT numbers obtained with the same scanner can

C
o
View A
(0
3
C
0)

CD

£
Q)
>

Attenuation

Figure 23-12 Two Views of a Body Section Used To Illustrate Back Projection
358 Physical Principles of Medical Imaging

Figure 23-13 The Concept of Back Projection Image Reconstruction

vary from one time to another and if the location of the specific tissue is changed
within the imaged area. If CT numbers are to be used for analytical purposes such
as the determination of bone density, it is usually necessary to scan a set of refer¬
ence materials along with the patient.

Back Projection

Although several mathematical methods can be used to reconstruct CT images,

one method, filtered back projection, is used almost exclusively. In principle, the
reconstruction of an image by the back projection method is the inverse of the
scanning process. During the scanning of a body section, the x-ray beam is pro¬
jected through the section from different directions to create different views, as
shown in Figure 23-12. Since the x-ray beam is projected through the sides of the

body section, a view "sees" only a composite attenuation profile rather than the
individual anatomical structures within the slice. This illustration shows only two
of the several hundred views usually made in an actual scan.
 Computed Tomography Image Formation 359

Figure 23-13 (continued)

It will be possible to reconstruct an image of the body section if a number of the

individual profiles are projected back onto an image area. The general concept of
back projection is illustrated in Figure 23-13. The bottom row shows the back

projection of four views onto an image surface. Each view profile contains only
enough information to project lines, or bands, through the image. However, if the
individual views are superimposed, as shown from left to right in the top row, the

image will be recreated, or reconstructed.

In this example, we used only four views to reconstruct a relatively simple im¬

age. Several hundred views are normally required to reconstruct the more com¬
plex and detailed image of a body section.
 Chapter 24

Computed Tomography Image

Quality

INTRODUCTION AND OVERVIEW

The CT image is distinctly different from the conventional radiograph. The best
use of CT imaging and accurate interpretation will be easier to achieve if one has
a good understanding of CT image quality characteristics and how they can be

altered to fit specific clinical needs.

Before initiating a scan, the operator must adjust values for a relatively large
number of imaging factors. The factors for a typical CT system are shown in Fig¬
ure 24-1; most will have a direct effect on one or more image quality characteris¬

tics. In many instances, changing a factor to improve one image characteristic will

adversely affect some other characteristic. Therefore, the issue is not which fac¬
tors give the "best" image, but which values produce maximum visibility of spe¬

cific anatomic or pathologic features. For example, a selection of imaging factors

to produce maximum visibility of detail generally lowers visibility of subtle dif¬

ferences in soft tissue. Image quality must also be balanced against patient expo¬
sure, x-ray tube heating, and imaging time.
In this chapter, we consider the characteristics of CT image quality and show
how they are related to the various imaging factors.
In comparison with radiography, CT imaging generally has a higher contrast

sensitivity and produces less visibility of detail, more noise, and more artifacts.

CONTRAST SENSITIVITY

Computed tomography has one image quality characteristic that is superior to

conventional radiography: a high contrast sensitivity that makes it possible to vi¬
sualize low-contrast structures and objects, especially within soft tissue. Several
factors associated with the formation of CT images contribute to its high-contrast
sensitivity.

361
362 Physical Principles of Medical Imaging

Figure 24-1 Operator-Selected Factors That Affect CT Image Quality

Tomography
In tomographic imaging, each anatomical feature is displayed directly and is
not superimposed on other objects. This makes it possible to enhance the contrast
in the areas of interest without interference from high-contrast bony structures.

Windowing

high-contrast sensitivity of CT imaging is

Another factor that contributes to the
its ability to window selected segments of the CT number scale, as illustrated in
Figure 24-2. By adjusting the window levels, any segment of the CT number scale
can be expanded to cover the entire gray scale range.

The window functions as a contrast control. In principle, tissue is divided into

three categories according to window setting. Tissues with CT numbers lower
than the lower window setting appear black in the image. Tissues with CT num¬
bers greater than the upper window setting appear white. Tissues with CT num¬
bers between the lower and upper levels appear as different shades of gray.
Image contrast is related to the difference between the upper and lower window
levels. A small window produces high image contrast because small differences in
tissue CT numbers are imaged with large differences in shades of gray. A large
window setting produces an image with relatively low contrast, but visibility ex¬
tends over a wider range of CT numbers.
The window function allows rather subtle differences in tissue CT numbers to
be isolated from the full range and then be displayed over the entire gray scale.
This is a significant factor in achieving high-contrast sensitivity.
 Computed Tomography Image Quality 363

CT Numbers + 250

^+2Qo)
( + 100
]
+50

i—50

^^Window
fc)
^200^ -250

Figure 24-2 The Use of Windowing To Control Contrast in CT Imaging

Reduced Scattered Radiation

The relatively narrow x-ray beam used in CT produces much less scattered ra¬
diation than the much larger beams used in conventional radiography.

VISIBILITY OF DETAIL, BLUR, AND RESOLUTION

In CT imaging, several factors produce blurring of the image and a reduction in

the visibility of detail. Some of the factors can usually be changed by the operator.
CT blur values are usually in the range of 0.7 mm to 2.0 mm.

During scanning and image reconstruction, a series of factors contribute to the

total (composite) blur, as illustrated in Figure 24-3.

Ray (Sample) Width

One of the most significant factors that blurs the CT image and limits visibility
of detail is the width of the ray, also known as the sampling aperture. All anatomi¬
cal detail within the width of a ray is blurred together during the measurement
process.
364 Physical Principles of Medical Imaging

Focal Spot
Size

Motion

Sampling Filter
Image Detail
Aperture Smoothing

+ + □ + □ + □
Voxel Size ( Blurring)
I I
Matrix FOV

Detector
Aperture

Figure 24-3 Factors That Produce Blurring and Loss of Detail in CT Imaging

Detector Aperture

The detector aperture is the effective size of each detector in the image plane
and is one major factors that determine ray width. A small detector
of the two
aperture produces a narrow ray, less blur, and better image detail. Many scanners
have adjustable collimating devices, which can be used to change the detector

aperture. A small aperture setting produces maximum image detail. When a por¬
tion of the detector is covered, however, the geometric efficiency is reduced. An
increase in radiation exposure to the patient is then required to produce the same

image quality with respect to noise.

Focal Spot
Each ray is created by the x-ray tube focal spot. Two factors associated with the
total spot affect ray width: (1) the size of the focal spot and (2) movement during
the interval of each measurement. Small focal spots create rays with narrow
widths, which produce better image detail. However, the heat capacity of the focal
spot area is often a limiting factor. Many scanners use x-ray tubes with dual focal
spots; the small spot is used for maximum image detail and the large spot for
maximum heat capacity.
The optimum imaging situation is generally one in which the focal spot size and
detector aperture are approximately equal. If the objects being imaged are ap¬

proximately the same distance from the focal spot and detector, no advantage is
 Computed Tomography Image Quality 365

gained if the size of one greatly exceeds the size of the other. If the objects are
closer to either the focal spot or detector, the closer device has more of an influ¬
ence on the ray dimension.

Ray (Sample) Interval

Another factor that affects detail at the time the measurements are made is the
distance, interval, between adjacent rays. If the spacing between rays signifi¬
or

cantly exceeds the dimensions of small objects, or anatomical detail, the detail
will not appear in the image. The rays must be sufficiently close during the scan¬

ning procedure to measure any anatomical detail that is to appear in the image. A
relatively large interval between rays not only reduces image detail but causes
aliasing artifacts.

Voxel and Pixel Size

The formation of an image into an array of pixels is, in itself, a blurring process.
Since specific pixel can have only one CT number value, there can be no detail
a

within a pixel. In other words, all detail within the tissue voxel represented by a

specific pixel is blurred together and assigned a single value. With respect to im¬
age quality, the significant dimension is not that of the pixel in the image but rather
that of the corresponding voxel in the patient's body. Anatomical detail within a
voxel cannot be imaged. Therefore, small voxels are needed when image detail is

required.
Three factors determine voxel size: (1) field of view, (2) matrix size, and (3)
slice thickness. In principle, voxel size can be changed by changing any one of
these factors. Reducing voxel size generally, but not always, improves image de¬
tail. It will not significantly improve image detail if the voxel size is not the limit¬
ing factor, nor if the focal spot, detector, or other factors produce significantly
more blur than the voxel.
The selection of theappropriate voxel size for a specific clinical procedure gen¬
erally depends on the requirement for image detail. Noise increases as voxel size is
decreased.

Reconstruction Filters

The scan typically passed through mathematical filter algorithms in the

data are

image reconstruction process. Most systems have several filters that can be se¬
lected by the operator. Functions performed by the filters include reducing arti¬
facts, smoothing to reduce image noise, and enhancing edges. Since image
smoothing is a blurring process, the use of this type of filter can limit visibility of
detail.
366 Physical Principles of Medical Imaging

Composite Blur
We have seenthat several factors contribute to image blurring in CT. Many of
them can adjusted by the user. However, compromises must often be made
be
between image detail and other factors. The following principles must be consid¬
ered:

•
Decreasing detector aperture decreases efficiency, leading to an increase in
patient exposure or image noise.
•
Decreasing focal spot size decreases x-ray tube heat capacity.
•
Increasing matrix size increases image noise.
•
Decreasing field of view increases image noise and can limit specific clinical
applications.
Reducing blur by changing any one factor will not significantly improve image
quality unless the factor is a significant source of blur with respect to the other
factors. For example, using a small detector aperture will not improve image detail
if the detail is limited by a large focal spot or large voxel. Figure 24-4 can be used
to compare the image blur produced by individual factors; a scale of blur values is

shown for the four most significant. The compromises associated with each factor
are also indicated. Maximum image detail is obtained by reducing the blur values

as much as possible.

Filter
Detector Aperture Focal Spot Algorithm Voxel Size
i\ i | 256 | Matrix I 512 |
2.2- 2.2 2.2- 2.2

■2.0- 2.0 2.0- r- -2.0

■1.8- 1.8 1.8- 48 cm 1.8 t )

(A

1.6 ■1.6 O
1.6- 1.6
z
><

1.4- 1.4
o> 1.4 36 cm ■1.4
o c
A3 >
a !E O •1.2
1.2- ra 1.2
o
1.2-
u. r
U o
1.0 1.0 24 cm ■1.0 48 cm
■
1.0- n
E
a> CO
-0.8- 3: 0.8 0.8- ■0.8

0.6- 0.6 0.6- 12 cm ■0.6 24 cm

•
0.4. 0.4 -0.4- - •
0.4

0.2- 0.2 -0.2- ■0.2

Figure 24-4 Factors That Must Be Considered in a Scanning Procedure

 Computed Tomography Image Quality 367

The best image procedure is generally one in which blur from all sources, ex¬
cept voxel size, is approximately the same. Voxel size can usually be adjusted to a
smaller value than the other factors.

NOISE

Effect on Visibility

Image noise is significant in CT images since CT imaging is often used to visu¬

alize low-contrast tissue differences, which are especially sensitive to the presence
of noise. The amount of noise in a CT image is a major factor in determining the
effective contrast sensitivity (or contrast resolution) of an imaging procedure.
Noise in a CT image is a variation in CT number values from pixel to pixel and
exists even when all pixels are associated with the same material. A section of a
CT image of water is shown in Figure 24-5. Water has an average CT number

-2 -6 -6

-
I

-
I

-2

-2 -4 -2

-I -3

-3 -4

-
I -2 -5

Attenuation Coefficient
.191 .195 .199

I SD= 0.5%

Figure 24-5 (A) Typical CT Numbers in an Image of a Volume of Water. (B) The Spread
of Values(Standard Deviation) Is an Indication of the Amount of Image Noise.
368 Physical Principles of Medical Imaging

value of 0, but because of the presence of noise, individual pixels have a range of
values as indicated. The variation in CT numbers (noise) can be expressed in terms
of the standard deviation of the values. The graph in Figure 24-5 shows a typical
distribution of CT numbers for water. The range of values represented by 1 stan¬
dard deviation below and above the average value (0) is indicated. The value of
the standard deviation be
expressed in CT numbers or as a percentage.
can

The amount of noise in CT

image can be determined by scanning a container
a

of water and then using the viewing functions to display the standard deviation
value for a specific region of interest (ROI).

Sources

In CT imaging, the predominant source of noise, in most cases, is the fluctuation

of x-ray photon concentration, which we know as quantum noise.

Factors Affecting Noise

Several factors associated with a CT procedure affect the amount of image
noise, and they can be changed, to some degree, by the operator. As each factor is
changed to reduce noise, it either adversely affects another aspect of image quality
or increases patient exposure. The amount of noise is inversely related to the total
amount of radiation absorbed in each voxel; changing either the dimension of a
voxel or the exposure produced by the x-ray beam alters the noise level.
Pixel Size

Noise can be decreased by increasing the dimensions of the pixel (voxel), but,
as we have seen, this increases image blurring and reduces visibility of detail. This
is one of the important compromises that must be made in selecting imaging fac¬
tors.

Slice Thickness

Since slice thickness forms

one dimension of the voxel, it affects
image noise.
Thin slices, which produce better detail and fewer partial-volume artifacts, pro¬
duce higher noise levels. Again, a compromise must be made in selecting imaging
factors.

Radiation Exposure
The amount of radiation used to create a CT image can usually be varied
by
changing either the MA or the scanning time. Changing either produces a propor¬
tional change in patient dose and the radiation absorbed in individual voxels. Im-
 Computed Tomography Image Quality 369

age noise can be decreased by increasing the quantity of radiation used (MAS), but
the radiation dose absorbed by the tissue will also increase.

Window Setting
The visibility of noise in a CT image depends on the setting of the window used
to view the image. Small windows, which enhance contrast, also increase the con¬
trast and visibility of noise.

Filtration

Some of the mathematical filter algorithms used in the reconstruction process

can reduce image noise by smoothing, or blurring, the image. The compromise
that must be considered in using these filter functions is the reduction in image
detail.

ARTIFACTS

Artifacts are significant problems in CT imaging. They come from a variety of

sources but can usually be identified by their appearance. Typical artifact sources
include

•
patient motion (streaks)
•
high-attenuation objects (streaks)
•
aliasing (streaks)
• beam hardening (cupping)
• detector imbalance (rings)
•
centering
•
partial volume effect.
 Chapter 25
Ultrasound Production and
Interactions

INTRODUCTION AND OVERVIEW

Sound is a physical phenomenon that transfers energy from one point to an¬
other. In this respect, it is similar to radiation. It differs from radiation, however, in
that sound can pass only through matter and not through a vacuum as radiation
can. This is because sound waves are actually vibrations passing through a mate¬
rial. If there is no material, nothing can vibrate and sound cannot exist.
One of the most significant characteristics of sound is its frequency, which is the
rate at which the soundsource and the material vibrate. The basic unit for specify¬

ing frequency is the hertz, which is one vibration, or cycle, per second. Pitch is a
term commonly used as a synonym for frequency of sound.

The human ear cannot hear or respond to all sound frequencies. The range of

frequencies that can be heard by a normal young adult is from approximately 20

Hz to 20,000 Hz (20 kHz). Ultrasound has a frequency above this range. Frequen¬
cies in the range of 2 MHz (million cycles per second) to 20 MHz are used in
diagnostic ultrasound. Ultrasound is used as a diagnostic tool because it can be
focused into small, well-defined beams that can probe the human body and inter¬
act with the tissue structures to form images.

The basic components of an ultrasound imaging system are shown in Fig¬

ure 25-1. Most diagnostic techniques use pulsed ultrasound. The pulses move into

the body until they are reflected by some structure. Actually, it is the boundary or
interface between different types of tissue that produces the reflection. This is the
source of echo pulses, which provide the information for creating the image. The

ultrasound beam is the pathway followed by the pulses. The ultrasound image is a

display showing the location of reflecting structures or echo sites within the body.
The location of a reflecting structure (interface) in the horizontal direction is deter¬
mined by the position of the beam. In the depth direction, it is determined by the

371
372 Physical Principles of Medical Imaging

Display
Processor

Scan Generator

Intensity ^
( Gain ) ( TCG )
Pulse Generator Amplifier

Transducer "
Echo Pulse
—

Ultrasound Pulse-

Beam

Reflecting Interface

Figure 25-1 The Principal Components of an Ultrasound Imaging System

time required for the pulse to travel to the reflecting site and for the echo pulse to
return.

Transducer

The transducer is the component of the ultrasound system that is placed in direct
contact with the patient's body. It alternates between two functions: (1) producing
ultrasound pulses and (2) receiving or detecting the returning echoes. Within the
transducer there are one or more piezoelectric elements. When an electrical pulse
is applied to the piezoelectric element it vibrates and produces the ultrasound.
Also, when the piezoelectric element is vibrated by the returning echo pulse it
produces a pulse of electricity.
 Ultrasound Production and Interactions 373

Pulse Generator

The pulse generator produces the electrical pulses that are applied to the trans¬
ducer. For conventional ultrasound imaging the pulses are produced at a rate of
approximately 1,000 pulses per second. The principal control associated with the
pulse generator is the size of the electrical pulses that can be used to change the
intensity of the ultrasound beam.

Amplifier
The amplifier is used to increase the size of the electrical pulses coming from
the transducer. The amount of amplification is determined by the gain setting. The
principal control associated with the amplifier is the time gain compensation
(TGC), which allows the user to adjust the gain in relationship to the depth of echo
sites within the body. This function will be considered in much more detail in

Chapter 26.

Scan Generator

The generator controls the scanning of the ultrasound beam over the body
scan

section being imaged. This is usually done by controlling the sequence in which
the electrical pulses are applied to the piezoelectric elements within the trans¬
ducer. This is also considered in more detail in Chapter 26.

Scan Converter

The scan converter digital memory in which the image is temporarily

is a

principal function is to convert from the format of the scanning ultra¬

stored. Its
sound beam into a format for digital processing and video display.

Image Processor
The digital image from the scan converter is processed to produce the desired
contrast characteristics.

Display
The processed images are converted to video images and displayed on the
recorded on film.
screen or

One additional component of the ultrasound imaging system that is not shown
is the digital disk or tape that is used to store images for later viewing.
374 Physical Principles of Medical Imaging

ULTRASOUND CHARACTERISTICS

Ultrasound pulses have several physical characteristics that may be considered

by the user in order to apply it properly to specific diagnostic applications.

Frequency
The frequency of ultrasound pulses must be carefully selected to provide a
proper balance between image detail and depth of penetration. In general, high
frequency pulses produce higher quality images but cannot penetrate very far into
the body. These issues will be discussed in greater detail later.
The basic principles of ultrasound pulse production and transmission are illus¬
trated in Figure 25-2. The source of sound is a vibrating object, the
piezoelectric
transducer element. Since the vibrating source is in contact with the tissue, it is
caused to vibrate. The vibrations in the region of tissue next to the transducer are

passed on to the adjacent tissue. This process continues, and the vibrations, or
sound, is passed along from one region of tissue to another. The rate at which the

Pressure Amplitude

Compression

Electrical Pulse Rarefaction

Beam
/Ci,
< >
< > Velocity
< >
'r> < >
U >)
4
/
A

Piezoelectric Element Ultrasound Pulse

. Vibration

Figure 25-2 The Production of an Ultrasound Pulse

 Ultrasound Production and Interactions 375

tissue structures vibrate back and forth is the

frequency of the sound. The rate at
which the vibrations move through the tissue is the
velocity of the sound.
The sound in most diagnostic ultrasound
systems is emitted in pulses rather
than a continuous stream of vibrations. At any instant, the vibrations are contained
within a relatively small volume of the material. It is this volume of
vibrating
material that is referred to as the ultrasound pulse. As the vibrations are
passed
from one region of material to another, the ultrasound pulse, but not the material,
moves away from the source.

In soft tissue and fluid materials the direction of vibration is the same as the
direction of pulse movement away from the transducer. This is characterized as
longitudinal vibration as opposed to the transverse vibrations that occur in solid
materials. As the longitudinal vibrations pass through a region of tissue, alternat¬

ing changes in pressure are produced. During one half of the vibration cycle the
tissue will be compressed with an increased pressure. During the other half of the

cycle there is a reduction in pressure and a condition of rarefaction. Therefore, as

an ultrasound pulse moves through tissue, each location is
subjected to alternating
compression and rarefaction pressures.
As shown in Figure 25-2, the space through which the ultrasound pulse moves
is the beam. In a diagnostic system, pulses are emitted at a rate of approximately
1,000 per second. The pulse rate (pulses per second) should not be confused with
the frequency, which is the rate of vibration of the tissue within the pulse and is in
the range of 2-20 Mhz.
The frequency of sound is determined by the source. For example, in a piano,
the source of sound is a string that is caused to vibrate by striking it. Each string
within the piano is adjusted, or tuned, to vibrate with a specific resonant fre¬

quency. In diagnostic ultrasound equipment, the sound is generated by the trans¬

ducer. The major element within the transducer is a crystal designed to vibrate
with the desired frequency. A special property of the crystal material is that it is
piezoelectrical. This means that the crystal will deform if electricity is applied to
it. Therefore, if an electrical pulse is applied to the crystal it will have essentially
the same effect as the striking of a piano string: the crystal will vibrate. If the
transducer is activated by a single electrical pulse, the transducer will vibrate, or

"ring," for a short period of time. This creates an ultrasound pulse as opposed to a
continuous ultrasound wave. The ultrasound pulse travels into the tissue in contact
with the transducer and moves away from the transducer surface, as shown in

Figure 25-2. A given transducer is often designed to vibrate with only one fre¬
quency, called its resonant frequency. Therefore, the only way to change ultra¬
sound frequency is to change transducers. This is a factor that must be considered
when selecting a transducer for a specific clinical procedure. Certain frequencies
are more appropriate for certain types of examinations than others. Some trans-
376 Physical Principles of Medical Imaging

ducers are capable of producing different frequencies. For these the ultrasound

frequency is determined by the electrical pulses applied to the transducer.

Velocity

The significance of ultrasound velocity is that it is used to determine the depth

location of structures in the body. The velocity with which sound travels through a
medium is determined by the characteristics of the material and not characteristics
of the sound. The velocity of longitudinal sound waves in a liquid type medium
like tissue is given by

Velocity =
P

where p is the density of the material, and E is a factor related to the elastic prop¬
erties of the material. The velocities of sound through several materials of interest
are given in Table 25-1.
Most ultrasound systems are set up to determine distances using an assumed
velocity of 1540 m/sec. This means that displayed depths will not be completely
accurate in materials that produce other ultrasound velocities such as fat and fluid.

Wavelength

The distance sound travels during the period of one vibration is known as the

wavelength, A. Although wavelength is not a unique property of a given ultra¬

sound pulse, it is of some significance because it determines the size (length) of
the ultrasound pulse. This has an effect on image quality, as we will see later.

Figure 25-3 shows both temporal and spatial (length) characteristics related to
the wavelength. A typical ultrasound pulse consists of several wavelengths or vi¬
bration cycles. The number of cycles within a pulse is determined by the damping
characteristics of the transducer. Damping is what keeps the transducer element

Table 25-1 Approximate Velocity of Sound in Various Materials

Velocity
Material (m/sec)

Fat 1450
Water 1480
Soft tissue(average) 1540
Bone 4100
 Ultrasound Production and Interactions 111

TIME

Pulse Duration
r« ►
Period

VELOCITY
ta A
(Compression)
Pressure Amplitude
(Rarefaction)

Wavelength
Pulse Length

DISTANCE

Figure 25-3 The Temporal and Length Characteristics of an Ultrasound Pulse

from continuing to vibrate and produce a long pulse. The wavelength is deter¬
mined by the velocity, v, and frequency, f, in this relationship:

Wavelength = v/f.

The period is the time required for one vibration cycle. It is the reciprocal of the
frequency. Increasing the frequency decreases the period. In other words, wave¬
length is simply the ratio of velocity to frequency or the product of velocity and
the period. This means that the wavelength of ultrasound is determined by the
characteristics of both the transducer (frequency) and the material through which
the sound is passing (velocity).

Amplitude
The amplitude of an ultrasound pulse is the range of pressure excursions as
shown in Figure 25-3. The pressure is related to the degree of tissue displacement
caused by the vibration. The amplitude is related to the energy content, or "loud¬
ness," of the ultrasound pulse. The amplitude of the pulse as it leaves the trans¬
ducer is determined by how hard the crystal is "struck" by the electrical pulse.
378 Physical Principles of Medical Imaging

Most systems have a control on the pulse generator that changes the size of the
electrical pulseand the ultrasound pulse amplitude. We designate this as the inten¬
sity control, although different names are used by various equipment manu¬
facturers.
In diagnostic applications, it is usually necessary to know only the relative am¬
plitude of ultrasound pulses. For example, it is necessary to know how much the
amplitude, A, of a pulse decreases as it passes through a given thickness of tissue.
The relative amplitude of two ultrasound pulses, or of one pulse after it has under¬

gone an amplitude change, can be expressed by means of a ratio as follows:

Relative amplitude (ratio) = A2/A1.

There are advantages in expressing relative pulse amplitude in terms of the loga¬
rithm of the amplitude ratio. When this is done the relative amplitude is specified
in units of decibels (dB). The relative pulse amplitude, in decibels, is related to the
actual amplitude ratio by

Relative amplitude (dB) = 20 log — .

Ai

When the amplitude ratio is greater than 1 (comparing a large pulse to a smaller
one), the relative pulse amplitude has a positive decibel value; when the ratio is
less than 1, the decibel value is negative. In other words, if the amplitude of a pulse
is increased by some means, it will gain decibels, and if it is reduced, it will lose
decibels.
Figure 25-4 compares decibel values to pulse amplitude ratios and percent val¬
ues. The first two pulses differ in amplitude by ldB. In comparing the second
pulse to the first, this corresponds to an amplitude ratio of 0.89, or a reduction of
approximately 11%. If the pulse is reduced in amplitude by another 11 %, it will be
2 dB smaller than the original pulse. If the pulse is once again reduced in ampli¬
tude by 11% (of 79%), it will have an amplitude ratio (with respect to the first

pulse) of 0.71:1, or will be 3 dB smaller.

Perhaps the best way to establish a "feel" for the relationship between pulse
amplitude expressed in decibels and in percentage is to notice that amplitudes that
differ by a factor of 2 differ by 6 dB. A reduction in amplitude of -6 dB divides the
amplitude by a factor of 2, or 50%. The doubling of a pulse amplitude increases it
by +6 dB.
During its lifetime, an ultrasound pulse undergoes many reductions in ampli¬
tude as If the amount of each reduc¬
it passes through tissue because of absorption.
tion is known in decibels, the total reduction can be found by simply adding all of
the decibel losses. This is much easier than multiplying the various amplitude
ratios.
 Ultrasound Production and Interactions 379

IdB 2dB A A A /N
89% 3dB
M/
6dB
79°/c
12 dB
71%
18 d B

24 dB
V
50%

V
25%

12.5%
6%

Figure 25-4 Pulse Amplitudes Expressed in Decibels and Percentages

Intensity and Power

Power is the rate of energy transfer and is expressed in the units of watts. Inten¬
sity is the rate at which power passes through a specified area. It is the amount of
power per unit area and is expressed in the units of watts per square centimeter.
Intensity is the rate at which ultrasound energy is applied to a specific tissue loca¬
tion within the patient's body. It is the quantity that must be considered with re¬
spect to producing biological effects and safety. The intensity of most diagnostic
ultrasound beams at the transducer surface is on the order of a few milliwatts per
square centimeter.
Intensity is related to the pressure amplitude of the individual pulses and the
pulse rate. Since the pulse rate is fixed in most systems, the intensity is determined
by the pulse amplitude.
The relative intensity of two pulses (Ii and I2) can be expressed in the units of
decibels by:

Relative Intensity =10 log .

Ii
Note that when intensities are being considered, a factor of 10 appears in the
equation rather than a factor of 20, which is used for relative amplitudes. This is
because intensity is proportional to the square of the pressure amplitude, which
introduces a factor of 2 in the logarithmic relationship. The intensity of an ultra¬
sound beam is not constant with respect to time nor uniform with respect to spatial
area, as shown in Figure 25-5. This must be taken into consideration when
380 Physical Principles of Medical Imaging

describing intensity. It must be determined if it is the peak intensity or the average

intensity that is being considered.

Temporal Characteristics
Figure 25-5 shows two sequential pulses. Two important time intervals are the
pulse duration and the pulse repetition period. The ratio of the pulse duration to the
pulse repetition period is the duty factor. The duty factor is the fraction of time that
an ultrasound pulse is actually being produced. If the ultrasound is produced as a

continuous wave (CW), the duty factor will have a value of 1. Intensity and power
are proportional to the duty factor. Duty factors are relatively small, less than 0.01,

for most pulsed imaging applications.

With respect to time there are three possible power (intensity) values. One is the

peak power, which is associated with the time of maximum pressure. Another is
the average power within a pulse. The lowest value is the average power over the

pulse repetition period for an extended time. This is related to the duty factor.

TIME AVERAGED INTENSITY

Average

SPATIAL AVERAGED INTENSITY

Figure 25-5 The Temporal and Spatial Characteristics of Ultrasound Pulses That Affect
Intensity Values
 Ultrasound Production and Interactions 381

Spatial Characteristics
The energy or intensity is
generally not distributed uniformly over the area of an
ultrasound pulse. It can be expressed either as the peak
intensity, which is often in
the center of the pulse, for the average intensity
as over a designated area.

Temporal!Spatial Combinations
There is significance associated with each of the intensity expressions
some
.

However, they are not all used to express the intensity with respect to potential
biological effects. Thermal effects are most closely related to the spatial-peak and
temporal-average intensity (Ispta). This expresses the maximum intensity deliv¬
ered to any tissue averaged over the duration of the exposure. Thermal effects
(increase in temperature) also depend on the duration of the exposure to the ultra¬
sound. Mechanical effects such as cavitation are more closely related to the spa¬

tial-peak, pulse-average intensity (Isppa).

INTERACTION OF ULTRASOUND WITH MATTER

As an ultrasound pulse passes through matter, such as human tissue, it interacts

with the matter in several different ways. Some of these interactions are necessary
to form an ultrasound image, whereas others absorb much of the ultrasound en¬
ergy or produce artifacts and are generally undesirable in diagnostic examinations.
The ability to conduct and interpret the results of an ultrasound examination de¬

pends on a thorough understanding of these ultrasound interactions.

Absorption
As the ultrasound pulse moves through matter, it continuously loses energy.
This is generally referred to as attenuation. Several factors contribute to this
reduction in energy. One of the most significant is the absorption of the ultrasound

energy by the material and its conversion into heat. Ultrasound pulses lose energy
continuously as they move through matter. This is unlike x-ray photons, which
lose energy in "one-shot" photoelectric or Compton interactions. Scattering and
refraction interactions also remove some of the energy from the pulse and contrib¬
ute to its overall attenuation, but absorption is the most significant.

The rate at which an ultrasound pulse is absorbed generally depends on two

factors: (1) the material through which it is passing, and (2) the frequency of the
ultrasound. The attenuation (absorption) rate is specified in terms of an attenuation
coefficient in the units of decibels per centimeter. Since the attenuation in tissue
increases with frequency, it is necessary to specify the frequency when an attenu¬
ation rate is given. The attenuation through a thickness of material, x, is given by:

Attenuation (dB) = (a) (f) (x)

382 Physical Principles of Medical Imaging

where a is the attenuation coefficient

(in decibels per centimeter at 1 MHz), and/
is the ultrasound frequency, in megahertz. Approximate values of the attenuation
coefficient for various materials of interest are given in Table 25-2.
From the attenuation coefficient values given in Table 25-2 it is apparent that
there is a considerable variation in attenuation rate from material to material. The
significance of these values is now considered. Of all the materials listed, water
produces by far the least attenuation. This means that water is a very good conduc¬
tor of ultrasound. Water within the body, such as in cysts and the bladder, forms

"windows" through which underlying structures can be easily imaged. Most of the
soft tissues of the body have attenuation coefficient values of approximately 1 dB

per cm per MHz, with the exception of fat and muscle. Muscle has a range of
values that depends on the direction of the ultrasound with respect to the muscle
fibers. Lung has a much higher attenuation rate than either air or soft tissue. This is
because the small pockets of air in the alveoli are very effective in scattering ultra¬
sound energy. Because of this, the normal lung structure is extremely difficult to

penetrate with ultrasound. Compared to the soft tissues of the body, bone has a
relatively high attenuation rate. Bone, in effect, shields some parts of the body
against easy access by ultrasound.
Figure 25-6 shows the decrease in pulse amplitude as ultrasound passes through
various materials found in the human body.

Reflection

The reflection of ultrasoundpulses by structures within the body is the interac¬

tion that creates the ultrasound image. The reflection of an ultrasound pulse occurs
at the interface, or boundary, between two dissimilar materials, as shown in
Figure
25-7. In order to form a reflection interface, the two materials must differ in terms
of a physical characteristic known as acoustic impedance Z. Although the tradi¬
tional symbol for impedance, Z, is the same symbol used for atomic number, the

Table 25-2 Approximate Attenuation Coefficient Values for Various Materials

Coefficient
Material (dB/cm MHz)

Water 0.002
Fat 0.66
Soft tissue (average) 0.9
Muscle (average) 2.0
Air 12.0
Bone 20.0
Lung 40.0
 Ultrasound Production and Interactions 383

two quantities in
way related. Acoustic impedance is a characteristic of a
are no
material related to its
density and elastic properties. Since the velocity is related to
the same material characteristics, a
relationship exists between tissue impedance
and ultrasound velocity. The
relationship is such that the impedance, Z, is the
product of the velocity, v, and the material density, p, which can be written as

Impedance = (p) (v).

At most interfaces within the body, only a portion of the ultrasound pulse is
reflected. The pulse is divided into two pulses, and one pulse, the echo, is reflected
back toward the transducer and the other penetrates into the other
material, as
shown in Figure 25-9. The brightness of a structure in an ultrasound
image de¬
pends on the strength of the reflection, or echo. This in turn depends on how much
the two materials differ in terms of acoustic impedance. The
amplitude ratio of the
reflected to the incident pulse is related to the tissue impedance values
by
Reflection loss (dB) = 20 log (Z2-ZO/Z2+Z1).

(decibels) Relative Amplitude (percent)

1
0 .Water |—100
\ _ Soft Tissue (2 Mhz)
\
-20- '\
[-10
;\ -Softjlssue (5 Mhz)
•
\
-40- ; \ 1
>
\
"^Soft Tissue (10 Mhz)
: \
-60- >
\ -0.1
\
\
-80- \ -0.01
\^- -Bone
Lung
_L -0.001
-100-

llll r
KJ

1
2 3 4 5 6 7 10

Distance (cm)
Figure 25-6 The Effect of Absorption on Ultrasound Pulse Amplitude in Relation to Dis¬
tance orDepth into the Body
384 Physical Principles of Medical Imaging

TRANSDUCER

Sending Receiving

Echo Pulse t
I
M ■ ■ Interface * * ►

Penetrating _ .

Pulse

I
Figure 25-7 The Production of an Echo and Penetrating Pulse at a Tissue Interface

At most soft tissue interfaces, only a small fraction of the

pulse is reflected. There¬
fore, the reflection process produces relatively weak echoes. At interfaces be¬
tween soft tissue and materials such as bone, stones, and
gas, strong reflections are
produced. The reduction in pulse amplitude during reflection at several different
interfaces is given in Table 25-3.
The amplitude of a pulse is attenuated both
by absorption and reflection losses.
Because of this, an echo returning to the transducer is much smaller than the
origi¬
nal pulse produced by the transducer.

Refraction
When an ultrasound pulse passes through an interface at a
relatively small angle
(between the beam direction and interface surface), the penetrating pulse direction
will be shifted by the refraction process. This can produce certain artifacts as we
will see in the Chapter 26.
 Ultrasound Production and Interactions 385

Table 25-3 Pulse Amplitude Loss Produced by a Reflection

Amplitude Loss
Interface (dB)

Ideal reflector 0.0

Tissue-air —0.01
Bone-soft tissue —3.8
Fat-muscle —20.0
Tissue-water —26.0
Muscle-blood —30.0

Pulse Diameter and Beam Width

An important characteristic of an ultrasound pulse is its diameter, which is also

the width of the ultrasound beam. The diameter of a pulse changes as it moves

along the beam path. The effect of pulse size on image detail will be considered in
Chapter 26. At this point we will observe the change in pulse diameter as it moves
along the beam and show how it can be controlled.
The diameter of the pulse is determined by the characteristics of the transducer.
At the transducer surface, the diameter of the pulse is the same as the diameter of
the vibrating crystal. As the pulse moves through the body, the diameter generally
changes. This is determined by the focusing characteristics of the transducer.

Transducer Focusing
Transducers can designed to produce either a focused or nonfocused beam,
be
as shown in Figure 25-8. A focused beam is desirable for most imaging applica¬
tions because it produces pulses with a small diameter which in turn gives better

visibility of detail in the image. The best detail will be obtained for structures
within the focal zone. The distance between the transducer and the focal zone is
the focal depth.
Unfocused Transducers. An unfocused transducer produces a beam with two
distinct regions, as shown in Figure 25-8. One is the so-called near field or Fresnel
zone and the other is the far field or Fraunhofer zone.

In the near field, the ultrasound pulse maintains a relatively constant diameter
that can be used for imaging.
In the near field, the beam has a constant diameter that is determined by the
diameter of the transducer. The length of the near field is related to the diameter,
D, of the transducer and the wavelength, X, of the ultrasound by

Near field length = D2/4X.

386 Physical Principles of Medical Imaging

Far Field

(Fraunhofer Zone) I
Unfocused . r\- T\

Transducer
iiiiiifIII'i
(Fresnel Zone) mKJ u.
L •

Near Field

Focal
Zone
Focused
V •
fY
Transducer

Focal
i " ^ .u
Depth

Figure 25-8 Beam Width and Pulse Diameter Characteristics of Both Unfocused and
Focused Transducers

Recall that the wavelength is inversely related to frequency. Therefore, for a given
transducer size, the length of the near field is proportional to frequency. Another
characteristic of the near field is that the intensity along the beam axis is not con¬
stant; it oscillates between maximum and zero several times between the trans¬
ducer surface and the boundary between the near and far field. This is because of
the interference patternscreated by the sound waves from the transducer surface.
An intensity of zero at a point along the axis simply means that the sound vibra¬
tions are concentrated around the periphery of the beam. A picture of the ultra¬
sound pulse in that region would look more like concentric
rings or "donuts" than
the disk that has been shown in various illustrations.
The major characteristic of the far field is that the beam diverges. This causes
the ultrasound pulses to be larger in diameter but to have less intensity along the
central axis. The approximate angle of divergence is related to the diameter of the

transducer, D, and the wavelength by

Divergence angle (degrees) = 70A/D.

Because of the inverse relationship between wavelength and frequency, diver¬
gence is decreased by increasing frequency. The major advantage of using the
 UItrasound Production and Interactions 387

higher ultrasound frequencies (shorter wavelengths) is that the beams are less di¬
vergent and generally produce less blur and better detail.
Figure 25-8 is a representation of the ideal ultrasound beam. However, some
transducers produce beams with side lobes. These secondary beams fan out
around the primary beam. The principal concern is that under some conditions
echoes will be produced by the side lobes and produce artifacts in the image.
Fixed Focus. A transducer can be designed to produce a focused ultrasound
beam by using a concaved piezoelectric element or an acoustic lens in front of the
element. Transducers are designed with different degrees of focusing. Relatively
weak focusing produces a longer focal zone and greater focal depth. A strongly
focused transducer will have a shorter focal zone and a shorter focal depth.
Fixed focus transducers have the obvious disadvantages of not being able to

produce the same image detail at all depths within the body.
Adjustable Transmit Focus. The focusing of some transducers can be adjusted
to a specific depth for each transmitted pulse. This concept is illustrated in Figure

25-9. The transducer is made up of an array of several piezoelectric elements

rather than a single element as in the fixed focus transducer. There are two basic

array configurations: linear and annular. In the linear array the elements are ar¬
ranged in either a straight or curved line. The annular array transducer consists of
concentric transducer elements as shown. Although these two designs have differ¬
ent clinical applications, the focusing principles are similar.

Focusing is achieved by not applying the electrical pulses to all of the trans¬
ducer elements simultaneously. The pulse to each element is passed through an
electronic delay. Now let's observe the sequence in which the transducer elements
are pulsed in Figure 25-9. The outermost element (annular) or elements (linear)

will be pulsed first. This produces ultrasound that begins to move away from the
transducer. The other elements are then pulsed in sequence, working toward the
center of the array. The centermost element will receive the last pulse. The pulses

from the individual elements combine in a constructive manner to create a curved

composite pulse, which will converge on a focal point at some specific distance
(depth) from the transducer.
The focal depth is determined by the time delay between the electrical pulses.
This can be changed electronically to focus pulses to give good image detail at
various depths within the body rather than just one depth as with the fixed focus
transducer. One approach is to create an image by using a sequence of pulses,
each one focused to a different depth or zone within the body.
One distinction between the two transducer designs illustrated here is that the
annular array focuses the pulse in two dimensions whereas the linear array can

only focus in the one dimension that is in the plane of the transducer.
Dynamic Receive Focus. The focusing of an array transducer can also be
changed electronically when it is in the echo receiving mode. This is achieved by
388 Physical Principles of Medical Imaging

Electrical Pulses

i i czz3
Time I I
Linear
i i i i

i i
nnnnnnnnn

(Crossection)

CTT

Annular

Focal Zone

Figure 25-9 The Principle of Electronic Focusing with an Array Transducer

processing the electrical pulses from the individual transducer elements through
different time delays before they are combined to form a composite electrical
pulse. The effect of this is to give the transducer a high sensitivity for echoes
coming from a specific depth along the central axis of the beam. This produces a
focusing effect for the returning echoes.
An important factor is that the
receiving focal depth can be changed rapidly.
Since echoes at different depths do not arrive at the transducer at the same time,
the focusing can be swept down through the
depth range to pick up the echoes as
they occur. This is the major distinction between dynamic or sweep focusing dur¬
ing the receive mode and adjustable transmit focus. Any one transmitted pulse can
only be focused to one specific depth. However, during the receive mode, the
focus can be swept through a range of depths to pick up the
multiple echoes pro¬
duced by one transmit pulse.
 Chapter 26

Ultrasound Imaging

INTRODUCTION AND OVERVIEW

An ultrasound image is formed by scanning an ultrasound beam over a body

section as shown inFigure 26-1. In each scan line or beam position a pulse is
transmitted into the body. If there are structures within the beam that produce
reflections, the echo pulses return to the transducer where they are converted into
an electrical pulse and processed to form the image. The resulting image is essen¬

tially a map showing the echo producing sites. Two factors are used to determine
the location of the echo producing structures. The depth or distance from the trans¬
ducer to a site is measured by the time interval between the transmission of the

pulse and the reception of the returning echo. The horizontal or lateral location of
an echo site is determined by knowing the location of the beam that produced a

specific echo.
The amplitude of the returning echo is an indication of the strength of the reflec¬
tion. This is displayed either as a graph showing amplitude versus depth (A mode)
or in an image where the echo amplitude controls the brightness of the structure.

This is the so-called B (brightness) mode, which is the conventional ultrasound

image. Unfortunately, the amplitude of the returning echo is also affected by tis¬
sue absorption. The technique of time-gain compensation (TGC) is used to re¬

move the absorption effects as much as possible so that the displays show only the

characteristics of the echo producing sites.

ECHO AMPLITUDE

Let us now consider the situation shown in Figure 26-2. Here we see four echo
producing structures that are at different depths within the body section. It is as¬
sumed that all four sites are producing identical reflections and echo pulses of the

389
390 Physical Principles of Medical Imaging

Transducer

Body Section

Figure 26-1 Scanning a Body Section To Produce an Ultrasound Image

same amplitude. Both the A-mode display and the B-mode image show how these
four structures would appear if there is no compensation for the tissue absorption.

A-Mode Display
The A-mode display is useful for comparing the amplitudes of returning echo
pulses in relationship to the depth of the echo producing site within the body. The
position of an echo signal on the depth scale is determined by the transmit-receive
time interval as previously described.

B-Mode Image
In the B-mode image the brightness of each structure is determined by the am¬
plitude of the received echo. In this illustration we see that the brightness is de-
 Ultrasound Imaging 391

Body Section

Figure 26-2 An A-Mode Display and B-Mode Image

creasing with depth. This is caused by tissue absorption of both the pulse traveling
to the echo site and the returning echo. Notice the relationship between the bright¬

ness of the structures in the B-mode image and the echo amplitudes in the A-mode

display.
The decrease in echo amplitude and brightness with increase in depth is unde¬
sirable because the displays do not give a true indication of echo strengths.

Time-Gain Compensation

Time-gain compensation (TGC) is the technique that is used to remove the ef¬
absorption as much as possible. It can also be used to emphasize or
fects of tissue
de-emphasize echoes coming from specific depths.
TGC is performed by the electronic pulse amplifier. When echoes are received
by the transducer they are converted into electrical pulses that go to the amplifier.
392 Physical Principles of Medical Imaging

The principle of TGC is to amplify the electrical pulse amplitude in relationship to

the transmit-receive time interval. Since the time interval is determined by the
depth of the echo site, the amount of amplification becomes related to depth. An
echo from a shallow depth structure, will return after a short time interval and will
receive a small amount of amplification. An echo from a deeper site that returns
after a longer time interval will receive more amplification.
The amplifier increases the size of the electrical pulse. The gain of an amplifier
is the ratio by which the electrical pulse amplitude is increased. It is expressed in
the units of decibels. The gain can be adjusted by the operator. Typically there is
one gain control, which can be set to apply the same amount of amplification to all

pulses and then there is the TGC which will automatically adjust the gain in rela¬
tionship to depth. For the TGC the operator must set the controls to specific gain
values at different depths, as shown in Figure 26-3.
In the A-mode display the arrows show the increase in amplitude produced by
the TGC. We also observe that all four of the echo sites are now displayed with the
same brightness in the B-mode image.

A Mod©

Figure 26-3 The Use of TGC To Compensate for Ultrasound Absorption

 Ultrasound Imaging 393

TISSUE CHARACTERISTICS

In all B-mode images an area of brightness is produced by tissue structures that

produce echoes. The exception to this is the undesirable display of artifacts, that
will be considered later. Within a body section there are several tissue characteris¬
tics which have specific appearances in the image, as illustrated in
Figure 26-4.

Tissue Boundaries

We have already that echos are produced when the ultrasound pulse en¬
seen
counters an interface boundary between tissues that have different acoustic
or

impedences. This is the basic process that creates the ultrasound image. When
boundaries are generally larger than the ultrasound pulse they are displayed as
distinctive bright areas. Examples are the boundaries of organs, vessel walls, soft

tissue-bpone interfaces, and inserted objects such as catheters or implants.

Specular Reflections
If a tissue boundary is relatively smooth, the ultrasound pulse can experience a

specular or "mirror-like" reflection in which all of the echo pulse is reflected in the
same direction. If this is back toward the transducer, the echo will contribute to the

display of the boundary. For a specular reflection this requires the ultrasound
beam to be normal to the boundary. If the incident pulse strikes the boundary at

Body Section Display

Figure 26-4 Three Specific Tissue Characteristics That Appear in Ultrasound Images
394 Physical Principles of Medical Imaging

otherangles, the echo will not return to the transducer and be displayed in the
image.

Scatter Reflections

Most images of tissue boundaries are produced by scattering as opposed to

specular reflections. Scattering occurs when an ultrasound pulse encounters an

uneven boundary that is not
sufficiently smooth to produce a specular reflection.
These irregular surfaces produce echoes that are scattered in many directions.
Some of these echoes will be in the direction of the transducer and will contribute
to the image display. Most tissue boundaries are imaged by scattered reflections.
With scattered reflections the incident beam does not have to be normal to the
surface in order to produce an image.

Parenchyma Patterns
The parenchymal structure of tissue provides many small reflection sites within
the tissue. These produce scattered reflections in virtually all directions. Some of
these reflections will be in the direction of the transducer and will be
displayed in
the image. However, there is an important characteristic that distinguishes the
ap¬
pearance of parenchyma from the larger tissue boundaries. In the tissue paren¬
chyma there are many closely spaced echo sites so that the pulses do not interact
with them on a one-to-one basis. The weak echoes from the individual sites are
combined by the process of constructive interference to produce the tissue texture
patterns seen in the image. This is the speckel which is a predominant characteris¬
tic in most ultrasound images. Although the speckel is not a direct
display of the
minute tissue structures, it does relate to overall
parenchymal characteristics. Dif¬
ferent types of tissue and organs tend to produce different
speckel displays. How¬
ever, the appearance of a specific type of tissue will not be the same under all

imaging conditions. It depends on factors such as the frequency and size of the
ultrasound pulses.

Fluid

Most fluids have a distinctive appearance in the conventional ultrasound image

because they are not echogenic. They are sufficiently homogeneous so that there
are no structures of sufficient size to
produce observable echoes. Therefore, most
fluid collections in the body such as the bladder and cysts will
appear as dark
voids.
It is possible to get echoes form the red blood cells. This is the basis for the
imaging of flowing blood, which will be considered in Chapter 27.
 Ultrasound Imaging 395

SCAN PATTERNS

Several scanning patterns are used to move the ultrasound beam over the body
section being imaged. Four of the basic patterns are compared in Figure 26-5.
A linear scan pattern is produced by moving the beam so that all beams remain

parallel. The image area will have the same width at all depths. General advan¬
tages of a linear scan are a wide field of view for anatomical regions close to the
transducer and a uniform distribution of scan lines throughout the region. General
disadvantages include a limited field of view for deeper regions and difficulty in
intercostal imaging.
Sector scanning is performed by angulating the beam path from one transducer
location. Imaging can be performed through an intercostal space. A general disad¬
vantage is the small field of view for regions close to the transducer surface.
A trapezoid pattern is, in principle, a combination of linear and sector scanning.
The beam is angulated and moved as in the linear scan.

TRANSDUCER SCAN METHODS

There are several different methods used to scan the ultrasound beam over a

body section and to achieve the different scan patterns described above. These
methods are related to specific transducer design characteristics. For many years
the scanning was done manually by the operator who used a single beam trans-

Linear Trapezoid

Figure 26-5 Four Basic Ultrasound Scan Patterns

396 Physical Principles of Medical Imaging

ducer attached to the end of an articulating Electronic sensors in the arm

arm.
measured the beam location and orientation. Manual scanning was a relatively
slow process often requiring several seconds to form one image. Contemporary
transducers provide rapid scanning that produce many images in a second. This is
often referred to as real-time scanning, which is capable of showing motion within
the body. Transducers fall into two major categories with subdivisions within
each.

Mechanical Scanners

Mechanical scannersproduce a scan pattern by means of a moving element

within the transducer. The moving element can be either the piezoelectric crystal
or a moving acoustic reflector (mirror). Mechanical scanners function like a single

beam searchlight sweeping over the body section producing a sector scan pattern.
Some scanners use transducer elements mounted on a rotating wheel, which

sweep the beam over the sector. Another design rocks or oscillates the transducer
element to produce the scan. A third approach is to use a stationary transducer
element, which projects the ultrasound beam onto an acoustic mirror. The mirror
is driven with an oscillating motion so that the sector is scanned by the beam
reflected from the mirror's surface.
A common characteristic of the mechanical scanners is that the ultrasound
beam is produced by either a single element transducer or an annular array. This is
quite different from the electronic scanners that will now be considered.

Electronic Scanners

Many contemporary transducers use an electronic scanning process. A common

characteristic of the electronic
scanners is that the transducer contains many small

piezoelectric elements arranged in an array. However, all of the elements are not
used simultaneously. Different scan patterns and focusing are determined by the

sequence in which the elements are pulsed.

Linear Array Transducers

The linear array transducer is used to produce a rectangular scan pattern in which
all of the scan lines are parallel. This functionis illustrated in Figure 25-6. The
ultrasound beam is scanned by sequentially pulsing small groups of elements

along the array. The group of elements that are pulsed together form the transducer
aperture. The size of the aperture (number of elements) determines the lateral di¬
mension (width) of the beam as it leaves the transducer surface. The dimension of
the beam in the slice-thickness direction is determined by the dimension of the
transducer elements in that direction.
 Ultrasound Imaging 397

A scan would
begin by electrical pulses being applied simultaneously to the
first groupof elements at the end of the array. All of the small ultrasound pulses
produced by the individual elements will be in phase and will form a combined
pulse that will move away in a direction normal to the surface of the transducer.
When echoes return along the same beam path
they will be received by the same
transducer elements and converted into electrical pulses. This creates the first
beam position or scan line for the image.
The second scan line is created by moving the aperture; for example, the second
beam would be created by adding one element to the right side of the aperture and

dropping one from the left. This process is repeated many times to scan the beams
over the body section.

Another form of linear array transducer is one in which the element array has a
convex curved shape. A curvilinear
array produces a trapezoid scan pattern.

Phased Array Transducer

The phased array transducer is used to produce a sector scan pattern by elec¬
tronically sweeping the beam over the body section. This is often referred to as
electronic steering of the beam. This principle is illustrated in Figure 26-7.

Electrical Pulses

nrrnmitTi^^

Scan

Figure 26-6 A Linear Array Transducer

398 Physical Principles of Medical Imaging

Electrical Pulses

Time

Figure 26-7 A Phased Array Transducer

In this transducer the elements are arranged in a relatively short array compared
to the linear array transducer. The different scan lines are created by changing the
angle between the ultrasound beam and the transducer. The beam angle is deter¬
mined by the sequence in which the electrical pulses are applied to the transducer
elements.
pulses are applied in a sequence with a short time delay between each. This
The
causes the transducer elements to produce ultrasound pulses at different times. As
the individual pulses are produced they move away from the face of the trans¬
ducer. The vibrations within the individual pulses combine in a constructive man¬
ner to create a composite pulse or "wavefront" moving away at a specific angle.

The angle is determined by the time delay between the pulses.

The beam is swept or steered over the body section by altering the time interval
between the pulses.
 Ultrasound Imaging 399

Intercavity Probes

Intercavity (transrectal and transvaginal) and intervascular probes make it pos¬

imaged. This
sible to locate the transducer closer to the anatomical site that is to be
permits the of higher frequencies, which improves image detail.
use
There is considerable variation in the design of intercavity transducers. Both
mechanical and electronic scanning methods are used. Probes often provide both
rectangular and sector patterns and the ability to image in different planes. The
360-degree radial scan pattern is unique to intercavity probes.

Image Detail

The major factor that limits visibility of detail in ultrasound imaging is the blur¬

ring associated with the size of the ultrasound pulse. A second factor is the spacing
of the scan lines within the imaged area. Therefore, image detail is determined by
characteristics of the specific transducer and the adjustment of certain scanning
parameters.
In Chapter 25 we discovered that an ultrasound pulse has two dimensions, di¬
ameter and length, which are generally independent of each other and determined
by different factors. We will now observe how the pulse dimensions affect image
detail.

Lateral Blur

Lateral blur, or resolution, is determined by the diameter of the ultrasound

pulse, or beam width, at the time it interacts with the object creating the echo. We
recall that the width of the ultrasound beam is determined by characteristics of the
transducer such as the size of the element and the focusing. The process of lateral
blurring is illustrated in Figure 26-8. Here we have a series of small objects lo¬
cated at different depths within a body section. When the ultrasound beam scans
across the area, echoes are produced whenever the object is within the beam. This

causes the image of the object to be blurred in the lateral or scan direction. The

dimension of the blur is determined by the width of the beam or pulse diameter. In
Figure 26-8 we see that the least blurring and best visibility of detail is obtained
where the transducer is focused. This is an important factor to consider when se¬
lecting transducers for specific clinical applications.
Axial Blur

Axial, or depth, blur is determined by the length of the ultrasound pulse. This, in
turn, is determined by characteristics of the transducer, primarily the frequency
and damping. We recall from Chapter 25 that pulse length is related to wave¬
length, which is inversely related to frequency. High frequency short wave-length
400 Physical Principles of Medical Imaging

Ultrasound Beam

Focus ■ ■ • ►

Body Section Display

Figure 26-8 Lateral Blurring Produced by an Ultrasound Beam

ultrasound produces shorter pulses and less blurring along the axis of the ultra¬
sound beam. We also recall that the absorption of ultrasound in tissue increases
with frequency and limits imaging depth.
The selection of frequency for a specific clinical application is a compromise
between image detail and depth. This is illustrated in Figure 26-9.
As the ultrasound pulse passes over an object, an echo is produced when the

object is within the pulse. This results in the image of the object being blurred in
the axial direction in relationship to the length of the pulse. The concept of resolu¬
tion is also illustrated in Figure 26-9. When the distance between two objects is
short compared to the pulse length the objects will be blurred together and not
resolved or imaged as separate objects.

High frequency pulses produce better visibility of detail and resolution but are
limited with respect to depth. Lower frequencies can image deeper structures but

produce more image blurring and less visibility of detail and resolution.

Scan Line Density

Another factor that affects visibility of detail, especially in the lateral direction,
is the spacing or density of the ultrasound beams or scan lines within the image
 Ultrasound Imaging 401

Frequency
Pulse Frequency High Low
( ^

High • ■
■ 1
ibe^ebeir mm
mm
b 1
b b

■ ■

■ b
■ b

i
Low
1 1
b b

■ii
1 1
n
j!
.
j

Body Section Display

Figure 26-9 Axial Blurring Produced by the Length or Thickness of an Ultrasound Pulse

area. This is determinedby several factors, as illustrated in Figure 26-10. Better

detail is achieved by using a larger number of scan lines within the image. How¬
ever, this involves a compromise with two other important factors: penetration

depth and imaging frame rate.

The number of lines within an image is limited by the time required for the
ultrasound pulses to travel into the body and for the echo pulses to return to the
transducer. We recall that the speed of ultrasound in tissue is approximately 1540
m/s or 154,000 cm/s.
The time required to scan one complete image frame is the total distance trav¬
eled by the ultrasound pulses divided by the velocity. This total distance is the
produce of three factors: the depth (D), a multiple of 2 to allow for the echo return,
and the number of scan lines (N). This can be written as:

Time (s) = 2 D (cm) N .

154,000 cm/s
402 Physical Principles of Medical Imaging

Transducer

Depth

Body Section
Figure 26-10 Factors that Determine the Density of Scan Lines in an Ultrasound Image

A more practical consideration is the rate at which images can be created. This
is especially significant when observing moving structures. This is given by:
r>t
Rate r t \ 77,000 cm/s
(lmage/s) = •
D (cm) N (lines/images)

For example, if we need to image to a depth of 10 cm with 240 scan lines in the
image, the maximum frame rate will be 32 image frames per second. This compro¬
mise between frame rate and image detail as affected by the number of scan lines
must be considered when setting up scanning protocols.

Contrast Sensitivity

Contrast sensitivity in ultrasound is primarily related to the system's ability to

detect and display weak echoes. This can be affected by several of the parameters
 Ultrasound Imaging 403

adjusted by the operator. The TGC will have an effect on contrast sensitivity at
specific depths within the body. Ultrasound systems apply electronic and digital
processing to the image data before it is displayed. It is possible to change the
processing parameters to produce a variety of image contrast characteristics as
shown in Figure 26-11. Contrast is determined by the relationship of brightness in
the image to the digital values in the image. Different relationships are shown here

by means of curves. These are similar in concept to the characteristic curves of

film. Here the user can select the desired contrast characteristic from several pos¬
sibilities.

Artifacts

Artifacts are relativelycommon in ultrasound images. We now consider some

of the most common. The image is Figure 26-12 illustrates three possible artifacts.
It is an image of a large fluid area with one small stone in it.

Shadowing
Some objects produce shadows in ultrasound images. If the object has either
high reflection or attenuation characteristics, very little pulse energy will pass

Figure 26-11 Curves That Show the Relationship between Brightness and Digital Values
Produced by Changing the Processing Parameters
404 Physical Principles of Medical Imaging

through it. This artifact appears in the image as a streak of reduced intensity
(shadow) behind the object. We see a shadowing artifact by the stone in Fig¬
ure 26-12.

Enhancement

Enhancement is the such as fluid-filled

opposite of shadowing. Certain objects,
cysts and bladders, produce much less attenuation than adjacent tissue. This ap¬
pears as an area or streak with increased intensity extending beyond the object, as
shown in Figure 26-12.

Refraction
The refraction of the ultrasound near the edges of a fluid area can produce shad¬
owy type artifacts, as shown in Figure 26-12. When the ultrasound beam scans
across the edges of the fluid area, the refraction process spreads the beam, which

reduces its intensity. It is this reduced intensity that appears as a shadow.

Reverberation

Reverberation can occur if two or more reflecting structures are located at dif¬
ferent points along the ultrasound beam, as shown in Figure 26-13. This artifact is
produced because some of the pulses are reflected back and forth between the two

Body Section Display

Fluid

* Enhancement
Stone
Shadowing

Refraction —
Refraction Artifacts

Figure 26-12 Conditions That Produce Shadowing, Enhancement, and Refraction

Artifacts
 Ultrasound Imaging 405

Body Section Display

Image

Reflecting Structure

Artifacts

Reverberations

Figure 26-13 Conditions That Produce a Reverberation Artifact

objects. Thiscauses a time delay before the echo pulse returns to the transducer.
Because of this delay, the echo appears to have originated from a structure that is
deeper within the body than it actually is. Therefore, the image shows the structure
at several points along the beam path.

Body Section Display

O
A

Resonating Object
Metal
Stone
Gas Bubble

Figure 26-14 The Production of a Ring-Down Artifact

406 Physical Principles of Medical Imaging

Ring Down
Ring-down artifacts appear as bright streaks radiating down from certain ob¬
jects within the body, as shown in Figure 26-14. These streaks are actually what
appears as an image of many closely spaced echo sites. These artifacts are caused
by objects or structures that tend to resonate or ring when struck by the ultrasound
pulse. This can happen with small metal objects and with layers of gas bubbles
that produce the so-called bugle effect.
 Chapter 27

Ultrasound Imaging
of Cardiac Motion and
Flowing Blood

INTRODUCTION AND OVERVIEW

Ultrasound
imaging is especially useful in the cardiovascular system because of
itsability to produce images of both the motion of cardiac anatomy and flowing
blood through many parts of the vascular system. In this chapter we will consider
the various methods and modes used for this purpose and the factors that must be
considered by the user in order to obtain optimum results.

MOTION MODE

In the motion (M) mode, the ultrasound system records the motion of internal

body structures, as shown in Figure 27-1. In conventional M-mode systems, the

transducer is stationary with respect to the body, and the echo pulses control the
brightness of the display, as in B-mode operation. This display of image points is
moved across the screen. A moving echo site produces a curved track with respect
to time. By using a properly calibrated distance scale, the amount of movement of

the body structures can be readily determined.

DOPPLER IMAGING

ability to image the flow of blood comes primarily from the Doppler effect.
The
The significance of Doppler imaging is that it allows us to directly visualize blood
flow and to assess flow velocity.

Doppler Effect
The Doppler effect, which is one method used for flow imaging, is the physical
interaction between the ultrasound and the flowing blood. The Doppler effect

407
408 Physical Principles of Medical Imaging

MOTION MODE

Transducer

Time ►

Figure 27-1 A Motion (M) Mode Display

occurs when ultrasound is reflected from moving object. In vascular imaging the
a

red blood cells are the

moving objects that produce the image. When ultrasound is
reflected from a moving object, such as red blood cells, the reflected ultrasound
will have a frequency that is different from that of the incident ultrasound. This

change in frequency shown in Figure 27-2 is the so-called Doppler shift. The Dop-
pler effect was described in 1842 by Christian Johann Doppler, an Austrian math¬
ematician who used it to explain the apparent shift in the color of
light from mov¬
ing stars. The Doppler effect generally applies when any form of sound or
radiation is either emitted by or reflected from
moving objects. Doppler radar is
widely used to detect speeding automobiles and produce color weather maps of
falling precipitation. There are three major factors—velocity, direction, and
angle—that determine the amount of frequency shift that will occur. These will
now be considered.

Velocity and Direction

The real value of Doppler imaging is that it gives a display of flow velocities.
This is because theDoppler frequency shift is directly proportional to the velocity
of the red blood cells. This includes a sensitivity to flow direction, as shown in

Figure 27-3. When the flow is toward the transducer, the Doppler effect increases
 Ultrasound Imaging of Cardiac Motion and Flowing Blood 409

DOPPLER SHIFT

Moving Object

the frequency of the reflected ultrasound. When the flow is away from the trans¬
ducer, there will bea decrease in frequency. The significance is that Doppler im¬

aging can distinguish between flow in different directions.

Color is generally used in Doppler images to indicate relative velocity direction
or flow.

Angle
An important consideration in Doppler imaging is the angle between the
Figure 27-4. The amount of
ultrasound beam and the direction of flow, as shown in

frequency shift depends on this angle. Maximum frequency shift occurs when the
ultrasound beam is aligned with the direction of flow. This is generally not pos¬
sible to achieve in most situations. The frequency shift decreases as the angle is
increased up to 90 degrees. When the ultrasound beam is perpendicular to the
direction of flow (90-degree angle), no Doppler shift will occur. The specific rela¬
tionship is that the Doppler frequency shift is proportional to the cosine of the
angle, which ranges from a value of 1 at 0 degrees to a value of 0 at 90 degrees.
410 Physical Principles of Medical Imaging

Transmitted Pulse Echo Pulses

Frequency

Transducer H

Velocity

# • •#

Figure 27-3 The Doppler Effect Applied to Flowing Blood

TRANSDUCER ANGLE 70

^ DOPPLER FREQUENCY SHIFT

Figure 27-4 The Effect of Angle on Doppler Frequency Shift

 Ultrasound Imaging of Cardiac Motion and Flowing Blood 411

When using Doppler imaging to evaluate flow, there are two important factors
to consider:

1. The ultrasound beam must be oriented that is has

so some component in the
direction of flow.
2. The angle must be known if accurate velocity values are to be determined.
In practice, the angle is determined by manually aligning a marker with the vessel
in a B-mode display.

Doppler Modes

The two different modes of Doppler applications are related to how the ultra¬
sound is produced. The two possibilities are continuous wave (CW) or pulsed
ultrasound.

Continuous Wave (CW)

SomeDoppler applications use a beam of continuous ultrasound as opposed to

a series of
pulses. This mode requires a transducer with separate elements for
transmitting and receiving. Because of the continuous wave of ultrasound, a single
transducer element cannot alternate between transmitting and receiving as in more
conventional imaging methods that use discrete ultrasound pulses. CW ultrasound
does not have the ability to determine distance from the transducer because there
are no individual pulses whose travel time can be measured by the equipment. In

other words, echoes arriving from different depths within the body cannot be sepa¬
rated as in conventional imaging. However, some degree of depth selectivity is
obtained by the geometric relationship between the transmitting and receiving
transducer elements. Echoes will be produced only in the region where the two

pathways or beams overlap to create a sensitive volume.

Pulsed Doppler

Thepulsed Doppler mode uses a series of discrete ultrasound pulses like the
other imaging modes. The primary advantage of a pulsed mode is that echoes
returning to the transducer can be sorted according to distance traveled (depth) and
used to form an image.

Display of Doppler Information

There are several different ways of displaying the information obtained from
Doppler interactions. The selection of a specific display depends on the Doppler
mode (CW or pulse) and the type of flow information required for a specific clini¬
cal application.
412 Physical Principles of Medical Imaging

The information developed with the Doppler effect can be conveyed either as an
audible sound or a graphical display.

Audible Sound

The Doppler frequency shift produced by most blood-flow velocities is in the

audible range. Most systems provide an audio output through a loudspeaker so
that you can hear the Doppler signals. The sound generally contains a mixture of

components that change in frequency and loudness with the pulsing flow.

Velocity Spectrum versus Time Display

Figure 27-5 shows a display of velocity with respect to time. This is a so-called
full spectrum display because it gives an indication of the different velocities that
are present at each time. Each vertical line in the display represents a specific

instant in time. The length of the vertical line represents the range of velocities

present. The top of the line indicates the maximum velocity. The brightness of the

Quantity of Blood
at Each Velocity

lime

Figure 27-5 A Velocity Spectrum Display

 Ultrasound Imaging of Cardiac Motion and Flowing Blood 413

line at a specific velocity is determined by the relative quantity of blood moving

with that particular velocity.

Single Velocity versus Time Display

Figure 27-6 shows a display in which a single velocity value is displayed with
respect to time. With this display a single velocity value is used to represent the
entire velocity spectrum at each point in time.
Generally the user has a choice of
several parameters for representing the spectrum. The maximum and mean veloci¬
ties are frequently used although other statistical parameters are possible.

Color Doppler Display

Doppler flow information can be added to an image by using color. The display
color is determined by the direction and relative flow velocity. Typically the color
display is superimposed on a conventional B-mode display, which shows the ana¬
tomical structures near the flowing blood.
In a typical color Doppler display, red indicates flow toward the transducer and
blue indicates flow in the opposite direction. A transition to other colors, such as

yellow, is used to indicate different velocities.

t: . .

iSpnifei

max

mean

Figure 27-6 A Single Velocity Display

 Chapter 28
The Magnetic Resonance Image

INTRODUCTION AND OVERVIEW

The magnetic resonance (MR) process is capable of producing images that are
distinctly different from the images produced by other imaging modalities. A pri¬
mary difference is that MR can selectively image several different tissue charac¬
teristics. A potential advantage of this is that if a pathologic process does not alter
one tissue characteristic, it might be visible in an image because of its effect on

other characteristics. This causes the MR imaging process to be somewhat more

complex than most imaging methods. In order to optimize an MR imaging proce¬

dure for a specific clinical examination, the user must have a good knowledge of
the characteristics of the MR image and how those characteristics can be con¬
trolled.
In thischapter we will develop a basic knowledge of the MR image, how the
image relates to specific tissue characteristics, the MR imaging system, and how
image quality characteristics can be controlled.

THE MR IMAGE

The MR image displays certain physical characteristics of tissue. Let us now

use Figure 28-1 to identify these characteristics and see how they are related.

Radio Frequency Signal Intensity

The conventional MR image is a display showing the intensity of radio fre¬

quency (RF) signals emitted by the tissues. Bright areas in the image correspond to
tissues that emit a high signal intensity. There are also areas in an image that ap¬
pear as a dark void because no signals are produced. Between these two extremes
there will be a range of signal intensities and shades of gray that show contrast or
differences among the various tissues.

415
 416 Physical Principles of Medical Imaging

The MR Image

RF Signals
t
Tissue
| Magnetization
t
Magnetic Protons Flow
Relaxation

Proton
T1 T2 | Density
Tissue Characteristics
Image Types

Figure 28-1 Physical Characteristics of Tissue That Are Displayed in the Magnetic
Resonance Image

Let us now move

deeper into the imaging process and discover the relationship
between RF signal intensity and other characteristics.

Tissue Magnetization
The condition within the tissue that
produces the RF signal is magnetization. At
this point we will use an analogy with radionuclide imaging. In nuclear medicine
procedures it is the presence of radioactivity in the tissues that produces the radia¬
tion. In magnetic resonance
imaging (MRI) it is the magnetization within the tis¬
sues that produces the RF
signal radiation that is displayed in the image.
We will soon discover that tissue becomes
magnetized when the patient is
placed in a strong magnetic field. However, all tissues are not magnetized to the
same level. It is the level of
magnetization at specific "picture snapping" times
during the imaging procedure that determines the intensity of the resulting RF
signal and image brightness.
 The Magnetic Resonance Image 417

The MR image is indeed an image of magnetized tissue. Tissues or other mate¬

rials that are not
adequately magnetized during the imaging procedure will not be
visible in the image.

Protons (Magnetic Nuclei)

The conventional MR image is an image of protons. That is why an MRI proce¬

dure is often referred to as protons imaging.
The magnetization of tissue, which produces the RF signals, comes from small
magnets that are present in the tissue. These small magnets are actually the nuclei
of certain atoms that have special magnetic property called a magnetic moment.
a

Not all chemical substances have magnetic nuclei. The only substance found in
tissue that has an adequate concentration of magnetic nuclei to produce good im¬

ages is hydrogen. The nucleus of a hydrogen atom is a single proton.

When tissue that contains hydrogen (small magnetic nuclei) is placed in a

strong magnetic field, some of the protons line up together to produce the magne¬
tization in the tissue which then produces the RF signal. If a tissue does not have
an adequate concentration of molecules containing hydrogen, it will not be visible

in an MR image.

Image Types

Magnetic resonance images are generally identified with specific tissue charac¬
teristics which are the predominant source of contrast. The equipment operator
determines the type of image that is to be produced by adjusting various imaging
factors.

Proton Density
The most direct tissue characteristic that can be imaged is the concentration or
density of protons. In a proton density image, tissue magnetization, RF signal in¬
tensity, and image brightness are determined by the proton (hydrogen) content of
the tissue. Tissues that are rich in protons will produce strong signals and have a

bright appearance.

Magnetic Relaxation Times—T1 and T2

During an MR imaging procedure the tissue magnetization is periodically
flipped into an unstable condition and then allowed to recover. This recovery pro¬
cess is known as relaxation. The time required for the magnetization to relax var¬

ies from one type of tissue to another. The relaxation times can be used to distin¬

guish (ie, produce contrast) among both normal and pathologic tissues.
418 Physical Principles of Medical Imaging

Each tissue is characterized by two relaxation times: T1 and T2. Images can be
created in which either one of these two characteristics is the predominant source
of contrast. It is not usually possible to create images in which one of the tissue
characteristics (eg, proton density, Tl, or T2) is the only source of contrast. Typi¬
cally there is a mixing or blending of the characteristics. When an image is de¬
scribed as a Tl-weighted image this means that Tl is the predominant source of
contrast but there is also some contamination from the proton density and T2 char¬

acteristics.

Flow

The MR imaging process is capable of producing images of flowing blood with¬

out the use of contrast media. Although flow effects are often visible in all types of
images, it becomes the predominant source of contrast in images produced specifi¬
cally for vascular examinations.

THE MR IMAGING SYSTEM

The MR imaging system consists of several major components, as shown in

Figure 28-2. At this time we will introduce the major components and indicate
how they work together to create the MR image. The more specific details of the

image forming process will be developed in later chapters.

The Magnetic Field

The heart of the MR system is a large magnet that produces a very strong mag¬
netic field. Thepatient's body is placed in the magnetic field during the imaging
procedure. The magnetic field produces two distinct effects that work together to
create the image.

Tissue Magnetization
When the patient is placed in the magnetic field the tissue becomes temporarily
magnetized because of the alignment of the protons, as described previously. This
is a very low-level effect that disappears when the patient is removed from the

magnet. The ability of MRI to distinguish among different types of tissue is based
on the fact that different tissues, both normal and pathologic, will become magne¬

tized to different levels or change their levels of magnetization (ie, relax) at differ¬
ent rates.

Tissue Resonance

The magnetic field also causes the tissue to "tune in" or resonate at a very spe¬
cific frequency. That is why the procedure is known as magnetic resonance
 The Magnetic Resonance Image 419

Super Conducting Magnet Coil

Gradient Coils- OOOOOOO OO Image
RF Coil

RF Pulses RP Signals

OOOOOOOOO

iSuper Conducting Magnet Coil

Radio Frequency Gradient Radio Frequency

Transmitter Power Receiver
Supply

Computer

C Protocols "*) Transform Image

Analysis
and
Acquisition Control Image Reconstruction I Storage and Retrieval Display

Figure 28-2 The Magnetic Resonance Imaging System

imaging. It is actually certain nuclei, typically protons, within the tissue that reso¬
nate. Therefore, the more comprehensive name for the phenomenon that is the
basis of both imaging and spectroscopy is nuclear magnetic resonance.
In the presence of the strong magnetic field the tissue resonates in the radio

frequency (RF) range. This causes the tissue to function as a tuned radio receiver
and transmitter during the imaging process. The production of an MR image in¬
volves two-way radio communications between the tissue in the patient's body
and the equipment.

Magnet Types

There are several different types of magnets that can be used to produce the
magnetic field. Each has its advantages and disadvantages.
Superconducting
Most MR systems use superconducting magnets. The primary advantage is that
a superconducting magnet is capable of producing a much stronger magnetic field
than the other two types considered below. It is an electromagnet that operates in a
superconducting state. A superconductor is an electrical conductor (wire) that has
no resistance to the flow of an electrical current. This means that very small super-
420 Physical Principles of Medical Imaging

conducting wires can carry very large currents without overheating, which is typi¬
cal of more conventional conductors like copper. It is the combined ability to con¬
struct a magnet with many loops or turns of small wire and then use large currents

that makes the strong magnetic fields possible.

There are two requirements for superconductivity. The conductor or wire must
be fabricated from
a special alloy and then cooled to a very low temperature. Su¬

perconducting magnets are cooled with liquid helium. A disadvantage of this

magnet technology is that the coolant must be replenished periodically.

Resistive

A resistive type magnet

is made from a conventional electrical conductor such
as The name "resistive" refers to the inherent electrical resistance that is
copper.
present in all materials except for superconductors. When a current is passed
through a resistive conductor to produce a magnetic field, heat is also produced.
This limits this type of magnet to relatively low field strengths.

Permanent

It is
possible to do MRI with a non-electrical permanent magnet. An obvious
advantage is that a permanent magnet does not require either electrical power or
coolants for operation. However, this type of magnet is also limited to relatively
low field strengths.

Gradients

When the MR system is in a resting state and not actually producing an image,
the magnetic field is quite uniform or homogeneous over the region of the
patient's body. However, during the imaging process the field must be distorted
with gradients. A gradient is just a change in field strength from one point to an¬
other in the patient's body. The gradients are produced by a set of gradient coils,
which are contained within the magnet assembly. During an imaging procedure
the gradients are turned on and off many times. This action produces the sound or
noise that comes from the magnet.

The Radio Frequency System

The radio frequency (RF) system provides the communications link with the

patient's body for the purpose of producing an image.

Coils

The RF coils are located within the magnet assembly and relatively close to the
patient's body. These coils function as the antennae for both transmitting and re-
 The Magnetic Resonance Image 421

ceiving to and from the tissue. There are different coil designs for different ana¬
tomical regions. The three basic types are body, head, and surface coils. In some
applications the same coil is used for both transmitting and receiving. At other
times separate transmitting and receiving coils are used.

Transmitter

The RF transmitter generates the RF energy, which is applied to the coils and
then transmitted to thepatient's body. The energy is generated as a series of dis¬
crete RF pulses. As we will see later the characteristics of an image are determined

by the specific sequence of RF pulses used.

Receiver

A short time after

sequence of RF pulses is transmitted to the patient's body,
a

the resonating tissue will respond by returning an RF signal. These signals are
picked up by the coils and processed by the receiver. The signals are converted
into a digital form and transferred to the computer where they are temporarily
stored.

Computer

digital computer is an integral part of an MR imaging system. The production

A
and display of an MR image is a sequence of several specific steps that are per¬
formed by the computer.

Acquisition Control
is the acquisition of the RF signals from the patient's body. This
The first step

acquisition process consists of many repetitions of an imaging cycle. During each

cycle a sequence of RF pulses are transmitted to the body, the gradients are acti¬
vated, and RF signals are collected. Unfortunately, one imaging cycle does not
produce enough signal data to create an image. Therefore, the imaging cycle must
be repeated many times to form an image. The time required to acquire images is
determined by the duration of the imaging cycle, an adjustable factor known as
TR, and the number of cycles. The number of cycles used is related to image
quality. More cycles generally produce better images.
The acquisition process is controlled by protocols stored in the computer. The

operator can select from many preset protocols for specific clinical procedures or
change protocol factors for special applications.

Image Reconstruction
The RF signal data collected during the acquisition phase is not in the form of
an image. However, the computer can use the collected data to create or "recon-
422 Physical Principles of Medical Imaging

struct" an image. This is a mathematical process known as a Fourier transform that

is relatively fast and usually does not have a significant effect on total imaging
time.

Image Storage and Retrieval

The reconstructed images are stored in the computer where they are available
for additional processing and viewing. The number of images that can be stored
and available for immediate display depends on the capacity of the storage media.

RADIO FREQUENCY RADIATION

All medicalimaging modalities use some form of radiation (eg, x-ray, gamma,
etc.) or energy(eg, ultrasound) to transfer the image from the patient's body.
The MR imaging process uses radio frequency (RF) signals to transmit the im¬

age from the patient's body. The radio frequency energy used in MRI is a form of
non-ionizing radiation. The RF pulses that are applied to the patient's body are
absorbed by the tissue and converted to heat. A small amount of the energy is
emitted by the body as the signals. Actually the image itself is not transmitted
from the body. The RF signals provide information (data) from which the image is
reconstructed by the computer. However, the resulting image is a display of RF

signal intensities produced by the different tissues.

An important concept is illustrated in Figure 28-3. Each tissue voxel is an inde¬

pendent RF signal course. The intensity of the RF signal from a voxel determines
the brightness of the corresponding image pixel. Bright areas (pixels) within an

image are properly described as areas of high RF signal intensity. Contrast be¬
tween two tissues will be visible only if they emit different signal intensities. In a

later chapter we will probe deeper into the process and discover the source of the
RF signals and the conditions that produce image contrast.
We are now at the point of recognizing that the MR image is a display of mag¬
netized tissue. If a specific tissue is not magnetized it cannot produce a signal and
be visible in the image. It will appear only as a dark void. Contrast in an image is
the result of different levels of tissue magnetization at specific times during the

imaging process.

SPATIAL CHARACTERISTICS

Figure 28-3 illustrates the basic spatial characteristics of the magnetic reso¬
nance image. MRI is basically a tomographic imaging process although there are
some procedures, such as angiography, in which a complete anatomical volume

will be displayed in a single image. The protocol for the acquisition process must
 The Magnetic Resonance Image 423

Set of
Slices

Figure 28-3 The Spatial Characteristics of the Magnetic Resonance Image

be set up toproduce the appropriate spatial characteristics for a specific clinical

procedure. This includes such factors as the number of slices, slice orientation,
and the structure within each individual slice.

Slices

A typical examination will consist of at least one set of contiguous slices. In

most cases the entire set of slices is acquired simultaneously. However, the num¬
ber of slices in a set can be limited by certain imaging factors and the amount of
time allocated to the acquisition process.
The slices can be oriented in virtually any plane through the patient's body. The

major restriction is that images in the different planes cannot be acquired simulta¬
neously. For example, if both axial and sagittal images are required, the acquisi¬
tion process must be repeated. However, there is the possibility of acquiring data
from a large volume of tissue and then reconstructing slices in the different planes.
424 Physical Principles of Medical Imaging

Voxels

Each slice of tissue is subdivided into and columns of individual volume

rows

elements or voxels. The size of a significant effect on image quality. It

voxel has a

is controlled by a combination of protocol factors and should be adjusted to an

optimum size for each type of clinical examination. Each voxel is an independent
source of RF signals.

Image Pixels

Theimage is also divided into rows and columns of picture elements, or pixels.
In general, an image pixel represents a corresponding voxel of tissue within the
slice. The brightness of an image pixel is determined by the intensity of the RF

signal emitted by the tissue voxel.

CONTROL OF IMAGE QUALITY

The operator of an MRI system has tremendous control over the quality of the

Image Quality Time

Contrast
Distortion Detail Sensitivity Noise Artifacts

Protocol Factors

\ t X

Operator

Figure 28-4 Image Quality Characteristics That Can Be Controlled by the Selection of
Protocol Factors
 The Magnetic Resonance Image 425

images that are produced. The five basic image quality characteristics are identi¬
fied in Figure 28-4. These are:

1. contrast sensitivity
2. detail

3. noise
4. artifacts

5. distortion.

Each of these image characteristics is affected by a combination of the imaging

factors that make up the acquisition protocol.
Not all types of clinical procedures require images with the same characteris¬
tics. Therefore, the primary objective is to use an imaging protocol in which the
acquisition process is optimized for a specific clinical requirement.
When considering and adjusting MR image quality, attention must also be

given to the time required for the acquisition process. In general, several aspects of
image quality can be improved by using longer acquisition times.
An optimum imaging protocol is one in which there is a proper balance among
the image quality characteristics and also a balance between overall image quality
and acquisition time.
 Chapter 29

Nuclear Magnetic Resonance

INTRODUCTION AND OVERVIEW

When certain materials are placed in a magnetic field, they take on a resonant
characteristic. This means the materials can absorb and then re-radiate electro¬

magnetic radiation that has a specific frequency, as illustrated in Figure 29-1. It is

actually the nuclei of the atoms that resonate. The phenomenon is generally
known as nuclear magnetic resonance (NMR). The resonant frequency of materi¬
als such as tissue is typically in the radio frequency range so that the emitted radia¬
tion is in the form of radio signals. The characteristics of the RF signals emitted by
the material are determined by certain physical and chemical characteristics of the
material. The RF signals produced by the nuclear magnetic resonance process can
be displayed either in the form of images (MRI) or as a graph depicting chemical

composition (MR spectroscopy).

MAGNETIC FIELDS

Nuclearmagnetic resonance occurs only when a magnetic nucleus is within a

magnetic field. The magnetic field for in-vivo imaging and spectroscopy is typi¬
cally created by a superconducting electrical coil surrounding the patient's body,
as shown in Figure 29-2. At any point within a magnetic field, its two primary

characteristics are direction and field strength.

Field Direction

It will be easier to visualize a magnetic field if it is represented by a series of

parallel lines, as shown in Figure 29-2. The arrow on each line indicates the direc¬
tion of the field. On the surface of the earth, the direction of the magnetic field is
specified with reference to the north and south poles. The north-south designation
isgenerally not applied to magnetic fields used for imaging. The electromagnets

427
428 Physical Principles of Medical Imaging

Magnetic Resonance Imaging

Magnetic Field

RF Pulse RF Signal

Tissue Voxel Image Pixel

• Nuclear density
•
Longitudinal relaxation rate (T1). >•
Brightness
• Transverse relaxation rate (T2)
• Flow

Figure 29-1 The Basic Principle of Magnetic Resonance Imaging

used for imaging produce a magnetic field that runs through the bore parallel to the
major patient axis. As the magnetic field leaves the bore, it spreads out and en¬
circles the magnet, creating an external field. The external field can be a source of
interference with other devices and is usually contained by some form of shield¬
ing. This part of the field is not shown in the illustration.

Field Strength
Each point within a magnetic field has a particular intensity, or
strength. Field
strength is expressed either in the units of tesla (T) or gauss (G). The relationship

Magnetic Coil

Figure 29-2 The General Direction of the Magnetic Field Used for Imaging
 Nuclear Magnetic Resonance 429

between the two units is that 1.0 T is equal to 10,000 G (or 10 kG). At the earth's
surface, its magnetic field is relatively weak and has a strength of less than 1 G.
Magnetic field strengths in the range of 0.15 T to 1.5 T are used for imaging. The
significance of field strength is considered as we explore the characteristics of MR
images and image quality in later chapters.
Magnetic resonance imaging requires a magnetic field that is very uniform, or
homogeneous. Field homogeneity is affected by magnet design, adjustments, and
environmental conditions. Imaging generally requires a homogeneity (field uni¬
formity) on the order of a few parts per million (ppm) within the imaging area.

Gradients

During an imaging procedure, the individual voxels are formed by a temporary

distortion of the uniform field. This distortion is in the form of a variation in field

strength across the imaging space and is known as a gradient. The use of magnetic
fieldgradients is considered later.

MAGNETIC NUCLEI

Materials that participate in the MR process must contain nuclei with specific
magnetic properties. In order to interact with a magnetic field, the nuclei them¬
selves must be small magnets and have a magnetic moment. The magnetic charac¬
teristic of an individual nucleus is determined by its neutron-proton composition.

Only certain nuclides with an odd number of neutrons and protons are magnetic
and have magnetic moments. Even though most chemical elements have one or
more isotopes with magnetic nuclei, the number of magnetic isotopes that might

be useful for either imaging or in-vivo spectroscopic analysis is somewhat limited.

Among the nuclides that are magnetic and can participate in an NMR process, the
amount of signal produced by each varies considerably.

The magnetic property of a nucleus has a specific direction known as the mag¬
netic moment. In Figure 29-3, the direction of the magnetic moment is indicated

by an arrow drawn through the nucleus.

The intensity of the RF signal emitted by tissue is probably the most significant
factor in determining image quality and the time required to acquire an image.
This important issue is considered in detail later. We now begin to introduce the
factors that contribute to signal intensity.
During the imaging process, the body section is divided into an array of indi¬
vidual volume elements, or voxels. It is the signal intensity from each voxel that
determines image quality. The signal is produced by the magnetic nuclei within
each voxel. Therefore, signal intensity is, in general, proportional to the quantity
of magnetic nuclei within an individual voxel. We now consider the factors that
affect the number of nuclei within an individual voxel.
430 Physical Principles of Medical Imaging

Magnetic Nuclei Nonmagnetic Nuclei

Hydrogen -1 Carbon - 12
Low
Carbon - 13 Nitrogen - 14
Isotropic Abundance
Nitrogen - 15 Oxygen -16
Oxygen - 17
Fluorine - 19 Low
Sodium - 23 Tissue Concentration
Phosphorus - 31
Potassium-39 -1

Figure 29-3 Isotopes That Have Magnetic Nuclei

Tissue Concentration

The concentration of chemical elements in tissue covers a considerable range,

depending on tissue type and such factors as metabolic or pathologic state. The
concentration of elements in tissue are in two groups. Four elements, namely, hy¬
drogen, carbon, nitrogen, and oxygen, typically make up at least 99% of tissue
mass. Other elements, such as sodium, phosphorus, potassium, and magnesium,

are present in very low concentrations. Calcium is concentrated in bone or local¬

ized deposits.
The most abundant isotopes of the four elements that account for over 99% of
tissue mass arehydrogen-1, carbon-12, nitrogen-14, and oxygen-16. Hydrogen is
the only one of these four isotopes that has a strong magnetic nucleus. The nucleus
of the hydrogen-1 atom is a single proton. Among all the chemical elements, hy¬
drogen is unique in that it occurs in relatively high concentrations in most tissues,
and the most abundant isotope (H-l) has a magnetic nucleus.
Within the group of elements with low tissue concentrations are several with
magnetic nuclei. These include fluorine-19, sodium-23, phosphorus-31, and
potassium-39.

Isotopic Abundance

Most chemical elements have several isotopes. When a chemical element is

found in naturally occurring substance, such as tissue, most of the element is
a

typically in the form of one isotope, with very low concentrations of the other
isotopic forms. Unfortunately, some of the magnetic isotopes are the ones with a
 Nuclear Magnetic Resonance 431

low abundance in the natural state. These include carbon-13, nitrogen-15, and
oxygen-17.

Relative Sensitivity

The signal strength produced by an equal quantity of the various nuclei also
varies over aconsiderable range. This inherent NMR sensitivity is typically ex¬

pressed relative to hydrogen-1, which produces the strongest signal of all of the
nuclides. The relative sensitivity of some magnetic nuclides are:

hydrogen-1 1
fluorine-19 0.83
sodium-23 0.093

phosphorus-31 0.066

Relative Signal Strength

The relative signal strength from the various chemical elements in tissue is de¬
termined by three factors: (1) tissue concentration of the element, (2) isotopic
abundance, and (3) sensitivity of the specific nuclide.
In comparison to all other nuclides, hydrogen produces an extremely strong

signal. This results from its high values for each of the three contributing factors.
Of the three factors, only the concentration, or density, of the nuclei varies from
point to point within an imaged section. The quantity is often referred to as proton
density and is the most fundamental tissue characteristic that determines the inten¬
sity of the RF signal from an individual voxel, and the resulting pixel brightness.
In most imaging situations, pixel brightness is proportional to the density (concen¬
tration) of nuclei (protons) in the corresponding voxel, although additional fac¬
tors, such as relaxation times, modify this relationship.

Radio Frequency Energy

During an imaging procedure, RF energy is exchanged between the imaging

system and the patient's body, as shown in Figure 29-4. This exchange takes place
through a set of coils located relatively close to the patient's body. The RF coil is
the antenna that transmits energy to and receives energy from the tissue.
Unfortunately, the patient's body also creates an undesirable form of RF
energy, which is designated as noise. It is also picked up by the RF coils and
degrades the quality of the image. Both image detail and image acquisition speed
are significantly limited by the presence of this undesirable RF energy.
432 Physical Principles of Medical Imaging

RF Coil

Figure 29-4 The RF Coils and Energy Exchange with the Human Body

Pulses

RF energy is applied to the body in several short pulses during each imaging

cycle. The strength of the pulses is described in terms of the angle through which
they rotate tissue magnetization, as described below. Many imaging methods use
both 90-degree and 180-degree pulses in each cycle.

Signals
At specific time in each imaging cycle, the tissue is stimulated to emit an RF
a

signal, which is picked up by the coil, analyzed, and used to form the image. The
spin-echo or gradient-echo methods are generally used to stimulate signal emis¬
sion. Therefore, the signals from the patient's body are commonly referred to as
echoes.

NUCLEAR MAGNETIC INTERACTIONS

The NMR process is a series of interactions involving the magnetic nuclei, a

magnetic field, and RF energy pulses and signals.
 Nuclear Magnetic Resonance 433

Nuclear Alignment
Recall that amagnetic nucleus is characterized by a magnetic moment. The
direction of themagnetic moment is represented by a small arrow passing through
the nucleus. If we think of the nucleus as a small conventional
magnet, then the
magnetic moment arrow corresponds to the south pole-north pole direction of the
magnet.
In the absence of strong magnetic field, magnetic moments of nuclei are ran¬
a

domly oriented in space. Many nuclei in tissue are not in a rigid structure and are
free to change direction. In fact, nuclei are constantly tumbling, or changing direc¬
tion, because of thermal activity within the material.
When a material containing magnetic nuclei is placed in a magnetic field, the
nuclei experience a torque that encourages them to align with the direction of the
field. In the human body, however, thermal energy agitates the nuclei and keeps
most of them from aligning parallel to the magnetic field. The number of nuclei

that do align with the magnetic field is proportional to field strength. The magnetic
fields used for imaging can align only a few of every million magnetic nuclei

present.

Resonance

When a magnetic nucleus aligns with a magnetic field, it is not fixed; the
nuclear magnetic moment precesses, or oscillates, about the axis of the magnetic
field, as shown in Figure 29-5. The precessing motion is a physical phenomenon
that results from an interaction between the magnetic field and the spinning mo¬
mentum of the nucleus. Precession is often observed with a child's spinning top. A

spinning top does not stand vertical for long, but begins to wobble, or precess. In
this case, the precession is caused by an interaction between the earth's gravita¬
tional field and the spinning momentum of the top.
The significance of the nuclear precession is that it causes the nucleus to be
extremely sensitive, or tuned, to RF energy that has a frequency identical with the
precession frequency (rate). This condition is known as resonance and is the basis
for all MR procedures: NMR is the process in which a nucleus resonates, or "tunes
in," when it is in a magnetic field.
Resonance is fundamental to the absorption and emission of energy by many

objects and devices. Objects are most effective in exchanging energy at their reso¬
nant frequency. The resonance of an object or device is determined by certain
physical characteristics. Let us consider two common examples. Radio receivers
operate on the principle of resonant frequency. A receiver can select a specific
broadcast station because each station transmits a different frequency. Tuning a
434 Physical Principles of Medical Imaging

Figure 29-5 The Interactions between RF Energy and Nuclei in a Magnetic Field

radio is actually adjusting its resonant frequency. Its receiver is very sensitive to
radio signals at its resonant frequency and insensitive to all other frequencies.
The strings of a musical instrument also have specific resonant frequencies.
This is the frequency at which the string vibrates to produce a specific audio fre¬

quency, or note. The resonant frequency of a string depends on the amount of

tension. It can be changed, or tuned, by changing the tension.
The resonant frequency of a nucleus is determined by a combination of nuclear
characteristics and the strength of the magnetic field. The resonant frequency is
also known as the Larmor frequency. The specific relationship between resonant

frequency and field strength is an inherent characteristic of each nuclide and is

generally designated the gyromagnetic ratio.
For all nuclides, the resonant frequency is proportional to the strength of the

magnetic field. In a very general sense, increasing the magnetic field strength in-
 Nuclear Magnetic Resonance 435

creases the tension on the nuclei (as with the strings of a musical instrument) and
increases the resonant frequency. The Larmor frequencies for selected nuclides in
a magnetic field of 1 T are:

hydrogen-1 42.58 MHz

fluorine-19 40.05
phosphorus-31 17.24
sodium-23 11.26

The fact that different nuclides have different resonant frequencies means that
most MR procedures can "look at" only one chemical element (nuclide) at a time.
The fact that a specific nuclide can be tuned to different radio frequencies by vary¬

ing the field strength (ie, applying gradients) is used in the imaging process, as
discussed later.
The resonant frequency of magnetic nuclei, such as protons, is also affected by
the structure of the molecule in which they are located. This is the chemical-shift
effect and is the basis of magnetic resonance spectroscopy.

Excitation

If RF energy with a frequency corresponding to the nuclear resonant frequency

is applied to the material, some of the energy will be absorbed by the individual
nuclei. The absorption of energy by a nucleus flips its alignment away from the
direction of the magnetic field. This increased energy places the nucleus in an
unnatural, or excited, state.

Relaxation

When a nucleus is in an experiences an increased torque from

excited state, it
the magnetic field, urging it to realign. The nucleus can return to a position of
alignment by transferring its excess energy to other nuclei or the general structure
of the material. This process is known as relaxation.
Relaxation is not instantaneous following an excitation. It cannot occur until the
nucleus is able to transfer its energy. How quickly the energy transfer takes place
depends on the physicalcharacteristics of the material. In fact, the nuclear relax¬
ation rate (or time) is, in many cases, the most significant factor in producing
contrast among different types of tissue.

Figure 29-5 compares excitation and relaxation, which are the two fundamental
interactions between RF energy and a resonant nucleus in a magnetic field.
 436 Physical Principles of Medical Imaging

TISSUE MAGNETIZATION

We have considered the behavior of individual nuclei when

placed in a mag¬
netic field. MRI depends on the collective, or net, magnetic effect of a large num¬
ber of nuclei within a specific voxel of tissue. If a voxel of tissue contains more
nuclei aligned in one direction than in other directions, the tissue will be
tempo¬
rarily magnetized in that particular direction. This process is illustrated in Figure
29-6. In the absence of a magnetic field, the nuclei are randomly oriented and
produce no net magnetic effect. This is the normal state of tissue before being
placed into a magnetic field. When the tissue is placed in a field, and some of the
nuclei align with the field, their combined effect is to
magnetize the tissue in the
direction of the field. A large arrow, generally referred to as a
magnetization vec¬
tor, is used to indicate the amount and direction of the magnetization. When tissue
is placed in a field, the maximum magnetization that can be
produced depends on
three factors: (1) the concentration (density) of magnetic nuclei in the tissue
voxel,
(2) the magnetic sensitivity of the nuclide, and (3) the strength of the magnetic

Figure 29-6 The Magnetization of a Tissue Voxel Resulting from the Alignment of Indi¬
vidual Nuclei
 Nuclear Magnetic Resonance 437

field. Since imaging magnetic field aligns a very small fraction of the magnetic
an

nuclei, the tissuesare never fully magnetized. The amount of tissue

magnetization
determines the strength of the RF signals emitted by the tissue
during an imaging
or analytical procedure. This, in turn, affects
image quality and imaging time, as
explained in Chapter 33.
When tissue is placed in magnetic field, it reaches its maximum magnetization
a
within a few seconds and remains at that level unless it is disturbed
by a change in
the magnetic field or pulses of RF energy. The MRI procedure is a dynamic
pro¬
cess in which tissue is cycled through
changes in its magnetization during each
imaging cycle.
The direction of tissue magnetization is specified in reference to the direction of
the applied magnetic field, as shown in Figure 29-7. With longitudinal magnetiza¬
tion, the tissue is magnetized in a direction parallel to the direction of the field.
With transverse magnetization, the direction of tissue magnetization is at a 90-

degree angle with respect to the direction of the magnetic field.

The actual direction of magnetization is not limited to longitudinal or trans¬
verse. It can exist in any direction. In principle, magnetization can have both lon¬

gitudinal and transverse components. Since the two components have distinctly
different characteristics, we consider them independently.

Longitudinal Magnetization and Relaxation

When tissue is placed in a magnetic field, it becomes magnetized in the longitu¬

dinal direction. It will remain in this state until the magnetic field is changed or
until the magnetization is redirected by the application of an RF pulse to the tissue.
If the magnetization is temporarily redirected by an RF pulse, it will then, over a

period of time, return to its original longitudinal position. The regrowth of longitu-

Tissue Magnetization

T
Longitudinal Transverse

Figure 29-7 The Two Basic Directions of Tissue Magnetization

438 Physical Principles of Medical Imaging

dinal magnetization is the relaxation process, which occurs after an excitation.

The time required for the longitudinal magnetization to regrow, or relax, depends
on characteristics of the material and the strength of the magnetic field.
Longitudinal magnetization does not grow at a constant rate, but an exponential
rate, as shown in Figure 29-8. The factor that varies from one type of tissue to
another, and can be used to produce image contrast, is the time required for the
magnetization to regrow, or the relaxation time. Because of its exponential nature,
it is difficult to determine exactly when the magnetization has reached its maxi¬
mum. The convention is to specify the relaxation time in terms of the time re¬

quired for the magnetization to reach 63% of its maximum. This time, the longitu¬
dinal relaxation time, is designated Tl. The 63% value is used because of
mathematical, rather than clinical, considerations. Longitudinal magnetization
continues to grow with time, and reaches 87% of its maximum after two Tl inter¬
vals, and 95% after three Tl intervals. For practical purposes, the magnetization
can be considered fully recovered after approximately three times the Tl value of

the specific tissue. We will see that this must be taken into consideration when

setting up an imaging procedure.

When an image is produced based on the Tl characteristic, the pixel intensity
(tissue brightness) is related to the level of magnetization when the "picture is
snapped" during the relaxation process. It increases with time.

Longitudinal Magnetization

95%

87%

63%

"V—T1-
i—i—i—ill—i—i—i—r

500 1000 1500 2000

Time (mSec)

Figure 29-8 The Growth of Longitudinal Magnetization during the Relaxation Process
 Nuclear Magnetic Resonance 439

Saturation

Saturation is the condition when the longitudinal magnetization is reduced to

zero by
a 90 degree RF pulse. It is an unstable condition and will not remain.
Relaxation is the process of recovering from saturation.

Transverse Magnetization and Relaxation

Transverse magnetization is produced by applying a pulse of RF energy to the
tissue. This is typically done with a 90-degree pulse, which converts longitudinal
magnetization into transverse magnetization. Transverse magnetization is an un¬
stable, or excited, condition and quickly decays after the termination of the excita¬
tion pulse. The decay of transverse magnetization is also a relaxation process,
which can be characterized by specific relaxation times, or T2 values. Different

types of tissue have different T2 values that can be used to discriminate among
tissues and contribute to image contrast.
Transverse magnetization is used during the image formation process for two
reasons: (1) to develop image contrast based on differences in T2 values, and (2)

to generate the RF signals emitted by the tissue.

The characteristics of transverse magnetization and relaxation are quite differ¬

ent from those for the longitudinal direction. A major difference is that transverse

magnetization is an unstable condition and the relaxation process results in the

decay, or decrease, in magnetization, as shown in Figure 29-9. The T2 value is the
time required for 63% of the initial magnetization to dissipate. After one T2, 37%
of the initial magnetization is present. Transverse relaxation is generally much
faster than longitudinal relaxation. In other words, T2 values are less than T1 val¬
ues for most tissues.
When an image is produced based on the T2 characteristic, the pixel intensity
(tissue brightness) is related to the level of magnetization when the "picture is
snapped" at the time of the echo event during the relaxation process. It decreases
with time.

CHEMICAL SHIFT AND SPECTROSCOPY

Earlier we discovered that the resonant frequency of a specific magnetic

nucleus such proton is determined by the strength of the magnetic field in
as a

which it is located. When a proton, or other magnetic nucleus, is part of a mol¬

ecule, they are slightly shielded from the large magnetic field. The amount of
shielding depends on the chemical composition of the molecule. This means that
protons in different chemical compounds will be in slightly different field
strengths and will therefore resonate at different frequencies. This change in reso-
440 Physical Principles of Medical Imaging

Transverse Magnetization
100-1

80-

60-

40- 37%

20-

-T2-
It TT-
5%

150 200
50 100

Time (mSec)

Figure 29-9 The Relaxation (Decay) of Transverse Magnetization

nant frequency from one compound to another is known as chemical shift. It can
be used to perform chemical analysis in the technique of NMR spectroscopy and
to produce images based on chemical composition. However, in conventional

MRI the chemical-shift effect can be the source of an unwanted artifact.

Spectroscopy

Let consider a simple but very common example of fat and water, as illus¬
us

trated inFigure 29-10. This is a display of MR signal intensity on a relative fre¬

quency scale. This is a magnetic resonance spectrum. The convention in MR spec¬
troscopy is to express the frequency differences in parts per million (ppm) of the
basic resonant frequency. This makes the scale independent of field strength.
However, the actual difference in frequency between two compounds, in the units
of Hz, increases with field strength.
The chemical shift between the major component of fat and water is approxi¬

mately 3.3 ppm. At a field strength of 1.5 T the protons have a basic resonant
frequency of approximately 64 MHz. Multiplying this by 3.3 gives a water-fat
chemical shift of approximately 210 Hz. At a field strength of 0.5 T the chemical
shift would be only 70 Hz.
Magnetic resonance spectroscopic analysis can be performed with MRI sys¬
tems equipped with the necessary components and software or with specially de-
 Nuclear Magnetic Resonance 441

w
c
Water
p210atHz
T 1.5
0
c

Fat
aJ
c
D>
0)

0 1 2 3 4 5 ppm

Relative Resonant Frequency

Figure 29-10 A Simple Magnetic Resonance Spectrum Showing the Chemical Shift
between Water and Fat

signed laboratory systems. In general, spectroscopy requires high field strengths

in order toproduce more chemical-shift separation between the chemical com¬
pounds and to increase signal strength.

Chemical-Shift Imaging

There are techniques that can be used to selectively image either the
several
water or fat tissue components.One approach is to suppress either the fat or water
signal with specially designed RF pulses. This technique is known as spectral
presaturation. Another technique makes use of the fact that the signals from water
and fat are not always in step, or in phase, with each other and can be separated to
create either water or fat images.
 Chapter 30

Magnetic Characteristics
of Tissue

INTRODUCTION AND OVERVIEW

A significant feature of MRI is the ability to selectively image several different

characteristics of tissue.Looking at it another way, we can select different tissue
characteristics to produce the contrast that is displayed in the image. This gives
MRI an advantage over most other imaging modalities because there is more than
one characteristic that can make tissue differences, both normal and pathologic,

visible in the image.

Because image contrast and tissue visibility come from several different char¬
acteristics, the MRI process is somewhat more complex than most other imaging
methods. The user must have a good knowledge of these various characteristics,
how they affect the appearance of tissues in an image, and how the imaging pro¬
cess can be adjusted to provide maximum contrast sensitivity for the desired tissue

characteristic.
In this chapter we will consider the various tissue characteristics that can be
visualized in an MR image.
The brightness of a particular tissue in an image (RF signal intensity) is gener¬
ally determined by the level of tissue magnetization at specific "picture-snapping"
times during the MR imaging cycle. Contrast is produced when tissues do not have
the same level of magnetization. We will now see how certain characteristics of
tissue and other materials affect levels of magnetization and tissue visibility.
There are primary magnetic characteristics of tissue that are the source of
three
image contrast. Two of these are associated with the longitudinal magnetization.
They are proton density and Tl, the longitudinal relaxation time. The third charac¬
teristic is associated with the transverse magnetization. It is T2, the transverse
relaxation time.

443
444 Physical Principles of Medical Imaging

CONTRAST SENSITIVITY

In MR imaging the usual procedure is to select one of the tissue characteristics

and then adjust the imaging process so that it has maximum, or at least adequate,
contrast sensitivity for that specific characteristic. The contrast
sensitivity of the
imaging process and the resulting image contrast is determined by the specific
imaging method and the combination of imaging protocol factor values, which we
will consider in much more detail in Chapter 31. Figure 30-1 provides an overview
of the process. The discussion in this chapter will be based on the conventional

spin-echo method that uses only two factors, TR and TE, to control contrast
sensitivity.

TR

TR is the time interval between the beginning of the longitudinal relaxation and
when the magnetization is measured to produce image contrast. This is when the
picture is snapped relative to the longitudinal magnetization.
TR is also the duration of the image acquisition
cycle or the cycle repetition
time (Time of Repetition).

I
Contrast
Sensitivity

Operator

Figure 30-1 The Process of Adjusting Contrast Sensitivity to Specific Tissue

Characteristics
 Magnetic Characteristics of Tissue 445

TE

TE is the time interval between the

beginning of transverse relaxation and when
the magnetization is measured to produce image contrast. This is when the picture
is snapped relative to the transverse magnetization.
The transverse magnetization is measured and converted into an RF
signal at
the time of the echo event. Therefore, TE is the Time to Echo event.

PROTON DENSITY

The density, or concentration, of protons in each tissue voxel determines the

maximum level of magnetization that can be obtained. Differences in proton den¬
sity among tissues can be used to produce image contrast, as illustrated in Figure
30-2. Figure 30-3 shows the growth of longitudinal magnetization for two tissues
with the same T1 values but different relative proton densities. The tissue with the
lowest proton density (80) reaches a maximum magnetization level that is only
80% that of the other tissue. The difference in magnetization levels at any point in
time is because of the difference in proton density and is therefore the source of
proton density contrast.
Although there is some proton density contrast early in the cycle, it is generally
quite small in comparison to the T1 contrast, which is not shown in Figure 30-3.

Voxel Signal Pixel

Magnetization Intensity Brightness
Proton
Density
Vtf*
High
vl ♦

Low

Figure 30-2 Proton Density Contrast

446 Physical Principles of Medical Imaging

Longitudinal Magnetization
Relative Proton Density = 100
100

>

'</)
c
a>
+-
c

a>
x
a.

0
0 500 1000 1500 2000

Time (mSec)
Figure 30-3 The Development of Proton Density Contrast

The basic difference between T1 contrast and proton density contrast is that T1
contrast produced by the rate of growth, and proton density contrast is produced
is
by the maximum level to which the magnetization grows. In general, T1 contrast
predominates in the early part of the relaxation phase, and proton density contrast
predominates in the later portion. In most situations, T1 contrast gradually gives
way to proton density contrast as magnetization approaches the maximum value.
A proton density-weighted image is produced by selecting a relatively long TR
snapped" in the later portion of
value so that the image is created or "the picture is
the relaxation phase, where tissue magnetizations approach their maximum val¬
ues. The TR values at which this occurs depend on the T1 values of the tissues

being imaged.
It was shown earlier that tissue reaches 95% of its magnetization in three Tls.
Therefore, a TR value that is at least three times the T1 values for the tissues being
imaged produces almost pure proton density contrast.

Tl, LONGITUDINAL RELAXATION TIME

During the relaxation (regrowth) of longitudinal magnetization, different tis¬

sues will have different levels of magnetization because of their different growth
rates, or Tl values. Figure 30-4 compares two tissues with different Tl values.
 Magnetic Characteristics of Tissue 447

Voxel Signal Pixel

jl Magnetization Intensity Brightness
(Longitudinal
Relaxation)
Short
(Fast)

The tissue with the shorter T1 value experiences a faster regrowth of longitudinal
magnetization. Therefore, during this period of time it will have a higher level of
magnetization, produce a more intense signal, and appear brighter in the image. In
T1 images brightness or high signal intensity is associated with short T1 values.
At the beginning of each imaging cycle, the longitudinal magnetization is re¬
duced to zero (or a negative value) by an RF pulse, and then allowed to regrow, or
relax, during the cycle. When the cycle is terminated during the regrowth phase
and the magnetization value is measured and displayed as a pixel intensity, or

brightness, a T1-weighted image is produced.

The time required for a specific level of longitudinal magnetization regrowth
varies from tissue to tissue. Figure 30-5 shows the regrowth curves for three tis¬
sues with different T1 values. The important thing to notice is that the tissue with

the shortest T1 has the most magnetization at any particular time. The clinical

significance of this is that tissues with short T1 values will be bright in Tl-
weighted images.
Typical T1 values for various tissues are listed in Table 30-1. Two materials
establish the lower and upper values for the T1 range: Fat has a short T1, and fluid
falls at the other extreme. Therefore, in T1-weighted images, fat is generally
bright, and fluid (cerebrospinal fluid, cyst, etc.) is dark. Most other body tissues
are within the range between fat and fluid.
448 Physical Principles of Medical Imaging

Longitudinal Magnetization

0 500 1000 1500 2000

Time (mSec)
Figure 30-5 Comparison of Longitudinal Relaxation (Growth) for Tissues with Different
T1 Values

The longitudinal relaxation process involves an interaction between the protons

and their immediate molecular environment. The rate of relaxation (T1 values) is
related to the naturally occurring molecular motion. The molecular motion is de¬
termined by the physical state of the material and the size of the molecules. The

relatively rigid structures of solids does not provide an environment for rapid re¬
laxation, which results in long T1 values. Molecular motion in fluids, and fluid¬
like substances, are more inducive to the relaxation process. In this environment
molecular size becomes an important characteristic.
Relaxation is enhanced by a general matching of the proton resonant frequency
and the frequency associated with the molecular motions. Therefore, factors that

change either of these two frequencies will generally have an effect on T1 values.

Molecular Size

Small molecules, such as water, have faster molecular motions than large mol¬
ecules such lipids. The frequencies associated with the molecular motion of
as

water molecules are both higher and more dispersed over a larger range for the

larger molecules. This reduces the match between the frequencies of the protons
and the molecular environment. This is why water and similar fluids have rela¬

tively long T1 values. Larger molecules, which have slower and less dispersed
molecular movement, have a better frequency match with the proton resonant fre-
 Magnetic Characteristics of Tissue 449

quencies. This enhances the relaxation process and produces short T1 values. Fat
is an excellent example of a large molecular structure that exhibits this character¬
istic.
Tissues generally contain a combination of water anda variety of larger mol¬
ecules. Some of the water can be in
relatively free state while other water is
a

bound to some of the larger molecules. In general, the T1 value of the tissue is
probably affected by the exchange of water between the free and bound states.
When the water is bound to larger molecular structures it takes on the motion
characteristics of the larger molecule. Factors such as a pathologic process, which
alters the water composition of tissue, will generally alter the T1 values.

Magnetic Field Strength Effect

T1 values depend on the strength of the magnetic field. This is because the field
strength affects the resonant frequency of the protons. As field strength is in¬
creased the resonant frequency also increases and becomes less matched to the
molecular motion frequencies. This results in an increase in T1 values, as indi¬
cated in Table 30-1.
In principle, at the beginning of each imaging cycle all tissues are dark. As the
tissues regain longitudinal magnetization, they become brighter. The brightness,
or intensity, with which they appear in the image depends on when during the

regrowth process the cycle is terminated and "the picture is snapped." When a
short TR is used, the regrowth of the longitudinal magnetization is interrupted
before it reaches its maximum. This reduces signal intensity and tissue brightness
within the image but produces T1 contrast. Increasing TR increases signal inten¬

sity and brightness up to the point at which magnetization is fully recovered,

which is determined by the proton density of each tissue. For practical purposes,
this occurs when the TR exceeds approximately three times the T1 value for the
specific tissue. Although it takes many cycles to form a complete image, the longi¬
tudinal magnetization is always measured at the same time in each cycle.

Table 30-1 T2 and T1 Values for Various Tissues

T2 T1(0.5T) T1(1.5T)
Tissue (msec) (msec) (msec)

80 210 260
Adipose
42 350 500
Liver
45 550 870
Muscle
90 500 780
White Matter
100 650 920
Gray Matter 2400
160 1800
CSF
450 Physical Principles of Medical Imaging

T1 Contrast Sensitivity

Longitudinal relaxation time, Tl, is one of the three basic tissue characteristics
that can be translated into image contrast. The extent to which the Tl values of

tissue contribute to image contrast is determined by the selected imaging method

and imaging factor values. With the spin-echo method TR is the factor that deter¬
mines Tl contrast sensitivity. The TR value also determines the moment during
the regrowth of longitudinal magnetization at which "the picture is snapped." This
is illustrated in Figure 30-6. In this illustration, we use two tissues, one with a Tl
of 250 msec and the other with a Tl of 500 msec. Tl contrast is the difference
between the two magnetization curves at any point in time. Notice that at the be¬

ginning of the cycle (time = 0), there is no contrast. As the two tissues regain
magnetization, they do so at different rates. Therefore, a difference in magnetiza¬
tion (ie, Tl contrast) develops between the two tissues. As the tissues approach
maximum magnetization, the difference between the two magnetization levels
diminishes.
In order to produce a Tl-weighted image, a value for TR must be selected to

correspond with the time at which Tl contrast is significant between the two tis¬
sues. Several factors must be considered in selecting TR. Tl contrast is repre¬

sented by the ratio of the tissue magnetization levels, and is at its maximum very
early in the relaxation process. However, the low magnetization levels present at
that time do not generally produce adequate RF signal levels for many clinical

Longitudinal Magnetization

Time (mSec)

Figure 30-6 Development of Tl Contrast between Two Tissues

 Magnetic Characteristics of Tissue 451

applications. The selection of a longer TR produces greater signal strength but less
T1 contrast.
The selection of TR must be appropriate for the T1 values of the tissues being

imaged. If a TR value is selected that is equal to the T1 value of a tissue, the

picture will be snapped when the tissue has regained 63% of its magnetization.
This generally represents a good compromise between T1 contrast and signal
intensity.
In Figure 30-6 we show both tissues approaching the same level of maximum

magnetization. This occurs only when both tissues have the same proton (nuclei)
density and is usually not the case with tissues within the body.

T2, TRANSVERSE RELAXATION TIME

During the decay of transverse magnetization, different tissues will have differ¬
ent levels of magnetization because of different decay rates, or T2 values. As
shown in Figure 30-7, tissue with a relatively long T2 value will have a higher
level of magnetization, produce a more intense signal, and appear brighter in the

image than a tissue with a shorter T2 value.

Figure 30-8 shows the decay of transverse magnetization for tissues with differ¬
ent T2 values. The tissue with the shortest T2 value loses its magnetization faster

than the other tissues.

Voxel Signal Pixel

Magnetization Intensity Brightness
T2
(T ransverse
Relaxation)

Long
(Slow)

Short
(Fast)

Figure 30-7 T2 Contrast

452 Physical Principles of Medical Imaging

Figure 30-8 A Comparison of Transverse Magnetization Decay for Tissues with Different
T2 Values

T2 Contrast Sensitivity

Under certain imaging conditions, the difference in T2 values of tissue can be

translated into image contrast, as illustrated in Figure 30-9. For the purpose of this
illustration we assume that the two tissues begin their transverse relaxation with
the same level of magnetization (100%). The decay of the magnetization proceeds
at different rates because of the different T2 values. The tissue with the longer T2

value (100 msec) maintains a higher level of magnetization than the other tissue.
The ratio of the tissue magnetization at any point in time represents T2 contrast.
At the beginning of the cycle, there is no T2 contrast, but it develops and in¬
creases throughout the relaxation
process. At the echo event the magnetization
levels are converted into RF signals and image pixel brightness; this is the time to
the echo event (TE) and is selected by the operator. Maximum T2 contrast is gen¬

erally obtained by using a relatively long TE. However, when a very long TE
value is used, the magnetization and RF signals are too low to form a useful image.
In selecting TE values, a compromise must be made between T2 contrast and

signal intensity.
In many clinical procedures, an imaging technique that creates a series of im¬

ages at different TE values is often used. This is known as multi-echo imaging.

 Magnetic Characteristics of Tissue 453

Transverse Magnetization

Figure 30-9 The Development of T2 Contrast

The transverse magnetization characteristics of tissue (T2 values) are, in prin¬

ciple, added to the longitudinal characteristics (eg, T1 and proton density) to form
the MR image. We will see how this is achieved in Chapter 31.
The decay of transverse magnetization (ie, relaxation) occurs because of a

dephasing among individual nuclei (protons) within the individual voxels.

Two basic conditions are required for transverse magnetization: the magnetic
moments of the nuclei must be oriented in the transverse direction, or plane, and a

majority of the moments must be in the same direction, or in phase, within the
transverse plane. When a nucleus has a transverse orientation, it is actually spin¬

ning around an axis that is parallel to the magnetic field.

After the application of a 90-degree pulse, the nuclei have a transverse orienta¬
tion and are rotating together, or in phase, around the magnetic field axis. This
rotation is the normal precession discussed earlier. The precession rate, or reso¬
nant frequency, depends on the strength of the magnetic field where the nuclei are

located. Nuclei located in fields with different strengths precess at different rates.
Even within a very small volume of tissue, nuclei are in slightly different magnetic
fields. As a result, some nuclei precess faster than others. After a short period of
time, the nuclei are not precessing in phase. As the directions of the nuclei begin to
spread, the magnetization of the tissue decreases. A short time later, the nuclei
454 Physical Principles of Medical Imaging

are randomly oriented in the transverse plane, and there is no transverse

magnetization.
Two major factors contribute to the dephasing of the nuclei and the resulting
transverse relaxation. One is the exchange of energy among the spinning nuclei,

which results in relatively slow dephasing and loss of magnetization. The rate at
which this occurs is determined by characteristics of the tissue. It is this dephasing
activity that is characterized by the T2 values. A second factor, which produces
relatively rapid dephasing of the nuclei and loss of transverse magnetization, is the
inherent inhomogeneity of the magnetic field within each individual voxel. The
field inhomogeneities are sufficient to produce rapid dephasing. This effect, which
is different from the basic T2 characteristics of the tissue, tends to mask the true
relaxation characteristics of the tissue. In other words, the actual transverse mag¬
netization relaxes much faster than the tissue characteristics would indicate. This
real relaxation time is designated as T2*. The value of T2* is always much less
than the tissue T2 value.

Susceptibility Effects
Certain materials are susceptible to magnetic fields and become magnetized
when located in fields. This magnetization can produce a local distortion in the
magnetic field. Magnetic field distortions or gradients are especially significant in
the region of boundaries between materials with different susceptibilities. This

produces a rapid dephasing and loss of transverse magnetization.

Thesusceptibility of a material is determined by the orbital electrons in the
atom magnetic properties of the nucleus. Significant susceptibility
rather than the
is present only when there are unpaired electrons in the outer orbit. Contrast agents
used in MRI are generally based on susceptibility effects.

CONTRAST AGENTS

The inherent tissue characteristics (proton density, Tl, and T2) do not always

produce adequate contrast for some clinical objectives. It is possible to administer

materials (ie, contrast agents) that will alter the magnetic characteristics within

specific tissues or anatomical regions. There are several different types of contrast
agents, whicht will now be considered.

Paramagnetic Materials

Paramagnetic materials play an important role in contrast enhancement. They

are materials with unpaired electrons, which give each atom a permanent mag-
 Magnetic Characteristics of Tissue 455

netic property. In paramagnetic materials each atom is magnetically independent,

which distinguishes it from other materials to be discussed later.
Paramagnetic substances include metal ions such as gadolinium, manganese,
iron, and chromium. Other substances such as nitroxide free radicals and molecu¬
lar oxygen also have paramagnetic properties.
Gadolinium has seven unpaired electrons in its outer orbit, which gives it a very
strong magnetic property. It must be chelated to reduce its toxicity. An example is
gadolinium chelated to diethylene triamine penta-acetic acid (GaDTPA).
When a paramagnetic substance, such as gadolinium, enters an aqueous solu¬
tion it affects the relaxation rate of the existing protons. It does not produce a
signal itself. In relatively low concentrations, the primary effect is to increase the
rate of longitudinal relaxation and shorten the value of Tl. In principle, the

fluctuating magnetic fields from the individual paramagnetic molecules enhances

the relaxation rate. The primary result is an increase in signal intensity with Tl-

weighted images. It is classified as a positive contrast agent.

Signal intensity will generally increase with the concentration of the paramag¬
netic agents until a maximum intensity is reached. This intensity is very dependent
on the imaging parameters. Higher concentrations will generally produce a reduc¬

tion of signal intensity. This occurs because the transverse relaxation rate is also
increased, which results in a shortening of the T2 value.

Superparamagnetic Materials
When materials with unpaired electrons are contained in a crystalline structure
they produce a stronger magnetic effect (susceptibility) in comparison with the
independent molecules of a paramagnetic substance. The susceptibility of
superparamagnetic materials is several orders of magnitude greater than that of
paramagnetic materials. These materials are in the form of small particles. Iron
oxide particles are an example.
The particles produce inhomogeneities in the magnetic field, which results in

rapid dephasing of the protons in the transverse plane and a shortening of T2.
Superparamagnetic materials generally reduce signal intensity and are classi¬
fied as negative contrast agents.
 Chapter 31

Imaging Methods

INTRODUCTION AND OVERVIEW

There are several different imaging methods that can be used to create the MR

image. The principal difference among these methods is the sequence in which the
RF pulses and gradients are applied during the acquisition process. Therefore, the
different methods are often referred to as the different pulse sequences. An over¬
view of the most common methods is shown in Figure 31-1. As we see, the differ¬
ent methods are organized in a hierarchy structure. For each imaging method there

is a set of factors that must be adjusted by the user to produce specific image
characteristics.
a specific imaging method and factor values is generally based
The selection of
on requirements for contrast sensitivity and acquisition speed. However, other
characteristics such as signal-to-noise and the sensitivity to specific artifacts might
vary from method to method.
In this chapter we will develop the basic concept of each method and then show
how the specific imaging factors can be adjusted to produce the desired image
characteristics.

THE IMAGING CYCLE

A common characteristic to all methods is that there are two distinct phases of
the image acquisition process, as shown in Figure 31-2. One phase is associated
with longitudinal magnetization and the other with the transverse magnetization.
In general, T1 and proton density contrast are developed during the longitudinal

magnetization phase and T2 contrast is developed during the transverse magneti¬

zation phase. The predominant type of contrast that ultimately appears in the im¬

age is determined by the duration of the two phases and the transfer of contrast
from the longitudinal phase to the transverse phase.

457
458 Physical Principles of Medical Imaging

Spin Echo Gradient Echo

Methods Methods

Spin Inversion Small Angle Magnetization

Echo Recovery Gradient Echo Preparation
TR TR TR TR

TE TE TE TE

A Tl Tl
i
Flip Angle Flip Angle
TS
Spoiling Spoiling
(on/off) (on/off)
A A
i

Adjustable Protocol Factors

Figure 31-1 The General Relationship of MR Imaging Methods

Excitation

The transition from thelongitudinal magnetization phase to the transverse mag¬

netization phase is produced by applying an RF pulse. This is generally known as
the excitation process because the transverse magnetization represents a more un¬
stable or "excited" state than longitudinal magnetization.
The excitation pulse is characterized by a flip angle. A 90-degree excitation

pulse converts all of the existing longitudinal magnetization into transverse mag¬
netization. This type of pulse is used in several imaging methods. However, there
are methods that use excitation pulses with a flip angle of less than 90 degrees.

Small flip angles (less than 90 degrees) convert only a fraction of the existing

longitudinal magnetization into transverse magnetization. Small angle (SA) meth¬

ods are used primarily to reduce acquisition time and will be discussed in more
detail later.

The Echo Event and Signals

The transverse magnetization phase terminates with the echo event, which pro¬
duces the RF signal. This is the signal that is emitted by the tissue and used to form
 Imaging Methods 459

RF Excitation Pulses

Figure 31-2 The Two Phases of an Imaging Cycle

the image. The echo event is produced by applying either an RF pulse or a gradient
pulse to the tissue.

Time to the Echo (TE)

The duration of the transverse magnetization phase, TE, is adjustable by the

user within certain limits. The two primary effects of increasing TE are (1) T2
contrast sensitivity increases, and (2) signal intensity decreases.

Spin Echo

Spin echo is the name of the process that uses an RF pulse rather than a gradient
pulse to produce the echo event. It is also the name for one of the imaging methods
that uses the spin-echo process. We will now see how an RF pulse can produce an
echo event and signal.
The decay of transverse magnetization (ie, relaxation) occurs because of

dephasing among individual nuclei. Figure 31-3 is a much simplified model used
to develop this concept.

Two basic conditions are required for transverse magnetization: (1) the mag¬
netic moments of the nuclei must be oriented in the transverse direction, or plane,
460 Physical Principles of Medical Imaging

FID Signal Echo Signal

■TE

~~
~

-------
J"^sije_Relaxatjon Rate - T2
Field Relaxation Rate -12*

&
«$/
Rephasing

Figure 31-3 The Events Contributing to Transverse Relaxation and the Formation of the
Spin-Echo Signal

and (2) a majority of the moments must be in the same direction within the trans¬
verse plane. When a nucleus has a transverse orientation, it is actually spinning
around an axis that is parallel to the magnetic field. In our example, we use four
nuclei to represent the many nuclei involved in the process.
After the application of a 90-degree pulse, the nuclei have a transverse orienta¬
tion and are rotating together, or in phase, around the magnetic field axis. This
rotation is the normal precession discussed earlier. The precession rate, or reso¬
nant frequency, depends on the strength of the magnetic field where the nuclei are

located. Nuclei located in fields with different strengths precess at different rates.
Even within a very small volume of tissue, there are small variations in field

strength. As a result, some nuclei precess faster than others. After a short period of
time, the nuclei are not precessing in phase. As the directions of the nuclei begin to
spread, the magnetization of the tissue decreases. A short time later, the nuclei are
randomly oriented in the transverse plane, and there is no transverse magnetiza¬
tion.
Two factors contribute to the dephasing of the nuclei and the resulting trans¬
verse relaxation. One is the
exchange of energy among the spinning nuclei, which
results in relatively slow dephasing and loss of magnetization. The rate at which
this occurs is determined by characteristics of the tissue. It is this dephasing activ¬

ity that is characterized by the T2 values. A second factor, which produces rela-
 Imaging Methods 461

tively rapid dephasing of the nuclei and loss of transverse magnetization, is the
inherent inhomogeneity of the magnetic field. Even within a small volume of tis¬
sue, the field inhomogeneities are sufficient to produce rapid dephasing. This ef¬

fect, which is generally unrelated to the characteristics of the tissue, tends to mask
the true relaxation characteristics of the tissue. In other words, the actual trans¬
verse magnetization relaxes much faster than the tissue characteristics would indi¬
cate. This real relaxation time is
designated as T2*. The value of T2* is always
much less than the tissue T2 value.
An RF signal is produced whenever there is transverse magnetization. Immedi¬

ately after an excitation pulse a so-called free induction decay (FID) signal is pro¬
duced. The intensity of this signal is proportional to the level of transverse magne¬
tization. Both decay rather rapidly because of the magnetic field inhomogeneities

just described. The FID signal is not used in the spin-echo methods. It is used in
the gradient-echo methods to be described later.
In many imaging procedures a special technique, called spin echo, is used to

compensate for the dephasing and rapid relaxation caused by the field
inhomogeneities. The sequence of events in the spin-echo process are illustrated
in Figure 31-3.
Transverse magnetization is produced with a 90-degree RF pulse that flips the

longitudinal magnetization in the transverse plane. Immediately following the RF

pulse, each voxel is magnetized in the transverse direction because protons are
positioned in the transverse direction, and they are rotating in phase. However,
because of the local magnetic field inhomogeneities within each voxel, the protons
rotate at different rates and quickly slip out of phase.

If a 180-degree pulse is applied to the tissue, it flips the spinning protons over by
180 degrees in the transverse plane and reverses their direction of rotation. This
causes the fast protons to be located behind the slower ones. As the faster protons

begin to catch up with the slower ones, they regain a common alignment, or come
back into phase. This, in turn, causes the transverse magnetization to reappear and
form the echo event. However, the magnetization does not grow to the initial value
because the relaxation (dephasing) produced by the tissue is not reversible. The
rephasing of the protons causes the magnetization to build up to a level determined
by the T2 characteristics of the tissue. As soon as the magnetization reaches this
maximum, the protons begin to move out of phase again, and the transverse mag¬
netization dissipates. Another 180-degree pulse can be used to produce another
rephasing. In fact, this is what is done in multi-echo imaging.
The intensity of the echo signal is proportional to the level of transverse magne¬
tization as determined by the tissue relaxation rate, T2. In most imaging proce¬
dures the intensity of the echo signal determines the brightness of the correspond¬

ing image pixel. The time between the initial excitation and the echo signal is TE.
462 Physical Principles of Medical Imaging

This is controlled by adjusting the time interval between the 90-degree and the
180-degree pulses.

Gradient Echo

It is possible to produce an echo event within the FID by applying a magnetic-

field gradient to the tissue. This also results in an RF signal that is emitted by the
tissue. There are several imaging methods that use the gradient echo rather than
the spin-echo technique to produce the RF signals. At this time we will develop
the concept of gradient echo.
Transverse magnetization is present only when a sufficient quantity of protons
are spinning in-phase in the transverse plane. As we have just seen, the decay

(relaxation) of transverse magnetization is the result of proton dephasing. We also

recall that an RF signal is produced any time there is transverse magnetization and
the intensity of the signal is proportional to the level of magnetization.
With the spin-echo technique we use an RF pulse to rephase the protons after

they have been dephased by inherent magnetic field inhomogeneities within the
tissue voxel. The gradient-echo technique is different in that the protons are first

dephased by turning on a gradient and then rephased by reversing the direction of

the gradient, as shown in Figure 31-4. A gradient echo can only be created when
transverse magnetization is present. This can be either during the free induction

decay (FID) period or during a spin-echo event. In Figure 31-4 the gradient echo is
being created during the FID. Let us now consider the process in more detail.
The transverse magnetization is produced by the excitation pulse. It immedi¬

ately begins to decay (the FID process) because of the magnetic field
inhomogeneities within each individual voxel. The rate of decay is related to the
value of T2*. A short time after the excitation pulse a gradient is applied, which

produces a very rapid dephasing of the protons and reduction in the transverse
magnetization. This occurs because a gradient is a forced inhomogeneity in the
magnetic field. The next step is to reverse the direction of the applied gradient.
Even though this is still an inhomogeneity in the magnetic field, it is in the oppo¬
site direction. This then causes the protons to rephase and produce an echo event.
As the protons rephase the transverse magnetization will reappear and rise to a
value determined by the FID process. The gradient-echo event produces a rather
well-defined peak in the transverse magnetization and this, in turn, produces a
discrete RF signal.
The time to the echo event (TE) is determined by adjusting the time interval
between the excitation pulse and the gradients that produce the echo event. TE
values for gradient echo are typically much shorter than for spin echo, especially
when the gradient echo is produced during the FID.
 Imaging Methods 463

I^ Decgy pjate

Gradient Echo Event

Time

i i

Rephasing
Gradient
Direction
De-
phasing

Figure 31-4 The Creation of a Gradient Echo

SPIN-ECHO METHODS

It becomes a little confusing because there are two different imaging methods

that use the spin-echo process. One is named spin echo and the other inversion
recovery. We will now see how they are related.

Spin Echo
The basic spin-echo imaging method is characterized by a 90-degree excitation

pulse followed by a 180-degree pulse to produce the echo event and signal. This
method can be used to produce images of the three basic tissue characteristics:
proton density, Tl, and T2. The sensitivity to a specific characteristic is deter¬
mined by the values selected for the two time intervals or imaging factors, TR and
TE.
The individual tissues and the contrast between different tissues
brightness of
are relationship between TR and TE and the basic tissue charac¬
determined by the
teristics (proton density, Tl, and T2). In most MR images, the contrast is not pro¬
duced by a single tissue characteristic but by a combination of the three tissue
464 Physical Principles of Medical Imaging

factors. The weighting of image contrast with respect to a particular tissue charac¬
teristic is achieved by adjusting the TR and TE values. We now consider the se¬
quence of events during an imaging cycle and how the various factors determine
the final image contrast.

Figure 31-5 illustrates the development of contrast between two tissues, A and
B. The process actually extends over a portion of two cycles. Although the same
events occur in each cycle, the process is easier to visualize when it is separated as

shown. Here we are observing the longitudinal magnetization in the first cycle
followed by the transverse magnetization that it produces in the next cycle.
The first cycle begins with a 90-degree pulse that converts longitudinal magne¬
tization into transverse magnetization. Therefore, the cycle begins with complete
saturation or no longitudinal magnetization. The magnetization begins to grow

(relax) at a rate determined by the T1 value for the specific tissue. If two tissues
have different T1 values, a difference in magnetization, or contrast, will develop
between the tissues. This is T1 contrast. As the tissues begin to approach their
maximum magnetization, proton density becomes the major factor affecting mag¬
netization level and contrast between the tissues. This cycle is terminated, and the
next cycle begins by the application of another 90-degree pulse. The pulse inter¬

rupts the growth of the longitudinal magnetization and converts it to transverse

magnetization. The transverse magnetization in each cycle is created from the lon¬
gitudinal magnetization of the previous cycle.

Pixel
Brightness
First Cycle Next Cycle

(ll J\Jd JWU lll\J<C?0/

Figure 27-18 Sequence of Events and Factors that Determine Image Contrast
 Imaging Methods 465

At the beginning of the cycle, the two tissues have different levels of transverse

magnetization (contrast) brought over from the longitudinal magnetization of the

previous cycle. This is a combination of T1 and proton density contrast. However,
as the transverse
magnetization begins to decay, it will do so at different rates if
the two tissues have different T2 values. This leads to the
development of T2
contrast. In general, the proton density and T1 contrast are
gradually replaced by
T2 contrast. In this example, we show the decay of the transverse
magnetization as
it relates to tissue characteristics, rather than the magnetic field effects as dis¬
cussed previously. At the appropriate time, a 180-degree pulse is applied to
pro¬
duce an echo event and signal from the transverse magnetization. The
intensity of
the signal is proportional to the level of transverse magnetization. The signal in¬

tensity, in turn, determines the brightness of the tissue as it appears in the image.
The two tissues will produce image contrast if their signal intensities are different.
To produce image contrast based on T1 differences between tissues, two factors
must be considered. Since T1 contrast develops during the early growth phase of

longitudinal magnetization, relatively short TR values must be used to capture the

contrast. The second factor is to preserve the T1 contrast during the time of trans¬

verse relaxation. The basic problem is that if T2 contrast is allowed to develop, it

generally counteracts T1 contrast. This is because tissues with short T1 values also
have short T2 values. The problem arises because tissues with short Tls are gener¬

ally bright, whereas tissues with short T2s have reduced brightness when T2 con¬
trast is present. T2 develops during the TE time interval. Therefore, s short TE

minimizes T2 contrast and the related loss of T1 contrast. A Tl-weighted image is

produced by using short TR and TE values.

Proton density contrast develops as the longitudinal magnetization approaches
its maximum, which is determined by the proton density of each specific tissue.
Therefore, relatively long TR values are required to produce a proton density-
weighted image. Short T2 values are generally used to reduce T2 contrast con¬
tamination and to maintain a relatively high signal intensity.
The first step in producing an image with significant T2 contrast is to select a

relatively long TR value. This minimizes T1 contrast contamination and the trans¬
verse relaxation process begins at a relatively high level of magnetization. Long
TE values are then used to allow T2 contrast time to develop. Table 31-1 summa¬

rizes the combination of TR and TE values used to produce the three basic image
types.

Inversion Recovery

Inversion recovery is a spin-echo imaging method used for several specific pur¬
poses. One application is to produce a high level of T1 contrast and a second
application is to suppress the signals and resulting brightness of fat. The inversion
466 Physical Principles of Medical Imaging

recovery pulse sequence is obtained by adding an additional 180-degree pulse to

the conventional spin-echo sequence, as shown in Figure 31-6. The pulse is added
at the beginning of each cycle. In inversion recovery, each cycle begins as the 180-

degree pulse inverts the direction of the longitudinal magnetization. The regrowth
(recovery) of the magnetization starts from a negative (inverted) value, rather than
from zero, as in the spin-echo method.
The inversion recovery method, like the spin-echo method, uses a 90-degree
excitation pulse to produce transverse magnetization, and a final 180-degree pulse
to produce a spin-echo signal. An additional time interval is associated with the

inversion recovery pulse sequence. The time between the initial 180-degree pulse
and the 90-degree pulse is designated the inversion time, TI. It can be varied by the

operator and used as a contrast control.

Tl Contrast

The principal characteristic of many inversion recovery images is high Tl con¬

trast. This occurs because the total longitudinal relaxation time is increased be¬

cause it starts from the inverted state. There is more time for the Tl contrast to
develop.

<s>

■-v-mA/WW"-* ►

|180"I
Inversion
Pulse

Figure 31-6 The Inversion Recovery Imaging Method

 Imaging Methods 467

Fat Suppression
We recall that fat has a
relatively short T1 value. Therefore, it recovers its lon¬
gitudinal magnetization faster than the other tissues after the inversion pulse. The
important point here is that the magnetization of fat passes through the zero level
before the other tissues. If the TI interval is selected
so that the excitation
pulse is
applied at that time, the fat will not produce a signal. This is achieved with rela¬
tively short values for TI. Therefore, this method of fat suppression is often re¬
ferred to as short time inversion recovery (STIR).

SMALL ANGLE GRADIENT ECHO METHODS

The
gradient-echo technique is generally used in combination with an RF exci¬
tationpulse that has a small flip angle of less than 90 degrees. We will discover the
advantages of this particular combination later. One source of confusion is that
each manufacturer of MRI equipment has given this imaging method a different
trade name. In this text we will use the generic name of small angle gradient echo
(SAGE) method.
The SAGE method generally requires a shorter acquisition time than the spin-
echo methods. It is also a more complex method with respect to adjusting contrast

sensitivity because the flip angle of the excitation pulse becomes one of the adjust¬
able imaging factors.

Excitation-Pulse Flip Angle

We recall that the purpose of the excitation pulse is to convert or flip longitudi¬
nal magnetization into transverse magnetization. When a 90-degree excitation
pulse is used, all of the existing longitudinal magnetization is converted into trans¬
verse magnetization as we have seen with the spin-echo methods. The 90-degree

excitation pulse reduces the longitudinal magnetization to zero (ie, complete satu¬
ration) at the beginning of each imaging cycle. This then means that a relatively
long TR interval must be used to allow the longitudinal magnetization to recover.
The time required for the longitudinal magnetization to relax or recover is one of
the major factors in determining acquisition time. The effect of reducing TR when

90-degree excitation pulses are used is shown in Figure 31-7. As the TR value is
decreased the amount of transverse magnetization and RF signal intensity pro¬
duced by each pulse is decreased. This would result in an increase in image noise
as described in Chapter33. Also, the use of short TR intervals with a 90-degree
excitation pulse cannot produce either proton density or T2 images.
One approach to reducing TR and increasing acquisition speed without incur¬

ring the disadvantages that have just been described is to use an excitation pulse
468 Physical Principles of Medical Imaging

Time

Figure 31-7 The Effect of Reducing TR on Longitudinal Magnetization and the Resulting
Signal Intensity

that has flip angle of less than 90 degrees. A small flip-angle (less than 90 de¬
a

grees) excitation pulse converts only a fraction of the longitudinal magnetization

into transverse magnetization. This means that the longitudinal magnetization is
not completely destroyed or reduced to zero by the pulse, as shown in Figure 31-8.

c Maximum
o

03
N Small Angle High C/D
c
CD

C3
c
g>
Low CO

Figure 31-8 The Effect of Using Small Flip-Angle Pulses on Longitudinal Magnetizatior
 Imaging Methods 469

Reducing the flip angle has two effects that must be considered together. The
effect that we have just observed is that the
longitudinal magnetization is not com¬
pletely destroyed and remains at a relatively high level even for short TR intervals.
This will increase RF signal intensity compared to the use of
90-degree pulses.
However, as the flip angle is reduced, a smaller fraction of the longitudinal magne¬
tization is converted into transverse magnetization. This has the effect of reducing
signal intensity. The end result is a combination of these two effects. This is illus¬
trated in Figure 31-9. Here we see that as the flip angle is increased over the range
from 0 degrees to 90 degrees, the level of longitudinal magnetization at the begin¬

ning of a cycle decreases. On the other hand, as the angle is increased, the fraction
of this longitudinal magnetization that is converted into transverse magnetization
and RF signal increases. The combination of these two effects is shown in Figure
31-10. Here we see how changing flip angle affects signal intensity. The exact

shape of this curve depends on the specific T1 value of the tissue and the TR
interval. For each T1\TR combination there is a different curve and specific flip

angle that produces maximum signal intensity.

Small Angle Large Angle

Figure 31-9 The Effects of Excitation Pulse Flip Angle on the Amount of Longitudinal
and Transverse Magnetization
470 Physical Principles of Medical Imaging

s
Flip Angle (Degrees)
Figure 31-10 The Relationship of Signal Intensity to Flip Angle

Let us now useFigure 31-11 to compare the magnetization of two different

tissues as wechange flip angle. For this illustration we have selected gray and
white matter, which have different T1 and proton density values. The gray matter
has a longer T1 and a higher proton density value. Contrast between the two tis¬
sues is represented by the difference in magnetization levels. At this point we are

assuming a short TE and considering the contrast associated with only the longitu¬
dinal magnetization. We will add the effects of transverse magnetization later.
The flip-angle range is divided into several specific segments as shown.

77 Contrast

Relatively large flip angles (45 degrees-90 degrees) produce T1 contrast. This
is what we would expect because a 90-degree flip angle and short TR and TE

values are identical to the factors used to produce T1 contrast with the spin-echo
method. Here we observe a loss of T1 contrast as the flip angle is decreased from
90 degrees.

Low Contrast

There is an intermediate range of flip-angle values that produces very little if

any contrast. This is the region in which the proton density and T1 contrast cancel
each other.
 Imaging Methods 471

>,

"w
c
0)

15
c
g>
in

Flip Angle (Degrees)

Figure 31-11 The Effect of Flip Angle on Contrast

Proton Density Contrast

Relatively low flip-angle values produce proton density contrast. As the flip
angle is reduced within this region there is a significant decrease in magnetization
and the resulting signal intensity.

Low Signal Intensity

Very low flip angles are generally not useful because they produce low RF sig¬
nal intensities. This is because a small flip angle converts only a small fraction of
the longitudinal magnetization into transverse magnetization, as was shown in
Figure 31-9.
Up to this point we have observed generally how changing the flip angle of the
excitation pulse affects signal intensity and contrast. In the SAGE imaging meth¬
ods the flip angle is one of the imaging factors that must be adjusted by the user.
However, it becomes somewhat complex because the specific effect of flip angle
is modified by the other imaging factors and techniques used to enhance a specific

type of contrast.

Transverse Magnetization Effects

T2 contrast is produced by the decay characteristics of transverse magnetiza¬
tion. We need to recall that there are two different decay rates of the transverse
magnetization, as shown in Figure 31-3. The slower decay rate is determined by
the T2 characteristics of the tissue. The faster decay is produced by small
472 Physical Principles of Medical Imaging

inhomogeneities within the magnetic field often related to variations in tissue sus¬
ceptibility. This decay rate is determined by the T2* of the tissue. When a spin-
echo technique is used the spinning protons are rephased, as shown in Figure 31-3,
and the T2* effect is essentially eliminated. However, when a spin-echo technique
is not used the transverse magnetization depends only on the T2* characteristics
of the tissue. The gradient-echo technique does not compensate for the suscepti¬
bility effect dephasing as the spin-echo technique does. Therefore, a basic gradi¬
ent-echo imaging method is not capable of producing true T2 contrast. The con¬
trast will be determined primarily by the T2* characteristics.

Because SAGE methods use relatively short TR values there is the possibility
that some of the transverse magnetization created in one imaging cycle will carry
over into the next cycle. This happens when the TR values are in the same general

range as the T2 values of the tissue. SAGE methods differ in how they use the
transverse magnetization.

Spin Echoes
A typical SAGE sequence is limited to one RF pulse per cycle. If additional
pulses were used, as in the spin-echo techniques, they would affect the longitudi¬
nal magnetization and upset its equilibrium condition. However, because of the

relatively short TR values it is possible for the repeating small-angle excitation

pulses to produce a spin-echo effect. This can occur only when the TR interval is
not much longer than the T2 value of the tissue.

Associated with each excitation pulse, there are actually two components of the
transverse magnetization. There is the FID produced by the immediate pulse and a

spin-echo component produced by the preceding pulses. The spin-echo compo¬

nent is related to the T2 characteristics of the tissue. The FID component is related

to the T2* characteristics. The contrast characteristics of the imaging method are

determined by how these two components are combined. Different combinations

are obtained by altering the location of the gradient-echo event relative to the

transverse magnetization and by turning the spin-echo component on or off as

described below.

Mixed Contrast

When both the FID and spin-echo components are used, an image with mixed
contrast characteristics will be obtained. This method
produces a relatively high
signal intensity compared to the methods described below.
T1 Contrast Enhancement

An image with increased T1 contrast is obtained by suppressing the spin-echo

component. This is known as spoiling. The spin-echo component, which is a
 Imaging Methods 473

Figure 31-12 The Magnetization Preparation Method

carryover of transverse magnetization from previous cycles, can be destroyed or

spoiled by either altering the phase relationship of the RF excitation pulses or by
applying gradient pulses to dephase the spinning protons.

T2 Contrast Enhancement

An image with enhanced T2 contrast can be obtained by using the spin-echo

component. This is achieved by positioning the gradient-echo event so that it pro¬
duces a signal from transverse magnetization from the previous cycle.

MAGNETIZATION PREPARATION METHODS

The magnetization preparation (MP) method combines some of the desirable

features of both thespin-echo and gradient-echo methods. It is capable of produc-
474 Physical Principles of Medical Imaging

ing contrast from the longitudinal magnetization as in the spin-echo methods and
a fast acquisition with the gradient-echo method. The
principle is illustrated in
Figure 31-12. Two options are shown.
The longitudinal magnetization is "prepared"
by applying either a saturation
pulse, as in the spin-echo method, or an inversion pulse, as in the inversion-recov¬
ery method. As the longitudinal magnetization relaxes, contrast is formed between
tissues with different T1 and proton density values. After a time interval (TI or
TS)
selected by the operator, a rapid gradient-echo acquisition begins.
The total acquisition time for this method is the produce of TR and the number
of acquisition cycles plus the TI or TS time interval.

ECHO PLANAR METHOD

Echo planar is an imaging method that is capable of

acquiring a complete image
in less than 1 second. However, it requires an MRI
system equipped with special
gradient coils and is not used in most clinical facilities. It consists of a rapid gradi¬
ent-echo acquisition executed during a single spin-echo event. The unique charac¬
teristic of this method is that each gradient-echo
signal receives a different spatial
encoding. This makes it possible to reconstruct a complete image from one spin-
echo event.
 Chapter 32

Spatial Characteristics of the

Magnetic Resonance Image

INTRODUCTION AND OVERVIEW

During the MR image formation process a section of the patient's body is sub¬
divided into a set of slices and then each slice is cut into rows and columns to form
a matrix of individual tissue voxels. The RF signal from each individual voxel
must be separated from all of the others and its intensity displayed in the corre¬

sponding image pixel, as shown in Figure 32-1. This process occurs in two distinct
phases, as illustrated in Figure 32-2. The first phase is signal acquisition and is
followed by image reconstruction.

SIGNAL ACQUISITION

During the acquisition phase the RF signals are emitted by the tissue and re¬
ceived by the RF coils of the equipment. During this process the signals from the
different slices and voxels are given distinctive frequency and phase characteris¬
tics so that they can be separated from the other signals during image reconstruc¬
tion. The acquisition phase consists of an imaging cycle that is repeated many
times. The time required for image acquisition is determined by TR, which is the
duration of one cycle, its repetition time, and the number of cycle repetitions. The
number of cycles is determined by the image quality requirements. In general, the

quality of an image can be improved by increasing the number of acquisition

cycles. This is considered in much more detail in Chapter 33.
The result of the image acquisition process is a large amount of data collected
and stored in computer memory. At this point the data represent RF signal intensi¬
ties characterized by the two characteristics, frequency and phase. The concept of

frequency and phase will be developed later. It is not yet in the form of an image.
At this point in the process the data is said to be located in "k space," which will
later be transformed into image space.

475
476 Physical Principles of Medical Imaging

Tissue Slice Image

Voxels Pixels

Magnetization Intensity Brightness

□
Tissue Voxel RF Signal Image Pixel

Figure 32-1 The Relationship of Tissue Voxels to Image Pixels

IMAGE RECONSTRUCTION

Image reconstruction is a mathematical process performed by the computer. It

transforms the data collected during the acquisition phase into an image, as shown

Image Image
Acquisition Reconstruction
"k"
ii ii iiiii i ■ 11 M M M
~*
Fourier Transform
Space
/ \ 1

1 Cycle
TR (mSec);

TR x Number of Cycles

Time
Figure 32-2 The Sequence of Events That Produces an MR Image
 Spatial Characteristics of the Magnetic Resonance Image All

inFigure 32-3. The mathematical process used is known as Fourier transforma¬

tion.Image reconstruction is typically much faster than image acquisition and re¬
quires very little, if any, control by the user. Later we will consider the basic con¬
cepts of image reconstruction.

IMAGE CHARACTERISTICS

The most significant spatial characteristic of an image is the size of the indi¬
vidual tissue voxels. Voxel size has a major effect on both the detail and noise

characteristics of the image. The user can select the desired voxel size by adjusting
a combination of imaging factors, as described in Chapter 33.

GRADIENTS

Magnetic field gradients are used to give the RF signals their frequency and
phase characteristics.
A gradient is a gradual change in field strength across a magnetic field, as illus¬
trated in Figure 32-4. Magnets are equipped with electrical coils, which are used to

produce the gradients. When a magnet is in a "resting state," it produces a mag¬

netic field that is uniform or homogeneous over most of the patient's body. In this
condition there are no gradients in the field. However, when a gradient coil is
turned on by applying an electrical current, a gradient or variation in field strength
is produced in the magnetic field.

"k" Space Image

Data Points Pixels

tllllllllllllll
"O ~

CO
Fourier
Transform

nymnmnmmt Phase Encoded

|
| Acquisition Cycles Finish
Start

Figure 32-3 The Role of Image Reconstruction

478 Physical Principles of Medical Imaging

o o o o o o 0 o

Gradient
Coils
Field Off
i57
Strength

o 0 o o o o o 0

• • • • • • • •

Gradient
Coils
Field On
1.5T
Strength

Figure 32-4 A Magnetic Field Gradient

Gradient Orientation

The typical imaging magnet contains three separate sets of gradient coils. These
are so that gradients can be produced in the three orthogonal directions (x,
oriented
y, and z), as shown in Figure 32-5. Also, two or more of the gradient coils can be
used together to produce a gradient in any desired direction.
As we will see later, a gradient in one direction is used to create the slices and
then gradients in the other direction are used to cut the slices into rows and col¬
umns to create the individual voxels. However, these functions can be inter¬

changed among the x, y, and z gradients to permit imaging in any plane through
the patient's body.

Gradient Function

In addition to the spatial encoding to be described here, gradients are also used
for other functions such as the production of gradient-echo signals and to compen¬
sate for adverse effects produced by the flow of blood and cerebrospinal fluid.

Gradients produce a rather loud sound when they are turned on and off. The
intensity of the sound is related to the strength of the gradient and can vary with
specific imaging methods.
 Spatial Characteristics of the Magnetic Resonance Image 479

Orthogonal Gradients
+
1ST
► Z

15 Y

Figure 32-5 The Three Orthogonal Gradients in an MRI System

Gradient Cycle
The functions performed by the various gradients usually occur in a specific
sequence. During each individual image acquisition cycle the various gradients
will be turned on and off at specific times. As we will see later, the gradients are

synchronized with other events such as the application of the RF pulses and the
acquisition of the RF signals.

SLICE SELECTION

There are two individual slices. The method

distinct methods used to create the
of selective excitation actually creates the slice during the acquisition phase. An
alternative method is to acquire signals from a large volume of tissue and then
create the slices during the reconstruction process. Both methods have their ad¬

vantages and disadvantages.

Selective Excitation

The first gradient action in a cycle defines the location and thickness of the
tissue slice to be imaged. We will illustrate the procedure for a conventional
transaxial slice orientation. Other orientations, such as sagittal and coronal, are
created by interchanging the gradient directions.
480 Physical Principles of Medical Imaging

Slice selection using the principle of selective excitation is illustrated in Figure

32-6. When amagnetic field gradient is oriented along the patient axis, each slice
of tissue is in a different field strength and is tuned to a different resonant fre¬
quency. This is because the resonant frequency of protons is directly proportional
to the strength of the magnetic field. This slice selection gradient is present when¬

ever RF pulses are applied to the body. Since RF pulses contain frequencies within

a limited range (or bandwidth), they can excite tissue only in a specific slice. The

location of the slice can be changed or moved along the gradient by using a
slightly different RF pulse frequency. The thickness of the slice is determined by a
combination of two factors: (1) the strength, or steepness, of the gradient, and (2)
the range of frequencies, or bandwidth, in the RF pulse.

Multi-Slice Imaging

In most clinical applications, it is desirable to have a series of images (slices)

covering a specific anatomical region. By using the multi-slice mode, an entire set
of images can be acquired simultaneously. The basic principle is illustrated in
Figure 32-7. The slices are separated by exciting and detecting the signals from the
during each imaging cycle.
different slices in sequence
When the slice selectiongradient is turned on, each slice is tuned to a different
resonant frequency. A specific slice can be selected for excitation by adjusting the

RF pulse frequency to correspond to the resonant frequency of the slice. The pro¬
cess begins by applying an excitation pulse to one slice. Then, while that slice

Selected Slice
 Spatial Characteristics of the Magnetic Resonance Image 481

—I ' I 1—I—'—i—'—l
200 400 600 800 1000 mSec \

Excitation Sequence
-

1 Cycle Time (TR) -

Repeat for each cycle

Figure 32-7 Multi-Slice Imaging

undergoes relaxation, the excitation pulse frequency is shifted to excite the next
slice. This process is repeated to excite the entire set of slices at slightly different
times within one TR interval.
The advantage of multi-slice imaging is that a set of slices can be acquired in the
same time as a single slice. The principal factor that limits the number of slices is

the value of TR. It takes a certain amount of time to excite and then collect the

signals from each slice. The maximum number of slices is the TR value divided by
the time required for each slice. This limitation is especially significant for T1

images that use relatively short TR values.

Another factor to consider is that selective excitation cannot produce thin con¬

tiguous slices compared to the volume acquisition technique.

Volume Acquisition

Volume (3D) image acquisition has some advantages and disadvantages with
respect to slice (2D) imaging. With this method, no gradient is present when the
RF pulse is applied to the tissue. Since all tissue within an anatomical region, such
as the head, is tuned to the same resonant frequency, all tissues are excited simul¬

taneously. The next step, as illustrated in Figure 32-8, is to apply a phase-encoding

gradient in the slice selection direction. In volume imaging, phase encoding is
used to create the slices in addition to creating the voxel rows as described below.
The phase-encoding gradient used to define the slices must be stepped through
different values, corresponding to the number of slices to be created. At each gra-
482 Physical Principles of Medical Imaging

Slices Produced
by
Phase Encoding
-'Phase Encoding
nt

Selectively Excited Slice

Slice
Selection
Gradient

Slices
B.

Figure 32-8 The Volume Acquisition Process (A), Compared to Selective Excitation (B)
 Spatial Characteristics of the Magnetic Resonance Image 483

dient setting, complete set of imaging cycles must be executed. Therefore, the
a
total number of cycles required in one acquisition is multiplied by the number of
slices to be produced. This has the disadvantage of increasing total acquisition
time.
The primary advantage of volume imaging is that the phase-encoding process
can generally produce thinner and more contiguous slices than the selective exci¬
tation process used in slice imaging.

FREQUENCY ENCODING

A fundamental characteristic of an RF
signal is its frequency. Frequency is the
number of cycles per second. The frequency unit of Hertz corresponds to one
cycle per second. Radio broadcast stations transmit signals on their assigned fre¬
quency. By tuning our radio receiver to a specific frequency we can select and
separate from all of the other signals the specific broadcast we want to receive. In
other words, the radio broadcast from all of the stations in a city are frequency
encoded. The same process (frequency encoding) is used to cause voxels to pro¬
duce signals that are different and can be used to create one dimension of the
image.
Let us review the concept of RF signal production by a voxel of tissue, as shown
in Figure 32-9. Radio frequency signals are produced only when transverse mag¬
netization is present. The unique characteristic of transverse magnetization that

produces the signal is a spinning magnetic effect, as shown. The transverse mag¬
netization spins around the axis of the magnetic field. A spinning magnet or mag¬
netization in the vicinity of a coil forms a very simple electric generator. It gener¬
ates one cycle for each revolution of the magnetization. When the magnetization is

Figure 32-9 The Production of an RF Signal by the Transverse Magnetization within a

Voxel of Tissue
484 Physical Principles of Medical Imaging

spinning at the rate of millions of revolutions per second the result is a radio fre¬
quency signal.

Resonant Frequency

The frequency of the RF signal is determined by the spinning rate of the trans¬
verse magnetization. This, in turn, is determined by two factors, as was described
in Chapter 29. One determining factor is the specific magnetic nuclei (usually

protons) and the other is the strength of the magnetic field in which the voxel is
located. When imaging protons, the strength of the magnetic field is the factor that
can be used to vary the resonant frequency and the corresponding frequency of the

RF signals.
Figure 32-10 shows the process of frequency encoding the signals for a column
of voxels. In this example, a gradient is applied along the column. The magnetic
field strength is increased from bottom to top. This means that each voxel is lo¬
cated in a different field strength and is resonating at a frequency different from all
of the others. The resonant and RF signal frequencies increase from the bottom to
the top as shown.

Magnetic Field Tissue

 Spatial Characteristics of the Magnetic Resonance Image 485

The frequency encoding gradient is turned on at the time of the echo event when
the signals are actually being produced. The signals from all of the voxels are
produced simultaneously and are emitted from the body mixed together to form a
composite signal. The individual signals will be separated later by the reconstruc¬
tion process.

PHASE ENCODING

Phase is relationship between one signal and another, as illustrated in Figure

a

32-11. Here two voxels producing RF signals. The transverse magnetiza¬

we see

tion is spinning at the same rate and producing signals that have the same fre¬
quency. However, we notice that one signal is more advanced in time or is out of
step with the other. In other words, the two signals are out of phase. The signifi¬
cance of voxel-to-voxel phase in MRI is that it can be used to separate signals and

create one dimension in the image.

A phase difference is created by temporarily changing the spinning rate of the

magnetization of one voxel with respect to another. This happens when the two
voxels are located in magnetic fields of different strengths. This can be achieved
by turning on a gradient, as shown in Figure 32-12.
Let us begin the process of phase encoding by considering the row of voxels
shown at the bottom of the illustration. We are assuming that all voxels have the

Figure 32-11 The Concept of Phase between Two Signals (A), Compared to a Frequency
Difference (B)
486 Physical Principles of Medical Imaging

Gradient Off (at Time of Echo Event)

Gradient On
Slow
A Fast
N\
\

T / y
/

N>

Figure 32-12 The Use of a Gradient To Phase Encode RF Signals

same amount magnetization and that the magnetization is spinning in

of transverse

phase at this time just prior to the phase-encoding process.

When the phase-encoding gradient is turned on we have the condition illus¬
trated with the bottom row of voxels. The strength of the magnetic field is increas¬

ing from left to right. Therefore, the magnetization in each voxel is spinning at a
different rate with the speed increasing from left to right. This causes the magneti¬
zation from voxel to voxel to get out of step or produce a phase difference. The
 Spatial Characteristics of the Magnetic Resonance Image 487

phase-encoding gradient remains on for a short period of time and then is turned
off. This leaves the condition represented by the top row of voxels. This is the
condition that exists at the time of the echo event when the signals are actually
produced. As we see, the signals from the individual voxels are different in terms
of their phase relationship. In other words, the signals are phase encoded. All of
the signals are emitted at the same time and mixed together as a composite echo

signal. Later the reconstruction process will sort the individual signal components.
Phase encoding is the second function performed by a field gradient during each

cycle, as shown in Figure 32-13. During each pass through an imaging cycle, the
phase-encoding gradient is stepped to a slightly different value. The different set¬
tings create the different "views" required to reconstruct the final image. The con¬
cept of a view in MRI is quite different from a view in CT.
One MRI phase-encoding step produces a composite signal from all voxels
within a slice. The difference from one step to another is that individual voxel

signals have a different phase relationship within the composite signal.

To reconstruct an image by the conventional 2D Fourier transformation
method, one composite signal, or phase-encoded step, must be collected for each
voxel to be created in the phase-encoding direction. Therefore, the minimum num¬
ber of steps required to produce an image is determined by the size of the image
matrix. A 128 x 128 matrix image can be created in 128 steps. It takes 256 steps to

produce an image with a 256 x 256 matrix.

GRADIENTS

Slice Selection

Phase Encoding

Frequency Encoding

RF PULSES

RF SIGNAL

Figure 32-13 Sequence of Events during a Typical Imaging Cycle

488 Physical Principles of Medical Imaging

THE GRADIENT CYCLE

We have seen that various gradients are turned on and off at specific times

within each imaging cycle. The relationship of each gradient to the other events
during an imaging cycle is shown in Figure 32-13. The three gradient activities
are:

1. The slice selection gradient is on when RF pulses are applied to the tissue.
This limits magnetic excitation and echo formation to the tissue located
within the specific slice.
2. The phase-encoding gradient is turned on for a short period in each cycle to
produce a phase difference in one dimension of the image. The strength of
this gradient is changed slightly from one step to another to create the dif¬
ferent "views" needed to form the image.
3. The frequency-encoding gradient is turned on during the echo event when
thesignals are actually emitted by the tissue. This causes the different
voxels to emit signals with different frequencies.

Because of the combined action of the three gradients, the individual voxels
within each slice emit signals that are different in two respects. They have a phase
difference in one direction and a frequency difference in the other. Although these

signals are emitted at the same time, and picked up by the imaging system as one
composite signal, the reconstruction process can sort the signals into the respec¬
tive components.

IMAGE RECONSTRUCTION

The next
major step in the creation of an MR image is the reconstruction pro¬
cess.Reconstruction is the mathematical process performed by the computer that
converts the collected signals into an actual image. There are several reconstruc¬

tion methods, but the one used for most clinical applications is the 2D Fourier
transformation.
The basic concept of the Fourier transformation is illustrated in Figure 32-14. It
is amathematical procedure that can sort a composite signal into individual fre¬
quency and phase components. Since each voxel in a column emits a different
signal frequency, the Fourier transformation can determine the location of each
signal component and direct it to the corresponding pixel.
The sorting of the signals in the phase-encoded direction is also done by a Fou¬
rier transformation in a rather complex process.
Let us now use the concept illustrated in Figure 32-15 to summarize the spatial
characteristics of the MR image. We will use a postal analogy for this purpose.
 Spatial Characteristics of the Magnetic Resonance Image 489

Figure 32-14 The Role of the Fourier Transform in Image Reconstruction

In theimage each column of pixels has a phase address corresponding to differ¬

ent street names.Each row of pixels has a frequency address corresponding to
house numbers. Therefore, each individual pixel has a unique address consisting
of a combination of frequency and phase values analogous to a street name and
house number.
The frequency-and phase-encoding process "writes" an address on the signal
from each voxel. These signals are mixed together and collected in a mailbox, the
composite signals. The mail (signals) is then sorted by the Fourier transform pro¬
cess and hopefully delivered to the correct pixel address.

Signal Encoding Image Reconslruction

(Addressing) (Sorting and Delivery)

Phase Address

Image Pixels

Tissue Voxels

Acquisition

Reconstruction

Figure 32-15 The Concept of Signal Encoding (Addressing) and Image Reconstruction
(Sorting and Delivery)
490 Physical Principles of Medical Imaging

In Chapter 35 we will see that if a voxel of tissue moves during the acquisition
process it might not receive the correct phase address and the signal will be deliv¬
ered to the wrong pixel. This creates ghost images and streak artifacts in the phase-
encoded direction.
The chemical-shift artifact is caused by the difference in signal frequency be¬
tween tissues containing water and fat.
 Chapter 33

Image Detail, Noise, and

Acquisition Speed

INTRODUCTION AND OVERVIEW

Two characteristics of the MR image that affect the visibility of anatomical

structures and objects within the body are blurring and noise. Both image blurring
and image noise are undesirable characteristics that collectively reduce the overall

quality of an image. In general, blurring reduces the visibility of anatomical detail

or other small objects and the presence of visual noise reduces the visibility of low

contrast objects. This is shown in Figure 33-1, where we see objects arranged

according to two characteristics. In the horizontal direction, the objects are ar¬
ranged according to size. Decreasing object size corresponds to increasing detail.
In the vertical direction, the objects are arranged according to their inherent con¬
trast. The object in the lower left is both large and has a high level of contrast. This

is the object that would be most visible under a variety of imaging conditions. The

object that is always the most difficult to see is the small low contrast object lo¬
cated in the upper right corner.
In every imaging procedure we can assume that some potential objects within
the body will not be visible because of the blurring and noise in the image. This is

represented by the area of invisibility indicated in Figure 33-1. The boundary be¬
tween the visible and invisible objects, often referred to as a contrast-detail curve,

is determined by the amount of blurring and noise associated with a specific imag¬

ing procedure.
The equipment operator can change the boundary of visibility by altering the
amount of blurring and noise. These two characteristics are determined by the
combination of many adjustable imaging factors, as shown in Figure 33-2. It is of
acomplex process because the factors that affect visibility of detail (blurring) also
affect noise. Another point to consider is that several of the factors that have an
effect on both image detail and noise also affect image acquisition time. There¬
fore when formulating an image protocol one must consider the multiple effects

491
 492 Physical Principles of Medical Imaging

Low

Invisible

Blurring
•\ • •

High

Anatomical Detail (Object Size)

Figure 33-1 The Impact of Image Noise and Blurring on Object Visibility

of the imaging factors and then select factor values that provide an appropriate
compromise and an optimized acquisition for a specific clinical study.
The three competing goals associated with some of the same
imaging factors
are shown in
Figure 33-3. These are:
1. high detail (low blurring)
2. low noise (high signal-to-noise)
3. acquisition speed.
Each set of imaging parameters in an
imaging protocol is represented by an
operating point located somewhere within the triangular area. It can be moved by
changing the protocol factors values. However, as the operating point is moved
closer to one of the desirable goals, it
generally moves away from the other two.
This is the compromise that must be considered when
selecting protocol factors.
We will now consider the many factors that have an effect on the characteristics
of image detail, noise, and
acquisition speed.

IMAGE DETAIL

The ability of a magnetic resonance image to show detail is determined

prima¬
rily by the size of the tissue voxels and corresponding image pixels. In principle,
all structures within an individual voxel are blurred
together and represented by a
 Image Detail, Noise, and Acquisition Speed 493

Image Quality
Acquisition
Time
2:10

Detail Noise
Matrix— Matrix Matrix
FOV-— FOV
Slice Thickness— Slice Thickness
Averaging (NSA)™Averaging (NSA)
RF Coil Type
TR TR
TE

Operator

Figure 33-2 The Imaging Protocol Factors That Have an Effect on Image Detail, Noise,
and Acquisition Speed

single signal intensity. It is not possible to see details within a voxel, just the voxel
itself. The amount of image blurring is determined by the dimensions of the indi¬
vidual voxel.
Three basic imaging factors determine the dimensions of a tissue voxel, as illus¬
trated inFigure 33-4. The dimension of a voxel in the plane of the image is deter¬
mined by the ratio of the field of view (FOV) and the dimensions of the matrix.
Both of these factors can be used, to some extent, to adjust image detail.
The selection of the FOV is determined primarily by the size of the body part

being imaged. One problem that often occurs is the appearance of foldover arti¬
facts when the FOV is smaller than the body section. The maximum FOV is usu¬
ally limited by the dimensions and characteristics of the RF coil.
Matrix dimension refers to the number of voxels in the rows or columns of the
matrix. The matrix dimension is selected by the operator before the imaging pro¬
cedure. Typical dimensions are in the range of 128 to 256.
494 Physical Principles of Medical Imaging

IMAGING GOALS

Image Signal to
Detail Noise

Acquisition Speed

Figure 33-3 Three Imaging Goals That Must Be Considered When Selecting Protocol
Factors

There is a considerable range of voxel sizes (image detail) because of the pos¬
sible choices of FOV and matrix dimension. The third dimension of a voxel is the
thickness of the imaged slice of tissue. In most imaging procedures, this is the
largest dimension of a voxel. The amount of blurring can be reduced and the vis¬
ibility of detail improved by reducing voxel size. Unfortunately, there is a com¬
promise. Signal strength is directly proportional to the volume of a voxel. There¬
fore, reducing voxel size to improve image detail reduces signal intensity. This
becomes especially significant with respect to image noise.

IMAGE NOISE

Magnetic resonance image noise is produced primarily by random RF energy

picked up along with the signals from the patient's body. The presence of image
noise limits image quality both directly and indirectly and often requires extended

acquisition times to partially compensate for its presence. If it were not for this
form of noise, it would be possible to acquire images with greater contrast sensi¬

tivity and more detail, and to acquire them in less time than is required for current
image acquisition.
 Image Detail, Noise, and Acquisition Speed 495

IMAGE DETAIL
(Voxel size)

FOV
Matrix

Field of View Matrix

(100mm-500mm) (64,128,256) (2mm—10mm)

Figure 33-4 Factors That Affect Detail in MR Images

NOISE SOURCES

Random RF energy can be generated by thermal activity within electrical con¬

ductors and circuit components. In principle, the patient's body is one of the com¬
ponents in the RF receiver circuit. Therefore, because of its mass, it becomes the
most significant source of image noise in most imaging procedures. The specific
noise source is the tissue contained within the sensitive FOV of the RF receiver
coils. Some noise is generated within the receiver coils, but it is usually much less
than noise from the patient. Many devices in the environment produce RF noise or

signals that can interfere with MRI. These include radio and TV transmitters,
electrosurgery units, fluorescent lights, and computing equipment. All MR units
are installed with an RF shield to reduce the interference from these external

sources. External interference is not usually a problem with a properly shielded

unit. When it does occur, it generally appears as an image artifact rather than the
conventional random noise pattern.

SIGNAL-TO-NOISE CONSIDERATIONS

Image quality is not dependent on the absolute intensity of the noise but rather
the amount of noise energy in relationship to the image signal intensity. Image
quality increases in proportion to the signal-to-noise ratio. When the intensity of
the RF noise is low in proportion to the intensity of the image signal, the noise has
a low visibility. In situations where the signal is relatively weak, the noise be¬

comes much more visible. The principle is essentially the same as with conven-
496 Physical Principles of Medical Imaging

tional TV reception. When a strong signal is received, image noise (snow) is gen¬
erally not visible; when one attempts to tune in to a weak signal from a distant
station, the noise becomes significant.
In MRI the interference from noise is reduced by either reducing the noise in¬

tensity or increasing the intensity of the signals that create the image, as illustrated
in Figure 33-5. Let us now see how this can be achieved.

Voxel Size

One of the major factors that affects signal strength is the volume of the indi¬
vidual voxels. The signal intensity is proportional to the total number of protons
contained within a voxel. Large voxels emit stronger signals and produce less
image noise. Unfortunately, large voxels reduce image detail. Therefore, when the
factors for an imaging procedure are being selected, this compromise between

signal-to-noise and image detail must be considered. The major reason for imag¬
ing with relatively thick slices is to increase the voxel signal intensity.

Field Strength

The strength of the RF signal from an individual voxel generally increases in

proportion to the square of the magnetic field strength. However, the amount of
noise picked up from the patient's body often increases with field strength because
of adjustments made to reduce artifacts at the higher fields. Because of differences
in system design, no one precise relationship between signal-to-noise ratio and

magnetic field strength applies to all systems. In general, MRI systems operating

IMAGE SIGNAL/NOISE FACTORS

Signal Source
Noise Source
(voxel)
(body section)
RF Coil
T~—r

Nuclear Density Field Strength

Voxel Size

FOV Matrix Thickness

Figure 33-5 Factors That Affect Signal-to-Noise Ratios in MR Images

 Image Detail, Noise, and Acquisition Speed 497

at relatively high field strengths produce images with higher signal-to-noise ratios
than images produced at lower field strengths.

Tissue Characteristics

Signal intensity, and thus the signal-to-noise ratio, depends to some extent on
the magnetic characteristics of the tissue being imaged. For a specific set of imag¬
ing factors, the tissue characteristics that enhance the signal-to-noise relationship
are high magnetic nuclei (proton) concentration, short Tl, and long T2. The pri¬

mary limitation in imaging nuclei other than hydrogen (protons) is the low tissue
concentration and the resulting low signal intensity.

TR and TE

Repetition time (TR) and echo time (TE) are the factors used to control contrast
in conventional spin-echo imaging. We have observed that these two factors also
control signal intensity. This must be taken into consideration when selecting the
factors for a specific imaging procedure.
When a short TR is used to obtain a Tl-weighted image, the longitudinal mag¬
netization does not have the opportunity to approach its maximum and produce
high signal intensity. In this case, some signal strength must be sacrificed to gain a
specific type of image contrast. Also, when TR is reduced to decrease image ac¬
quisition time, image noise often becomes a limiting factor.
When relatively long TE values are used to produce T2 contrast, noise often
becomes noticeable. The long TE values allow the transverse magnetization and
the signal it produces to decay to very low values.

RF Coils

The most direct control over the amount of noise energy picked up from the
patient's body is by selecting appropriate characteristics of the RF receiver coil. In
principle, noise is reduced by decreasing the amount of tissue within the sensitive
region of the coil. Most imaging systems are equipped with interchangeable coils.
These include a body coil, a head coil, and a set of surface coils. The body coil is
the largest and usually contains a major part of the patient's tissue within its sensi¬
tive region. Therefore, body coils pick up the greatest amount of noise. Also, the
distance between the coil and the tissue voxels is greater than in other types of
coils. This reduces the intensity of the signals actually received by the coil. Be¬
cause of this combination of low signal intensity and higher noise pickup, body

coilsgenerally produce a poorer signal-to-noise ratio than the other coil types.
comparison to body coils, head coils are both closer to the imaged tissue and
In

generally contain a smaller total volume of tissue within their sensitive region.
 498 Physical Principles of Medical Imaging

Because of the increased signal-to-noise characteristic of head coils, relatively

small voxels can be used to obtain better
image detail.
The surface coil provides the highest signal-to-noise ratio of the three coil

types. Because of its small size, it has a limited sensitive region and picks up less
noise from the tissue. When it is placed on or near the surface of the
patient, it is
usually quite close to the voxels and picks up a stronger signal than the other coil
types. The compromise with surface coils is that their limited sensitive region
restricts the useful field of view, and the sensitivity of the coil is not uniform
within the imaged area. This non-uniformity results in
very intense signals from
tissue near the surface and a significant decrease in signal
intensity with increasing
depth. The relatively high signal-to-noise ratio obtained with surface coils can be
traded for increased image detail by using smaller voxels.

Averaging
One of the most direct methods used to control the signal-to-noise characteris¬
tics of MR images is the process of averaging. In principle, each basic imaging
cycle (phase-encoding step) is repeated several times and the resulting signals are
averaged to form the final image. The averaging process tends to reduce the noise
level because of its statistical fluctuation nature from one
cycle to another.
The disadvantage of averaging is that it increases the total
image acquisition
time in proportion to the number of cycle
repetitions or number of signals aver¬
aged (NSA). The NSA is one of the protocol factors set by the operator. Typical
values are 1 (no averaging), 2, or 4,
depending on the amount of noise reduction
required.
The general relationship is that the NSA must be increased
by a factor of 4 in
order to improve the signal-to-noise
by a factor of 2. The signal-to-noise is propor¬
tional to the square root of the NSA.

IMAGE ACQUISITION TIME

Acquisition speed is an important consideration in MR imaging. The time re¬

quired for the acquisition of an image or one set of multi-slice images is generally
the product of the factor TR, which is the duration of one
acquisition cycle multi¬
plied by the number of cycles. There are several factors that determine the number
of acquisition cycles required to create an image.

Matrix Size

A basic requirement for MR image reconstruction is that there must be one

phase-encoding step for each voxel to be created in the phase-encoded direction.
 Image Detail, Noise, and Acquisition Speed 499

For example, if there are to be 256 voxels in the phase-encoded direction, a mini¬
mum of 256 steps is required. However, there are some
modifying factors that will
be described later. It should be noted that the number of voxels or matrix size in
the frequency-encoding direction does not have an effect on
acquisition time. It is
a common procedure to use an asymmetrical matrix with more voxels in the fre¬
quency-encoding direction than in the phase-encoding direction. This helps to
maintain image detail and reduce acquisition time to some extent.

Averaging
When averaging is used to reduce image noise the acquisition cycles are re¬
peated. This increases acquisition time by the number of repetitions or NSA.

Half Acquisition
A basic acquisition requires one phase-encoded step for each voxel in the
phase-encoded direction. There is the possibility to reconstruct an image with only
one half of the normally required phase-encoded
steps, as shown in Figure 33-7.
The process makes use of the symmetry that exists between the first half and the
second half of the phase-encoded steps. In principle, the data collected during the

Image Matrix
(Phase Encode Direction)
Cycle Duration

—TR (Sec) —

Start— Matrix Finish

J Size r
Acquisition Cycles [j|T|T mm
Number of signals Averaged

Acquisition Time

Matrix X E X NSA Turbo Factor

(if used)

Figure 33-6 Factors That Determine Image Acquisition Time

500 Physical Principles of Medical Imaging

Conventional Acquisition

Acquired Half Scan Technique

Calculated from 1st Half

Figure 33-7 The Half-Scan Technique That Can Be Used To Reduce Acquisition Time

first half of an acquisition can be "flipped over" in k space to mathematically pro¬

duce the second half of the acquisition. This process reduces acquisition time but
the signal-to-noise is also reduced because fewer signals are collected. An image
created by this process will generally have the signal-to-noise characteristics cor¬
responding to an NSA value of one-half.

Turbo Factor

With some imaging methods it is possible to perform more than one phase-
encoded step during one acquisition cycle. This has the potential of decreasing
total acquisition time. The number of phase-encoded steps within one cycle is
often designated as the turbo factor. Increasing the turbo factor decreases acquisi¬
tion time proportionally.

PROCEDURE OPTIMIZATION

In general, there is a major compromise between acquisition speed and image

quality. When factors are changed to reduce acquisition time there is also an im¬
pact on image quality.
An imaging protocol should be optimized to provide the necessary image char¬
acteristics for each type of clinical procedure. However, we must recognize that
we cannot adjust the
acquisition to produce maximum values for the three charac¬
teristics being considered. This relationship is summarized in Figure 33-8. Here
 Image Detail, Noise, and Acquisition Speed 501

,, Voxel Size
small
large
Lm!ge I I I I I I I I I I I I I I 1 I Signal to
Noise

2 Number of
Signals
Matrix
Averaged
(Phase Direction)

(Halfscan)

Acquisition Speed

Figure 33-8 The Relationship of Protocol Factors to the Three Imaging Goals of Detail,
Signal-to-Noise, and Acquisition Speed

we see how the various protocol factors can be used to set the operating point
relative to the specific image characteristics. These factors include:
• Voxel size is selected to produce the desired balance between image detail
and signal-to-noise.
• Matrix size, in thephase-encoding direction, affects the balance between
image detail and acquisition speed.
• The number of signals averaged (NSA) provides a balance between signal-
to-noise and acquisition speed.
 Chapter 34

Magnetic Resonance Imaging of

Flowing Blood

INTRODUCTION AND OVERVIEW

One of the important characteristics of MRI is its ability to create an image of

flowing blood without the use of contrast media. The contrast between the blood
and the adjacent stationary tissue is produced by interactions between the move¬
ment of the blood and certain events within the imaging process.

It is a somewhat complex process because under some imaging conditions the

flowing blood will produce an increased signal intensity while under other condi¬
tions very little or no signal will be produced by the flowing blood. We will desig¬
nate these two possibilities as "bright blood" imaging and "black blood" imaging,
as indicated in Figure 34-1. There are several different physical effects that can

produce both bright blood and black blood as indicated. These effects can be di¬
vided into three categories:

1. time effects

2. phase effects
3. selective demagnetization (saturation).

Unfortunately, in addition to producing useful image contrast, the movement of

blood often produces undesirable artifacts within the image.
In this chapter we will explore the various effects associated with flowing blood
and show how they can be controlled and used.

TIME EFFECTS

The time effects are related to the movement of blood during certain time inter¬
vals within the acquisition cycle. The production of bright blood is related to the
TR time interval whereas the production of black blood is related to the TE time
interval.

503
504 Physical Principles of Medical Imaging

Bright Blood Black Blood

\
Flowing Blood
f ( \

Ipr .
( 0 •
V J
TIME EFFECTS \ /

In-Flow Enhancement A
Flow Void 1

PHASE EFFECTS
Intravoxel Dephasing
-

Flow Compensation
-

Even- Echo Rephasing

Phase Contrast

SATURATION
Figure 34-1 The Different Effects That Can Produce Contrast of Flowing Blood

Flow-Related Enhancement

The process that causes flowing blood to show an increased intensity, or bright¬
ness, is illustrated in Figure 34-2. This occurs when the direction of flow is
through the slice, as illustrated, and is also known
as the in-flow effect. The
degree
of enhancement is determined by the relationship of flow velocity to TR. Three
conditions are illustrated. The arrow indicates the amount of
longitudinal magne¬
tization at the end of each imaging cycle. Because of the slice-selection
gradient
the RF pulses affect only the blood within the slice.
When a long TR is used in the absence of flow, the
longitudinal magnetization
regrows to a relatively high value during each cycle, as indicated at the top. This
condition produces a relatively bright image of both the blood and the
stationary
tissue. If a short TR value is used, each cycle will begin before the
longitudinal
magnetization has approached its maximum. This results in a reduced signal in¬
tensity and a relatively dark image because both the blood and tissue remain par¬
tially saturated.
 Magnetic Resonance Imaging of Flowing Blood 505

Image

Long TR 11 r ^
urn ft ««««o
No Flow
ft/ I J
Short TR ft f
um
No Flow
ft
ft /
ft ft ft ft o |;;T|pT|
I J
f

Short TR ft
Flow
(m ft ft ft ft c
/
ft
90
High Magnetization Low Magnetization
(Unsaturated) RF Pulses (Partial Saturation)

Figure 34-2 Conditions That Produce an Increase in Image Brightness (Enhancement)

with Flow

The effect of flow is to replace some of the blood in the slice with fully magne¬
tized blood from outside the slice. The increased magnetization at the end of each
cycle increases image brightness of the flowing blood. The enhancement increases
506 Physical Principles of Medical Imaging

with flow until the flow velocity becomes equal to the slice thickness divided by
TR. This represents full replacement and maximum enhancement.
There are several factors that can have an effect on flow enhancement. In multi-
sliceimaging, including volume acquisition, the degree of enhancement can vary
with slice position. Only the first slice in the direction of flow receives fully mag¬
netized blood. As the blood reaches the deeper slices, its magnetization and result¬
ing signal intensity will be reduced by the RF pulses applied to the outer slices.
Slowly flowing blood will be affected the most by this. Faster flowing blood can
penetrate more slices before losing its magnetization. Related to this is a change in
the cross-sectional area of enhancement from slice to slice. A first slice might
show enhancement for the entire cross section of a vessel. However, when laminar
flow is present the deeper slices will show enhancement only for the smaller area
of fast flow along the central axis of the vessel.
Any other effects that produce black blood can counteract flow-related en¬
hancement. One of the most significant is the flow-void effect, which takes over at
higher flow velocities.
Bright blood from flow-related enhancement is especially prevalent with gradi¬
ent-echo imaging. There are two major reasons for this. The short TR values typi¬
cally used in SAGE imaging increase the flow-related enhancement effect. Also,
when a gradient rather than an RF pulse is used to produce the echo there is no
flow-void effect to cancel the enhancement.

FLOW-VOID EFFECT

Relatively high flow velocities through a slice reduce signal intensity and image
brightness. In Figure 34-3 the arrow in the slice indicates the level of residual
transverse magnetization when the 180-degree pulse is applied to form the spin-

echo signal. This is the transverse magnetization produced by the preceding 90-

degree pulse. The time interval between the 90-degree and 180-degree pulses is
one-half TE. If the blood is not moving, the blood that was magnetized trans¬
versely by the 90-degree pulse will be within the slice when the 180-degree pulse
is applied. This results in maximum rephasing of the transverse protons and a
relatively bright image.
If blood moves out of the slice between the 90-degree and 180-degree pulses,

complete rephasing will not occur. This is because the 180-degree pulse can affect
only the blood within the slice. The spin-echo signal is reduced, and the flowing
blood appears darker than blood moving with a lower velocity. The intensity con¬
tinues to drop as flow is increased until the flow velocity removes all magnetized
blood from the slice during the interval between the two pulses (one-half TE).
 Magnetic Resonance Imaging of Flowing Blood 507

Image

c
1
%
Slow
Flow
'
(11 If i l

* k \

90 180
Blood Excited
RF Pulses By 90 Degree Pulse

Image

Fast
m Flow
J

No Excited Blood
90 180 In Slice

RF Pulses

Figure 34-3 The Process of Flow-Related Reduction of Image Brightness or Flow-Void

Effect

Presaturation

A type of flow-void effect can be created by destroying (saturating) the longitu¬

dinal magnetization of the blood just before it flows into the imaging slice. This
technique is generally known as presaturation. The concept is illustrated in Figure
34_4. An RF pulse is selectively applied to the anatomical region that supplies
blood to the slice. This pulse destroys the longitudinal magnetization by flipping it
into the transverse plane. When this saturated, or unmagnetized, blood flows into
the slice a short time later it is not capable of producing a signal. Therefore, the
508 Physical Principles of Medical Imaging

Flow Enhancement

FLOW
cm ft ft ft ft ft |
11
/
Images

Presaturatlon

w}(M

Saturation Excitation

RF Pulses

Figure 34-4 The Use of RF Pulses To Demagnetize (Saturate) Blood Before It Flows into
a Slice

image displays a void or black blood in the vessels. The region of presaturation
can be placed on either side of the imaged slice. This makes it
possible to selec¬
tively turn off the signals from blood flowing in opposite directions.
The presaturation technique can be used to: (1)
produce black-blood images, (2)
selectively image either arterial or venous flow, and (3) reduce flow-related arti¬
facts, as described in Chapter 35.

PHASE EFFECTS

There important phase relationships that can be affected by movement

are two

of blood during the imaging process. One is the phase relationship among the
spinning protons within each individual voxel (intravoxel) and the other is the
voxel-to-voxel (intervoxel) relationship of the transverse
magnetizations, as
shown in Figure 34-5. Both of these
concepts have been described before. We will
 Magnetic Resonance Imaging of Flowing Blood 509

T ransverse Flow Effects

Magnetization

Intervoxel
Phase

Decrease Flow
and Compensation
Phase Shift
Protons

Intravoxel
Phase

In Phase Dephasing Rephasing

Figure 34-5 The Dephasing and Rephasing Effects Produced by Gradients

now see how they are affected by flowing blood and how they can be corrected by
the technique of flow compensation.

Intravoxel Phase

In order to produce a signal, the protons within an individual voxel must be in

phase at the time of the echo event. In general, dephasing and the loss of transverse
magnetization occurs when the magnetic field is not perfectly homogeneous or
uniform throughout a voxel. A gradient in the magnetic field is one form of

inhomogeneity that produces proton dephasing. Since gradients are used for vari¬
ous purposesduring an image acquisition cycle, this dephasing effect must be
taken into account. For stationary (non-flowing) tissue or fluid the protons can be
rephased by applying a gradient in the opposite direction, as shown in Figure 34-6.
Let us now consider this process in more detail.
In general, we are considering events that happen within the TE interval, that is,
between the excitation pulse and the echo event. We recall that the phase-encod-
510 Physical Principles of Medical Imaging

Gradient Gradient
Excitation Dephasing Rephasing Echo Event
Field In Phase
Non-moving Strength
Tissue <!> <J> 6 $$$

Flowing Dephased
Blood <t> 6 $
Dark Blood

Flowing In Phase

Blood
m
Bright Blood

Figure 34-6 Intravoxel Dephasing and Rephasing Produced by Gradients

ing gradient is applied during this time. We will use it as the example for this
discussion. When the gradient is applied as shown, the right side of the voxel is in
a stronger magnetic field than the left. This means that the
protons on the right are
spinning faster than those on the left and quickly get out of phase. However, they
can be rephased by applying a gradient in the reversed direction, as shown. Now

the protons on the left are in the stronger field and will be spinning faster. They
will catch up with and come into phase with the slower spinning protons on the

right. At the time of the echo event the protons are in phase and a signal is pro¬
duced. The process that has just been described is used in virtually all imaging
methods to compensate for gradient dephasing.

Flow Dephasing

Our next step is to consider what happens to the protons in a voxel of flowing
bloodor other fluid. This is also illustrated in Figure 34-6. If the voxel is
moving
the protons will not be completely rephased by the second gradient. This is be¬
cause the protons will not be in the same position relative to the gradient and will
not receive complete compensation. The result of this is that flow in the direction
 Magnetic Resonance Imaging of Flowing Blood 511

of a gradient will generally produce proton dephasing and little or no signal at the
time of the echo event. This is one possible source of black blood.

Flow Compensation

There are techniques that can be used to rephase the

protons within a voxel of
flowing blood or other fluid. These techniques use a somewhat complex sequence
of gradients to produce the rephasing, as shown in Figure 34-6. The technique is
generally called flow compensation or gradient moment nulling.
One of the selectable protocol factors controls the flow compensation gradients.
The technique can be turned on or off and adjusted to compensate for specific

types of flow. Flow with a constant velocity is the easiest to compensate. It is

possible to compensate pulsatile (changing velocity or acceleration) flow by using
a more complex gradient waveform. Flow
compensation is somewhat velocity
dependent. That is, all velocities are not equally compensated by the same gradi¬
ent waveform.

One factor that must be considered is the time

required within the TE interval
for the flowcompensation process. Some of the more complex compensation
techniques might increase the shortest TE that can be selected.

Even-Echo Rephasing

The phenomenon of even-echo rephasing can be observed when a multi-spin

echo technique is used to image blood flowing at a relatively slow and constant
velocity. This effect produces an increase in signal intensity (brightness) in the
even-echo images (second, fourth, etc.) compared to the odd-echo images.
This effect occurs when there is laminar flow through the vessel and the indi¬
vidual voxels. This means that the different layers of protons within a voxel are
moving at different velocities and will experience different phase shifts as they
flow through a gradient. This is a dephasing effect that will reduce transverse mag¬
netization and signal intensity at the time of the first echo event. The key to even-
echo rephasing is that the second 180-degree pulse reverses the direction of proton

spin. Before the pulse, the protons in the faster layers had moved ahead and gained
phase on the slower moving protons. However, immediately after the pulse they
are flipped so that they are behind the slower spinning protons. This sets the stage

for them to catch up and come back into phase. This occurs at the time of the
second echo event and results in an increase in transverse magnetization, higher

signal intensity, and brighter blood than was observed in the first echo image.
The alternating of blood brightness between the odd- and even-echo images
will continue for subsequent echoes but there will be an overall decrease in inten-
 512 Physical Principles of Medical Imaging

sity because of the T2 decay of the transverse magnetization. Both turbulent and
pulsatile flow tend to increase proton dephasing within a voxel, which results in a
loss of signal intensity. Under some conditions this can counteract the effect of
even-echo rephasing.

Intervoxel Phase

If a voxel of tissue moves during the image acquisition

process, the phase rela¬
tionship of its spinning transverse magnetization can be shifted relative to that of
other voxels. There are both advantages and
disadvantages of this effect.
Phase Imaging
Most MRI systems are capable of producing phase images. A phase image is
onein which the brightness of a voxel is determined by its phase relationship
rather than the magnitude of transverse magnetization. This is illustrated in Figure
34-7.
Consider a row of voxels vessel through which blood is flowing. We
across a

will assume laminar flow with thehighest velocity along the central axis of the
vessel. As this blood flows through a
magnetic field gradient the phase of the indi¬
vidual voxels will shift in proportion to the flow
velocity. Therefore, if we create
an image at a
specific time we can observe the phase relationships. If the phase of
a voxel's transverse
magnetization is then translated into image brightness (or
perhaps color) we will have an image that displays flow velocity and direction.
This type of image is somewhat
analogous to a Doppler ultrasound image in that it
is the velocity that is being measured and
displayed in the image.
Analytical software can be used in conjunction with phase images to calculate
selected flow parameters.
Phase effects can also be used to
produce angiographic images as described
later.

Artifacts

Flow and other forms of motion

produce serious artifacts in MR images.
can

Although the techniques that can be used to suppress artifacts will be described in
Chapter 35, it is appropriate to consider the source of one such artifact here. We
recall that the process of phase
encoding is used to produce one dimension in the
MR image. A gradient is used to
give each voxel in the phase-encoded direction a
different phase value. This phase value of each voxel is measured
by the recon¬
struction process (Fourier transform) and used to direct the
signals to the appropri¬
ate image pixels, as described in
Chapter 32. This process works quite well if the
tissue voxels are not moving during the acquisition
process. However, if a voxel
 Magnetic Resonance Imaging of Flowing Blood 513

Phase Image Pixel Brightness

Figure 34-7 Intervoxel Phase Effects That Can Be Used To Produce Images of
Flowing Blood

moves through a gradient, the phase relationship of its transverse magnetization

will be altered, as described above. This means that the RF signal will no longer
carry the correct phase address and will be directed to and displayed in the strong
pixel location. The observable effect is streaking or ghost images in the phase-
encoded direction.

ANGIOGRAPHY

Generally MR angiographic techniques are used to produce vascular images

covering a thick anatomical volume as opposed to a relatively thin slice.
Angiograms are also characterized by high contrast between the flowing blood
and stationary tissues. There are several different approaches to producing MR

angiograms. Each method has specific characteristics that must be considered

when producing clinical images. The various methods fall into two major catego¬
ries relating to the source of image contrast. Some methods produce contrast based
514 Physical Principles of Medical Imaging

on phase effects while others rely on the magnetic characteristics of the blood
flowing into the imaging area. We will now consider these two major techniques
and variations within each one.

Phase Contrast

We recall that when blood flows through a magnetic-field gradient the phase
relationship is affected. This applies both to the phase relationship of protons
within a voxel and the voxel-to-voxel relationship of transverse magnetization.
Both of these—intravoxel and intervoxel—phase effects can be used to produce
contrast of flowing blood. However, the intervoxel phase shift of the transverse

magnetization is the effect most frequently used to produce phase contrast in

angiographic images.
When blood flows through a gradient the phase relationship of the transverse

magnetization changes in proportion to the velocity. When this technique is used,

The phase shift, not the magnitude of the magnetization, is used to create the im¬

age. Therefore, image brightness is directly related to flow velocity in the direc¬
tion of the flow-encoding gradient.

Figure 34-8 illustrates the basic process of creating a phase contrast angiogram.
At least two image acquisitions are required. In one image the phase of the magne¬
tization is shifted in proportion to the flow velocity. Flow compensation is used

during the acquisition of the second image to reset the phase of the flowing blood.
The phase in the stationary tissue is not affected and is the same in both images.
The mathematical process of phase or vectory subtraction is then used to pro¬
duce the phase contrast image. The stationary tissue, which has the same phase in
the two images, completely cancels and produces a black background in the im¬

age. The flowing blood, which has a different phase in the two images, produces a
bright image.
The contrast in this type of image is related to both the velocity and direction of
the flowing blood.

Velocity
The
degree of phase shift and the resulting contrast is related to flow velocity.
When using this imaging method the user must set a velocity value as one of the
protocol factors. Flow at this rate will produce maximum contrast. An advantage
of phase contrast angiography is the ability to image relatively slow flow rates if
the proper factors are used.

Flow Direction

Phase contrast is produced only when the flow is in the direction of a gradient.
To image blood that is flowing in different directions several images must be ac-
 Magnetic Resonance Imaging of Flowing Blood 515

Flow-Related Phase Shift Flow Compensated

0 ft ft ft ft ft
Flow I Flow
ft ft ft ft ft ft

r i > r
\
I J r~
First Image Second Image

Phase Contrast Image

Figure 34-8 The Process of Creating a Phase-Contrast Angiogram

quired with gradients in the appropriate directions. Flow in all possible directions
can be imaged by acquiring three images with three orthogonal gradient direc¬

tions.
The images for the different flow directions are combined along with the sub¬
traction process to produce one composite angiographic image.

Inflow Effects

An angiographic image can be created by using the flow-related enhancement

principle described previously. This is also called the time of flight technique. In
angiography the method must be extended to cover an anatomical volume rather
than a single slice. There are two acquisition techniques that can be used to
achieve this. Each has its special characteristics that must be considered in clinical

applications.
516 Physical Principles of Medical Imaging

Spatial Characteristics

In addition to the technique used to produce contrast, consideration must be

given to the different methods that can be used to create the spatial characteristics
of the image.
The creation of an angiographic image is a two-step process. The first step is the

acquisition and reconstruction of a stack of slice images covering the anatomical

volume. The second step is to create a composite image from the stack of slice

images. This is usually by means of the maximum intensity projection (MIP) tech¬
nique, which will be described below, or by surface rendering methods.

Two-Dimension (2D) Slice Acquisition

With this technique the anatomical volume is covered by acquiring a series of

single-slice images, as shown in Figure 34-9. This approach provides relatively

strong signals (bright blood) throughout the volume because each slice is imaged
independently and not affected by blood saturated in other slices. This makes it
possible to image relatively large volumes. Also, the signals from the flowing
blood are relatively independent of flow velocity.

Angiographic Image

RF Pulses

Figure 34-9 A Two-Dimensional (2D) Slice Acquisition To Produce an Angiographic

Image
 Magnetic Resonance Imaging of Flowing Blood 517

Three-Dimension (3D) Volume Acquisition

A 3D volume acquisition can be used to create an angiographic image, as shown

in Figure 34-10. We recall that with this acquisition method signals are acquired
from an entire volume simultaneously, which are phase encoded in the slice selec¬
tion direction. The individual slices are then created during the image reconstruc¬
tion process. The principal advantage is the ability to create thin contiguous slices
with small voxel dimensions. In vascular imaging small voxels reduce intravoxel

dephasing and signal loss.

The principal disadvantage of this method is that relatively slow flowing blood
becomes saturated as it passes through the acquisition volume. This can limit the
volume size, which is capable of producing good image contrast. Blood flowing
with a relatively high velocity, as along the central axis of a vessel, will be imaged

deeper into the acquisition volume than slow flowing blood. This is illustrated in
Figure 34-10.

Angiographic Image

A A

RF Pulses

Figure 34-10 A Three-Dimensional (3D) Volume Acquisition To Produce an

Angiographic Image
 518 Physical Principles of Medical Imaging

Maximum Intensity Projections

The maximum intensity projection (MIP) technique is used to create a single
composite image from a stack of images, as shown in Figure 34-11. This is a
mathematical process performed by the
computer. The stack of images is
"viewed" along a series of pathways
through the volume. The maximum signal
intensity, or blood brightness, encountered in any slice along each pathway is then
projected onto the composite image. The resulting MIP image is a 2D image of the
3D vascular structure. This process
generally enhances the contrast between the
flowing blood and the stationary tissues.
It is possible to create images
by projecting in different directions through the
volume. This gives the impression of
rotating the vascular structure so that it can
be viewed from different directions.

Maximum Intensity Projection Image —

Stack of Slice Images

Figure 34-11 The Concept of Maximum Intensity Projection (MIP) To Produce an
Angiographic Image
 Chapter 35

MRI Artifacts

INTRODUCTION AND OVERVIEW

There variety of artifacts that can appear in MR images. There are many
are a

different causesfor artifacts, including equipment malfunctions and environmen¬

tal factors. However, most artifacts occur under normal imaging conditions and
are caused by the sensitivity of the imaging process to certain tissue characteristics

such as motion and variations in composition.

There are many techniques that can be applied during the image acquisition

process to suppress artifacts. In this chapter we will consider the most significant
artifacts that degrade MR images and how the various artifact suppression tech¬
niques can be employed.
An artifact is something that appears in an image and is not a true representation
of an object or structure within the body. Most MRI artifacts are caused by errors
in the spatial encoding of RF signals from the tissue voxels. This causes the signal
from a specific voxel to be displayed in the wrong pixel location. This can occur in
both the phase-encoding and frequency-encoding directions, as shown in Figure
35-1. Errors in the phase-encoding direction are more common and larger, result¬
ing in bright streaks or ghost images of some anatomical structures. Motion is the
most common cause but the aliasing effect can produce ghost images that fold
over or wrap around into the image.

Errors in the frequency-encoding direction are limited to a displacement of just

a few pixels that can occur at boundaries between fat and nonfat tissues in which

most of the protons are contained in water.

MOTION-INDUCED ARTIFACTS

Movement of body tissues and the flow of fluid during the image acquisition
process is the most significant source of artifacts. The selection of a technique that

519
520 Physical Principles of Medical Imaging

Artifacts

Streaks
and Pixel

Ghost Displacement

/
Phase Encoding Frequency Encoding

Motion Aliasing Chemical Shift

Fold Over Water - Fat Shift
or

Wrap Around
Figure 35-1 Classification of the Most Common MRI Artifacts

can be used to suppressmotion artifacts depends on the temporal characteristic of

the motion (periodic or random) and the spatial relationship of the moving tissue
to the image area. Figure 35-2 shows the types of motion that can produce artifacts

and techniques that can be used to reduce them.

At this point we need to make a clear distinction between blurring and artifacts.
We recall that the principal source of blurring in MRI is the size of the individual
voxels. Under some imaging conditions motion can produce additional blurring,
which reduces visibility of detail and gives the image an unsharp appearance. This
is especially true for motion that causes a voxel to change location from one acqui¬
sition cycle to another. Blurring occurs when the signals from an individual voxel
come from the different locations occupied by the voxel. The signals are smeared

over the region of movement. Artifacts, or ghost images, occur when the signals

are displayed at locations that were never occupied by the tissue.

Most of the motion-induced artifacts are produced by dephasing or phase er¬

rors. We recall from Chapter 34 that flow and other forms of motion can produce

both intravoxel and intervoxel phase problems. Intravoxel dephasing generally

results in reduced signal intensity whereas intervoxel phase errors produce arti-
 MR1 Artifacts 521

Source Of Motion Artifacts

Ordered
Phase Encoding

Serial Averaging
Regional Saturation
Figure 35-2 Various Types of Motion That Produce Artifacts in MR Images and
Correction Techniques

facts in the phase-encoded direction. The phase-encoding process is especially

affected by body motion, which causes a particular anatomical structure to be in a
different location from one acquisition cycle to another. This contributes to the

phase error and to the production of artifacts.

Phase-Encoded Direction

Motion artifact streaks and ghosting always occur in the phase-encoded direc¬
tion. Prior to an acquisition the operator can select which direction in the image,
vertical or horizontal, is to be phase encoded as opposed to frequency encoded.
This makes it possible to place the artifact streaks in either the horizontal or verti¬
cal direction. This is a very helpful technique for protecting one anatomical area
from motion and flow artifacts produced in another area. It does not eliminate the
artifacts but orients them in a specific direction.
 522 Physical Principles of Medical Imaging

Cardiac Motion

Cardiac activity is a source of motion in several anatomical locations. The

movement of the heart
produces artifact streaks through the thoracic region and
blurring of cardiac structures when the heart is being imaged. In other parts of the
body, pulsation of both blood and cerebrospinal fluid (CSF) can produce artifacts
and loss of signal intensity.

Triggering
Synchronizing the image acquisition cycle with the cardiac cycle is an effective
technique for reducing cardiac motion artifacts. An EKG monitor attached to the
patient provides a signal to trigger the acquisition cycle. The R wave is generally
used as the reference point. The initiation of each
acquisition cycle is triggered by
the R wave. Therefore, an entire
image is created at one specific point in the car¬
diac cycle. This has two advantages. The motion artifacts are reduced and an
unblurred image of the heart can be obtained. The
delay time between the R wave
and the acquisition cycle can be adjusted to
produce images throughout the car¬
diac cycle. This is typically done in cardiac
imaging procedures.
Maximum artifact suppression by this technique
requires a constant heart rate.
Arrhythmias and normal heart-rate variations reduce the effectiveness of this
technique.
Cardiac triggering is also useful for
reducing artifacts from CSF pulsation. This
can be
especially helpful in thoracic and cervical spine imaging.
Flow Compensation
The
technique of flow compensation or gradient moment nulling was described
in Chapter 34. In addition to compensating for blood flow effects, it can be used to
reduce problems arising from CSF
pulsation, especially in the cervical spine. It
actually provides two desirable effects. The rephasing of the protons within each
voxel increases signal
intensity from the CSF, especially in T2 images. It also
reduces the motion artifacts.

Respiratory Motion

Respiratory motion can produce artifacts and blurring in both the thoracic and
abdominal region. Several techniques can be used to suppress these motion
effects.

Averaging
The technique of signal averaging is used primarily to reduce signal noise, as
described in Chapter 33. However, averaging has the additional benefit of reduc-
 MRI Artifacts 523

ing streak artifacts arising from motion. If a tissue voxel is moving at different
velocities and in different locations during each acquisition cycle, the phase errors
will be different and somewhat randomly distributed. Averaging the signals over
several acquisition cycles produces some degree of cancellation of the phase er¬
rors and the artifacts. There are several different
ways that signals can be aver¬
aged. Serial rather than parallel averaging gives the best artifact suppression.
Serial averaging is performed by repeating two or more complete acquisitions and
averaging. Parallel averaging is performed by repeating an imaging cycle two or
more times for each phase-encoded gradient step. With serial averaging there is a

much longer time between the measurements made at each phase-encoded step.
This gives a more random distribution of phase errors and better cancellation. As
with noise, increasing the number of signals averaged (NSA) reduces the intensity
of artifacts but at the cost of extending the acquisition time. The averaging process
reduces artifacts but not motion blurring.

Ordered Phase Encoding

An artifact reduction technique that is used specifically to compensate for respi¬
ratory motion is ordered phase encoding. We recall that a complete acquisition
requires a large number of phase-encoded steps. The strength of the phase-en-
coded gradient is methodically changed from one step to another. In a normal

acquisition the gradient is turned on with maximum strength during the first step
and is gradually decreased to a value of zero at the midpoint of the acquisition
process. During the second half the gradient strength is increased, step by step, but
in the opposite direction. The basic problem is that two adjacent acquisition cycles

might catch a voxel of moving tissue in two widely separated locations. The loca¬
tion is also somewhat random from cycle to cycle. This contributes to the severity
of the artifacts.
Ordered phase encoding is a technique in which the strength of the gradient for
each phase-encoded step is related to the amount of tissue displacement at that
particular instant. This requires a transducer on the patient's body to monitor res¬
piration. The signals from the transducer are processed by the computer and used
to select a specific level for the phase-encoded gradient.

Regional Presaturation
Regional presaturation is a technique that has several different applications. In
Chapter 34 we saw how it could be used with flowing blood to eliminate the signal
and produce a black-blood image. An application of this technique to reduce respi¬
ratory and cardiac motion artifacts in spine imaging is shown in Figure 35-3. With
thistechnique a 90-degree RF saturation pulse is selectively applied to the region
of moving tissue. This saturates or reduces any existing longitudinal magnetiza¬
tion to zero. This is then followed by the normal excitation pulse. However, the
524 Physical Principles of Medical Imaging

region that had just experienced the saturation pulse is still demagnetized (or satu¬
rated) and cannot produce a signal. This region will appear as a black void in the
image. It is also incapable of sending artifact streaks into adjacent areas.

Flow

Flow is different from the types of motion described above because a specific
structure does not appear to move from cycle to cycle. This reduces the blurring
effect but artifacts remain a problem.
The flow of blood or CSF in any part of the body can produce artifacts because
of the phase-encoding errors. Several of the techniques that have already been
described can be used to reduce flow-related artifacts.

Regional Presaturation
Regional presaturation as described in Chapter 34 is especially effective be¬
cause it turns the blood black. Black blood, which produces no signal, cannot
produce artifacts.

\ / \

90° 9cp 180°

♦ I
Saturation Echo

Excitation

RF Pulses

Figure 35-3 The Use of Regional Presaturation To Reduce Motion Artifacts

 MRI Artifacts 525

Figure 35-4 illustrates the use of presaturation to reduce flow artifacts. The area
of saturation is locatedso that blood flows from it into the image slice.

Flow Compensation
Flow compensation is useful when it is desirable to produce a bright-blood im¬
age.It both reduces intervoxel phase errors, the source of streaking, and restores
some of the intravoxel magnetization and signal intensity.

ALIASING ARTIFACTS

Aliasing, which produces fold-over or wrap-around artifacts, can occur when

some part of the patient's body extends beyond the selected field of view (FOV).
The anatomical structures that are outside of the field of view appear to "wrap
around" and are displayed on the other side of the image, as shown in Figure 35-5.
This occurs because the conventional imaging process does not make a sufficient
number of signal measurements or samples. Because of this undersampling the
anatomical structures outside of the FOV produce signals with the same frequency
and phase characteristics of structures within the image area. This phenomenon is

Saturated

I a 4
Saturation T Echo
Excitation

RF Pulses

Figure 35-4 The Use of Regional Saturation To Reduce Flow Artifacts

526 Physical Principles of Medical Imaging

known as aliasing because structures outside of the FOV take on an alias in the
form of the wrong spatial-encoding characteristics. Wrap around can occur in both
the frequency- and phase-encoded direction but is more of a problem in the phase-
encoded direction.
Two techniques that can be used to eliminate wrap-around artifacts are illus¬
trated inFigure 35-5. One procedure is to increase the size of the acquisition FOV
and then display only the specific area of interest. The FOV is extended
by in¬
creasing the number of voxels in that direction. This is described as oversampling.
Under some conditions these additional samples or measurements will
permit a
reduction in the NSA so that acquisition time and signal-to-noise is not
adversely
affected by this technique.
An alternative method of eliminating wrap-around or fold-over artifacts is to

apply presaturation pulses to the areas adjacent to the FOV. This eliminates sig¬
nals and the resulting artifacts.

Oversampling

Presaturation

t t
Saturated Areas

Figure 35-5 The Wrap-around or Fold-over Artifact and Methods for Suppressing It
 MRI Artifacts 527

CHEMICAL-SHIFT ARTIFACTS

The so-called chemical-shift artifact mis-registration or pixel displace¬

causes a

ment between water and fat tissue direc¬

components in the frequency-encoded
tion, as shown in Figure 35-6. The problem occurs because the protons in water
and fat molecules do not resonate at precisely the same frequency. The shifting of
the water tissue components relative to fat can produce both a void and regions of
enhancement along tissue boundaries.
There are several factors, as illustrated in Figure 35-7, that determine the num¬
ber of pixels of chemical shift. A knowledge of these factors can be used to predict
and control the amount of chemical shift that will appear in a clinical image.

Field Strength

We recall from Chapter 29 that the chemical shift or difference in resonant fre¬
quency between water and fat is approximately 3.3 ppm. This is the amount of
resonant frequency. The product
chemical shift expressed as a fraction of the basic
of this and the proton resonant frequency of 64 MHz (at a field strength of 1.5 T)

Tissue
Water FaT
Freouancv

■BIBBS
BBHBB
■saws
■■BBS
■BBSS
Image
■
■BIBS
■BBSS
■ BBSS
■ ■■■■
■■ass

256 Pixels.
Image Width (pixels) -16 Pixels/kHz
Bandwidth (kHz) 16 kHz """

210 Hz at 1.5 T

70 Hz at 0.5 T

Water Fat

Spectrum 1
3.3 ppm

Relative Resonant Frequency

Figure 35-6 The Chemical-Shift Artifact

528 Physical Principles of Medical Imaging

gives a chemical shift of 210 Hz. At a field strength of 0.5 T the chemical shift will
be only 70 Hz. The practical point is that chemical shift increases with field
strength and is generally more of a problem at the higher field strengths.

Bandwidth

In the
frequency-encoded direction the tissue voxels emit different frequencies
so thatthey can be separated in the reconstruction process. The RF receiver is
tuned to receive this range of frequencies. This is the bandwidth of the receiver.
The bandwidth is often one of the adjustable protocol factors. It can be used to
control the amount of chemical shift (number of pixels) but it also has an effect on
other characteristics such as signal-to-noise.
In Figure 35-6 we assume a bandwidth of 16 kHz. If the
image matrix is 256
pixels in the frequency-encoded direction, this gives 15 pixels per kHz of fre¬
quency (256 pixels/16 kHz). If we now multiply this by the chemical shift of 0.210
kHz (210 Hz) we see that the chemical shift will be 3.4
pixels.
The amount of chemical shift in terms of pixels can be reduced
by increasing
the bandwidth. This works because the chemical shift, 210 Hz, is now a smaller
fraction of theimage width and number of pixels.
On most MRI systems the water-fat chemical shift (number of
pixels) is one of
the protocol factors that can be adjusted
by the operator. When a different value is
selected the bandwidth is automatically changed to
produce the desired shift. Even
through the chemical-shift artifact can be reduced by using a large bandwidth, this
is not always desirable. When the bandwidth is increased more RF noise
energy
will be picked up from the patient's body and the
signal-to-noise relationship will
be decreased. Therefore, a bandwidth or chemical-shift value should be selected
that provides a proper balance between the amount of artifact and
adequate signal-
to-noise.
 Chapter 36

The Gamma Camera

INTRODUCTION AND OVERVIEW

Many nuclear medicine procedures require an image that shows the distribution
of a radioactive substance within the patient's body. For many years nuclear im¬

ages were obtained by using a rectilinear scanner. Today most imaging is done
with the gamma camera. The gamma camera takes a picture of a gamma-emitting
radioactive source much like a conventional camera takes a picture of an illumi¬
nated object. Not all gamma cameras in use today are identical in design, but most
have a number of common features. This chapter considers the general construc¬
tion, function, and characteristics of a typical gamma camera.
The gamma camera consists of a number of components, as shown in Figure 36-
1. Each component performs a specific function in converting the gamma image
into a light image and transferring it to an appropriate viewing device or film. The
first component, the collimator, projects the gamma image onto the surface of the

crystal. The scintillation crystal absorbs the gamma image and converts it into a
light image. The light image that appears on the rear surface of the scintillation
crystal has a very low intensity (brightness) and cannot be viewed or photo¬
graphed directly at this stage. The photomultiplier (PM) tube array, which is be¬
hind the crystal, performs two specific functions. It converts the light image into
an image of electrical pulses, and it amplifies, or increases, the intensity of the

image. The electrical pulses from the tube array go to an electronic circuit that
creates three specific signals for each gamma photon detected by the camera. One

signal is an electrical pulse whose size represents the energy of the gamma photon.
The other two signals describe the location of the photon within the image area.

Typically, the size of one pulse represents the horizontal position, and the size of
the other pulse the vertical position.
The pulse representing the energy of the photon goes to the input of a pulse

height analyzer (PHA). (The PHA function is discussed in detail later.) If the pulse

529
530 Physical Principles of Medical Imaging

Figure 36-1 Components of a Gamma Camera

is within the selected window (energy) range, it will pass through the PHA and be
recorded in the computer memory along with the location information. The data
pulses are available to a computer for future processing, viewing, and analysis.

CAMERA CHARACTERISTICS

To use a gamma camera properly for various types of examinations, one must
be familiar with its imaging characteristics. In some instances, it is desirable to
alter the characteristics of the
camera to fit the examination being conducted. After

considering the significance of basic camera characteristics, we will see how they
depend on the various components that make up the camera system.

Sensitivity

In atypical imaging situation, only a small fraction of the gamma photons emit¬
ted by the radioactive material contribute to the formation of the image. Consider
the situation illustrated in Figure 36-2. The photons leave the small radioactive
source equally distributed in all directions. The only photons that contribute to the

image are the ones passing through the appropriate collimator hole and absorbed
in the crystal. Photons from the source that are not absorbed in the crystal are, in
effect, wasted and do not contribute to image formation. This characteristic of a
gamma camera is generally referred to as the sensitivity. The sensitivity of a cam¬
era can be described in terms of the number of photons detected and used in the

image for each unit (|iCi) of radioactivity, as illustrated in Figure 36-2.

The sensitivity of a camera system is affected by several of its components; it is,
for example, very dependent on the design of the collimator. Most camera systems
have interchangeable collimators, and this is one factor that can be used to alter the
 The Gamma Camera 531

Camera Image

r
\

Counts per second

Sensit ivity
Microeurie
Source

Figure 36-2 The Concept of Gamma Camera Sensitivity

sensitivity. The problem is that a collimator that yields maximum sensitivity usu¬
ally produces maximum image blur. The compromise between these two factors is
discussed in detail in a later chapter.
The thickness of a scintillation crystal has an effect on detector efficiency. De¬
tector efficiency and camera sensitivity are reduced when photons pass through

the crystal. Therefore a thick crystal tends to yield higher sensitivity, especially for

high-energy photons, but also produces more image blur.

Another factor that affects the sensitivity of a camera system is the setting of the
PHA, which will be discussed later. The only photons that contribute to the image
are the ones within the PHA window. A window that is very small or incorrectly

positioned with respect to the photon energy spectrum can significantly reduce
camera sensitivity.

Many cameras have a short dead time after each photon is detected during
which an arriving photon is not counted. Dead time reduces sensitivity when the

photon rate is high and the photons tend to overlap.

Camera sensitivities are generally in the range of 100 to 1,000 cps/pCi. Since 1
ftCi typically yields 37,000 photons per second, this means that less than 3% of the
emitted photons are used for image formation.

Field of View

The field of view (FOV) of a gamma camera is an important characteristic be¬

cause it determines how much of a patient's body can be imaged at any one time.
The FOV depends on the size of the crystal, the type of collimator, and, in some
532 Physical Principles of Medical Imaging

systems, the distance between the object being imaged and the camera crystal.

COLLIMATORS

The purpose of the collimator is to "project" an image of the radioactivity onto

the surface of the camera crystal. The manner in which this is accomplished is
illustrated in Figure 36-3. The collimator is constructed of a metal that is a good
photon absorber, such as lead or tungsten. Holes are positioned in the collimator
so that each point on the crystal's surface has a direct view of only one point on the

surface of the body. In effect, each point of the crystal is able to see only the
radiation originating from a corresponding point on the patient's body. Although
the illustration shows only a few holes in the collimator, actual collimators contain
hundreds of holes located very close together in order to see all points within the
FOV. The one exception is the pin-hole collimator, which is discussed later.

Typically, a gamma camera is equipped with several interchangeable collima-

Front View

Crystal Collimator Section

J1 J Side View
Image
A
O
1
Source A

Image -
^ -

B
O 'Source B

Figure 36-3 The Basic Function of a Collimator

 The Gamma Camera 533

tors.The differences among the collimators are the thickness, number, and size of
the holes and the way they are arranged or oriented. This, in turn, has an effect on
the camera sensitivity, FOV image magnification, and image blur. The user must
be aware of these differences in order to select the best collimator for a given
examination.
When selecting a collimator, it is necessary to consider the energy of the gamma

photons. The ability of a photon to penetrate a given material generally increases

with photon energy. In other words, it takes a thicker piece of material to absorb

high-energy photons than it does to absorb low-energy photons. The purpose of

the collimator septa (thin dividing walls) is to prevent photons from penetrating
from one hole to another. This depends on the relationship of the photon energy to
the thickness of the metal septa separating the holes. With low-energy photons,

relatively thin septa are adequate. The advantage of thin septa is that more holes
can be located in a given area, and this results in a higher sensitivity. However,

thicker septa must be used with high-energy photons in order to prevent photons
from crossing over from one hole to another.

Figure 36-4 compares sections of low-energy and high-energy collimators. If a

low-energy collimator is used with high-energy photons, significant septal pen¬
etration will occur, and the image will be abnormally blurred. If a high-energy

Low-Energy
Collimator

Source of
High-Energy
Photons
High-Energy
Collimator

Sharp
Image
%

Figure 36-4 Comparison of Low-Energy

and High-Energy Collimators
534 Physical Principles of Medical Imaging

collimator is used with low-energy photons, an image of normal quality will be

obtained, but the camera will be operating with less than optimum sensitivity.
Collimator holes are oriented in different ways, which affects collimator function.

Parallel-Hole Collimators

A common arrangement is for the collimator holes to be parallel, as illustrated

in Figure 36-5. The FOV is determined by the size (diameter) of the crystal and
remains the same at all source-to-camera distances. The size of the image at the
crystal is the same as the actual size of the radioactive source being imaged. This
relationship does not change with distance. Therefore, the parallel-hole collimator
does not produce either magnification or minification of the image. The photons
that pass through the parallel-hole collimator are the ones moving in a direction

parallel to the holes. Assuming there is no photon absorption between the source
and collimator, the number of these parallel photons does not change significantly
with the source-to-camera distance. Therefore, camera sensitivity with a parallel-
hole collimator is generally not affected by changing the distance between the
source and camera. Note that the inverse-square effect does not occur with a colli-

mated system of this type.

Diverging Collimators

diverging collimator, the holes fan out from the surface of the crystal, as
In the
shown in Figure 36-6. With this arrangement of holes, the camera can image a
source larger than the crystal. The FOV increases with distance from the face of

the collimator. The major advantage of the diverging collimator is the increased
FOV. The rate at which the FOV increases with distance depends on the

angulation of the holes. For a typical diverging collimator, the FOV at a distance
of 15 cm is approximately 1.6 times the FOV at the collimator surface.
With the diverging collimator, the image at the crystal surface is smaller than
the actual size of the radioactive source. For a given collimator, the degree of
minification increases with the distance between the source and collimator face.
The change in magnification with distance can produce distortion in the image,
because objects close to the camera are minified less than objects located at a
greater distance from the camera surface. For example, two identical lesions will
appear to have different sizes if they are not located at the same distance from the
camera.

The sensitivity of a camera equipped with a diverging collimator decreases with

distance between the source and camera. As the radioactive source is moved away
from the face of the collimator, it is in the FOV of a smaller number of holes. This
reduces the number of photons that reach the crystal and decreases camera sensi¬
tivity.
 The Gamma Camera 535

IMAGE

~i

JJ

Object

Figure 36-5 Parallel-Hole Collimator

Converging Collimators
The holes in the converging collimator arranged so that they point to, or
are
converge on, a point located in front of thecollimator, as shown in Figure 36-7.
This is, in effect, the reverse arrangement of the diverging collimator. In fact,
some collimators are reversible so that they can be used as either a diverging or

converging collimator. As might be expected, the FOV for a converging collima-

536 Physical Principles of Medical Imaging

tor decreases with increased distance from the collimator face. The converging
collimator produces image magnification. The degree of magnification depends
on design of the collimator and the distance from the collimator surface. As a
the
radioactive source is moved away from the collimator, it comes into the view of
more collimator holes, and this produces an increase in sensitivity. The sensitivity

increases approximately as the square of the distance from the collimator. Because
of its magnification and sensitivity properties, the converging collimator is useful
for imaging small organs, such as the thyroid gland, kidneys, and heart. However,

converging collimators tend to produce distortion around the edges.

Pin-Hole Collimators

Thepin-hole collimator differs from other collimators in that it has a single

small hole rather than several thousand holes. A typical pin-hole collimator is
shown in Figure 36-8. The basic principle of this collimator is the same as that of
the pin-hole camera from the early days of photography. The "lens" of the camera
is a small hole (pin-hole) in an absorbing material. Radiation from each point
within the body is limited to a corresponding point on the crystal as the radiation

passes through the hole. This creates an image of the source on the crystal surface.
With this type of collimator, the orientation of the image at the crystal is inverted
with respect to the source. The FOV of a pin-hole collimator is very dependent on
the distance between the source and the collimator. When the source is located as

far in front of the collimator crystal is behind the collimator, the FOV is
as the

equal to the size of the crystal. If the source is located closer, the image will be
magnified. The degree of magnification increases as the source approaches the
collimator. Because it has only one hole, the sensitivity of the pin-hole collimator
 The Gamma Camera 537

IMAGE

>» \

1" S
\

in s
c \
0)
_ x
CO ^

Figure 36-8 Pin-hole Collimator

isobviously less than for typical multihole collimators. It also decreases as the
distance between the source and pin-hole is increased. In many cameras, the pin¬

hole can be changed. A large hole gives more sensitivity, but also more blur.

CRYSTALS

As in any scintillation detector system, the crystal in the gamma camera has two
basic functions: (1) to absorb the gamma photons and (2) to convert the gamma
image into a light image. Crystals used for this purpose are typically in the form of
disks. Both dimensions, diameter and thickness, have an effect on the characteris¬
tics of the camera. The diameter of the crystal establishes the basic FOV, which is
then modified by the type of collimator used and the distance between the camera
and the source being imaged. The thickness of the crystal affects sensitivity and

image blur. Increasing crystal thickness generally decreases crystal penetration

and improves sensitivity. However, increasing the thickness also increases image
blur, which is discussed in Chapter 37. Therefore, a crystal thickness is used that
provides a reasonable compromise between sensitivity and image quality. Typical
thicknesses are in the range of one-fourth to one-half inch.

PHOTOMULTIPLIER TUBE ARRAY

The photomultiplier (PM) tubes are generally arranged in a hexagonal array; the
number that will completely fill a circular area depends on the relative diameters
of the area and the PM tubes. Specific numbers of PM tubes uniformly fill a given
538 Physical Principles of Medical Imaging

circular area: 7, 19, 37, 61,91, etc. The first gamma camera used seven PM tubes.

Throughout the evolution of the camera, both the size of the array and the number
of PM tubes have gradually increased.
In addition to converting the light from the crystal into electrical pulses and

amplifying the pulses, the PM tube array also detects where each gamma photon is
absorbed in the crystal. This information is necessary to transfer the image from
the crystal to the viewing unit. The manner in which the location of a photon
interaction is measured is illustrated in Figure 36-9. Assume that a gamma photon
is absorbed in the crystal at the location shown. The light spreads throughout the

crystal and light pipe and is viewed by a number of PM tubes. The brightness of
the scintillation, as seen by a specific PM tube, depends on the distance between
the PM tube and the scintillation. In the illustration, PM tube B is closest and sees
the brightest scintillation and receives the most light from it. It responds by pro¬

ducing a relatively large electrical pulse. PM tube C receives less light and pro¬
duces a correspondingly smaller electrical pulse. Because it is even farther away
from the scintillation, PM tube A produces an even smaller electrical pulse. In
other words, when one photon is absorbed by the crystal, a number of PM tubes
around the specific point see the light and produce electrical pulses. The relative

Figure 36-9 Three of the PM Tube Pulses Generated by the Capture of a Single Photon
 The Gamma Camera 539

size of the pulses from the various PM tubes represents the location of the scintil¬
lation, or gamma photon, within the image area.

IMAGE FORMATION

The gamma camera must take the pulses from the PM tube array and use them
to form an image. This function is performed by an electronic circuit. The first
function of this circuit is to take all of the electrical
pulses created by a single
photon interaction and use them to calculate, or determine, the location of the
interaction within the image area. The circuit then produces two new pulses that
describe the location of the photon. The amplitude of one pulse represents the
location of the photon in the horizontal (H) direction, and the amplitude of the
other pulse specifies the vertical (V) location.
A second function of the circuitry is to combine all of the PM tube pulses into
one electrical pulse whose amplitude
represents the energy of the photon. This
pulse is passed on to a pulse height analyzer (PHA) in the viewing unit.
The function of the viewing unit is the formation of a visible image from electri¬
cal pulses. Most conventional viewing units create the image on the screen of a
cathode ray tube (CRT), more commonly known as a picture tube, especially
when found in television equipment. In a CRT the image is formed on the screen
by a small electron beam striking the screen from the rear. The image is actually
created by controlling the position of the electron beam. When the electron beam
strikes the CRT screen, which is made of a fluorescent material, it creates a small
spot of light. When the two position pulses arrive at the CRT, they are used to
position the electron beam to the appropriate location on the CRT screen. If the
energy pulse is within the appropriate range to pass through the PHA, it is also
directed to the CRT. When this pulse arrives at the CRT, it turns on the electron
beam, momentarily causing a small spot of light to be formed on the CRT screen.
This spot of light is, in effect, the image of a single gamma photon coming from
the patient's body. This process is repeated for each photon accepted by the

gamma camera. Many CRTs can store or maintain each light spot while the total
image is being formed.
A viewing unit generally has an intensity control that can be used to adjust the

brightness of each spot. This control also adjusts the film exposure when the image
is transferred from the CRT screen to film.

SPECTROMETRY

In many nuclear medicine procedures, it is desirable for the counting or imaging

system to respond only to radiation from a specific primary source within the pa¬
tient or sample. A problem arises because radiation from other sources might be
540 Physical Principles of Medical Imaging

present and enter the detector, as shown in Figure 36-10. Also, some of the radia¬
tion from the primary source undergoes Compton interactions with materials out¬
side the source volume. This produces scattered radiation, which can enter the
detector. If an imaging system responds to this scattered radiation, the resulting
image will include areas around the primary source. This distorts the image and
makes it impossible to determine the actual size, shape, and activity of the primary
source organ or lesion. Radiation from other sources might also be present. Cos¬

mic radiation, naturally occurring radioactive nuclides in building materials, and

radioactive contamination of the environment produce what is generally referred
to as background radiation. Background radiation can reduce contrast in images

and introduce errors into the counting of radioactive samples. Occasionally, two
radioactive materials are administered to a patient, and the system must selec¬
tively respond to each source at the appropriate time.
An imaging or counting system can be made selective by adding an energy

spectrometer after the detector and amplifier, asshown in Figure 36-10. The spec¬
trometeris actually a PHA that works with the electrical pulses produced by the
detector. The purpose of the PHA is to allow pulses created by the desired (pri¬

mary) source of radiation to pass on to the counting and imaging devices and to
reject the pulses associated with other sources of radiation. The user must always
adjust the controls of the PHA to ensure the proper selection of pulses.

Counter
or

Detector PHA Imager

scatter JT -

>
r -

\
I Primary
n
ySource J
1
x-ray J~L
l ^
-

->

f \_
Other
^ _ _
1
-

ySourcesJ
Background 1

Figure 36-10 The Rejection of Unwanted Detector Pulses by the Spectrometer

 The Gamma Camera 541

The Gamma Spectrum

The pulses from a scintillation detector will not be the same size because most
radioactive materials emit gamma photons of several
energies. Variation in pulse
size is also created by Compton interactions,
energy escaping from the crystal, and
statistical factors within the crystal and PM tube. We now consider some of these
factors in detail and show how they relate to the proper use of a PHA.
For simplicity, that the radioactive material emits all of its photons
we assume
with the same energy.The spectrum of such a monoenergetic source and the
pulses it would produce in an ideal detector system are shown in Figure 36-11. In
an ideal detector system,
monoenergetic photons would produce a series of pulses
of the same size. The spectrum of these pulses would be a single line, as shown in

Figure 36-11. Remember that pulse size height now represents photon energy. The
spectrum shown here is the spectrum of a monoenergetic gamma emitter as seen
"through the eyes of' an ideal detector system. Unfortunately, real detector sys¬
tems do not produce a pulse size spectrum that precisely represents the
photon
energy spectrum. The various factors that affect the pulse size spectrum will now
be considered.

Statistical Fluctuations

The various events taking place between the absorption of the gamma photon
and the formation of the electrical pulse are illustrated in Figure 36-12. A gamma

90 _
PULSES SPECTRUM

80 _

70

60-

50 _

1^
50 60 70 80

Time Pulse Size

(Relative Photon Energy)

Figure 36-11 The Pulse Spectrum That Would Be Produced by a Monoenergetic Radia-
ion Source and an Ideal Detector
542 Physical Principles of Medical Imaging

— —
Same Photon Energy
r
I
Different Pulse Size — —

I
If
* CRYSTAL

Electron
•m Multiplication ^

i P_M _Tube_ j

Figure 36-12 Factors That Produce a Variation in Detector Pulse Size

photon is absorbed in the crystal and creates a cluster of light photons. There is
always variation in the number of light photons created by a specific gamma en¬
ergy. Also, all of the light photons associated with one scintillation are not neces¬
sarily absorbed by the photocathode of the PM tube; some are absorbed within the
crystal itself. The number absorbed within the crystal is influenced, to some ex¬
tent, by the location of the scintillation within the crystal. The number of electrons
emitted from the photocathode by a cluster of light photons is also subject to statis¬
tical fluctuation. The number of electrons also fluctuates at each of the dynodes.
The cluster of electrons (electrical pulse) varies in size because of the combined
effect of the various fluctuations. A series of typical pulses and the resulting spec¬
trum are shown in Figure 36-13.

The variation in pulse size causes the pulse spectrum to assume the form of a
broadened peak rather than a narrow line. An important characteristic of a detector

system is the amount of variation in pulse size, or spreading, of the spectrum it

produces. This characteristic is known as the energy resolution of the detector
system and is generally expressed in terms of the full width at half maximum
(FWHM). The FWHM is the full width of the spectrum peak measured at one-half
of the maximum height of the peak. It is generally expressed as a percentage of the
average pulse size (photon energy). In the example shown in Figure 36-13, the full
width is 10 units and the average pulse size is 70 units. Therefore,

FWHM = 10/70 x 100 = 14%.

The FWHM might be considered as an expression of the "average" variation in

pulse size. The ideal detector system would have an FWHM of 0. Actual scintilla¬
tion detector systems generally have an energy resolution capability (FWHM) of

approximately 10% to 15%. The energy resolution of a detector system generally

depends on the overall quality of the crystal and PM tube and the stability of the
 The Gamma Camera 543

50 60 70 80 90
Time Pulse Size

Figure 36-13 Pulse Spectrum Produced by a Monoenergetic Radiation Source and a Typi¬
cal Detector

pulse amplifier. Severe loss of energy resolution capability can result from condi¬
tions such as a fractured crystal or inadequate light transmission between the crys¬
tal and PM tube.
Poor energy resolution, or high FWHM values, means that the pulse size associ¬
ated with themonoenergetic photons from the primary source varies considerably.
This makes it difficult for the PHA to separate these pulses from the pulses arising
from other radiation sources.

The peaked spectrum shown in Figure 36-13 results from the complete absorp¬
tion of the gamma photons in the crystal by the photoelectric process. It is there¬
fore often referred to as the photopeak portion of the spectrum. The following
sections discuss other portions of the pulse spectrum created by other interactions.

Compton Scatter
When a gamma photon is engaged in a Compton interaction with a material, it
both loses energy at the site of interaction and changes direction, as discussed in
Chapter 10. Compton interactions can take place between the photon and the ma¬
terial containing the radioactive source, the detector crystal, or material located
between the source and crystal.
In radionuclide imaging procedures, a significant number of Compton interac¬
tions usually occur in the tissue surrounding the radioactive material. If these scat¬
tered photons are included in the image, the image will not be a true representation
of the distribution of radioactive material. It is therefore desirable to exclude the
544 Physical Principles of Medical Imaging

scattered photons from the imaging process. This can be achieved, to some extent,
because their energy is different from the energy of the primary photons.
For a given primary energy, such as 140 keV, the energy of the scattered photon
depends on the angle of scatter. Scatter that takes place within the body adds a
component to the spectrum, as shown in Figure 36-14. Photons that scatter in the
forward direction (directly toward the detector) lose very little energy in the scat¬
tering interaction and have energies very close to 140 keV. The statistical
fluctuation within the detector causes some of these to appear to have energies

greater than 140 keV. The fluctuations within the detector system cause the over¬
lap between the scatter component and the photopeak of the spectrum. Photons
that scatter in the backward direction (180°) have the lowest energy. For 140-keV

primary photons, complete backscatter produces 90-keV photons. This means that
the scattered radiation produced by a 140-keV primary source has photon energies

ranging from 90 keV to 140 keV. However, some photons may undergo two or
more Compton interactions before leaving the body, and this creates some pho¬

tons with energies well below 90 keV. The exact shape of the scatter portion of the

spectrum and its amplitude relative to the photopeak depend on a number of fac¬
tors, especially the thickness of tissue covering the radioactive material.

Photopeak

60 80 IOO 120 140

Photon Energy (KeV)

Figure 36-14 Spectrum Component Produced by Compton Interactions within the Body
 The Gamma Camera 545

If Compton interactions take place within the detector crystal, a different spec¬
trum component is created. The spectrum as seen "through the eyes of' the detec¬
tor represents energy deposited within the detector. If a 140-keV photon under¬

goes a single Compton interaction in the crystal, the maximum energy it can
deposit is 50 keV. This occurs when the photon is scattered back out of the crystal
(180°) and carries an energy of 90 keV. The energy deposited in the crystal (50
keV) is the difference between the primary photon energy (140 keV) and the scat¬
tered photon energy (90 keV). Photons that scatter in a more forward direction
have higher energies and therefore deposit less energy in the crystal. The high-
energy side of this spectrum component is known as the Compton edge.

Characteristic X-Rays

When gamma photons interact with materials with relatively high atomic num¬
bers, photoelectric interactions can occur. A photoelectric interaction removes an
electron from an atom and creates a vacancy in one of the shell locations. When
the vacancy is refilled, a characteristic x-ray photon is often produced. The energy
of the characteristic photon is essentially the same as the binding energy of the K-
shell electrons. This type of interaction and the resulting characteristic x-ray pho¬
tons can produce distinct components in the spectrum.

If the interaction occurs in a material other than the crystal, the spectrum com¬
ponent corresponds to the energy of the characteristic x-ray. In many procedures,
a lead collimator is located between the radioactive source and detector crystals.

The predominant characteristic x-ray produced in lead has an energy of 77 keV,

which gives rise to a lead x-ray peak centered at about this energy.
If the characteristic x-ray photon is created within the crystal, a different type of

spectrum component is created, as shown in Figure 36-15. This particular compo¬

nent occurs only if the x-ray photon escapes from the crystal. The energy depos¬
ited in the crystal is the difference between the energy of the primary photon and
the escaping characteristic x-ray photon. In a sodium iodide crystal, the predomi¬
nant characteristic x-ray is the 28-keV iodine x-ray. When a 140-keV photon pro¬

duces a 28-keV x-ray photon that escapes from the crystal, the energy deposited is
the difference between these two, or 112 keV. In other words, the detector sees
only 112 keV rather than 140 keV. This gives rise to a spectrum component gener¬
ally referred to as an iodine escape peak. The energy of an iodine escape peak is
always 28 keV below the photopeak energy.

Background
No facility is completely free of background radiation. Sources of background
radiation include cosmic radiation, naturally occurring radioactive nuclides in
 546 Physical Principles of Medical Imaging

Figure 36-15 Spectrum Component (Escape Peak) Produced by X-Ray Photons Leaving
the Crystal

building materials, and environmental contamination. The photon energy spec¬

trum for background radiation depends on the relative contribution from these
sources. For simplicity, it is
usually assumed to be evenly distributed throughout
the energy range.

The Composite Spectrum

The photon energy spectrum presented through
as a typical detector system
consists of several components produced
by the different types of interactions that
have been discussed. The composite
spectrum is the sum of all the components, as
shown in Figure 36-16. The relative contribution of each component depends on
many factors and varies considerably from one type of procedure to another. The
spectrum shown in Figure 36-16 illustrates the concept, rather than presenting its
exact form. In most cases, the
composite spectrum can be considered to be made
up of "desirable" and "undesirable" components. The photopeak is usually con¬
sidered a desirable component because it
represents photons coming directly from
the radioactive source. What constitutes an undesirable
component depends, to
some extent, on the nature of the
procedure. For example, in most imaging proce¬
dures the body scatter component is undesirable. This subject is discussed in more
detail later.
 The Gamma Camera 547

Photon Energy (KeV)

Figure 36-16 Composite Spectrum Produced by Adding the Different Spectral

Components

THE PULSE HEIGHT ANALYZER

A spectrometer is, in general, a device that allows the operator to select and use
a specific portion of a spectrum. The type of spectrometer used in most nuclear
medicine systems is a PHA. The PHA is located between the detector and the
counting or imaging components of the system. The pulses from the detector must
pass through the PHA in order to contribute to the image or counting data. The
basic characteristic of a PHA is that it can be set to permit only pulses of a specific

height to pass through.

Figure 36-17 illustrates the general function of a PHA. The pulse sizes that pass
through the PHA are determined by the setting of two controls, the baseline and
window.
Most PHAs operate on an arbitrary pulse height scale. The PHA shown in Fig¬
ure 36-17 has a pulse height scale ranging from 0 to 100 units. By properly cali¬
brating the detector and amplifier components, the PHA scale can be made to
correspond to a specific photon energy range. For example, we will assume that
the PHA scale of 0 to 100 is being used to represent a photon energy range of 0 to
200. This is achieved by adjusting the detector and amplifier gain so that a 200-
keV photon produces a pulse with an amplitude of 100 units. Other photon ener¬

gies and pulse amplitudes are related in the same manner.

548 Physical Principles of Medical Imaging

Figure 36-17 Basic Function of a Pulse Height Analyzer

The baseline control sets the minimum pulse amplitude that will pass through
the PHA. The window control sets the range of pulse amplitudes that will pass
through. Window controls are usually calibrated in either pulse height units, like
the baseline control, or as a percentage of the pulse height scale. In the example
shown in Figure 36-17, the baseline is set at 60 pulse height units and the window
has a width of 20 units. The only pulses that can pass through the analyzer with
this setting are those within the range of 60 units (120 keV) and 80 units (160
keV).
Letus now consider the action of the PHA with
regard to the three pulses shown
in Figure 36-17. The 50-unit pulse (100 keV) is below the baseline setting and is
blocked by the analyzer. The 70-unit pulse (140 keV) is well within the range of

acceptable pulse sizes established by the baseline and window and therefore
passes through the analyzer. Since the 90-unit pulse (180 keV) is above the top of
the window, it is also blocked by the analyzer.
PHA settings should be considered in relation to the photon energy spectrum, as
illustrated in Figure 36-18. In effect, the baseline and window settings determine
the portion of the spectrum that will be used for imaging or data collection. The
window is generally positioned over the desired portion of the spectrum, such as
the photopeak. The area under the spectrum curve that falls within the window
(shaded area) represents the relative number of photons that are being collected
and used. A wide window setting, which encompasses more of the spectrum, pro¬
duces an increase in the rate at which photons are counted. With a wide window,
an image can be formed faster, or a certain number of counts can be collected in a

shorter period. The problem with increasing window width is that it decreases the
 The Gamma Camera 549

Window

Figure 36-18 PHA Window Positioned To Select the Photopeak from the Other
Components of the Spectrum

ability to discriminate between the desirable and undesirable portion of the spec¬
trum.
In many situations, most of the undesirable portions of the spectrum are at ener¬
gies below the desirable portion, or photopeak. Good data collection can be
achieved by carefully positioning the baseline and opening the window to include
all energies above the baseline setting. This is referred to as an integral counting.
 Chapter 37

Radionuclide Image Quality

INTRODUCTION AND OVERVIEW

The radionuclide image produced by a gamma camera is distinctly different

when compared with images from the other imaging methods. It is difficult to
compare the contrast sensitivities because a gamma camera looks at a different
tissue characteristic: the concentration of a specific radionuclide. The sensitivity

generally depends on a specific tissue's ability to collect a specific pharmaceuti¬

cal. There are a variety of pathologic conditions for which radionuclide imaging
has a high contrast sensitivity.
The gamma camera image generally shows much less detail and a higher noise
level than other medical images.
In this chapter we explore the factors that determine radionuclide image quality
and how they can be used by the operator to optimize an imaging procedure.

CONTRAST

Contrast can exist when the radiation from an object is either more or less than
the radiation from the background area. If the radiation from the object is greater
than from the background, the object is commonly referred to as being "hot," and
if it is less, it is referred to as being "cold" (eg, a nodule).

Figure 37-1 illustrates the three stages in the imaging process. The object within
the patient has a certain amount of inherent contrast with respect to its surrounding

background. The background can consist of radiation from a number of different

sources, including
• radiation from the same radionuclide in the surrounding tissue
• scattered radiation

551
552 Physical Principles of Medical Imaging

and Contrast Enhancement

Figure 37-1 Contrast at Three Different Points in the Imaging Process

• radiation from other nuclides within the patient

• radiation from external sources.

The amount of inherent contrast generally depends on the amount of activity

contained in the object of interest in comparison with the "activity" of the back¬
ground area. Many factors affect the inherent contrast. A very significant factor is
the physiologic function of the object (such as a tumor), which affects the radionu¬
clide uptake.
One of the functions of the gamma camera is to increase the contrast between a
radioactive object and the surrounding background. This is usually achieved by
using the pulse height analyzer (PHA) to "separate" the object radiation from the
background area radiation. Using the PHA usually creates an intermediate radia¬
tion image whose contrast is greater than the inherent contrast from the object

being imaged.
Since the energy of scattered photons is less than the energy of the photons
coming directly from the radioactive source, it is possible to produce some separa¬
tion with a PHA. The difference between the energy of a scattered photon and the

primary radiation depends on two factors: the angle of scatter and the initial en¬
ergy of the primary radiation. For example, a 140-keV photon scattered at an angle
of 90° has an energy of 116 keV. This is less than a 20% difference between the
scattered and primary radiation. If we assume that one half of the scatter occurs at

angles less than 90°, much of the scattered radiation is very close in energy to the
primary radiation.
As discussed in Chapter 36, a scintillation detector system produces a certain
amount of energy spreading, or loss of energy resolution. This spreading and the

relatively small energy difference between scatter and primary radiations make it
impossible in many cases to remove all of the scattered radiation from an image.
 Radionuclide Image Quality 553

Figure 37-2 shows a typical photon energy spectrum for both the direct and the
scattered radiation.By carefully positioning the PHA window, it is usually pos¬
sible to exclude a significant amount of the scattered radiation from the image.
Figure 37-3 compares two images of a radioactive object. In the one on the left, the
amount of scattered radiation was reduced by using a PHA.

Body Section

Figure 37-2 The Use of the PHA Window To Exclude Scattered Radiation from the Image

Figure 37-3 Radioactive Object Imaged without and with Scattered Radiation Present
554 Physical Principles of Medical Imaging

Scattered radiation is generally more of a problem in imaging a "cold" lesion,

which is surrounded by activity, than a "hot" lesion.
In some cases it is desirable to image one radionuclide when another radioac¬
tive substance is present in the same area. The ability to separate the two radiations

depends very heavily on their relative energies. The problem can be appreciated
by considering the photon energy spectra of the two nuclides shown in Figure
37-4. If there is a sufficient energy difference between the two photon peaks, it
will be possible to set the PHA window to image nuclide B. The problem arises
when we attempt to image nuclide A. Because the photopeak energy of nuclide A
is less than that of nuclide B, it might coincide with a significant amount of scat¬
tered radiation from nuclide B.

BLUR AND VISIBILITY OF DETAIL

The method commonly used in nuclear medicine to assign a value to blur is

illustrated in Figure 37-5. The blurred image of an object point is generally not a
circle of uniform intensity or film density. Typically the image is most intense at
the center with a gradual decrease toward the periphery, best illustrated by means
of a profile, as shown. Since the blur is not uniform in intensity, the question arises

Figure 37-4 Overlapping of the Energy Spectra of Two Nuclides

 Radionuclide Image Quality 555

Full Width at Half Maximun

(Blur Size)

Blur

Figure 37-5 Profile of the Blurred Image of a Small Object (Radioactive Source)

as to which dimension should be used to express the size of the blur pattern. The
common practice is to use the diameter of a circle located at one half of the maxi¬
mum intensity. With respect to the profile, this corresponds to the full width of the

profile at one half of its maximum height. This blur value is generally expressed in
millimeters and is the FWHM. This is also the name of the parameter used to
express radiation detector energy resolution, but the two entirely different applica¬
tions of the term FWHM should not be confused.
image profile of a point object, such as in Figure 37-5, is generally desig¬
The
nated point spread function (PSF). It is usually easier to measure the image
as a

spread, or blur, of a source that is in the form of a thin line, ie, a small tube filled
with radioactive material. The profile obtained in this manner is known as a line

spread function (LSF). In either case, the blur width is expressed in terms of the
FWHM.
Because blur tends tospread image points, it can make it difficult to resolve, or
separate, small objects or features that are located close together. Because of this,
the term resolution is often used to describe the blur characteristics of an imaging

system. This results from the common practice of using resolution test objects to
measure blur. An image of a typical test object used for this purpose is illustrated

in Figure 37-6. The object consists of a series of lead strips that are placed over a

large uniform source of radiation. In the four sections of the test object, the width
and separation distance between the lead strips varies from section to section.
Each section is characterized by the number of line pairs (one lead strip and one
space) per centimeter. The blur is measured by imaging the test object and deter-
 556 Physical Principles of Medical Imaging

Figure 37-6 Image of a Test Object Used To Measure the Resolving Ability (Amount of
Blur) of a Gamma Camera

mining the closest strips that can be resolved. The approximate relationship
between resolution and blur is

Resolution (lp/cm) = 1/FWHM (cm).

The two quantities are inversely related: As blur increases, resolution
decreases.
There are several sources of image blur in a nuclear imaging procedure. The

equipment user should be familiar with them so that blur can be minimized as
much as possible.

Motion

Motion of the patient during the imaging procedure is an obvious source of blur.
The amount of blur is equal to the distance that each point within the object moves
during the time the image is actually being formed.
 Radionuclide Image Quality 557

Gamma Camera Blur

Two kinds of blur are introduced by the gamma camera itself: intrinsic blur and
collimator blur. The distinction between them can be made by referring to Figure

37-7.

Intrinsic Blur

Consider an image point that has been formed within the camera crystal. (For
the moment we are assuming that the gamma photons from a point source have all
been absorbed in the crystal at this point.) The light spreads as it moves from the

image point to the surface of the crystal. This spreading, or diffusion, of light
within the crystal causes the image at the crystal surface to be blurred. The amount
of blurring introduced by the crystal is more or less proportional to crystal thick¬
ness. This is similar to what happens in intensifying screens. The selection of a

crystal thickness involves a compromise between blur and camera sensitivity (de¬
tector efficiency). A thick crystal captures more photons, and therefore increases

camera sensitivity, but it also increases the amount of intrinsic blur. Thin crystals,

which reduce image blur, can be effectively used with radionuclides that emit
relatively low energy photons.
The light image from the crystal is transferred electronically to the viewing
device. The inability of the electronic circuitry to position precisely each image

point on the viewing screen can be an additional source of intrinsic blur.

Crystal

^Intrinsic Blur Collimator Blur ^

^^

Figure 37-7 The Two Basic Components of Gamma Camera Blur: Intrinsic Blur and
Collimator Blur
558 Physical Principles of Medical Imaging

At the present time, gamma cameras have intrinsic blur values in the approxi¬
mate range of 3 mm to 6 mm when measured at the crystal surface. The amount of
intrinsic blur in gamma cameras has been reduced over the years, with improve¬
ments in both the crystals and electronic circuits.

When considering the blur value for a specific camera application, one must
consider the location of the object being imaged. The degree of image quality
usually depends on the relationship of the amount of blur to the size of the object.
Therefore, the amount of blur must be considered not only at the crystal surface
but at the location of the object. If a parallel-hole collimator is used, the value of
the intrinsic blur will be the same for an object located at any distance from the
camera. If either a diverging, converging, or pin-hole collimator is used, the

amount of intrinsic blur projected to the object location will depend on the dis¬

tance between the object and the camera surface. This is illustrated in Figure 37-8.

If a diverging collimator is used, the amount of intrinsic blur, expressed at the

object location, increases with an increase in the distance between the object and
the camera. This occurs because a diverging collimator minifies the image and
minification increases with distance between the object and camera. Therefore, as
the object is moved away from the camera surface, the image becomes smaller,
and the ratio of intrinsic blur to apparent object size increases. For reasons dis-

Diverging

T
Blur

Image
Object
Blur

Converging

o :::i.:

Figure 37-8 Illustration of How Collimator Characteristics Affect the Relationship of

Intrinsic Blur to Object Size
 Radionuclide Image Quality 559

cussed later, this effect is represented as an increase in blur with respect to object
size.
If a
converging collimator, which produces image magnification, is used, the
intrinsic blur with respect to object size decreases as the object is moved away
from the camera surface.
In summary, the amount of intrinsic blur with respect to object size depends on
whether the image is magnified or minified by the collimator. Minification in¬
creases the effective blur, whereas magnification reduces it.

Collimator Blur

The purpose of the collimator is to "focus" the radiation from each point of the
object toa corresponding point on the crystal. Because of the finite size of the
collimator holes, no image point in the crystal can correspond to a single object
point, as shown in Figure 37-7. This causes the gamma photon image that is fo¬
cused onto the crystal by the collimator to be blurred. This effect is generally
designated collimator blur.
It is best to analyze collimator blur by starting from an image point within the

crystal, as shown in Figure 37-7. In the ideal, no-blur, imaging system, the field of
view (FOV) from the image point would be limited to a corresponding object

point of equal size. However, with an actual collimator, the FOV from a single
image point is much larger than the corresponding object point. From the stand¬
point of an image point within the crystal, this causes each object point to look
larger than it really is, or, in other words, to be blurred. If an object point (small
source) is located at the face of the collimator, it appears to be the same size as the
collimator hole; if the object point is moved away from the face of the collimator,
as shown in Figure 37-7, it appears to become even larger, or more blurred. This

effect should not be confused with the minification and magnification produced by

converging and diverging collimators. Here we are considering the characteristics

of an individual collimator hole. The amount of blur is, in effect, the FOV from a

point within the crystal through an individual collimator hole.

Because of the increased FOV of an individual hole, the camera cannot resolve,
or separate, small sources located near each other. For example, in Figure 37-7,
three small sources located at points a, b, and c would be blurred together and
appear as one.
The amount of collimator blur is primarily dependent on three factors:

1. size of the collimator hole

2. length of the collimator hole (collimator thickness)
3. distance between the camera and the object being imaged.

The three factors determine the FOV from a point on the crystal through a single
collimator hole. To the camera, a small point source appears to be the size of the
560 Physical Principles of Medical Imaging

FOV through a single hole. Figure 37-9 compares the blur produced by collima¬
tors with different hole sizes. As the collimator thickness is increased, the single-
hole FOV or blur, is decreased. Figure 37-9 also shows that a reduction in collima¬
tor hole size (diameter) reduces blur at a specific object location.
When selecting a collimator for a specific application, consideration must be
given to the compromise between blur and sensitivity. Design factors that de¬
crease blur, such as decreased hole diameter and increased hole length (collimator

Figure 37-9 Relationship of Blur to Collimator Hole Size

 Radionuclide Image Quality 561

thickness), also reduce detector efficiency and camera sensitivity. This relation¬
ship is shown in Figure 37-10 for some typical collimators. Collimators are often
placed into general categories by virtue of their blur/sensitivity characteristics.
Names for the various categories are usually chosen that emphasize the positive

aspects of a particular collimator. These general categories are indicated in Figure

37-10.
With all collimators, blur increases with distance from the collimator face, as
shown in Figures 37-7 and 37-9. This is a rather significant factor when the object
being imaged is not in direct contact with the collimator face. Figure 37-11 shows
the general relationship between collimator blur and the distance between the col¬
limator face and the object being imaged. The blur value at a distance of 0 (at the
collimator surface) represents the intrinsic blur of the camera plus the minimum
value of collimator blur. As the object is moved away from the collimator surface,
the collimator blur increases and adds to the intrinsic blur.

IMAGE NOISE

In nuclear
imaging, the major source of noise is the random distribution of pho¬
tons over thesurface of the image. A gamma camera image typically contains
much more noise than a conventional x-ray image. This is because nuclear images

l T r
10 it 12
Blur FWHM (mm)

Figure 37-10 General Relationship between Gamma Camera Sensitivity and Collimator
Blur
562 Physical Principles of Medical Imaging

Collimator-Object Distance (cm)

Figure 37-11 Relationship of Gamma Camera Blur to the Distance between the
Radioactive Object and the Collimator

are generally formed with fewer photons than x-ray images. The amount of noise,
or variation in photon concentration, is inversely related to the number of photons
used to form the image. The noise in an image can be reduced by increasing the
number of photons used in the imaging procedure.
The relationship between image noise and photon concentration, or count den¬

sity, is illustrated in Figure 37-12. A series of circular areas are drawn across the
surface of an image. The size of the area that should be used to analyze image
noise is approximately equal to the camera blur size (FWHM). For the purpose of
this discussion, an area size of 1 cm2 is used. A camera with a large blur value
tends to produce an image with less noise because the blur, in effect, averages or
blends the photons together over a larger area. The image section shown in Figure
 Radionuclide Image Quality 563

140-1
(VI
120-
"
100
(O

c
3
80-
O
O 60"

40-

20-

1400-1 Noise -3.2%

CVJ 1200-
E
o 1000-
\
(A
800-
C
3
O 600-
O
400-

200-

Figure 37-12 Area-to-Area Variation in Photon Concentration for Two Average Count
Densities

37-12 was(theoretically) produced by a uniformly distributed radioactive source.

That is, there is no variation in activity, as there would be from the presence of a
lesion, that would provide useful information. Any variation in count density is
produced by the natural random distribution of photons. The variation in the num¬
ber of photons, or counts, from area to area is an indication of the image noise
level.
564 Physical Principles of Medical Imaging

The upper count-density profile in Figure 37-12 shows the variation in count

density when the average is 100 counts per cm2. The standard deviation of the
count densities can be used to assign a numerical value to the noise. In our earlier

discussion of image noise (Chapter 21), we showed that an average of 100 counts
(photons) had a standard deviation of 10 counts, or 10%. Therefore, when the
count density is 100 counts per area, the standard deviation noise level is 10%.

The lower profile shows the area-to-area variation when the average count den¬

sity is 1,000 counts per cm2. In this case, the standard deviation (the square root of
1,000) is 32 counts, or 3.2%. This demonstrates that as the number of photons used
to form an image (count density) is increased, the area-to-area variation in photon

concentration, or noise, is decreased. The noise level is inversely proportional to

the square root of the average count density.

Lesion Visibility

Image noise degrades the overall quality of an image and makes it difficult to
detect certain lesions. Let us consider the situation shown in Figure 37-13. As¬

sume we have a lesion that has sufficient radioactive uptake to produce 20% con¬

trast. If an imaging system that is completely noise-free is used, the lesion will be

readily visible against a smooth background, illustrated by the upper graph. If, on
the other hand, the image is produced with a gamma camera that collects, on the

average, 100 counts per area, the situation changes rather dramatically. The ratio
of the lesion contrast to the noise level will be only 2:1. It is generally considered
that a lesion contrast-to-noise ratio of at least 4:1 is necessary in nuclear medicine
to ensure reliable lesion detection. In this case, detectability can be improved sim¬

ply by collecting more counts to form the image, so that it has a lower noise level.

UNIFORMITY

In order to produce an image that accurately shows the distribution of radioac¬

tive material, a gamma camera should have an equal sensitivity over the entire

image area. A non-uniform sensitivity generally occurs when the various PM tube
outputs are not properly balanced. Most modern gamma cameras use special cir¬
cuits, usually containing microprocessors, to correct for the inherent non-uniform¬
ity in the detector array.
A gamma camera should be checked periodically to determine if it has a uni¬
form sensitivity response. This procedure requires a source of radiation that will
cover the entire crystal area with a uniform intensity. This can be achieved in two

ways, as illustrated in Figure 37-14.

One method is to use a large flat radioactive source at least as large as the crys¬
tal, generally referred to as a flood source. To test for uniformity, the flood source
 Radionuclide Image Quality 565

• i

Lesion 1
_ Contrast 20%
>%
Background
v>
c
4>
o

"c Without Noise

O
o

Figure 37-13 Relationship of Lesion Contrast to Background, Both with and without
Noise

is mounted on the face of the camera, usually with a collimator in place. Another
method is to small radioactive source located at least 1.5 m from the face of
use a

the camera. With this method, the collimator must be removed in order to produce
a uniform exposure to the crystal surface.
566 Physical Principles of Medical Imaging

Small Source
4

Figure 37-14 Radioactive Sources Used To Test a Gamma Camera for Uniformity over
the Image Area

SPATIAL DISTORTION

Because of the manner in which the image is transferred from the crystal to the
viewing screen, a gamma camera may introduce spatial distortion. Distortion oc¬
curs when various points within an image are moved with respect to each other in

the transfer process. This distorts the size and shape of objects within the image.
A gamma camera can be checked for spatial distortion by using one of several

types of test objects, or phantoms. For this test, the test object must have a series of
lines or holes that are spaced uniformly within the image area. The test is per¬
formed by imaging the test object and then determining if the uniform spacing is
maintained in the image.
 Chapter 38

Radionuclide Tomographic
Imaging

INTRODUCTION AND OVERVIEW

Tomographic imaging provides several advantages over conventional imaging

with a gamma camera. An increase in contrast sensitivity for detecting lesions is

possible because overlying regions of radioactivity are removed as each slice of

tissue is viewed directly. Tomographic imaging also makes it possible to quantita¬

tively evaluate the amount of radioactivity in specific tissue regions.

There are two very different approaches to tomographic imaging with radionu¬
clides. The two methods are related to the different radiation emission characteris¬
tics of radionuclides. Most radionuclides used for gamma-camera imaging emit
one major photon for each radioactive transition. Tomographic images utilizing
these conventional radionuclides can be created by scanning around the patient's

body with a gamma camera and then mathematically reconstructing tomographic

images. This technique is known as single-photon emission computed
tomography (SPECT). An entirely different approach to tomography is used with
positron-emitting radionuclides. Positron emission tomography (PET) requires
special imaging equipment that is quite different from the conventional gamma
camera.

In this chapter we will consider the concept and general characteristics of both
methods.

POSITRON EMISSION TOMOGRAPHY

Positron emission tomography (PET) is based on a unique characteristic of the

radiation associated with positrons. The basic process of positron emission was
described in Chapter 5 and the interaction between positrons and matter was illus¬
trated in Figure 10-6. Let us briefly review the process. We recall that positrons are

particles of anti-matter that have the same mass as electrons. Certain radioactive

567
568 Physical Principles of Medical Imaging

substances are positron emitters. When a positron is emitted by a radioactive

nucleus it travels a short distance and then interacts with an electron. The interac¬
tion between anti-matter (the positron) and matter (the electron) results in the
complete annihilation of both particles. The entire mass of the two particles is
converted into energy, which is in the form of a pair of photons. Each photon has
an energy of 510 keV, which is the energy equivalent of one electron or positron

mass. The most important characteristic is that the two photons leave the site of

the annihilation interaction traveling in precisely opposite directions. It is this

unique characteristic that makes tomographic imaging possible.

The major advantage of PET imaging comes from the chemical nature of many
of the positron emitters. Isotopes of chemical elements such as oxygen, nitrogen,
and carbon, are positron emitters. Because these elements occur naturally in many

biological molecules it makes it possible to tag and image a large number of com¬
pounds that play a role in biological functions.

The Imaging Process

A basic PET imaging system is shown in Figure 38-1. It consists of a circular

array of radiation detectors surrounding the patient's body. When a detector inter¬
cepts a radiation photon an electrical signal is produced. These signals are pro¬
cessed and fed into a computer where a digital image is actually reconstructed.
In order for a positron emission to be detected and displayed in the image, the
two photons from the annihilation process must be detected simultaneously.

Each possible pair of detectors is sampled for a very short period of time, which
is called a coincidence time window. If both detectors in a pair receive a photon

during the window, the event is recorded. The straight-line path between the two
detectors that passes through the annihilation point is known as the line of re¬

sponse (LOR). The geometric coordinates of the line of response for each annihi¬
lation event are stored in the computer memory. There can be many LORs passing

through each annihilation point, as shown in Figure 38-1.

A typical PET system will have several adjacent detector arrays. This permits
the simultaneous acquisition of data, which can be used to reconstruct images in
several planes.

Image Reconstruction

Image reconstruction is a mathematical process that converts the acquired data

(LOR coordinates) into a digital image. A back projection method, which is simi¬
lar in principle to computed tomography image reconstruction, is generally used.
Mathematical filters are included as part of the reconstruction process to improve

the quality of the image.

 Radionuclide Tomographic Imaging 569

Figure 38-1 A PET Imaging System

Attenuation Correction

The photons from annihilation events can interact with and be attenuated by the
tissue of thepatient's body. Photons from near the center of the body will be at¬
tenuated more than those from near the surface. This produces a distortion in the

apparent distribution of radioactivity within the slice. Steps must be taken to cor¬
rect for the attenuation effects.
The basic process is to place a large ring-shaped source within the detector
array. The ring source is typically filled with Ge-68. The daughter product is Ga-
68, which is a positron emitter. Data is then collected both with and without the
patient's body in place. This data is then used to determine the amount of attenua¬
tion along each LOR and by the computer to correct the patient emission data for
attenuation effects.

Positron-Emitting Nuclides

There are two principal sources of positron-emitting radionuclides for clinical

imaging. Most are produced with cyclotrons although it is possible to separate
570 Physical Principles of Medical Imaging

certain positron-emitting daughter products in a generator. The most common

cyclotron-produced nuclides and their half-lives are:
Carbon-11 20.5 min.
Nitrogen-13 10 min.
Oxygen-15 2.03 min.
Fluorine-18 110 min.

A frequently used generator-produced nuclide is:

Rubidium-82 78 sec.

Carbon, nitrogen, and oxygen are naturally occurring elements in most organic
compounds. The positron-emitting isotopes of these elements can be used to tag a
variety of compounds. Fluorine can be substituted for hydrogen in many com¬
pounds. Rubidium is a potassium analog that is taken up by the myocardium.
Most of these positron emitters are characterized by short lifetimes. This means
that they must be produced on-site just prior to their use.

The Cyclotron

A cyclotron is a necessary component of a PET imaging facility unless applica¬

tions are to be limited to the generator-produced nuclides such as rubidium. Cy¬

clotrons produce positron-emitting nuclides by bombarding target materials with

high-velocity protons. This bombardment produces a reaction that results in a ra¬
dioactive positron-emitting nucleus.
When a stable nucleus is bombarded by a high-energy particle such as a proton,
there is an immediate reaction in which another particle is expelled from the
nucleus. This changes the nucleus to one of a different nuclide. It is this new nu¬
clide that is the positron emitter. For example, nitrogen-13 is produced by the
following reaction:

Oxygen-16 (proton, alpha) Nitrogen-13.

This is a so-called proton-alpha reaction. When an oxygennucleus (the target
material) is bombarded by a high-energy proton, the reaction gives off an alpha
particle. The net effect is the reduction in atomic number by one and a reduction in
mass number by three. This yields a nucleus of nitrogen-13. Other target materials

and nuclear reactions are used to produce the other positron-emitting nuclides.

Design
The basic components typical cyclotron are shown in Figure 38-2. First,
of a
there is a produces a magnetic field between the two poles.
large magnet that
Within the magnetic field there are two electrodes that are known as dees because
 Radionuclide Tomographic Imaging 571

of their general shape. A source of ions (typically negativehydrogen ions) is lo¬

cated at the center. The targets for bombardment are locatedaround the periphery.
A stripping foil is located as shown. The operating region of the cyclotron is in a
vacuum to permit the unimpeded movement of the beam of ions.

Operation
Let us useFigure 38-2 to follow the sequence of events leading to the produc¬
tion of positron-emitting nuclide. Negative hydrogen ions are produced by the
a

ion source near the center. Because they are charged particles they follow a curved

path in the magnetic field. An electrical voltage is applied between the two dees
(electrodes). The negative ions are attracted to the positive electrode. They will be
accelerated and gain velocity and energy as they move between the electrodes.
This is similar, in principle, to the acceleration of electrons in an x-ray tube. After
the ions reach the dee, the polarity of the applied voltage is reversed so that the
other electrode is now positive and attractive to the ions. The ions continue their

^
x Stripping
Foil

ss Target To Be Made
Radioactive

Figure 38-2 The Basic Design and Function of a Cyclotron

572 Physical Principles of Medical Imaging

circular path and move back and forth between the dees. They are accelerated and
gain velocity as they move between the two dees. This causes the circular path to
enlarge. As the ions move back and forth between the two dees they gain addi¬
tional energy with each passage and follow a spiral pathway. When they have

gained the desired energy and have reached the periphery, they strike a stripping
foil. The stripping foil removes the electrons from the negative ion, leaving a posi¬

tively charged proton. The difference in electrical charge changes the direction of
curvature in the magnetic field and directs the protons to the target where the reac¬

tion produces the positron-emitting nuclide.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY

Single photon emission computed tomography (SPECT) is the technique for

producing tomographic images with conventional radionuclides that emit only

Figure 38-3 A SPECT Imaging System

 Radionuclide Tomographic Imaging 573

one photon per nuclear transition. The process is similar in principle to x-ray com¬
puted tomography (CT) except that a gamma camera is used as the imaging de¬
vice, as shown in Figure 38-3.

Data Acquisition
SPECT requires a gamma camera that can rotate or scan the detector assembly
around the patient's body. In each position it collects data that represent projection
profiles of the radiation emitted from the patient's body.

Image Reconstruction

The tomographic image is reconstructed by the computer from the acquired

data. The back projection process is used as in conventional x-ray CT.
The reconstruction process generally includes a choice of mathematical filters
that can be used to improve image quality and algorithms to provide corrections
for undesirable effects such as attenuation of the radiation within the body.
 Chapter 39

Statistics

INTRODUCTION AND OVERVIEW

Photons are emitted from a radioactive source in a random manner with respect
to both time and location. The random emission of photons with respect to time
makes it somewhat difficult to get a precise indication of source activity. This is
because the random emission produces a fluctuation in the number of photons
emitted from one time interval to another. If the photons from the sample are
counted for several consecutive time intervals, the number of counts recorded will
be different for each, as illustrated in Figure 39-1. This natural variation intro¬
duces an error in the measurement of activity that is generally referred to as the
statistical counting error.
The random emission of photons with respect to location, or area, produces
image noise. The presence of this spatial noise within an image decreases the abil¬
ity to see and detect small objects, especially when their contrast is low.
In this chapter we first consider the nature of the random variation, or fluctua¬
tion, in photons from a radioactive source, and then show how this knowledge can
be used to increase the precision of activity measurements (counting) and the qual¬

ity of nuclear images.

We must first know something about the extent of the fluctuation, and if it is
related to a factor over which we have control. One approach is to imagine we are

conducting an experiment for the purpose of studying the random nature of photon
emissions. Let us assume we have a source of radiation in a scintillation well
counter that is being counted again and again for 1-minute intervals. We quickly

notice that the number of counts, or photons, varies from one interval to another.
Some of the values we observe might be 87, 102, 118, 96, 124, 92, 108, 73, 115,
97, 105, and 82. Although these data show that there is a fluctuation, they do not
readily show the range of fluctuations. The amount of fluctuation will become
more apparent if we arrange our data in the form of a graph, as shown in Figure

575
576 Physical Principles of Medical Imaging

COUNTS/SECOND IMAGE
92
I 15 •

V' '

87
105
Radioactive Source s. /

/ Counting \ f Image \
( Error I Noise
J
J

Figure 39-1 Statistical Photon Fluctuation As a Source of Counting Error and Image
Noise

39-2. In this graph, we plotted the number of times we measured a specific number
of counts versus the actual number of counts observed. Obviously, we would have
to count the number of
photons from our source many many times to obtain the
data to plot this type of graph.
When the data are presented in this manner, it is apparent that some count val¬
ues occurred more frequently than others. In our experiment we observed 100

counts more frequently than any other value. Also, most of the count values fell

within the range of 70 to 130 counts. Within this range, the number of times we
observed specific count values is distributed in the Gaussian, or normal, distribu¬
tion pattern. (This is actually a special type of Gaussian distribution known as the
Poisson distribution and is discussed later.)
At this point we need to raise a very significant question: Of all of these values,
which one is the "true" count rate that best represents the activity of our sample?
In example, the average, or mean, of all of the values is 100 counts. This
our is
considered to be the value that best represents the true activity of the sample.
 Statistics 577

Number of Count*

Figure 39-2 Graph Showing the Relative Number of Times Different Count Values (Num¬
ber of Counts) Are Obtained When a Specific Radioactive Sample Is Counted Again and
Again

COUNTING ERROR

In our experiment, took one sample of radioactive material and counted it

we
many times to determine the fluctuation in the number of counts, or photons, from
the sample. However, in the clinical laboratory we normally count a sample only
one time. Any time we make a single count on a source we are faced with a ques¬
tion: How close is our measured count value to the true count value for that par¬
ticularsample? As illustrated in Figure 39-3, the difference between these two
values is the error in our observed count value. At this point we have a problem:
Since we do not know what the true count value is, we have no way of knowing
what the error associated with a single measurement is.

Error Ranges

From our experiment, we know that the value of any individual count
earlier
falls within certain range around the true count value. In our experiment, we
a

observed that all counts fell within 30 counts (plus or minus) of the true value
(100 counts). Based on this observation, we could predict the maximum error that
578 Physical Principles of Medical Imaging

Figure 39-3 The Amount of Error Is the Difference between the Measured and True Count
Values

could occur we make a single count. In our case, the maximum error would
when
(± 30%). We also observed that very few count values approached
be ± 30 counts
the maximum error. In fact, a large proportion of the count values are clustered
relatively close to the true value. In other words, the error associated with many
individual counts is obviously much less than the maximum error. To assume that
the error in a single count is always the maximum possible error is overstating the

problem. Although it is necessary to recognize that a certain maximum error is

possible, we must be more realistic in assigning values to the error itself because it
is usually much less than the maximum possible error.
If, at this point, we were to go back to the data from our earlier experiment and
analyze it from the standpoint of how the individual count values are clustered
around the true value (mean), we would get results similar to those illustrated in
Figure 39-4. For the purpose of this analysis, we established three error ranges
around the true value. In our particular case, the error ranges are in ten-count in¬
crements. The first range is ± 10 counts (10% error), the second range is ± 20
counts (20% error), and the largest range is ± 30 counts (30% error). At this point
we are interested in how often the value of a single measurement fell within the
 Statistics 579

Figure 39-4 Number of Measurements That Fall within Specific Error Ranges

various error ranges. Upon careful analysis of our data, we find that 68% of the

time the count values are within the first error range ( ± 10%), 95% of all count
values are within the next error range (± 20%), and essentially all values (theoreti¬

cally 99.7%) are within the largest error range ( ± 30%).

With this information as background, let us now see what we can say about the
error of an individual measurement. Note that in the case of a single measurement,

there is no determine the actual error because the true value is unknown.
way to
Therefore, think in terms of the probability of being within certain error
we must

ranges. With this in mind, we can now make several statements concerning the
error of an individual measurement in our earlier experiment:

• There is a probability (chance) that the error is within ± 10%.

68%
• There is a probability that the error is within ± 20%.
95%
• There is a 99.7% probability that the error is within ± 30%.

While we are still not able to predict what the actual error is, we can make a
statement as to the probability that the error is within certain stated limits.
580 Physical Principles of Medical Imaging

might appear that the error ranges used above were chosen because they were
It
in simple increments of ten counts. Actually, they were chosen because they repre¬
sent "standard" error ranges used for values distributed in a Gaussian manner.

Error ranges can be expressed in units, or increments, of standard deviations (a).

In our example, one standard deviation (o) is equivalent to ten counts. However,
one standard deviation is not always equivalent to ten counts.

The general situation is illustrated in Figure 39-5. For values distributed in a

Gaussian manner, the relationship between the probability of a value falling
within a specific error range remains constant when the error range is expressed in
terms of standard deviations. For the general case, we have the following relation¬

ship between error limits and the probability of a value falling within the specific
limits:

Error Limits Probability

± 1 a 68.0%
±2(5 95.0%
±3o 99.7%

might be helpful to draw an analogy between the error limits and a bull's-eye
It

target, as shown in Figure 39-6. The small bull's-eye in the center represents the
true count value for a specific sample. If we make one measurement, we can ex¬

pect the count value to "hit" somewhere within the overall target area. Although
there is no way to predict where the value of a single measurement will fall, we do

Number of Counts

Figure 39-5 Relationship between the Number of Measurements within Error Limits
When the Limits Are Expressed in Terms of Standard Deviations
 Statistics 581

Figure 39-6 An Analogy between Counting Error and a Bull's-Eye Target

know something about the probability, or chance, of it falling within certain areas.
For example, there is a 68% chance that our count value will fall within the small¬
est circle, which represents an error range of one standard deviation. There is a

95% probability that the value will fall within the next largest circle, which repre¬
sents an error range of two standard deviations. Essentially all of the values

(99.7%) will fall within the largest circle, which represents an error range of three
standard deviations.
Measuring the relative activity of a radioactive sample is like shooting at a
bull's-eye. We do not expect to get the true count value (hit the bull's-eye) each
time. The problem is that after making a measurement (taking a shot) we do not
know what our actual error is (by how far we missed the bull's-eye). This is be¬
cause we do not know what the true value is, only the value of our single measure¬

ment. We must, therefore, describe our performance in terms of error ranges and

the confidence we have of falling within the various ranges. We can express a
 582 Physical Principles of Medical Imaging

level of confidence of falling within a certain error range if we know the probabil¬
ity of a single value falling within that range. For Gaussian distributed count val¬
ues, 68% will fall within one standard deviation of the true, or mean, value. Based
on this we could make the statement that we are 68% confident that the value of a

single measurement will fall within the one standard deviation error range. A more
complete description of our performance could be summarized as follows:
Error Range Confidence Level
±lo 68.0%
± 2 G 95.0%
± 3 G 99.7%

A clear distinction between an error range and a confidence level is

necessary.
Error range describes how far a single measurement value
might deviate, or miss,
the true count value of a sample. Confidence level
expresses the probability, or
chance, that a single measurement will fall within a specific error
range. Notice
that as we increase the size of our error range our confidence level also increases.
In terms of target, this simply means we are more confident that our shot will
our

hit within larger circle than within a smaller circle.

a

The relationship between confidence level and error

range expressed in stan¬
dard deviations does not change for measurement values distributed in a Gaussian
manner. What does
change, however, is the relationship between an error range
expressed in standard deviations and an error range expressed in actual number of
counts or percentages. In our earlier
example, one standard deviation was equal to
ten counts, or 10%. We will now find that for other measurements one standard
deviation can be a different number of counts.
Radiation events (such as count values), unlike the value of
many other
nonradiation variables, are distributed in a very special
way. The value of the stan¬
dard deviation, expressed in number of counts, is related to the actual number of
photons counted during the measurement. Theoretically, the value of the standard
deviation is the square root of the mean of a large number of measurements. In
actual practice, we never know what the true count value of a
sample is. In most
cases, our measurement value will be sufficiently close to the true value so that we
can use it to estimate the value of the standard deviation as follows:

Standard deviation = V Measured value.

For example, if we make a measurement in which 100 counts will be

recorded,
the value of the standard deviation will be

G = "n/ 100 =10 counts.

This will be recognized as the count value in our earlier example, where it was
stated that the value of one standard deviation was 10 counts, or 10%. Now let us
 Statistics 583

examine the values of one standard deviation for other recorded count values
shown in Table 39-1. Examination of this table shows that as the number of counts
recorded during a single measurement increases, the value of the standard devia¬
tion, in number of counts, also increases; but it decreases when expressed as a
percentage of the total number of counts. We can use this last fact to improve the
precision of radiation measurements.
The error range, expressed as a percentage of the measured value, decreases as
the number of counts in an individual measurement is increased. The real signifi¬
cance of this is that the precision of a radiation measurement is determined by the

actual number of counts recorded during the measurement. The error limits for
different count values and levels of confidence are shown in Table 39-2.
We can use the information in Table 39-2 to
plan a radiation measurement that
has specific precision. For example, if we want our measurement to be within a
a

2% error range at the 95% confidence level, it will be necessary to record at least
10,000 counts. Most radiation counters can be set to record counts either for a
specific time interval or until a specific number of counts are accumulated. In
either case, the count rate of the sample (relative activity) is determined by divid¬

ing the number of counts recorded by the amount of time. Presetting the number of

Table 39-1 Standard Deviation Expressed in Number of Counts and Percentage of Count
Value

Number of Counts Standard Deviation

Counts Percent

100 10 10

1,000 32 3.2

10,000 100 1

100,000 316 0.32

1,000,000 1,000 0.1

Table 39-2 Error Limits (Percent) for Different Count Values and Levels of Confidence

Number of Counts Confidence Level

68% 95% 99. 7%

100 10 20 30
1,000 3.2 6.3 9.5
10,000 1 2 3
100,000 0.32 0.63 0.95
584 Physical Principles of Medical Imaging

counts and then measuring the time required for that number of counts to accumu¬
late allows the userto obtain a specific precision in the measurement.

Combined Errors

In some applications, it is necessary to add or subtract counts in order to obtain

adesired parameter. An example is the subtraction of background from a
sample
measurement. The first step is to count the sample. (Counts from
background ra¬
diation are included in this measurement.) The next
step is to remove the radio¬
active sample from the counting system, and then measure only the background
radiation. The background count rate is then subtracted from the
sample-plus-
background count rate to obtain a measurement of the relative sample activity.
The question now arises: What is the error in the sample count rate that was ob¬
tained by subtracting one count value from another?
Let us use the example shown in Figure 39-7 to investigate the error in the
difference between two count values. Assume that we have two radiation sources.
For the same counting time, has a true value of 3,600 counts and the other a
one
true value of 6,400 counts. The true
difference between the two is 2,800 counts. If
we now measure the two
samples, we expect the measured values to fall some¬
where within the error ranges indicated in Figure 39-7. With
respect to the mea¬
sured difference we now have two errors to contend with, one for each of the
sample measurements. The question is now: What will be the error range for the
difference between the two measured values? In some instances, the error in the
measurement of one sample
might be in a direction that compensates for the error
in the measurement of the other sample, and the net error in the difference would
be relatively small. There is also the
possibility that the two errors are in opposite
directions, in which case the error in the difference would be relatively large.

3,600 6,400

60 counts True difference - 2,800 counts 80 counts

(1.67%) (1.25%)

Possible Measured Difference

Figure 39-7 Errors Associated with the Difference between Two Count Values
 Statistics 585

When making measurements on two samples, we have no way of knowing either

the amount or direction of the individual errors. Therefore, we must consider the
range of errors possible in the difference between the two measured count values.
Because of the possibility of errors compounding (by being in
opposite direc¬
tions), it should be obvious that the error range for the difference (era) will be larger
than the error range associated with the individual measurement (01 and 02). When
the error ranges are expressed in terms of standard deviations, the relationship
becomes

CJd= V O12 + c22 .

Let us now examine the actual values in

Figure 39-7 and see what the error
rangewill be for the difference between the two count values. The first sample
measurement has a true value of 3,600 counts. By taking the square root of this

number, we find that the standard deviation is 60 counts, or 1.67%. The second
sample has a count standard deviation of 80 counts, or
total of 6,400 counts with a
1.25%. If we now determine the standard deviation for the difference by using the
relationship given above, we see that

od= V (60)2 + (80)2= 100.

A standard deviation of 100 counts is 3.6% of the difference between the two
count values, 2,800 counts.
Any time we add or subtract count values, the error range (standard deviation)
of the sum or difference will be larger than the error range of the individual mea¬
surements. When two count values are added, the standard deviation of the sum

(Os) is related to the standard deviation of the individual measurements (01 and 02)
by
CTs = V Oi2 + o22.
Notice that this is the same relationship that for the difference between two
as
count values. A common mistake is to assume that the sign between the two stan¬
dard deviation values is different for addition and subtraction. It does not change;
it is positive in both cases.
Let us now determine the error range of the sum of the two count values in
Figure 39-7. As we have just seen, the standard deviation for the sum is the same
as the standard deviation for the difference. That is, in this case, 100 counts, but

since the sum of the two count values is 10,000 counts this now represents an error

range of only 1%. This is the same error range as we would find on a single mea¬
surement of 10,000 counts.
When expressed as a percentage, the error range increases when we take the
difference between two measurements, but it decreases when we add the results of
the two measurements.
 Chapter 40
Patient Exposure and Protection

INTRODUCTION AND OVERVIEW

All medical
imaging methods deposit some form of energy in the patient's
body. Although the quantity of energy is relatively low, it is a factor that should be
given attention when conducting diagnostic examinations. In general, there is
more concern for the energy deposited by the ionizing radiations, x-ray and

gamma, than for ultrasound energy or radio frequency (RF) energy deposited in
magnetic resonance imaging (MRI) examinations. Therefore, this chapter gives
major emphasis to the issues relating to the exposure of patients to ionizing radia¬
tion.
undergoing either x-ray or radionuclide examinations are subject to a
Patients
wide range of exposure levels. One of our objectives is to explore the factors that
affect patient exposure. This is followed by an explanation of methods that can be
used to determine patient exposure values in the clinical setting.

Figure 40-1 identifies the major factors that affect patient exposure during a
radiographic procedure. Some factors, such as thickness and density, are deter¬
mined by the patient. Most of the others are determined by the medical staff. Many
of the factors that affect patient exposure also affect image quality. In most in¬
stances when exposure can be decreased by changing a specific factor, image

quality is also decreased. Therefore, the objective in setting up most x-ray proce¬
dures is to select factors that provide an appropriate compromise between patient

exposure and image quality.

X-RAY EXPOSURE PATTERNS

In any x-ray examination, there is considerable variation in exposure from point

topoint within the patient's body. This must be considered when expressing val¬
ues for patient exposure. In fact, when exposure values are given, the specific

587
588 Physical Principles of Medical Imaging

Figure 40-1 Factors That Affect Patient Exposure in a Radiographic Procedure

anatomical location of the value should also be stated. Some exposure patterns are
characteristic of the different x-ray imaging methods. A review of these patterns
willgive us some background for considering factors that affect exposure and
applying methods to determine actual exposure values.

Radiography

typical radiographic examination, the x-ray beam is projected through the

In the

patient's body, as shown in Figure 40-1. The point that receives maximum expo¬
sure is the entrance surface near the center of the beam. There are two reasons for
this. The primary x-ray beam has not been attenuated by the tissue at this point,
and the is exposed by some of the scattered radiation from the body. The
area

amount of surface exposure produced by the backscatter depends on the spectrum

of the primary beam and the size of the exposed area. For typical radiographic
situations, scattered radiation can add at least 20% to the surface exposure pro¬
duced by the primary beam.
As the x-ray beam progresses through the body, it undergoes attenuation. The
rate of attenuation (or penetration) is determined by the photon-energy spectrum
 Patient Exposure and Protection 589

(KV and filtration) and the type of tissue (fat, muscle, bone) through which the
beam passes. For the purpose of this discussion, we assume a body consisting of
homogeneous muscle tissue. In Figure 40-2, lines are drawn to divide the body
into HVLs. The exposure is reduced by a factor of one half each time it passes

through 1 F1VL. The thickness of 1 HVL depends on the photon-energy spectrum.

However, for the immediate discussion, we assume that 1 HVL is equivalent to 4
cm of tissue. A 20-cm thick body section consists of 5 HVLs. Therefore, the expo¬

sure decreases by one half as it passes through each 4 cm of tissue. At the exit

surface, the exposure is a small fraction of the entrance surface exposure.

The exposure to a specific organ or point of interest within the direct x-ray beam
depends on its proximity to the entrance surface.
Tissue located outside the primary beam receives some exposure from the scat¬
tered radiation produced within the beam area. The scatter exposure to the sur¬
rounding tissue is relatively low in comparison to the exposure levels within the
primary beam.

Fluoroscopy

The fluoroscopic beam projected through the body will produce a pattern simi¬
lar to a radiographic beam if the beam remains fixed in one position. If the beam is

100%

Figure 40-2 Typical Exposure Pattern (Depth Dose Curves) for an X-Ray Beam Passing
through a Patient's Body
590 Physical Principles of Medical Imaging

moved during the procedure, the radiation will be distributed over a large volume
of tissue rather thanbeing concentrated in one area. For a specific exposure time,
tissue exposure values (roentgens) are reduced by moving the beam, but the total
radiation (R - cm2) into the body is not changed. This was illustrated in Figure
3-5 (Chapter 3).

Computed Tomography
In computed tomography (CT) two factors are associated with exposure distri¬
bution and must be considered: (1) the distribution within an individual slice and
(2) the effect of imaging multiple slices.
The rotation of the x-ray beam around the body produces a much more uniform
distribution of radiation exposure than a stationary radiographic beam. A typical
CT exposure pattern is shown in Figure 40-3. A relatively uniform distribution

throughout the slice is obtained if a 360° scan is performed. However, if other scan
angles that are not multiples of 360° are used, the exposure distribution will be¬
come less uniform.
When multiple slices are imaged, the exposure (roentgens) does not increase in
proportion to the number of slices because the radiation is distributed over a larger
volume of tissue. This point was also illustrated in Chapter 3. However, when
slices are located close together, radiation from one slice can produce additional

exposure in adjacent slices because slice edges are not sharply defined (as de¬
scribed in Chapter 23) and because of scattered radiation.

Figure 40-3 Typical Exposure (Dose) Pattern Produced with Computed Tomography
 Patient Exposure and Protection 591

RADIATION AND IMAGE QUALITY

One of the major compromises that must be made in imaging procedures

using
ionizing radiation is between patient exposure and image quality. Within certain
limits, increasing image quality requires an increase in patient exposure. It is usu¬
ally the specific image quality requirements that determine the quantity of radia¬
tion that must be used in the imaging process. The three basic image quality fac¬
tors (contrast sensitivity, detail, and noise) are each related to patient exposure.

This holds true for both x-ray and nuclear radiation imaging procedures. The vari¬
ables of an imaging procedure should be selected to produce adequate image qual¬

ity with the lowest possible radiation exposure.

We now consider each factor that affects patient exposure and show how it
relates to image quality.

FACTORS AFFECTING EXPOSURE

The exposure, or dose, to a specific point within a patient's body is determined

by a combination of factors. One of the most significant is whether the point in
question is in or out of the primary beam. Points not located in the direct beam can
receive exposure from scattered radiation, but this is generally much less than the
exposure to points within the beam area. The factors that determine exposure lev¬
els to points within the body will be discussed in reference to the situation illus¬
trated in Figure 40-4.

Surface Exposure
200 mR

Patient Penetration = 0.05 KV, Filter *■ Contrast

4.0 mR
I
Tabletop, 1 HVL '

r2.0 mR •Contrast
Grid Bucky Factor = 4 UllllilllililllllllillUillllllllllll
0.5 mR
♦ Film Noise
Receptor
Sensitivity =
■

0.5 mR
c Screen —»-Blur

Figure 40-4 Factors That Determine Exposure Values in Radiography

592 Physical Principles of Medical Imaging

Receptor Sensitivity

One of the most significant factors is the amount of radiation that must be deliv¬
ered to the receptor to form a useful image. This is determined by the sensitivity of
the receptor. It was shown in Chapter 14 that there is a rather wide range of sensi¬

tivity values encountered in radiography. It is generally desirable to use the most

sensitive receptor that will give adequate image quality. The exposure to points
within the patient's body will be a multiple of the receptor exposure.
The sensitivity of a radiographic receptor is determined both by characteristics
of the intensifying screen (Chapter 14) and the film (Chapter 15). To produce a net
film density of one, radiographic receptors require exposures ranging from 0.16
mR, for 800 speed systems, to more than 10 mR, for some mammographic recep¬
tors. We will illustrate our immediate discussion using a receptor that requires a

0.5-mR exposure, as shown in Figure 40-4.

Intensifying Screens
The selection of intensifying screens for a specific procedure involves a com¬

promise between exposure and image blur or detail. The screens that require the
least exposure generally produce more image blur, as discussed in Chapter 14.

Films

Films with different sensitivity (speed) values are available for radiographic
procedures. The primary disadvantage in using high sensitivity film is that quan¬
tum noise is increased, as described in Chapter 21. In fact, it is
possible to manu¬
facture film that would require much less exposure than the film generally used.
However, the image noise level would be unacceptable.

Grid

It was shown in
Chapter 13 that the penetration of grids is generally in the range
of 0.17 to 0.4. This corresponds to a Bucky factor ranging from 6.0 to 2.5. The
exposure to the exit surface of the patient is the product of the receptor exposure
and the grid Bucky factor. This is assuming that the receptor surface is not sepa¬
rated from the surface of the patient by a significant distance. The use of a high-
ratio grid, which generally has a relatively low penetration, or high Bucky factor,
tends to increase the ratio of patient-to-receptor exposure. Low-ratio grids reduce

patient exposure by allowing more scattered radiation to contribute to the film

exposure. In selecting grids, the user should be aware of the general compromise
between patient exposure and image contrast.
 Patient Exposure and Protection 593

Tabletop

In many x-ray examinations, the receptor is located below the table surface that
supports the patient's body. The attenuation of radiation by the tabletop increases
the ratio of patient-to-receptor exposure. It is generally recommended that the
tabletop have a penetration of at least 0.5 (not more than 1 HVL). The patient
exposure with a tabletop that has a penetration of 0.5 will be double the exposure
if no tabletop is located between the patient and receptor.

Distance

Because of the diverging nature of an x-ray beam, the concentration of x-ray

photons, or exposure, decreases with distance from the focal spot. This is the in-
verse-square effect. This effect increases the ratio of patient-to-receptor exposure.
Consider a point located 20% of the way between the receptor surface and the
focal spot. The geometric magnification is 1.25. The exposure at this point is 1.56
times the receptor exposure because of the inverse-square effect. The distance
between the surface, or point of interest, and receptor is generally fixed by the size
of the patient. Therefore, the only factor that can be changed is the distance be¬
tween the focal spot and point of interest.

Patient exposure is reduced by using the greatest distance possible between the
focal spot and body. The effect of decreasing this distance on patient exposure is
illustrated in Figure 40-5; two body sections are shown with x-ray beams that
cover the same receptor area. The x-ray beam with the shorter focal-to-patient

distance covers a smaller area at the entrance surface. Because the same radiation
is concentrated into the smaller area, the exposure to the entrance surface and
points within the patient is higher than for the x-ray beam with the greater focal-
patient distance.
It is generally recommended that the distance between focal spot and patient
surface should be at least 38 cm (15 in) in radiographic examinations. Fluoro¬

scopic tables should be designed so that the focal spot is at least 38 cm below the
tabletop.
The inverse-square effect increases the concentration of radiation (exposure
and dose) in the patient's body. However, the total amount of radiation (surface

integral exposure) is not significantly increased by decreasing the tube-to-patient

distance. The same radiation energy, or number of photons, is concentrated in a
smaller area.

In procedures in which the body section is separated from the receptor surface
to achieve magnification, exposure can significantly increase because of the in¬

verse-square effect. An air gap is also introduced, which reduces the amount of
scattered radiation reaching the receptor. To compensate for this and to achieve
594 Physical Principles of Medical Imaging

the Concentration of Radiation or Surface Exposure

the same film exposure,it is generally necessary to increase the x-ray machine
output, which also increases exposure to the patient.

Tissue Penetration

If the point of interest, or organ, is not located at the exit surface of the body, the
attenuation in the tissue layer between the organ and exit surface will further in¬
crease the exposure. The ratio of the organ-to-exit surface exposure is determined

by the penetration of the tissue.

The penetration of the tissue between the point of interest and the exit surface is
determined by the distance between the two points, the type of tissue (lung, soft
tissue, bone, etc.), and the effective energy of the x-ray beam. For a given patient,
the only factor that can be varied to alter penetration is the effective energy. This,
in turn, depends on waveform, KV, and filtration. Generally speaking, three-

phase, or constant potential, waveforms produce more penetrating radiation,

which reduces patient exposure. It was shown earlier that adding filters to an x-ray
beam selectively removes the low-energy, low-penetrating photons. This pro¬
duces an x-ray beam with a greater penetrating ability. Filtration of an x-ray beam
is especially significant in reducing the exposure to points near the entrance sur¬
face. Patient exposure is generally reduced by increasing KV. The problem is that
the higher KV values give lower image contrast because of object penetration and
more scattered radiation.
 Patient Exposure and Protection 595

Exposure Values

The entrance surface exposure for a

radiographic procedure covers a consider¬
able range because of variations in the factors discussed above. Table 40-1 gives
some typical values for a variety of procedures.

Beam Limiting

Changing thex-ray beam area (or field of view, FOV) has relatively little effect
on the entrance surface exposure but has a significant effect on the total amount of
radiation delivered to the patient. The surface integral
exposure is directly propor¬
tional to the beam A
large beam will deliver more radiation to the body than
area.

a small beam if all other factors

are equal.

Limiting the FOV to the smallest area that fulfills the clinical requirements is an
effective method for reducing unnecessary patient exposure. Under no circum¬
stances should an x-ray beam cover an area that is larger than the
receptor.

EXPOSURE DETERMINATION

Theprevious section identified the significant factors that affect the exposure,
or dose, to
a patient undergoing an x-ray examination. It is often desirable to deter¬
mine the dose received by a patient in a specific examination. The relationships
discussed above are generally not useful for this purpose because many of the
factors, such as receptor sensitivity, scatter factor, etc., are not precisely known. It
is usually easier to determine patient exposure and dose by starting with the tech¬
nical factors, KVP and MAS.

Table 40-1 Typical Patient Surface Exposure Values for Various X-Ray Procedures

Procedure Exposure

Skull(L) 40 - 60 mR

Chest(L) 50 - 100 mR
Chest (PA) 10- 30 mR

Breast 500 - 2,000 mR

Abdomen 100- 400 mR
500 1,500 mR
Lumbar Spine (L) -

Pelvis 250 - 500 mR

Fluoroscopy (1 min) 2,000 - 5,000 mR

1,000 4,000 mR
Computed Tomography -
596 Physical Principles of Medical Imaging

The exposure (X) delivered to a point located 1 m from the focal spot is given
by
X(mR) = Ex x MAS
where Ex is the efficacy of the x-ray tube. In most facilities, x-ray machines are
calibrated periodically, and the efficacy value can be obtained from the calibration
reports. In the absence of a measured efficacy value for a specific machine, it
might be necessary to use typical values such as are found in Figure 7-8. The
efficacy values depend on KVP, waveform, filtration, and the general condition of
the x-ray tube anode. The exposure to points at other distances from the focal spot
can be determined by adding an inverse-square correction to the above relation¬

ship. This gives

where d is the distance between the focal spot and the point of interest. This rela¬

tionship will apply if there is no attenuation of the x-ray beam by materials such as
tissue.
When the point of interest is within the body, two additional factors must be
considered: (1) the attenuation of the radiation as it passes through the overlying
tissue and (2) the contribution of scattered radiation to the exposure. This can be
done by multiplying the exposure value in air by the appropriate tissue-air ratio
(TAR), as illustrated in Figure 40-6. Some typical TAR values for diagnostic
x-ray examinations are given in Table 40-2. TAR values depend on the depth of

A
l \
\

\
Dose «TAR • Exposure
\

\
\
\
Air \

Figure 40-6 Relationship of Tissue Dose to Air Exposure

 Patient Exposure and Protection 597

Table 40-2 TAR Values for a 40 40

cm x cm Field and 2.5 mm Aluminum Filtration

Tissue
depth
(cm)
__ kVp
70 80 90 100 120

0 1.07 1.10 1.12 1.14 1.15

2 1.06 1.09 1.11 1.15 1.20
4 0.791 0.845 0.904 0.955 1.09
6 0.566 0.625 0.679 0.726 0.813
8 0.406 0.461 0.510 0.552 0.630
10 0.291 0.340 0.383 0.420 0.489
12 0.208 0.250 0.288 0.320 0.379
14 0.149 0.185 0.217 0.243 0.294
16 0.107 0.136 0.163 0.185 0.228
18 0.077 0.100 0.122 0.141 0.177
20 0.055 0.074 0.092 0.107 0.137

aData provided by R. J. Schulz.

the point of interest within the body, the penetrating ability of the x-ray beam (KV,
filtration, waveform), and the size of the x-ray beam field that affects the amount
of scattered radiation produced.
The relationships discussed above can be combined to give

TV
Dose ( A\ VvTAD Exx MAS x TAR
(mrad) = X x TAR = -L
d2

The fact that both x-ray tube efficacy, E, and TAR increase with KV does not
mean that patients receive more radiation when the KV is increased in an exami¬
nation. An increase in KV must be compensated for by decreasing MAS to obtain
the same film exposure. This results in less radiation to the patient because of
better penetration.

RADIONUCLIDE DOSIMETRY

problems with using radioactive materials for diagnostic purposes is

One of the
that significant portion of the radiation energy is deposited in the human body. In
a

this section we consider the characteristics of the radioactive material and the hu¬
man body that determine the amount of energy that will be deposited.
598 Physical Principles of Medical Imaging

Total Energy (Integral Dose)

The determination of the integral dose, or total energy deposited, is rather

straightforward. As illustrated in Figure 40-7, the two factors that determine inte¬
gral dose are (1) the total number of radioactive transitions that occur within the
body and (2) the average energy emitted by each transition. The product of these
two quantities is the total energy emitted by the radionuclide, excluding the energy

carried away by the neutrino. If the radionuclide is located within the body, it can
generally be assumed that most of the emitted energy will be absorbed by the
body. This, however, depends on the penetrating characteristic of the radiation. If
the emitted radiation is in the form of high-energy photons, some of the energy
will escape from the body, but this will usually be a relatively small fraction of the
total amount.
The relationship among total energy (integral dose), the average energy per
transition, and the number of transitions expressed in terms of the cumulated ac¬
tivity is shown in Figure 40-7.

Cumulated Activity
Cumulated activity, A, is
a convenient way of expressing the number of transi¬
tions that occur. The units used for this quantity are microcurie-hours. Recall that
1 p.Ci-hr is equivalent to 1.33 x 108 radioactive transitions.
The first step in determining the amount of radiation energy deposited in a body
is to determine the cumulated activity. The cumulated activity depends on two

Integral Dose
(Total Energy)

Ai .1 a IK
Integral Dose (gm-rad)= 2.I3XIO A(xlC i -hr )-E(keV/Transition)

Integral Dose (gm-rad) = A(julC i -hr ) & (gm-rad/>«.C i - hr)

Figure 40-7 Factors That Determine the Total Amount of Radiation Energy (Integral
Dose) Imparted to the Patient's Body
 Patient Exposure and Protection 599

Elapsed Time (hrs)

Figure 40-8 Effect of Radioactive Lifetime on Cumulated Activity

factors: (1) the amount of activity administered to the patient (Ao) and (2) the
lifetime of the radioactive material within the body or organ of interest. The rela¬
tionship between cumulated activity and these two quantities is
A = 1.44 Ao, Te.

The half-life that determines cumulative activity is always the effective half-
life, Te. The relationship shown above applies only if the radioactive material is
administered to or taken up by the body or organ of interest very quickly. This is
usually the situation after administering a radiopharmaceutical in a single dose.
It is important to recognize the dependence of the number of transitions (cumu¬
lated activity) on the lifetime of the radionuclide. This is illustrated in Figure 40-8
for two nuclides with different half-lives. In both cases the administered activity is
the same, ie, 10 pCi. The illustrations show the relationship between activity re¬
maining in the body and elapsed time. The cumulated activity, or number of tran-
600 Physical Principles of Medical Imaging

sitions, is represented by the shaded area under the curve. The point to be made is
simply this: For a given amount of administered activity, the number of transitions
that occur within the body (cumulated activity) is directly proportional to the half-
life of the radionuclide.
In many cases when a radionuclide is administered to the patient, there is some

delay in the build-up of activity in a specific organ, as illustrated in Figure 32-9. In

determining the cumulated activity for the organ, it is necessary to take this delay
into account. If the build-up of activity in the organ has an exponential relationship
with time, the rate of uptake can be expressed in terms of an uptake "half-life."
When there is a delay in organ uptake, and the uptake half-life, Tu, is significant
with respect to the effective removal half-life, Te, the relationship for finding cu¬
mulated activity becomes

A= 1.44 Ao (Te-Tu).
Cumulated activity is related to the characteristics of both the radionuclide and
the patient. In other words, both physical and biological factors affect cumulated
activity. The physical factors, ie, administered activity and physical half-life of the
nuclide, are always known. The problem in determining cumulated activity is in

10-

VTotal Body-A = 7l ju.C i-hr

Hrn/in • A r 49 .. C ! . Kr

o Y"i'1V 'i1 ■»'■ ''Y'. 'i'' 'I' ' ."t 1T ■ ■ r ■ T ■''ty Y •

5 10 15 20
Elapsed Time (hrs)

Figure 40-9 Effect of Organ Uptake Rate on Cumulated Activity

 Patient Exposure and Protection 601

assessing the rate of uptake and elimination. The uptake of a radionuclide in a

specific organ often depends on the condition of the organ and can vary from
patient to patient for the same radionuclide.

Transition Energy
Most radionuclides emit a mixture of radiations, as discussed in
Chapter 5. The
radiation can consist of both electrons and
photons. Although the total transition
energy is the same for all nuclei of a specific nuclide, the radiation energy might
vary from nuclei to nuclei because of energy carried away by neutrinos and the
fact that all nuclei do not go through exactly the same transition
steps. The transi¬
tion diagram and radiation spectrum for a hypothetical nuclide are shown in Fig¬
ure 40-10. The total transition
energy of 290 keV is shared by the beta electrons,
neutrinos, and gamma photons.
This particular nuclide has two possible transition routes. Twenty percent of the
nuclei emit a beta and neutrino followed by a 190-keV gamma photon (gamma 1).

Eighty percent of the nuclei emit more energy in the form of beta and neutrino

T
290keV

Figure 40-10 Components of a Radiation Spectrum That Must Be Considered When

Determining Patient Exposure
602 Physical Principles of Medical Imaging

radiation and a 160-keV gamma photon (gamma 2). It is assumed in this example
that the average energy of all beta electrons is 50 keV. The average beta and
gamma energy emitted per transition is
Gamma 1: 0.2 x 190 =38
Gamma 2: 0.8 x 160 = 128
Beta: = 50

216 keV.

Notice that the average radiation energy per transition (216 keV) is less than the
total transition energy (290 keV) because we exclude the energy carried away
from the body by the neutrinos.
The average transition energy is usually expressed in the units of gram-rad per
microcurie-hour, which is designated the equilibrium dose constant, A. The equi¬
librium dose constant is the amount of radiation energy emitted by 1.33 x 108
transitions (1 pCi-hr). This is a useful quantity because the integral dose can be
found by multiplying two quantities, the equilibrium dose constant and the cumu¬
lated activity, as shown in Figure 40-7. Since
1 pCi-hr = 1.33 x 108 transitions
and

1 g-rad = 6.24 x 1010 keV

the relationship between the equilibrium dose constant, A, and the average energy
per transition, E, is
A (g-rad/pCi-hr) = 2.13 x 1CH E (keV/transition).

ABSORBED DOSE

Absorbed dose is the concentration of absorbed radiation

energy at a specific
point. It is especially important to recognize that an absorbed dose value applies to
a specific
point within the body. Since radiation is usually not uniformly distrib¬
uted throughout the body, there will be many absorbed dose values for the various

points throughout the body or organ of interest.

Electron Radiation

If the radioactive material emits electron or particle radiation such as beta, inter¬

nal conversion, Auger, or positron, the energy will be absorbed in the close vicin¬
ity of the radioactive material. Recall that a 300-keV electron can penetrate less
than 1 mm of soft tissue. Most of the electron radiations encountered in nuclear
 Patient Exposure and Protection 603

medicine have energies much less than this and shorter ranges.
From the standpoint of dose estimation, the simplest situation is an organ that
contains an electron emitter that is
uniformly distributed throughout the organ, as
illustrated in Figure 40-11. In this case, the absorbed dose is
essentially the same
throughout the organ and is simply the total emitted energy divided by the mass of
the organ. The factors that determine the total emitted
energy (integral dose) were
discussed above. The absorbed dose is inversely related to
organ mass. If the same
amount of radiation energy is deposited in two
organs that differ in size, the ab¬
sorbed dose will be greater in the smaller organ.

Photon Radiation

Photon radiation, such as gamma, characteristic x-ray, and annihilation radia¬

tion, can penetrate a significant thickness of tissue and deposit energy a consider¬
able distance from the radioactive material. This causes the absorbed dose from
photon radiation to differ from that of electron radiation in two major respects: (1)
Organs or parts of the body that do not contain a radioactive material can be ex¬
posed to radiation energy, and (2) the range of dose values throughout the body is
generally wider.
In considering dosage factors associated with photon radiation, it is desirable to

identify two organs, as shown in Figure 40-12. The organ that contains the radio¬
active material is designated the source organ. The organ in which the dosage is

being considered is designated the target organ. With photon radiation, several
target organs must usually be considered. Obviously, the source organ is also a
target organ and is generally the organ that receives the greater dose.
In most cases, only a fraction of the emitted radiation energy is absorbed in a

specific target organ. The fraction absorbed depends on

• the distance between the source and target organs
• the composition of the tissue between the source and target organs
• the penetrating ability (individual photon energy) of the radiation.
It was shown above that in the case of electron radiation, where the source and
target organ are the same, the absorbed dose is inversely proportional to the mass
of the organ. In the case of photon radiation and a target organ that is different
from the source organ, the absorbed dose generally does not depend on the mass of
the target organ. If the point of interest in each of two organs is located the same
distance from the source organ, the points will receive the same absorbed dose

regardless of the size of the target organ. The size of the target organ affects the
total amount of energy absorbed by the organ, but has relatively little effect on the
concentration or absorbed dose. The reason that changing target organ size might
604 Physical Principles of Medical Imaging

Same Activity (lmCx)

and

Integral Dose (600gm rad)

/ \

Figure 40-11 Effect of Organ Size on Absorbed Dose

Source Organ Target Organ

I I
l I
From From
A=1.44A0(Te-Tu) MIRD Tables
Figure 40-12 Factors Used To Determine the Dose to a Target Organ

not significantly affect absorbed dose is that dose is the amount of absorbed en¬
ergy per unit mass of tissue. A larger organ might absorb more energy, but because
of its greater mass the energy per unit mass is essentially the same.
 I o
a a a a.
a s ON
"o
"T3

Other Tis ue 1.4 1.8 0.98 1.3 1.5 1.6 1.7 1.3 1.1 1.3 2.0 2.7 2.0 1.8 0.72 1.4 1.1 1.3 2.3 1.9

(Muscle)
Lungs 2.7 0.036

0.16
1.5 1.8 0.19 0.22 0.071

0.23
0.84 2.5
52.0 1.9 1.3 0.094

0.45
2.6 0.53 2.3 0. 079 0.92 0.082

0.062
2.0

Liver 4.5
1.1 1.9 1.6 2.5 3.9
46.0
2.5 1.6 1.1 4.2 0.49 0.92 0.15 0.39 2.2

11.0
0.28 1.4 3.6 2.9 2.9 0.72 3.9 0.85 3.8 1.3 1.1 6.6 0.53 8.6 0.088 0.048 0.94 2.2

190.0
0.36 6.9 1.6 1.8 9.4 4.2 0.86 0.25 0.079 5.1 1.7 0.74 0.48 0.8 1.8 0. 054 7.1 2.3

fT(AeCUDcrhaouncdmoptiu/mntC-9ilesvi.fet),y OSorguacnes
18.0
190.0

LUSIIKCCioodnntteeysss
0.91 2.2 1.1 3.8 3.2 2.8 2.6 0.26 3.7 1.5
12.0
2.3 0.41 1.4 0.27 0.016 5.4 2.2

17.0
130.0

TIntreasicnatl 1.0

2.7
2.6

0.27
1.3

0.9
3.7

130.0
78.0 24.0

2.7 3.5
7.3

1.2
3.2

3.5
1.8

2.0
0.22

1.7
4.3

1.6
1.5

1.4
11.0

0.5
2.1

18.0
0.41

0.44
1.5

10.0
0.31 0.015

0.051 0.087
0.6

0.77
2.4

1.9

Stomach 0.024 0.021

WS1Nnaey.odlt.,r,
Blad er 0.15
160.0
0.92 0.27 3.0 2.2 7.4 0.26 0.17 2.2 1.8 7.3 0.23 0.55 0.66 4.7

16.0
1.9

Contes
Adrenals 0.13 2.0 2.9 0.83 0.93 0.22
11.0
4.9 2.4 3.6 1.4 0.61 9.0 0.51 6.3 0.032 0.13 1.1 2.2

ASVbaosloureef,sd
310 .0

40-3
Table
Organs
Target Wal (Total) wal) wal)
Gl Gl Gl Gl
(Red) (Muscle) (Nongravid) Body PMfDramoIaRpmthDlet
Adrenals Blad er Bone (Stomach (SI) (ULI (LwLIal) Kidneys Liver Lungs Marow TOtishuere Ovaries Pancreas Skin Sple n Testes Thyroid Uterus Total Source:
606 Physical Principles of Medical Imaging

ESTIMATION OF DOSAGE VALUES

We have considered the factors that affect dose to

patient produced by an
a

internal radioactive source. Some of the factors relate to thephysical characteris¬

tics of the radioactive material, such as its half-life, initial activity, type of radia¬
tion, and radiation energy. Other factors relate to the anatomy and physiology of
the patient's body. These include the size and location of the organs and the rates
at which the body and specific organs concentrate and eliminate the radioactive

material. The knowledge of these factors is helpful in understanding the variation

in dose among different radionuclides and different patients. However, it is a
rather difficult procedure to attempt to determine dosage values by starting from
these basic factors.
Thecomputation of estimated dosage values is greatly simplified by combining
all of the physical, anatomical, and physiological factors into two composite fac¬
tors, which can be multiplied together to obtain a dose estimate. One of these
factors is cumulated activity, A. The other quantity is the absorbed dose per unit of
cumulated activity, S (rad per microcurie-hour or rad per curie-hour). Values for S
have been tabulated and published by the Medical Internal Radiation Dose
(MIRD) Committee of the Society of Nuclear Medicine. A typical tabulation for a
specific radionuclide is shown in Table 40-3. The MIRD tables contain the values
of S for different combinations of source and target organs. The tabulated values
of S are for one particular body size selected to represent a range of body sizes
encountered in actual practice.
After values of A and S are obtained for a particular radionuclide and
patient, an
estimation of the dose is obtained by multiplying the two factors:

Dose (rad) = A (pCi-hr) x S (rad/pCi-hr)

or

Dose (rad) = KT6 A (pCi-hr) x S (rad/Ci-hr)

when S is in the units of rad per curie-hour.

 Chapter 41
Personnel Exposure and
Protection

INTRODUCTION AND OVERVIEW

Personnel in the immediatevicinity of x-ray equipment or radioactive materials

can be
exposed to ionizing radiation. Therefore, certain actions must be taken to
minimize their exposure and maintain it within acceptable levels.
This chapter covers the general concepts of radiation protection that apply to

non-patient personnel in a medical imaging facility.

EFFECTIVE DOSE EQUIVALENT

There are circumstances in which the body is not exposed uniformly to

many
the same exposurevalue. The risk of cancer and genetic effects will be related to
the actual exposure to specific tissues and the sensitivity of the tissues to the unde¬
sirable effects.
The effective dose equivalent expresses the risk of nonuniform radiation in
terms of uniform whole body exposure that would produce the same risk.
The value for the effective dose equivalent is found by multiplying the dose

equivalent to specific tissue by established weighting factors. The weighting fac¬

tors express the relative sensitivity of the individual tissues. The sum of the dose

equivalent-weighting factor products is the effective dose equivalent.

EXPOSURE LIMITS

Since it is not practical to eliminate human exposure, certain exposure limits

have been established as part of the radiation protection guidelines. The exposure
limits established by the National Council on Radiation Protection (NCRP) are
generally adopted by other agencies involved in radiation protection. The estab-

607
608 Physical Principles of Medical Imaging

lished exposure limits do not represent levels that ensure absolute safety but rather
exposure levels that carry acceptable risk to the persons involved. The recommen¬
dations of the NCRP are in the form of effective dose equivalent limits. The limits
are used in designing radiation facilities and in monitoring the effectiveness of

safety practices.
The recommended limits vary with the occupational status of the individual and
the parts of the body, as shown in Figure 41-1 as reported in NCRP Report No. 91.

Dose Equivalent Limits

Whole Body Specific
or Tissues / Organs
Effective Dose N
Eves
Equivalent
^J5 rerry)
Other

Kjp rertT)

Occupational Exposure

Fetus Public

Figure 41-1 Dose Equivalent Limits

 Personnel Exposure and Protection 609

Occupational Exposure

One set of exposure limits applies to persons

receiving radiation exposure be¬
causeof their work. The effective dose equivalent limit is 5 rem per year. The dose
equivalent to some individual tissues can be higher than this value without ex¬
ceeding the effective dose equivalent limit.

Nonoccupational^ Exposed Persons

Persons who enter facility as patients, visitors, or persons who do not rou¬
a

tinely work in the facility might be exposed to radiation. The effective dose
equivalent limit for the nonoccupationally exposed person is 0.1 rem per year.

Fetus

The limit for a fetus is 0.5 rem for the total gestational period.

Area Exposure Limits

Areas adjacent to rooms containing radiation sources can receive significant

exposure from radiation that penetrates through the walls. Wall penetration is re¬
duced by adding a shielding or barrier material, such as lead, at the time of con¬
struction. The amount of lead added to the wall depends on the quantity of radia¬
tion produced within the room containing the equipment and the permissible
levels of exposure in the adjacent areas. The permissible exposure into an area

depends on two factors: (1) the limit of the personnel occupying the areas and
(2) the occupancy rate by specific individuals.
For purposes of evaluating shielding requirements, the occupancy rate of an
area is assigned an occupancy factor (T). The occupancy factor represents the

fraction of time the area is occupied by any one individual. Most work areas (of¬
fices, laboratories, etc.) have occupancy factor values of 1 because they are typi¬
cally occupied by the same persons on a full-time basis. Areas such as stairways,
toilets, etc., have relatively low occupancy factor values because the same persons
are not present in these areas for any extended period of time. These areas are

typically assigned minimum occupancy factor values of 1/16. Other areas, such as
hallways, have occupancy factor values between these two extremes.
The maximum permissible exposure into any area is equal to the limit for the

personnel occupying the area divided by the appropriate occupancy factor, T. Ar¬
eas with relatively low occupancy factors have greater area exposure limits than

the limits for the personnel in the area.

610 Physical Principles of Medical Imaging

EXPOSURE SOURCES

The amount of radiation directed toward the walls of an x-ray room and produc¬
ing exposure in the adjacent areas depends on several factors that must be evalu¬
ated to determine the amount of wall shielding required.

Workload

The workload, W, represents how much a specific x-ray machine is used during
atypical week. It is expressed in the units of milliampere-minutes and is the sum
of the MAS values for all exposures during 1 week divided by 60. For example, if
we have a room that produces 250 exposures per week with an average MAS of 20

mAs per exposure, the workload would be calculated as follows:

Workload = 250 exposures x 20 mAs/exposure/60 sec/min s 83 mA-min.

The total exposure produced each week is the product of 60 times the workload,
W, and the factor K, which represents the average exposure (roentgens) at a dis¬
tance of 1 m from the focal spot for each 1 mAs of tube charge. The actual expo¬

sure an x-ray tube depends on factors such as KVP, waveform, and

produced by
filtration, discussed in Chapter 7. Values of K corresponding to the maximum
as

x-ray machine KVP are used to calculate exposure. A K value of 20 mR/ mAs is a
typical value for a three-phase x-ray machine operating at 120 kVP, taken from
Figure 7-10 (Chapter 7). The weekly exposure produced at this K value is

Exposure = 60 (sec/min) x 83 (mA/min) x 20 (mR/mAs) = 100,000 mR/wk.

Utilization Factor

The direction of the x-ray beam must also be considered. For the purposes of
exposure analysis, beam direction is expressed in terms of a utilization fac¬
x-ray
tor, U, for each of the walls, ceiling, and floor of the room containing the x-ray
equipment. Each surface (wall) has a utilization factor value that represents the
fraction of time the x-ray beam is directed toward it. If an x-ray beam is fixed in
one direction, that particular wall will have a utilization factor value of 1.

The exposure to each wall also depends on the distance, d, between the x-ray
source and the wall. The exposure decreases inversely with the square of the dis¬

tance. These two factors are used in conjunction with the machine exposure to

determine the exposure to a specific wall.

We now carry our example one more step and determine the x-ray beam expo¬
sure to a wall located 3 m from the x-ray tube that has a utilization factor value of

0.5.

Exposure = 100,000 mR/wk x 0.5/32 = 5,555 mR/wk.

 Personnel Exposure and Protection 611

Scattered Radiation

We have considered the

possibility of a primary x-ray beam projecting expo¬
sure onto walls and into
adjacent areas. Calculations of the type illustrated here
generally produce a conservative overestimate of all exposure because the pri¬
mary x-ray beam is always attenuated by the patient's body and the image recep¬
tor.

In most facilities, the most significant source of area exposure is the scattered
radiation produced by the patient's body. The relationship used to calculate pri¬
mary beam exposure is modified in the following manner to produce an estimate
of exposure produced by scattered radiation.
It is generally assumed for this type of analysis that the scatter exposure at a
distance of 1 m from a patient's body is 0.001 of the primary beam exposure enter¬

ing the body; or, in other words, each roentgen of primary beam exposure pro¬
duces 1 mR of scattered radiation. Since scattered radiation goes in virtually all
directions, utilization factor values of 1 are assigned to all walls, ceilings, and
floors. The distance between the irradiated portion of the patient's body and the
wall is also used in the calculation.
If we assume that the wall of interest in our example is also 3 m from the
patient's body, the scattered radiation exposure to the wall is
Scatter Exposure = 100,000 (mR/wk) x 0.001 (Scatter Factor)/32 =11 mR/wk.

AREA SHIELDING

If the exposure to a wall exceeds the exposure limit for the adjacent area, a
barrier or shield is required. A specific barrier or shield is characterized by its
penetration value. The maximum permissible wall penetration is the ratio of the
area exposure limit to the calculated wall exposure. As an example, if the wall of

an area that has an exposure limit of 100 mR per week receives an exposure of

5,555 mR per week, the maximum barrier penetration will be:

Wall Penetration = 100 (mR/wk)/5,555(mR/wk) = 0.018.

Several materials are used to shield areas within an x-ray facility. Many build¬
ing materials provide significant shielding. Where the building material shielding
is inadequate, sheets of lead are added to the walls to reduce the total penetration
to an acceptable level.

PERSONNEL SHIELDING

Shielding is usually required for personnel located in the same area as a patient
undergoing an x-ray examination. Although the scattered exposure produced by a
612 Physical Principles of Medical Imaging

single procedure is relatively small, significant exposures can result from working
with patients on a regular basis. The greatest potential for personnel exposure usu¬
ally comes from fluoroscopic procedures. If we assume a side scatter value of
0.001 (1 mR/R), a 10-minute fluoroscopic procedure with a patient exposure rate
of 3 R/min will produce a scatter exposure of 30 mR at a distance of 1 m from the

patient. This is approximately one-third the limit for 1 week. At a distance of 0.5 m
from the patient, the exposure from this one procedure could easily exceed the
limit for 1 week.

Exposure to personnel can be reduced to acceptable levels by using lead aprons,

drapes, and other shielding devices.

EXPOSURE FROM RADIOACTIVE SOURCES

It is necessary to consider the exposure produced by a radiation

occasionally
source external to the body. This is primarily a problem with photon radiation.
Since electron radiation has a short penetrating range and is easily contained or
shielded, it generally does not present an exposure problem when the source is not
within the body. We therefore limit this discussion to exposure produced by pho¬
ton radiation.
Several factors affect the exposure produced by an external radioactive source,
as illustrated in Figure 41-2. At this point, we need to distinguish between expo¬
sure (milliroentgens) and exposure rate (milliroentgens per hour). The exposure

produced by a radioactive source is related to the cumulated activity (microcurie-

hours), whereas exposure rate is related to the activity, A (microcuries), at a par¬
ticular time.
The number of photons per transition and photon energy have characteristic
values for each radionuclide. When these factors are known, it is possible to deter¬
mine the exposure rate at a standard distance, such as 1 m from a radioactive
source. This exposure value is generally
designated the gamma constant (T). The
value of the gamma constant is the exposure rate (mR/hr) at a distance of 1 m from
a 1-mCi source. It also is the
exposure (mR) produced by a cumulated activity of 1
mCi-hr. The gamma constant can therefore be expressed in the units of milliroent¬
gens per millicurie-hour or milliroentgens per hour per millicurie.
The gamma constants for three selected nuclides are

Nuclide Gamma Constant

(mR/mCi-hr)
Technetium-99m 0.072
Iodine-131 0.22
Cobalt-57 0.093
Shield

tables
from

SRaodiurctve
fGEraxmoatemn-ling
DEHexutpmorsainre
FTahctoarst
41-2
Figure
614 Physical Principles of Medical Imaging

Values for other nuclides are tabulated in various nuclear medicine reference
books. The precise calculation of the gamma constant value for a specific nuclide
requires a knowledge of the attenuation coefficient of air at each photon energy.
However, over the range of photon energies normally encountered in nuclear
medicine, the approximate gamma constant can be calculated from

T (mR/mCi-hr) = 0.0005n x E(keV)

where n is the fraction of transitions that produce a specific energy photon (yield)
and E is the energy of the photons. If a radionuclide produces photons of more
than one energy, the gamma constant value for the nuclide will be the sum of the
values for each photon energy.
Since the gamma constant value represents the exposure (or exposure rate) for 1
unit of cumulated activity (or activity), it is necessary to multiply the gamma con¬
stant value by the actual activity value. This product is the exposure at a distance
of 1 m from the
source. The exposure at any other distance is determined by divid¬

ing the exposure at 1 m by the square of the distance (d2) because of the inverse-
square effect. If the radiation passes through a material that has significant absorp¬
tion characteristics, such as a shield, the exposure value must be multiplied by the

penetration value of the material (P).

The relationship of these factors can be summarized as follows:

Exposure Rate (mR/hr) = [A(mCi) T(mR/hr/mCi) P]/d2(m2)

Exposure (mR) = [A(mCi-hr) T(mR/mCi-hr) P]/d2(m2).

In manyinstances the exposure time (t) to an external source is relatively short
in comparison with the lifetime (half-life) of the radionuclide. If there is no signifi¬
cant radioactive decay during the exposure interval, then the cumulative activity

(A) will be the product of the activity (A) and the exposure time (t). In this case,
the expression for exposure is

Exposure (mR) = [A(mCi) x t(hr) x T(mR/mCi-hr) x P]/d2(m2).

 Chapter 42
Radiation Measurement

INTRODUCTION AND OVERVIEW

There aremany occasions when it is necessary to measure the radiation used in

diagnostic procedures. Several instruments are used for this purpose. The selec¬
tion of a specific measuring device depends on several factors including the rela¬
tive intensity of the radiation and the required measurement accuracy.
The most general radiation measurement activities and the devices used to mea¬
sure each are

Measurement Device

X-ray beamexposure Ionization chambers

Environment exposure Survey meters
Personnel exposure Film badges
Thermoluminescence dosimeters

Radioactivity Scintillation detectors

Activity calibrators

IONIZATION CHAMBERS

Exposure is defined in terms of the amount of ionization produced by the radia¬

tion. Therefore, the most direct way to measure exposure is to collect and measure
the ions produced by the radiation in air. This can be done by using an ionization
chamber. All chambers consist of a volume of air located between two electrical
conductors, or electrodes, mounted on insulating material. The electrodes collect
formed within the air volume. Ionization chambers are generally used in
the ions
two modes of operation: (1) to measure exposure rates and (2) to measure total

accumulated exposure over a period of time.

615
616 Physical Principles of Medical Imaging

Electrometer

Figure 42-1 Ionization Chamber System for Measuring Exposure Rate

Exposure Rate Measurements

The basic system for measuring exposure rate with an ionization chamber is
shown in Figure 42-1. In addition to the ionization chamber, a power supply and a
device that will measure small electrical currents are required. The device nor¬

mally used to measure the currents is the electrometer.

The three components are connected in a circuit, as shown. The power supply

applies a voltage to the chamber, which causes one electrode to be negative and
the other positive. If the air between the electrodes is not ionized, it is an insulator,
and no electrical current can flow between the electrodes and through the circuit.
However, when the air is exposed to x-radiation, it becomes ionized and electri¬

cally conductive. Ionization is a process that either adds or removes electrons from
an atom. This causes the atom to take on an electrical charge.

Figure 42-1 shows how conduction takes place when an electron is removed
from an atom by the radiation. The electron is attracted to the positive electrode,
where it is collected and pumped through the circuit by the power supply. The
arrows indicate the direction of electron flow. The positive ion is attracted to the

negative electrode. When it reaches the electrode, it picks up an electron and be¬
comes neutral. The electron that was absorbed from the negative electrode is re¬

placed by an electron from the circuit. Because electrons enter the ionization
chamber at the negative terminal and leave from the positive terminal, the ioniza¬
tion chamber becomes, in effect, a conductor. For a given ionization chamber, the
amount of conduction, or current, is proportional to the exposure rate. When the

system is calibrated, the electrometer indicates the exposure rate in units, such as
roentgens per minute or milliroentgens per hour.

Exposure Measurements

Ionization chambers can also be used to measure accumulated exposure. One

method is three-step process, as illustrated in Figure 42-2.
a

The first step is to "charge" the ionization chamber by connecting it to a power

supply. This is done before the chamber is exposed to the radiation. Since an ion-
 Radiation Measurement 617

Charge
°

Power Supply v
"T~| i

Exposure
V *
x-ray .
©
-

r^> >

Read
electrometer

Exposure
t
V
412| 1151
I

Figure 42-2 Ionization Chamber System for Measuring Accumulated Exposure

ization chamber consists of two conductors separated by an insulator (non-ionized

air), it forms electrical capacitor. The power supply pumps some of the elec¬
an
trons from the positive electrode to the negative. The quantity of electrons moved

depends on the size of the chamber and the voltage applied by the power supply.
The movement of electrons is what is generally referred to as charging the cham¬
ber. If the ionization chamber is disconnected from the power supply, the charge
will remain until a conductive path is formed between the two electrodes. Voltage
is present between the two electrodes even after the power supply is removed. For
a given ionization chamber, the voltage is proportional to the charge, or number,
of displaced electrons.
In the second step, the charged chamber is exposed to ionizing radiation, and
the air becomes conductive and discharges the chamber. This happens in the fol¬
lowing way. The positively charged ions are attracted to the negative electrode,
where they pick up some of the excess electrons. The electrons formed in the air
618 Physical Principles of Medical Imaging

by the ionization are attracted to and collected by the positive electrode. The num¬
ber of electrons that are returned to their normal locations is proportional to the

exposure to the air within the chamber.

The third step is to determine the exposure value by reading the voltage that
remains across the chamber after it is exposed to radiation. The voltage is usually
read with an electrometer. By using appropriate calibration factors, the drop in

chamber voltage produced by the ionization can be converted into appropriate

exposure units, such as roentgens or milliroentgens.
In practice, exposure measurements should be made over relatively short time
intervals to avoid error from chamber leakage. Leakage is the discharge of the
chamber from sources other than radiation, such as moisture on the insulating
materials.

Errors in Exposure Measurement

Several factors must be considered when using ionization chambers to make

exposure measurements. Most ionization chambers are not absolute devices and
must be calibrated against a standard. A "free air ionization chamber" is used as
the standard in most calibration laboratories. The device is a specially designed
instrument in which the sensitive air volume is not in direct contact with the elec¬
trodes but is surrounded by a buffer region of air. This prevents x-ray interactions
with the electrodes from influencing the amount of ionization within the sensitive
air volume. In the free air ionization chamber, the ions are collected from a pre¬
cisely determined volume of air. When the amount of ionization is measured with
a properly calibrated electrometer, an accurate exposure determination can be

made. Free air ionization chambers are not used for routine exposure measure¬
ments but as a standard for calibrating other types of ionization chambers.
The response of an ionization chamber in terms of the number of ions produced
and collected per unit of exposure can change with exposure conditions. Because
of this, it is often necessary to use various correction factors to get precise expo¬
sure measurements.

Photon Energy Dependence

In most ionization chambers the amount of ionization produced per exposure

unit varies with photon energy. This is usually related to the interaction of the
x-ray beam with the walls of the chamber. A significant portion of the x-ray pho¬
tons that contribute to the ionization are absorbed in the chamber walls. Some of

the energetic electrons created by photoelectric and Compton interactions within

the walls enter the air volume and produce ionization. For a given energy, there is
a specific wall thickness that allows maximum ionization. This is known as the
 Radiation Measurement 619

equilibrium thickness and is approximately proportional to the photon energy. At

low photon
energies, a thick chamber wall attenuates the x-ray beam and reduces
the chamber response. At
high photon energies, a thin chamber wall does not pro¬
vide adequate material to interact with the
x-ray beam and produce maximum
ionization.
An ionization chamber should be selected for the
particular type of radiation to
be measured. For example, most chambers designed for high-energy therapy ra¬
diation are generally not well suited to the measurement of
diagnostic radiation.
Even when a chamber is designed for a
specific photon energy range or beam
quality, it is often necessary to use correction factors for the different beam quality
(KV) values.

Saturation

There are conditions in which all ions formed

by the radiation are not collected
and measured. The electrons and positive ions that result from the ionization pro¬
cess are known as ion
pairs. Unless they are quickly separated, there is a good
chance they will recombine because of their opposite electrical charges. The ion

pairs that recombine do not contribute to the exposure measurement. Therefore, in

order to get an accurate indication of the amount of ionization produced, it is nec¬

essary to separate the ion pairs before recombination can occur. This is achieved
by applying a sufficient voltage between the electrodes. As the voltage across the
chamber is increased, the force on the ions is also increased, and they are separated
more quickly. When the voltage applied to the chamber is enough to prevent any

recombination, the chamber is said to be saturated. The voltage required to pro¬

duce saturation depends on the size and shape of the chamber and the rate at which
ionization is being produced. Large chambers require a higher voltage to produce
saturation than small chambers. For a given chamber, the voltage required to pro¬
duce saturation depends on the exposure rate. When some chambers are used to
make measurements at high exposure rates, saturation is not achieved, and it is

necessary to apply a saturation correction factor to obtain the correct exposure

value.

SURVEY METERS

Laboratories that use radioactive materials are usually required to have an in¬
strument that can be used to measure exposure to personnel and to locate and
measure the relative activity of sources, such spilled radionuclide. From time
as a
to time it is also necessary to measure the environmental exposure produced by
scattered radiation during an x-ray procedure. An instrument that can be used for
these purposes is generally referred to as a survey meter. Survey meters can be
620 Physical Principles of Medical Imaging

constructed using several radiation detectors. The most common detectors used
for this purpose are Geiger-Mueller (GM) tubes and ionization chambers. Scintil¬
lation detectors are not widely used for this purpose because they are generally

larger, more complex, and more expensive than the other types of detectors.

Geiger-Mueller Detector

The major components of a GM survey meter are shown in Figure 42-3. The
detector (GM or Geiger tube) is a cylindrical tube that contains a specially formu¬
lated gas mixture and two electrodes. One electrode is a small wire running along
the axis of the cylinder. The other electrode is the wall of the cylinder, which is

electrically conductive. The tube is connected to a power supply that applies a

relatively high voltage (500 to 1,000 V) between the two electrodes. The other two
components are a count-rate meter and a device, such as a small speaker or ear¬
phones, that produces an audible signal.
When a radiation photon or electron enters the tube and interacts, it produces
ionization within the gas. Generally, each ionization produces an ion pair consist¬
ing of an electron and an atom with a positive charge. Because the electrons and
ions have electrical charges, they are attracted to the electrodes that have the oppo¬
site electrical polarity. For example, the negative electrons produced in the initial

Count-Rate Meter
CPM

G-M Tube +
Source High-Voltage
Power Supply

J_L Speaker
m ""click"
"click"

Figure 42-3 Geiger-Mueller (GM) Survey Meter

 Radiation Measurement 621

ionization process are pulled toward the

positive electrode located at the center of
the tube. Because of the
relatively high voltage applied between the electrodes, the
electrons are accelerated as
they move along. After moving a short distance, the
electrons gain sufficient kinetic energy so that they, in turn, collide with and ionize
other gas atoms and molecules. This process
produces a second generation of elec¬
trons that is larger in number than the first
generation produced by the radiation.
The second-generation electrons are also accelerated until
they can produce addi¬
tional ionizations and an even larger third generation of electrons. This electron

multiplying process is repeated until the ionization spreads throughout the tube.
Because of this avalanche effect, the number of electrons that eventually reach the
central electrode is many times larger than the number of electrons
produced by
the radiation photon or particle. When the electrons reach the electrode, they are
collected and conducted out of the tube in the form of an electrical pulse. An

important characteristic of a GM tube is that the pulse is relatively large and re¬
quires very little, if any, additional amplification. The avalanche effect is a form of
amplification that occurs within the tube.
The number of pulses produced by a GM tube is proportional to the number of

photons or radiation electrons interacting with the detector. The efficiency of a

GM detector, compared with a scintillation detector, for gamma photons is rela¬

tively low. This is because many photons can penetrate the tube without interact¬
ing. Recall that radiation must interact with and be absorbed in a detector before a
signal can be created. Even so, a GM survey meter can detect low levels of radia¬
tion because it can respond to individual photons.
The basic problem in measuring beta radiation is getting the electrons into the
tube. Most beta electrons cannot penetrate the glass walls of the tube. This prob¬
lem is overcome by constructing tubes with a thin window in the end that can be

penetrated by radiation particles, such as beta electrons. A GM tube cannot gener¬

ally distinguish between a photon and a beta electron.
The pulses from the GM tube can be counted in two ways. Many instruments
are equipped with a speaker or earphone in which each pulse is heard as a sharp

"click." This type of output is useful when searching for a source, such as spilled
radioactive material. When listening to the pulses, it is relatively easy to detect
small changes in the radiation level.
A more precise indication of radiation level can be obtained by electronically

counting the pulses and displaying the count rate on a meter. On most survey
meters, the count-rate meter has two scales. One scale indicates the count rate in
counts per minute (cpm), and the other scale indicates exposure rate, typically in

the units of milliroentgens per hour (mR/hr). GM survey meters usually do not

produce precise measurements of exposure rate. This is because the response of

GM tubes is often photon-energy dependent. In other words, an exposure of 1 mR
of 100-keV photons might produce a different number of counts than a 1-mR expo-
622 Physical Principles of Medical Imaging

sure of 300-keVphotons. Survey meters are usually calibrated at one specific pho¬
ton energy. If the instrument is to be used to measure exposure rates, it is neces¬
sary to have some knowledge of its energy dependence.
The major advantage of a GM survey meter is that it is relatively simple and can
detect low levels of radiation.

Ionization Chambers

Another type of survey meter uses an ionization chamber detector. The cham¬
bers designed for survey meters generally use the cylinder wall as one electrode
and a wire along the cylinder axis for the other. The ionization chamber differs
from the GM tube in several respects. It is generally much larger. Rather than a

special gas mixture, the ionization chamber contains air at atmospheric pressure.
The survey meter contains a power supply that applies a voltage between the two
chamber electrodes. However, the voltage used to operate an ionization chamber
is much less than that required to operate a GM tube.
When radiation enters the ionization chamber, it interacts with the air and pro¬
duces ionization. The ions and electrons are attracted to the electrodes. Because a
lower voltage is used, the electrons in the ionization chamber are not accelerated
enough to produce additional ionization, as in the GM tube. The only electrons
and ions collected by the electrodes are the ones produced directly by the radia¬
tion. Because no electron multiplication (amplification) occurs in the ionization
chamber, the output signal is relatively small. The signal is in the form of a very

\ Ionization
"V. Source

chamber

Figure 42-4 Ionization Chamber Survey Meter

 Radiation Measurement 623

weak current that is

proportional to the radiation exposure rate. The current is
amplified, and its value displayed on a meter calibrated to indicate exposure rate
(mR/hr).
In comparing an ionization chamber
survey meter to a GM-tube type, the ion¬
ization chamber is generally less sensitive and does not detect low radiation levels.
It is, however, a more precise instrument for
measuring exposure levels.
A common configuration for this type of
survey meter is one in which the cham¬
ber, electronics, and meter are mounted on a pistol-grip handle, as shown in Figure
42-4. This type of instrument is often referred to as a
"cutie-pie."

Film Badges
Film can be used to exposure. The most common application of film is
measure

to measure personnel exposure within the clinical facility. This is normally done
by placing a small piece of film in a badge that is then worn on the body. Film
badges can be used to monitor personnel exposure over extended periods of time,
such as 1 month or longer. Film badges generally cannot measure exposure with
the same accuracy as most other devices.

Thermoluminescence Dosimetry
Thermoluminescence is a process in which materials emit light when they are
heated. Certain thermoluminescent materials can be used as dosimeters because
the amount of light emitted is proportional to the amount of radiation absorbed by
the material before heating. Two materials used in thermoluminescence dosimetry
(TLD) are lithium fluoride and calcium fluoride. These materials consist of small
crystals that can be used in a powdered form or molded into various shapes.
TLD is a two-step procedure, as illustrated in Figure 42-5. The first step is to

expose the TLD material to the radiation. A portion of the absorbed radiation en¬
ergy is used to raise electrons to higher energy levels. A characteristic of TLD
material is that some of the electrons are trapped in the higher energy locations.
The number of electrons that remain in the elevated energy positions is propor¬
tional to the amount of radiation energy absorbed, or the absorbed dose. The sec¬
ond step is to place the irradiated TLD material in a special reader unit. This unit
heats the TLD material and measures the amount of light emitted during the heat¬

ing process. Heating frees the trapped electrons and allows them to drop to their
normal low energy positions. The energy difference between the two electron lo¬
cations is given off in the form of light. By calibrating the system, the light output
is converted into absorbed dose values.
TLD dosimeters have several advantages over ionization chambers. A TLD can
measure a much greater range of dose (or exposure) values than a single ionization
624 Physical Principles of Medical Imaging

> Dose
1312141
Light Detector

X-ray

444

r 11
Heat

Figure 42-5 The Two Steps in Radiation Measurement Using a Thermoluminescence

Dosimeter

chamber. They are also dose-rate independent and do not have the saturation prob¬
lems to ionization chambers. Another useful property is the ability of a
common

TLD to collect radiation over a much longer period of time than is possible with
ionization chambers. This makes them very useful for monitoring personnel and
area exposures.
A TLD actually measures absorbed dose in the thermoluminescent material.
Since most materials used as thermoluminescent dosimeters have approximately
the same effective atomic number as soft tissue and air, the TLD reading will be
proportional to both tissue absorbed dose and exposure in air. Some TLD materi¬
als have a response that changes more with photon energy than others. Therefore,
it is desirable to calibrate a TLD system for the type of radiation (photon energy)
to be measured.

ACTIVITY MEASUREMENT

In nuclear medicine procedures, diagnostic information is obtained by either

measuring the relative activity in a specific organ or sample, or by forming an
image that shows the spatial distribution of the radioactive material. In many situ¬
ations, it is also desirable to measure the quantity of radioactive material (activity)
before it is administered to a patient.
Most systems used for these purposes use a scintillation detector. The major

components of such a system are shown in Figure 42-6. Systems used to measure
 Radiation Measurement 625

Figure 42-6 Basic Components of a Nuclear Medicine Counting or Imaging System

relative activity do so by counting photons radiation particles

or over a period of
time, and therefore generally referred to as scintillation counters.
are
All systems contain a detector that absorbs the
photons and produces electrical
pulses. The size of the pulses is generally proportional to the energy of the pho¬
tons. The pulses then pass through a linear amplifier, which increases the size of
each pulse. From the amplifier the pulses enter a pulse height analyzer (PHA). If
the pulse size (height) is within a certain range (set
by the operator), it will pass
through the PHA. If the pulse size is not within the selected range, it will be
blocked by the PHA. Since pulse size is proportional to photon
energy, the PHA
passes pulses that correspond to a specific range of photon energies. The main
purpose of the PHA is to eliminate pulses created by scattered radiation, back¬
ground radiation, or other radioactive materials in or near the patient. In order to
measure relative activity, the
pulses go to a counter circuit.

The Scintillation Detector

A scintillation, or scintilla, is a flash of

light. In the scintillation detector, the
radiation, typically a gamma photon, is absorbed by a crystal that converts some of
the absorbed energy into a flash of light, or a scintillation. The light from the

crystal enters a PM tube in which it is converted into an electrical pulse. The rela¬
tionship of the crystal to the PM tube is shown in Figure 42-7.

Crystals
The crystals in scintillation detectors perform two major functions: (1) to ab¬
sorb the gamma photons and (2) to convert the energy into light. A number of
materials will do this, but the most commonly used is sodium iodide (Nal). The
626 Physical Principles of Medical Imaging

Electron
Photomultiplier Tube Pulse

Figure 42-7 Typical Scintillation Detector Consisting of a Crystal and a Photomultiplier

Tube

presence of the iodine in the crystal enhances photon absorption. When the crystal
is impregnated with an appropriate activator, such as thallium, Nal(Tl), it becomes
an efficient scintillator.
Animportant characteristic of a detector crystal is its ability to capture the pho¬
tons emitted by the radioactive material and produce a pulse. This is generally
referred to as the efficiency of the detector. To a large extent, the efficiency is
related to the size of the crystal. Photons from a radioactive source are emitted

uniformly in all directions. Therefore, if the detector crystal is located at some

distance from the source, only a small fraction of the emitted photons will enter
the crystal. More photons can be captured by either increasing the size (surface
area) of the crystal or by reducing the distance between the crystal and the radioac¬
tive source.

All photons intercepted by the crystal are not necessarily absorbed. A photon
can penetrate the crystal without interacting and producing a scintillation. For a
given crystal material, the chance of a photon penetrating the crystal is determined
by photon energy and crystal thickness. The penetration through a specific crystal
increases with photon energy, except when a K edge is encountered. The point to
be made is simply this: The crystal thickness determines the absorption efficiency
for the various photon energies. In general, thick crystals must be used with high

energy photons to obtain good absorption efficiencies.

The size of the crystal does not affect the amount of light produced by a given
photon energy. Its only significant effect is on the number of photons absorbed.
 Radiation Measurement 627

Photomultiplier Tubes
The scintillations produced in the crystal orliquid scintillators by the absorbed
radiation is detected and converted into an electrical
pulse by the PM tube. The
basic construction of a PM tube is illustrated in
Figure 42-7. The electrical compo¬
nents are contained in a
glass cylinder approximately 15 cm long with a diameter
between 2.5 cm and 5 cm. One end of the tube is a flat
transparent window through
which the light from the scintillator enters. Inside the window is a thin
layer of
material that forms a photocathode. When
light photons strike the front surface of
the photocathode, they undergo a photoelectric interaction, and electrons are emit¬
ted from the rear surface. The number of electrons emitted is
proportional to the
number of light photons, which, in turn, is
proportional to the brightness of the
scintillation. The number of electrons produced by a single scintillation is rela¬
tively small and would be a very weak electrical pulse. In order to have a pulse that
can be counted or used to form an
image, it is necessary to increase the size, or
strength, of the pulse. This is the second function performed by the PM tube.
The PM tube contains a series of cup-shaped metal electrodes,
commonly re¬
ferred to as dynodes, positioned as shown in Figure 42-7. An electrical voltage
from an external power supply is applied to the dynodes through wires that enter
the rear end of the tube. The voltage is divided among the dynodes and applied so
that each succeeding dynode is more positive than the one before it. The first dyn-
ode is positive with respect to the photocathode. The electrons emitted from the

photocathode are therefore attracted to the first dynode. As they travel from the
photocathode to the dynode, they are accelerated and gain kinetic energy. When
one of the energetic electrons strikes the dynode, it has sufficient energy to knock

out several electrons. This process increases the number of electrons in the group

associated with a single scintillation. The group of electrons from the first dynode
is accelerated toward the second dynode where they strike the surface and emit
additional electrons. This process is repeated throughout the series of dynodes.
The electron group reaching the last electrode is collected and conducted out of
the tube in the form of an electrical pulse. The size of the pulse is determined by
the number of electrons. The number of electrons reaching the last electrode is

approximately 1 million times the number of electrons emitted from the cathode.
The output from the PM tube is an electrical pulse whose size is proportional to
the brightness of the scintillation, which should be proportional to the energy of
the radiation photon or particle. For a given scintillation brightness (photon en¬
ergy), the size of the pulse depends on the electron multiplication, or gain, that
occurs within the PM tube. This is influenced, to some extent, by the amount of

voltage applied between the tube dynodes. As this voltage is increased, the elec¬
trons gain more energy in moving from one dynode to another. This causes each
electron to produce a greater number of electrons when it strikes the next dynode.
628 Physical Principles of Medical Imaging

In some detector systems, the voltage applied to the PM tube is adjustable and can
be used as a gain control to change the pulse size (and to calibrate a scintillation
detector with respect to radiation energy).

Amplifier
Even though the pulse from the PM tube is increased in size approximately 1
million times, it is still too small to be processed by the counting or imaging com¬
ponents. The sizes of the pulse can be increased by passing it through an electronic
amplifier, important that all pulses be amplified by
as shown in Figure 42-8. It is
the same between pulse size and photon energy is
factor so that a proportionality
maintained. An amplifier with this characteristic is generally known as a linear

amplifier. In many systems, the gain, or amount of amplification, is adjustable.

This can also be used to calibrate the system with respect to photon energy.

Scintillation Probes

In a number of procedures it is necessary to measure the radiation coming from

specific organs or areas of the body. While this can be done with a gamma camera,
it may be more practical in some situations to perform the measurements with a
collimated scintillation detector or probe. This type of detector consists of a single
scintillation crystal mounted in a shield or collimator. The shield is usually con¬
structed of lead and performs two basic functions: It shields the detector crystal
from environmental radiation and produces a known field of view (FOV) for the

Photon Energy Pulse Height

Amplifier

- -

High Voltage

Figure 42-8 Two Factors, Amplifier Gain and PM Tube High Voltage, Used To Adjust the
Size of the Pulse from a Scintillation Detector
 Radiation Measurement 629

crystal. The efficiency of the detector is determined by the size of the crystal and
its distance from the radiation source.

Well Counters

When the radiation source is small and be

placed in a vial, maximum count¬
can

ing efficiency is obtained by inserting the source into a hole or well in the crystal,
as shown in Figure 42-9. This configuration virtually surrounds the source with

Radioactive Sample

iCryisiftil

PM Tube

Shield

Figure 42-9 Scintillation Well Counter Used To Measure the Relative Activity of Radio¬
active Samples
630 Physical Principles of Medical Imaging

the crystal and gives a veryhigh geometric efficiency. Maximum efficiency is

obtained with small confined to the bottom portion of the well. If the
sources

source material fills the well, more of the radiation will escape out of the top, and

the efficiency will be reduced.

Liquid Scintillator Counters

Solid scintillation materials are quite adequate for radiation that can penetrate
into the scintillator, such as photon radiation. Beta radiation has a very short range
and is normally absorbed within 1 mm of the point of origination. Liquid
scintillatorsovercome this problem by allowing the radioactive material to be

mixed into the scintillator itself, as shown in Figure 42-10. The scintillation liquid
usually consists of three components: (1) a solvent, (2) a primary scintillator, and
(3) a secondary scintillator. The scintillators are chemical compounds with
fluorescent properties. The function of the primary scintillator is to convert some
of the beta particle energy into light. A portion of the light from many primary
scintillators is in the ultraviolet region of the spectrum and is not readily detectable
by the PM tubes. The purpose of the secondary scintillator is to absorb the ultra¬
violet light and emit light of a color (wavelength) more readily detectable by the
PM tubes.
The radioactive material must beproperly prepared so that it does not signifi¬
cantly decrease the transparency of the liquid. Also, the presence of certain chemi-

Radioactive Sample

Figure 42-10 Liquid Scintillation Counter Used To Measure the Activity of Beta-Emitting
Radionuclides
 Radiation Measurement 631

cal substances reduces the

energy transfer to the primary scintillator and thereby
reduces light output. The reduction in
light output produced by the presence of
unwanted chemical substances is referred to as quenching.

Activity Calibrators
It isusually desirable to measure the activity of a radionuclide before it is ad¬
ministered to a patient. In most facilities, this is done with an instrument known as

an activity or dose calibrator. The basic

components of a typical calibrator are
shown in Figure 42-11.
The detector used in most calibrators is an ionization chamber. The ionization
chamber is generally filled with an inert gas, such as argon, to a pressure of several
atmospheres. The radioactive material to be calibrated is placed into a well sur¬
rounded by the gas. Some of the photons from the radioactive material interact
with the gas and produce ionization. Within limits, the rate at which ions are pro¬
duced is proportional to the activity of the sample being calibrated. The activity of
the sample can therefore be determined by measuring the amount of ionization

Sample

Gas- filled
ionization chamber

Activity
0 0 5 4 0

Nuclide
• _

High-Voltage
Power Supply

Figure 42-11 Basic Components of an Activity Calibrator

632 Physical Principles of Medical Imaging

produced in a known period of time. Two additional components are required to

collect and measure the ionization. One is a high-voltage power supply and the
other is an electrometer. These are connected to the ionization chamber, as shown
in Figure 42-11. In addition to the gas, the ionization chamber has two electrodes,
or conductors. When the power supply is energized, it causes one of the electrodes
to assume a positive and the other a negative voltage. The ions formed in the gas

are attracted to the electrode with a polarity opposite to the charge on the ion.

Positive ions attracted to the negative electrode, and negative ions, or freed elec¬
trons, are attracted to the positive electrode. The ionization, in effect, makes the
chamber electrically conductive. While ionization is taking place, electrons are
collected by the positive electrode, and a current flows through the circuit as indi¬
cated. The current is proportional to the rate at which ions are being produced,
which, in turn, is related to the activity. The current is measured by the electrom¬
eter. The system is calibrated so that the current value is displayed in units of

activity, millicuries or microcuries.

The relationship between ionization rate and sample activity is not the same for
all radionuclides for several reasons. All nuclides do not emit exactly one photon

per transition. (This was discussed in Chapter 5.) Some nuclei go through a transi¬
tion process that creates only one photon, whereas others undergo transitions that
create two or more photons. The various nuclides also produce photons with dif¬

ferent energies. Both the percentage of photons that will interact with a gas and the
number of ions produced by each photon depend on the photon energy. Because of
this, it is necessary to use a different calibration factor to relate activity to ioniza¬
tion for each radionuclide. Most systems have a switch that can be used to set the
correct calibration factor for a variety of radionuclides.
 Index

A ultrasound, 373
time gain compensation, 373

Amplitude, ultrasound, 377-378

A-mode display, ultrasound, 390, 391 Analog to digital conversion, digital
Absorbed dose, 46-48, 602-604 image, 326-329
concept, 46 Angiography, flowing blood, 513-518
dose flow direction, 514-515
equivalent, relationship, 49, 50
effect of organ size, 603, 604 inflow effects, 515
electron radiation, 602-603 maximum intensity projection (MIP)
exposure,relationship, 46, 47, 49, 50 technique, 518
photon radiation, 603-604 phase contrast, 514-515
units, 46 spatial characteristics, 516-518
three-dimension (3D) volume acquisi¬
Absorption
efficiency and receptor sensitivity, 309 tion, 517-518
two-dimension (2D) slice acquisition,
ultrasound, 381-382, 383
516-517
Activator, photographic process, 215
Activity velocity, 514
elapsed time, 83, 84 Annihilation, positron, 148
number of nuclei, 83, 84 Anode

units, 83 damaged by overheating, 132

x-ray production efficiency, 108
Activity calibrator, 631-632
Air, contrast, 174 x-ray tube, 97-99

Air gap, contrast, 185 design, 99

focal spot, 99
Aliasing artifact, magnetic resonance
Anode angle, focal spot, 273-274
imaging, 525-526
Anode body, heat capacity, 138-139
Alpha emission, 80
Alternating current, 34-35 cooling curve, 138-139
heating curve, 138-139
frequency, 35
waveform, 35 Aperture, fluoroscopy, 297-298
Area contrast, 178-180
Aluminum, penetration, 166—167
Artifact, 7-8, 192-194
Amplifier
scintillation detector, 628 computed tomography, 369

633
634 Physical Principles of Medical Imaging

film, 226 Beta radiation

grid cutoff, 193-194 diagram, 74

grid lines, 193 spectrum, 74
intensifying screen, 205 Beta transition, 72, 74

magnetic resonance imaging, 519-528 Binary number, 320-322

classification, 520 Blood. See Flowing blood
ultrasound, 403^-06 Blooming, focal spot, 272-273
Atom Blur, 253-255
model, 52, 53 computed tomography, 363-367, 463
structure, 53, 54 contrast, 255-257, 258
Atomic number, 67-68 contrast transfer function, 261, 262

photoelectric interaction, 154 detail visibility, 6-7, 255-257

photon energy, 152 by imaging method, 7
Attenuation, photon interaction, 149-152 distribution patterns, 254—255
Attenuation coefficient fluoroscopy, 288-289, 293-296, 463
half value layer, aluminum, 162 focal spot size, 271
photon range, 160 gamma camera, 463, 554—561
value, 382 intrinsic, 557-559
Automatic exposure control, 125 intensifier tube, 288-289
radiographic density, 250-251 magnetic resonance imaging, 463
radiation-measuring device, 250 magnification, 269
Autotransformer, 114—115 noise, 315
Average photon range, 160 object visibility, 491, 492
Averaging radiograph, sources, 268
magnetic resonance imaging, 498 resolution, 258-263
noise, 498 shapes, 253-254
Avogadro's number, 67 size, 253, 254
Axial blur, ultrasound, 399-400, 401 ultrasound, 463
unsharpness, 257-258
Blurred-mask subtraction technique, 332,
B
334

Bremsstrahlung, x-ray production, 102—

B-mode image, ultrasound, 390-391 104
Back projection, computed tomography, kilovolt
peak, 104
357, 358-359 production process, 102
Background brightness, 10, 11-12 spectrum, 102-104
Background radiation, gamma camera, Bucky factor value, grid penetration, 188,
545-546 189
Background structure, 13-14
Barium, contrast, 174, 176-178 C
Baseplus fog density, film, 223
Beam limiting, patient exposure, 595 Calcium, contrast, 174, 176
Beam width, ultrasound, 385-388 Camera, fluoroscopy, 300-301
Becquerel, defined, 83 film exposure, 301
 Index 635

framing, 300-301 Composite blur, 278-281

image size, 300-301 computed tomography, 366-367
Capacitor, 120-123 Compton interaction, 143-144
concept, 121 photoelectric interaction, rate compari¬
energy storage, 121-122 son, 156,157
filtration, 122-123 rates, 154
principles, 121 scattered radiation energy, 155-156
Capacitor-storage x-ray machine, 121, Compton scatter, gamma camera, 543-
122 545
Carbon, radionuclide, 80 Computed radiography, digital image
Cardiac motion, ultrasound, 407^113
processing, 338-339
Cascading, modulation transfer function, Computed tomography
265 artifact, 369
Cathode back projection, 357, 358-359
MA control, 123-124 blur, 363-367, 463
x-ray tube, 99-100 camera, 352
Characteristic radiation, x-ray production, composite blur, 366-367
104-107 computer, 350-352
kilovoltpeak, 106-107 control, 352
molybdenum spectrum, 105, 106 processing, 352
production process, 104-105 storage and retrieval, 352
tungsten spectrum, 105, 106 contrast

Chemical shift, 439—440 scatter, 363

Chemical-shift artifact, magnetic sensitivity, 361-363
resonance imaging, 490, 527-528 windowing, 362, 363
bandwidth, 528 contrast sensitivity, 4

field strength, 527-528 detail visibility, 363-367

Chemical-shift imaging, 441 detector aperture, 364
Chromium, radionuclide, 80 detectors, 347-350
Cobalt, radionuclide, 80 configurations, 349-350
Coherent scatter, 144 construction, 348
Coincidence time window, positron efficiency factors, 348, 349
emission tomography, 568 function, 347-348
Collimation, scattered radiation, 184 sensitivity profile, 348
Collimator, gamma camera, 532-537 display unit, 352
converging collimator, 535-536 focal spot, 364-365

diverging collimator, 534—535 gantry, 345-346

function, 532 image formation, 343-359
parallel-hole collimator, 534, 535 image quality, 361-369
pin-hole collimator, 536-537 image reconstruction, 355-359
Collimator blur, gamma camera, 559- computed tomography numbers,
356-357
561, 562
Collimator lens, fluoroscopy, 299 image format, 355-356
Color, digital image, 338 integral dose, 48
636 Physical Principles of Medical Imaging

matrix size, 323 digital image

noise, 367-369 calculations, 330, 331
factors, 368-369 lookup tables, 330, 332
filtration, 369 modification, 330
pixel size, 368 fat, 174
radiation exposure, 368-369 film, 224
slice thickness, 368 average gradient, 234—235
sources, 368 characteristics, 227-242
visibility effect, 367-368 contrast curve, 232, 233

window setting, 369 contrast transfer, 227-235

patient exposure, 590 exposure error, 235
pixel size, 365 film latitude, 235-236

power supply, 347 gamma, 232-233

ray (sample) interval, 365 processing effects, 239-241
ray (sample) width, 363-365 subject contrast range, 235-236
reconstruction, 343, 344 fluid, 176
reconstruction filter, 365 gamma camera, 551-554
resolution, 363-367, 463 intensifier tube, 287-288
scanning, 353-355 iodine, 174, 176-178
measurements, 355 magnetic resonance imaging,
rays,353, 354 sensitivity, 444
samples, 355 muscle, 174
views, 353-355 noise, 314
scanning phase, 343, 344 photon energy, 175-178
voxel, 365 sensitivity, 4—6
x-ray tube, 345-346 computed tomography, 4
beam hardening, 346 radiography, 4
collimation, 346 soft tissue, 176

compensation, 346-347 ultrasound, sensitivity, 402-403

filtration, 346-347 value, 4
Condenser. See Capacitor video system, 292
Continuous wave, Doppler imaging, 411 water, 174
Contrast, 3-6 x-rayimage, 171-175
air, 174 contrast-producing materials
air gap, 185 physical characteristics, 174
area, 178-180 development stages, 171, 173
barium, 174, 176-178 factors, 171, 172
blur, 255-257, 258 image contrast, 174—175
calcium, 174, 176 object contrast, 172, 174
computed tomography subject contrast, 174
scatter, 363 types, 171-175
sensitivity, 4, 361-363 Contrast agent

windowing, 362, 363 magnetic resonance imaging, 454-455

contrast transfer function, 261, 262 physical characteristics, 174
 Index 637

Contrast index, film, 224

Digital image, 317-322
Contrast reduction, scattered radiation,
analog to digital conversion, 326-329
181-184
analysis
Contrast transfer, 227-235
profiles, 338
Contrast transfer function
regions of interest, 338
blur, 261, 262 color, 338
contrast, 261, 262 contrast
focal spot blur, 262 calculations, 330, 331
motion blur, 262 lookup tables, 330, 332
receptor blur, 262 modification, 330
Converging collimator, 535-536 conversion, 322-329
Conversion efficiency, intensifying detail enhancement, 330-332
screen, 308, 309 disk, 337
Counting error, 577-585 display, 337-338
combined errors, 584-585 erasable reusable memory, 336
error ranges, 577-584 field of view, 319
Crossover, 204—205 frame mode, 324—325

Crystal grayscale, 345

gamma camera, 537 image detail, 318-319
scintillation detector, 625-626 list mode, 326
Curie, defined, 83 matrix size, 318
Current, 31 noise, 333-334
Cyclotron, positron emission tomography, pixel value, 320-322
569-572 production, 322-329
radionuclide image acquisition, 323-
326
D random access memory, 336, 337
read only memory, 336
Decay constant, 85 reconstruction, 323
Decay scheme, 69-70, 71 storage and retrieval, 334—337
Decimal number, 320-322 speed, 337
Densitometer, 211 storage capacity, 319
Detail, radiography, 267-281 storage capacity requirements, 336-337
Detail visibility tape, 337
blur, 6-7, 255-257 windowing, 330, 333
by imaging method, 7 write once read many, 336

computed tomography, 363-367 writing and reading, 335-336

gamma camera, 554—561 Digital image processing
Detector aperture, computed tomography, computed radiography, 338-339
364 digital fluoroscopy, 341
Development, photographic process, 214- digital subtraction angiography, 341—
215 342

Digital fluoroscopy, digital image display, 341

stimulable phosphor receptor, 339
processing, 341
638 Physical Principles of Medical Imaging

Digital imaging system, image process¬ Electrical circuit, 30

ing, 329-342 Electrical

quantities, 31-34
image integration, 316 Electromagnetic radiation, 19, 20
Digital scale conversion, 329 Electromagnetic spectrum, 24, 25
Digital subtraction angiography, digital Electron, 64—68
image processing, 341-342 charge, 31-32
Direct current, 34 concentration, 66-68
Disk, digital image, 337 electrical charge, 26
Display, ultrasound, 373 energy, 26-31
time gain compensation, 373 energy exchange, 28-29
Distortion, 8 energy level, 64—65, 66
Doppler effect, 407^-11 energy transfer, 29-31
Doppler imaging initial energies, 145, 146

angle, 409^-11 kinetic energy, 27-28

audible sound, 412 mass, 26
color Doppler display, 413 number, 64
continuous wave, 411 potential energy, 28, 32-33
direction, 408^109 quantity, 31-32
information display, 411—413 rest mass energy, 27

modes, 411 Electron capture, 76-77

single velocity display, 413 diagram, 76

time display, 412^413 Electron energy
ultrasound, 407^113 linear energy transfer, 146-147
velocity, 408-4-09 x-ray production, 101
velocity spectrum display, 412—413 kinetic, 101
Dose equivalent, 49 potential, 101
absorbed dose, relationship, 49, 50 Electron radiation, absorbed dose, 602-

exposure, relationship, 49, 50 603

unit, 49 Electron range, initial energy, 146, 147
Electron volt, defined, 22
Electronic noise, 314
E fluoroscopy, 296
Electronic scanner, ultrasound, 396-398
Echo amplitude, ultrasound, 389-392 Element, 55
Echo event, magnetic resonance imaging, Energy, 17
458^159 categories, 17-18
Echo planar method, 474 conversion, 18
Echo signal, magnetic resonance imaging, electron, 26-31
458^159 forms, 18
Echo time medical imaging role, 17, 18
magnetic resonance imaging, 497 quantities, 20-22
noise, 497 radiation, 44-45
Effective dose equivalent, 607 total, 45
Effective lifetime, 96 units, 20-22
Electrical charge, electron, 26 x-ray, 18, 19
 Index 639

Energy fluence, 44-45 base plus fog density, 223

Energy level, electron, 64-65, 66 contrast, 224
Energy resolution of detector, 542 average gradient, 234-235
Energy storage, capacitor, 121-122 characteristics, 227-242
Enhancement, ultrasound, 404 contrast curve, 232, 233
Erasable reusable memory, digital image, contrast transfer, 227-235
336 exposure error, 235
Erg, defined, 22 film latitude, 235-236
Even-echo rephasing, 511-512 gamma, 232-233
Excitation processing effects, 239-241
magnetic resonance imaging, 458 subject contrast range, 235-236
nuclear magnetic resonance, 435 contrastindex, 224
Excitation-pulse flip angle, 467-471 emulsion, 212
Exposure functions, 207-209
absorbed dose, relationship, 46, 47, 49, gamma value, 232-233
50 image display, 209
dose equivalent, relationship, 49, 50 image formation, 207, 208
film density, 207, 208 image recording, 207-208
characteristic curve, 230-232 image storage, 209
photon concentration, 42 overprocessing, 222
radiation, 4144 patient exposure, 592
concept, 4142 processing accuracy, 222-223
Exposure contrast, film contrast, 228 processing conditions, 223
Exposure time, 221-223 processing consistency, 223
radiographic density, 245-246 processing quality control, 222-226
Exposure timer, 124-125 sensitivity, 216-222
blue sensitivity, 220
F developer composition, 219
developer concentration, 219
False negative diagnostic, 13-14 developer contamination, 219
False positive diagnostic, 13-14 developer replenishment, 219
Fat, contrast, 174 development temperature, 220
Fat suppression, magnetic resonance development time, 219
emulsion composition, 218
imaging, 467
Fetus, exposure limit, 609 exposure time, 221-223
Field of view green sensitivity, 220

digital image, 319 light color, 220-222

foldover artifact, 493 processing, 218-220
gamma camera, 531-532 processing effects, 239-241
Field strength red sensitivity, 221

magnetic resonance imaging, 496497 safelighting, 221

noise, 496497 wavelength, 220-222
Film, 207-226 speed, 223
artifact, 226 structure, 211-212
base, 212 types, 236-239
640 Physical Principles of Medical Imaging

underprocessing, 222 flow dephasing, 510-511

verification, 223 flow-related enhancement, 504-506
Film badge, 623 flow-void effect, 506-508
Film contrast, exposure contrast, 228 gradient moment nulling, 510, 511
Film density intervoxel phase, 512, 513
exposure, 207, 208 intravoxel phase, 509-510
characteristic curve, 230-232 phase effects, 508-513
light penetration, 209, 210 phase imaging, 512, 513
measurement, 211 presaturation, 506-508
Film fog, 241-242 time effects, 503-506
age, 241 ultrasound, 407—413
chemical, 241 Fluid
heat, 241 contrast, 176
inherent, 241 ultrasound, 394
radiation exposure, 242 Fluoroscopy, 283-302
Film latitude, 235-236 aperture, 297-298
Film processing, quality control chart, blur, 288-289, 463
225 camera, 300-301
Film processor, 214 film exposure, 301
Film speed, 216-222 framing, 300-301
Filtration image size, 300-301
capacitor, 122-123 collimator lens, 299
x-ray beam, 165-167 components, 283-284
Flourine, radionuclide, 80 electronic noise, 296
Flow, magnetic resonance imaging, 418 evolution, 283
Flow compensation, 510, 511, 522 image distributor, 298-299
Flow-void effect, 506-508 intensifier tube, 284-289
Flowing blood lens, 296-297
angiography, 513-518 matrix size, 323
flow direction, 514-515 mirror, 299
inflow effects, 515 noise, 296
maximum intensity projection (MIP) optical system, 296-300
technique, 518 patient exposure, 589-590
phase contrast, 514-515 quantum noise, 296
spatial characteristics, 516-518 receptor sensitivity, 301, 313
three-dimension (3D) volume resolution, 463
acquisition, 517-518 video system, 289-296
two-dimension (2D) slice acquisi¬ blur, 293-296
tion, 516-517 contrast, 292
velocity, 514 function, 290
magnetic resonance imaging, 503-518 horizontal blur, 295-296
artifacts, 512-513 interlacing, 291
even-echo rephasing, 511-512 picture tube, 291-292
flow compensation, 510, 511 plumbicon tube, 289-291
 Index 641

vertical blur, 293-295

Frequency encoding, magnetic resonance
video principles, 289-292
imaging, 483-485
vidicon tube, 289-291 Full-wave rectifier circuit, 116-117
vignetting, 299 Full width at half maximum, 542-543
Focal spot, 99
anode angle, 273-274
G
blooming, 272-273
computed tomography, 364-365
intensity distribution, 273, 274 Gain, intensifier tube, 285
manufacturer's tolerance, 272 Gallium, radionuclide, 80
Focal spot area Gamma camera, 529-549
heat capacity, 131-138 background radiation, 545-546
anode angle, 134—135, 136 blur, 463, 554-561
anode rotation speed, 135-136 intrinsic, 557-559
focal spot size, 131-135 characteristic x-rays, 545, 546
kilovoltage waveform, 136-138 characteristics, 530-532
tube rating chart, 131, 133-134 collimator, 532-537
x-ray tube, 131-138 converging collimator, 535-536
Focal spot blur, 270-276 diverging collimator, 534—535
contrast transfer function, 262 function, 532
focal spot size, 272 parallel-hole collimator, 534, 535
object location, 272 pin-hole collimator, 536-537
Focal spot size, 273 collimator blur, 559-561, 562

blur, 271 components, 530

focal spot blur, 272 composite spectrum, 546, 547
measurement, 274-276 Compton scatter, 543-545
pin-hole camera, 274-275 contrast, 551-554
star test pattern, 275-276 crystal, 537
detail visibility, 554-561
Focal-spot-to-object distance, radiogra¬
field of view, 531-532
phy, 267-270
Focal-spot-to-receptor distance, radiogra¬ image formation, 539
phy, 267-270 linespread function, 555
Foldover artifact matrix size, 323

field of view, 493 motion, 556

magnetic resonance imaging, 493, 525- noise, 561-564

526 lesion visibility, 564, 565

Fourier transformation, magnetic photomultiplier tube array, 537-539

resonance imaging, 477, 488-489 point spread function, 555
Frame mode, digital image, 324-325 pulse height analyzer, 547-549, 552-
554
Free induction decaysignal, magnetic
resonance imaging, 461
radionuclide image quality, 551-566
resolution, 463
Frequency, 25
sensitivity, 530-531
alternating current, 35
collimator, 559-561, 562
ultrasound, 374-376
642 Physical Principles of Medical Imaging

spatial distortion, 566 H

spectrometry, 539-547
statistical fluctuations, 541-543 Halation, 205
tomographic imaging, 567-573 Half-life, 85
uniformity, 564-565, 566 radioactive material fraction, 88-90
Gamma emission, isomeric transition, tabulation, 89
77-79 Half value layer
Gamma photon attentuation coefficient, aluminum, 162
energy spectrum, 78 penetration, 161-164
quantum noise, 305 Half-wave rectifier circuit, 117
Gamma spectrum, 541 Hardener, photographic process, 215, 216
Gantry, computed tomography, 345-346 Heat capacity
Geiger-Mueller detector, 620-622 anode body, 138-139
Generator cooling curve, 138-139
exposure timing, 124-125 heating curve, 138-139
manual timer, 124 focal spot area, 131-138
functions, 111, 112 anode angle, 134—135, 136
Glare, 13 anode rotation speed, 135-136
Gold, radionuclide, 81 focal spot size, 131-135
Gradient, magnetic resonance imaging, kilovoltage waveform, 136-138
420, 477-479 tube rating chart, 131, 133-134
cycle, 479, 487, 488 relationship to heat and temperature,
function, 478 129,130
orientation, 478, 479 x-ray tube, 128, 129-130
Gradient echo, magnetic resonance x-ray tube housing, 139-140
imaging, 462 Heat production, x-ray tube, 127-129
Gradient moment nulling, 510, 511 Heat unit, defined, 21
Grain, structure noise, 313-314 High contrast film, 236-239
Gram-rad, defined, 22, 47 High latitude film, 236-239
Gray (gy), defined, 46 High voltage transformer, 114
Gray scale Human vision, image integration, 315
digital image, 345 Hydrogen, radionuclide, 80
pixel value, 321-322
Grid

misalignment, 193-194
patient exposure, 592
receptor sensitivity, 248-249 Illuminance, 51-52
scattered radiation, 186
Image acquisition time, magnetic
artifact, 192-194 resonance imaging, 498-500

penetration, 189-190 averaging, 499

selection, 194—195 half acquisition, 499-500
Grid penetration, Bucky factor value, 188, matrix size, 498^4-99
189 turbo factor, 500
 Index 643

Image blur Initial energy,electron range, 146, 147

intensifying 202, 203-205
screen, Integral dose, 46-48, 598
crossover, 204-205 computed tomography, 48
halation, 205 unit, 47
screen-film contact, 203, 204 Intensified radiography
sensitivity, 203, 204 quantum noise, 310-312
Image contrast, 3-6, 174-175 receptor sensitivity, 310-312
Image detail Intensifier tube
digital image, 318-319 blur, 288-289
magnetic resonance imaging, 492-494 contrast, 287-288
ultrasound, 399^102 conversion factor, 285-287

Image distributor, fluoroscopy, 298-299 dual-mode (FOV), 287, 288

Image integration electronicgain, 286
digital processing, 316 fluoroscopy, 284-289
human vision, 315 gain, 285
noise, 315-316 gain characteristics, 285
video camera tube, 316 noise, 289
Image mottle. See Noise Intensifying screen
Image pixel, tissue voxel, 475, 476 artifact, 205
Image processing, digital imaging system, conversion efficiency, 308, 309
329-342 exposure reduction, 199
Image processor, ultrasound, 373 functions, 197-199
time gain compensation, 373 image blur, 202, 203-205
Image quality, 3-9 crossover, 204-205

computed tomography, 361-369 halation, 205

observer performance, 13-15 screen-film contact, 203, 204

patient exposure, 591 light production, 198-199

Image reconstruction, computed materials, 200
tomography, 355-359 noise, 205
computed tomography numbers, 356- patient exposure, 592
357 photon energy, 202
image format, 355-356 radiographic receptor, 197
Image subtraction, 316 receptor blur, 277, 278
Imaging method spectral characteristics, 201
compromises, 8-9 thickness, 202

sensitivity, 13-15 types, 203

specificity, 13-15 x-ray absorption, 197-198
tissue characteristics, 9 Intensity
defined, 22
viewing perspective, 9
ultrasound, 379-381
Imaging process
ultrasound pulse
components, 1, 2
overview, 1, 2 spatial characteristics, 380-381
Indium, radionuclide, 81 temporal characteristics, 380-381
644 Physical Principles of Medical Imaging

Intensity distribution, focal spot, 273, 274 heatproduction, 127

Intercavity probe, ultrasound, 399 production, 111
Inverse-square effect, 38-39 selection, 249
Inversion pulse, 474 penetration, 175
x-ray
Inversion recovery, 466 production, 104—109
x-ray

magnetic resonance imaging, 465^467 KVp, radiographic density, 246-247

spin echo, 465^467
Inverter, 123
Iodine L

contrast,174, 176-178
radionuclide, 81 Lateral blur, ultrasound, 399, 400
Ionization, 145 Latitude film, 240

positron, 148 Lens, fluoroscopy, 296-297

Ionization chamber, 615-619 Light, 50-52
exposure measurement errors, 618 quantities, 50, 51
exposure measurements, 616-618 units, 50, 51
exposure rate measurements, 616 Light penetration
film density, 209, 210
photon energy dependence, 618-619
saturation, 619 optical density, 209-211
survey meter, 622-623 Light photon, 50
Iron, radionuclide, 80 Line of response, positron emission

Isobar, 57-58 tomography, 568, 569

comparison, 59 Line spread function, gamma camera, 555
Isobaric transition, 71-77 Linear array transducer, ultrasound, 396-

Isomer, 58-59 397

Isomeric transition, 77-80 Linear attenuation coefficient, 149, 150

gamma emission, 77-79 Linear energy transfer, 146-148

internal conversion, 79-80 electron energy, 146-147

Isotone, 60 Liquid scintillator counter, 630-631

Isotope, 57, 58 List mode, digital image, 326

Isotopic abundance, nuclear magnetic Longitudinal relaxation time. See T1

resonance, 430-431 Lumen, 50
Luminance, 50-51
J
M
Joule, defined, 21
MA, radiographic density, 244-245
K MA selector, 123-124

Magnetic field
Kinetic energy, electron, 27-28 magnetic resonance imaging, 418^419
K edge, 153 nuclear magnetic resonance, 427-429

KV, kilovoltage defined, 34 field direction, 427^128

control, 114 fieldstrength, 428^429

effect on contrast, 179 gradient, 429
 Index 645

Magnetic nucleus frequency encoding, 483—485

magnetic resonance imaging, 417 gradient, 420, 477^479
nuclear magnetic resonance, 429-432
cycle, 479, 487, 488
Magnetic relaxation time, magnetic function, 478
resonance imaging, 417^418
orientation, 478, 479
Magnetic resonance imaging, 415^425 gradient echo, 462
acquisition control, 421 image, 415-418
aliasing artifact, 525-526 image acquisition time, 498-500
artifact, 519-528. See also Specific averaging, 499
type half acquisition, 499-500
classification, 520 matrix size, 498^499

averaging, 498 turbo factor, 500

blur, 463 image characteristics, 477
chemical-shift artifact, 490, 527-528 image detail, 492-494
bandwidth, 528 image quality control, 424-425
field strength, 527-528 image reconstruction, 421-422, 476-
computer, 421^-22 477,488-491
contrast, sensitivity, 444 image types, 417^418
contrast agent, 454-455 imaging cycle, 457-462
echo event, 458^459 imaging methods, 457^474
echo signal, 458-459 imaging system, 418^422
echo time, 497 inversion recovery, 465^467
event sequence, 475, 476 magnet types, 419^420
excitation, 458 magnetic characteristics of tissue, 443-
fat suppression, 467 455
field strength, 496-497 magnetic field, 418-419
flow, 418 magnetic nucleus, 417
flowing blood, 503-518 magnetic relaxation time, 417^418
artifacts, 512-513 matrix size, 323
even-echo rephasing, 511-512 motion-induced artifact, 519-525

flowcompensation, 510, 511 averaging, 522-523

flow dephasing, 510-511 cardiac motion, 522
flow-related enhancement, 504-506 flow, 524-525
flow-void effect, 506-508 flow compensation, 522, 525
ordered phase encoding, 523
gradient moment nulling, 510, 511
intervoxel phase, 512, 513 phase-encoded direction, 521
intravoxel phase, 509-510 regional presaturation, 523-525
phase effects, 508-513 respiratory motion, 522-524
phase imaging, 512, 513 triggering, 522
multi-slice imaging, 480-481
presaturation, 506—508
503-506
time effects, noise, 494
493, 525-526
foldover artifact, signal-to-noise considerations, 495-
498
Fourier transformation, 477, 488^489
free induction decay signal, 461
sources, 495
646 Physical Principles of Medical Imaging

paramagnetic material, 454-455 tissue resonance, 418—419

permanent magnet, 420 volume acquisition, 481-483

phase encoding, 485-4-87 voxel, 424
pixel, 424 voxel size, 496

procedure optimization, 500-501 wrap-around artifact, 525-526

proton, 417 Magnetic resonance spectrum, 440, 441
proton density, 417, 445^146 Magnetization preparation method, 473-
radio frequency radiation, 52, 422, 423 474
radio frequency signal intensity, 415— Magnification
416 motion blur, 270
radio frequency system, 420-421 radiography, 267-270
coils, 420-421 receptor blur, 277
receiver, 421 Mammography, x-ray spectrum, 176, 177
transmitter, 421 Mass, electron, 26
repetition time, 497 Mass attenuation coefficient, 150-152
resistive magnet, 420 Matrix dimension, 493
resolution, 463 Matrix size
resonant frequency, 484-485 computed tomography, 323
RF coil, 497-498 digital image, 318
signal acquisition, 475 fluoroscopy, 323
k space, 475 gamma camera, 323
slice selection, 479-483 magnetic resonance imaging, 323
selective excitation, 479—480, 482 radiography, 323
slices, 423 ultrasound, 323
spatial characteristics, 422-424, 475- Matter, 17
490 categories, 17-18
spin echo, 459^162, 463-465, 472^473 characteristics, 53-68
methods, 463-467 quantum nature, 23
storage and retrieval, 422 radiation

superconducting magnet, 419-420 coherent scatter, 144

superparamagnetic material, 455 competitive interaction, 156-157
Tl, 417-418, 446-451 Compton interaction, 143-144
contrast sensitivity, 450-451 electron interactions, 144-148

magnetic field strength, 449 electron range, 145-146

molecular size, 448-449 interaction, 141-158
values, 449 linear energy transfer, 146-148
T2, 417—418, 451—454 pair production, 144
contrastsensitivity, 451, 452-454 photoelectric interaction, 142-143
susceptibility effects, 454 photon interactions, 141-144
values, 449 positron interactions, 148-149
time of repetition, 444 structure, 53-68
time to echo, 459 Maximum intensity projection (MIP)
time to echo event, 445 technique, 518
tissue characteristics, 497 Mechanical scanner, ultrasound, 396
tissue magnetization, 416-417, 418 Medium contrast film, 236-239
 Index 647

Mercury, radionuclide, 81 visibility effect, 367-368

Mirror, fluoroscopy, 299 window setting, 369
Modulation transfer function, 263-265 contrast, 314
cascading, 265 digital image, 333-334
composite, 265 echo time, 497

Molybdenum, anode, 176 field strength, 496^497

Molybdenum-99, transient equilibrium, fluoroscopy, 296
93-95 gamma camera, 561-564
Motion, gamma camera, 556 lesion visibility, 564, 565
Motion blur, 270 image integration, 315-316
contrast transfer function, 262 intensifier tube, 289

magnification, 270 intensifying screen, 205

Motion-induced artifact, magnetic magnetic resonance imaging, 494
resonance imaging, 519-525 signal-to-noise considerations, 495-
averaging, 522-523 498
cardiac motion, 522 sources, 495
flow, 524-525 object visibility, 7, 8, 491, 492
compensation, 522, 525
flow repetition time, 497
RF coil, 497-^498
orderedphase encoding, 523
tissue characteristics, 497
phase-encoded direction, 521
regional presaturation, 523-525 visibility, 303-305
voxel size, 496
respiratory motion, 522-524
triggering, 522 Nuclear alignment, nuclear magnetic
Motion mode, ultrasound, 407, 408 resonance, 433
Multi-slice imaging, magnetic resonance Nuclear composition, 54-55
imaging, 480-481 mass, 55
Muscle, contrast, 174 Nuclear energy, 63-64
Nuclear magnetic resonance, 427^-41
excitation, 435
N interactions, 432-435
isotopic abundance, 430-431
Neutralizer, photographic process, 215 magnetic field, 427^429
field direction, 427-428
Neutron, 54-55
Neutron-proton ratio, 72
fieldstrength, 428^429
Nitrogen, radionuclide, 80 gradient, 429
Noise, 7, 303-316. See also Specific type magnetic nucleus, 429-432
nuclear alignment, 433
averaging, 498
radio frequency energy, 431 —432
blur, 315
pulse, 432
computed tomography, 367-369
factors, 368—369 signal, 432
relaxation, 435
filtration, 369
resonance, 433-435
pixel size, 368
radiation exposure, 368-369 signal strength
relative sensitivity, 431
slice thickness, 368
relative signal strength, 431
sources, 368
648 Physical Principles of Medical Imaging

tissue concentration, 430 determination, 595-597

tissuemagnetization, 436-439 distance, 593-594
longitudinal magnetization and exposure values, 595
relaxation, 437^438 factors, 591-595
saturation, 439 film, 592
transverse magnetization and fluoroscopy, 589-590
relaxation, 437, 439 grid, 592
Nuclear stability, 60-63 image quality, 591
Nuclear structure, 52-60 intensifying screen, 592
Nuclide, 55, 55-60 radiography, 588-589
Nuclide chart, 56-57 radionuclide dosimetry, 597-602
cumulated activity, 598-601
O
integral dose, 598
Object contrast, 10, 11, 172, 174 total energy, 598

Object location transition energy, 601-602

focal spot blur, 272 receptor sensitivity, 591, 592
radiographic blur, nomogram, 279 tabletop, 593
radiography, 267-270 tissue penetration, 594

receptor blur, 278 Penetration, 159-170

Object size, 13 aluminum, 166-167
Object-to-receptor distance, radiography, factors, 159, 160
267-270 filtration, 165-167
Object visibility grid, 187-195
blur, 491,492 half value layer, 161-164
noise, 7, 8, 491, 492 object thickness, 163
Occupational exposure, 609 photon range, 159-160
Optical density, 209-211 scatter, 167-170
control, 243-251 scattered radiation, 187-195

light penetration, 209-211 soft tissue, 166-167

Optical system, fluoroscopy, 296-300 values, 170

Ordered phase encoding, 523 Penumbra, 258
Overprocessing, 240-241 Permanent magnet, magnetic resonance
film, 222 imaging, 420
Oxygen, radionuclide, 80 Personnel exposure, 607-614
areashielding, 611
P
exposure limits, 607-609
Pair production, 144 exposure sources, 610-611
Parallel-hole collimator, 534, 535 utilization factor, 610

Paramagnetic material, magnetic workload, 610

resonance imaging, 454-455 personnel shielding, 611-612
Parenchyma pattern, ultrasound, 394 scattered radiation, 611
Particle radiation, 20 Phase encoding, magnetic resonance
Patient exposure,587-606 imaging, 485-487
beam limiting, 595 Phased array transducer, ultrasound, 397-

computed tomography, 590 398

 Index 649

Photoelectric interaction, 142-143 Photon range

atomic number, 154 attenuation coefficient, 160
Compton interaction, rate comparison, penetration, 159-160
156,157 Pin-hole camera, focal spot size, 274-275
photon energy, 152-153 Pin-hole collimator, 536—537
rates, 152-155 Pixel, magnetic resonance imaging, 424
Photographic process, 212-216 Pixel size, computed tomography, 365

activator, 215 Pixel value

clearing, 215 digital image, 320-322

development, 214-215 gray scale, 321-322
dry, 216 Point spread function, gamma camera,
555
fixing, 215-216
hardener, 215, 216 Positron

latent image formation, 213-214 annihilation, 148

neutralizer, 215 ionization, 148
Positron emission, 73-75
preservative, 215, 216
reducer, 214—215 Positron emission tomography, 567-572
restrainer, 215 attentuation correction, 569
coincidence time window, 568
wash, 216
Photomultiplier tube cyclotron, 569-572
gamma camera, 537-539 image reconstruction, 568
scintillation detector, 626, 627-628 imaging process, 568
Photon, 40 imaging system, 568, 569
line of response, 568, 569
physical characteristics, 23-24
physical characteristics of materials, 68 positron-emitting nuclide, 569-570
random nature of emissions, 575 Positron-emitting nuclide, positron
scatter direction, 154—155 emission tomography, 569-570
statistical fluctuation Positron radiation,diagram, 75
Potential energy, electron, 28, 32-33
counting error, 575-576
counting noise, 575-576 Power, 33, 52

total, 40 defined, 22
Photon concentration, 40 ultrasound, 379-381
unit, 52
exposure, 42
Photon energy, 24—25
Power supply. See also Generator
atomic number, 152 high-frequency, 123
Presaturation
contrast, 175-178
flow-void effect, 507-508
intensifying screen, 202
regional, 523-525
photoelectric interaction, 152-153 Preservative, photographic process, 215,
wavelength, relationship, 26 216
Photon fluence, 40
Proton, 54—55
Photon interaction, 141-144
attenuation, 149-152 magnetic resonance imaging, 417
Proton density, magnetic resonance
rates, 149—156
imaging, 417, 445^146
Photon radiation, 612-614 Pulse diameter, ultrasound, 385-388
absorbed dose, 603-604
650 Physical Principles of Medical Imaging

Pulse generator,ultrasound, 373 quantities, 38—40

Pulse height analyzer, 529 quantum nature, 23-26
gamma camera, 547-549, 552-554 surface integral exposure, 42—44
Pulsed Doppler, 411 unit systems, 37-38

Radiation-measuring device, 250

Q Radiation penetration, 159-170
Radio frequency energy, nuclear magnetic

Quality assurance, x-ray equipment, 125 resonance, 431—432

Quantum noise, 305-307 pulse, 432
fluoroscopy, 296 signal, 432
gamma photon, 305 Radio frequency radiation, magnetic
intensified radiography, 310-312 resonance imaging, 52, 422, 423

x-ray photon, 305 Radio frequency signal intensity,

Quenching, 631 magnetic resonance imaging, 415-416
Radio frequency system, magnetic
resonance imaging, 420—421

coils, 420—421
Rad, defined, 46 receiver, 421
Radiation, 18-20 transmitter, 421
area exposure limits, 609 Radioactive equilibrium, 90-95
biological impact, 48-50 secular equilibrium, 91-92
conversion factors, 38 transient equilibrium, 92-95
energy,44-45 Radioactive lifetime, 83-87
exposure, 41—44 variation, 83, 84
concept, 41-4-2 Radioactive material fraction, half-life,
exposure limits, 607-609 88-90
exposure sources, 610-611 tabulation, 89
utilization factor, 610 Radioactive transition, 69-82
workload, 610 radiation produced, 69, 70
external source, 612-614 Radioactivity, 83-96
matter, interactions with cumulated activity, 86-87
coherent scatter, 144 effective lifetime, 96
competitive interaction, 156-157 quantity of radioactive material, 86
Compton interaction, 143-144 time, 87-90
electron interactions, 144-148 Radiographic blur
electron range, 145-146 object location, nomogram, 279
interaction, 141-158 sources, 268
linear energy transfer, 146-148 Radiographic density
pair production, 144 automatic exposure control, 250-251
photoelectric interaction, 142-143 radiation-measuring device, 250
photon interactions, 141-144 exposure time, 245-246
positron interactions, 148-149 factors, 244
measurement, 615-632 KVp, 246-247
occupational exposure, 609 MA, 244-245
 Index 651

waveform, 247 patient exposure, 597-602

x-ray generator, 244 cumulated activity, 598-601
x-ray tube, 247 integral dose, 598
Radiographic density control, 243-251 total energy, 598
Radiographic receptor, 197-205 transition energy, 601-602
intensifying screen, 197 Radionuclide image acquisition, digital
sensitivity, 199-202 image, 323-326
types, 197 Radionuclide tomographic imaging, 567-
Radiography 573
contrast sensitivity, 4 Random access memory, digital image,
detail, 267-281 336, 337
focal-spot-to-object distance, 267-270 Ray (sample) interval, computed
focal-spot-to-receptor distance, 267- tomography, 365
270 Ray (sample) width, computed
magnification, 267-270 tomography, 363-365
matrix size, 323 Read only memory, digital image, 336

object location, 267-270 Receptor blur, 276-278

contrast transfer function, 262
object-to-receptor distance, 267-270
effective blur value, 277
patient exposure, 588-589
receptor sensitivity, 301-302 intensifying screen, 277, 278
resolution, 463 magnification, 277
Radionuclide object location, 278
carbon, 80 pattern, 277
chromium, 80 Receptor exposure
cobalt, 80 grid ratio, 189, 190
flourine, 80 sensitivity, 243
gallium, 80 Receptor sensitivity, 248-249, 307-313
gold, 81 absorption efficiency, 309
area, 249
hydrogen, 80
distance, 249
indium, 81
iodine, 81 fluoroscopy, 301, 313
iron, 80 grid, 248-249
intensified radiography, 310-312
mercury, 81
nitrogen, 80 patient, 249
oxygen, 80 patient exposure, 591, 592
radiography, 301-302
production, 82
screen-film radiography, 307-310
selenium, 81
Reconstruction filter, computed
strontium, 81
technetium, 81
tomography, 365
Rectification, x-ray tube, 115-117
xenon,81
Rectifier, 115
ytterbium, 81 Rectifier circuit, 115-117
zinc, 81
Reducer, photographic process, 214—215
Radionuclide dosimetry
Reflection, ultrasound, 382-385
estimation of dosage values, 605, 606
652 Physical Principles of Medical Imaging

Refraction, ultrasound, 384, 404 353, 354

rays,
Relative biological effectiveness, 49 samples, 355
Relaxation, nuclear magnetic resonance, views, 353-355
435 Scatter direction, photon, 154-155
Rem, defined, 49 Scatter reflection, ultrasound, 394
Remaining fraction, tabulation, 89 Scattered radiation

Repetition time collimation, 184

magnetic resonance imaging, 497 computed tomography, 363
noise, 497 contrast reduction, 181-184
Resistive magnet, magnetic resonance grid, 186
imaging, 420 artifact, 192-194
Resolution penetration, 189-190
blur, 258-263 selection, 194-195
computed tomography, 363-367, 463 penetration, 167-170
fluoroscopy, 463 personnel exposure, 611
gamma camera, 463 Scintillation detector, 624—631

magnetic resonance imaging, 463 amplifier, 628

radiography, 463 crystal, 625-626
test object, 258-259 photomultiplier tube, 626, 627-628
ultrasound, 463 Scintillation probe, 628-629
Resonance, nuclear magnetic resonance, Scintillation well counter, 629-630
433^435 Screen-film radiography, receptor
Resonant frequency, magnetic resonance sensitivity, 307-310
imaging, 484-485 Secular equilibrium, radioactive
Rest mass energy, electron, 27 equilibrium, 91-92
Restrainer, photographic process, 215 Selenium, radionuclide, 81
Reverberation, ultrasound, 404-405 Sensitivity
Ring-down artifact, ultrasound, 405, 406 film, 216-222
blue sensitivity, 220
developer composition, 219
S developer concentration, 219
developer contamination, 219
Safelighting, 221 developer replenishment, 219
Safety. See Patient exposure; Personnel development temperature, 220
exposure development time, 219
Saturation, ionization chamber, 619 emulsion composition, 218
Saturation pulse, 474 exposure time, 221-223
Scan converter, ultrasound, 373 green sensitivity, 220
Scan generator, ultrasound, 373 light color, 220-222
Scan line density, ultrasound, 400-402 processing, 218-220
Scan pattern,
ultrasound, 395 processing effects, 239-241
Scanning, computed tomography, 353— red sensitivity, 221
355 safelighting, 221
measurements, 355 wavelength, 220-222
 Index 653

gamma camera, 530-531 Star test pattern, focal spot size, 275-276
collimator, 559-561, 562 Statistical counting error, 575-585
image blur, 203, 204 Statistical fluctuation,
photon
imaging method, 13-15 counting error, 575-576
receptor exposure, 243 counting noise, 575-576
Shadowing, ultrasound, 403^104 Statistics, 575-585
Sievert (Sv), defined, 49 Step-down transformer, 113
Signal acquisition, magnetic resonance Step-up transformer, 113
imaging, 475 Stimulable phosphor receptor, digital
k space, 475 image processing, 339
Signal strength, nuclear magnetic Storage capacity, digital image, 319
resonance Strontium, radionuclide, 81
relative sensitivity, 431 Structure noise, grain, 313-314
relative signal strength, 431 Subject contrast, 174
Single photon emission computed Superconducting magnet, magnetic
resonance imaging, 419-420
tomography, 572-573
data acquisition, 573 Superparamagnetic material, magnetic
resonance imaging, 455
image reconstruction, 573
imaging system, 572 Surface integral exposure, radiation, 42-
Slice selection, magnetic resonance 44

imaging, 479^183 Survey meter, 619-623

selective excitation, 479-480, 482 ionization chamber, 622-623
Small angle gradient echo method, 467-
473 T
Soft tissue
contrast, 176 Tl, magnetic resonance imaging, 417-
418,446-451
penetration, 166-167
Sound contrastsensitivity, 450-451
frequency, 375 magnetic field strength, 449
molecular size, 448-449
velocity, 375, 376
values, 449
Spatial distortion, gamma camera,566
Specificity, imaging method, 13-15
T2, magnetic resonance imaging, 417-
418,451-454
Spectral presaturation, 441
contrast sensitivity, 451, 452-454
Spectrometry, gamma camera, 539-547
susceptibility effects, 454
Spectroscopy, 440-441
values, 449
Specular reflection, ultrasound, 393-394
Tape, digital image, 337
Speed, film, 223
Technetium, radionuclide, 81
Spin echo Technetium-99m, transient equilibrium,
465-467
inversion recovery,
93-95
magnetic resonance imaging, 459-462, Terminal, 31
463-465, 472-473
Thermoluminescence dosimetry, 623-624
methods, 463-467
Three-dimension (3D) volume acquisi¬
spoiling, 472 tion, 517-518
Spoiling, spin echo, 472
654 Physical Principles of Medical Imaging

Time, radioactivity, 87-90 Transverse relaxation time. See T2

Time-gain compensation, ultrasound, Triggering, 522

391-392 True negative diagnostic, 13-14
Time of repetition, magnetic resonance Tube rating chart, 131, 133-134

imaging, 444 Two-dimension (2D) slice acquisition,

Time to echo, magnetic resonance 516-517

imaging, 445, 459

Tissue characteristics, imaging method, 9 U
Tissue concentration, nuclear magnetic
resonance, 430 Ultrasound, 371-106, 389-106
Tissue
magnetization A-mode display, 390, 391
magnetic resonance imaging, 416—417, absorption, 381-382, 383
418 amplifier, 373
nuclear magnetic resonance, 436-439 time gain compensation, 373

longitudinal magnetization and amplitude, 377-378

relaxation, 437-438 artifact, 403—106
saturation, 439 axial blur, 399-400, 401
transverse magnetization and B-mode image, 390-391
relaxation, 437, 439 beam width, 385-388
Tissue penetration, patient exposure, 594 blur, 463
Tissue resonance, magnetic resonance cardiac motion, 407-413

imaging, 418-419 characteristics, 374-381

Tissue voxel, image pixel, 475, 476 components, 371-372
Total energy, 34 contrast, sensitivity, 402-403
Total transition energy, 70 display, 373
Transducer, ultrasound, 372 Doppler imaging, 407—113
adjustable transmit focus, 387, 388 echo amplitude, 389-392
dynamic receive focus, 387-388 electronic scanner, 396-398
fixed focus, 387 enhancement, 404
focusing, 385-388 flowing blood, 407—113
unfocused, 385-387 fluid, 394
Transducer scan method, ultrasound, 395- frequency, 374-376
406 image detail, 399—102
Transformation constant, 85 image processor, 373
Transformer, 113 intensity, 379-381
autotransformer, 114-115 interaction with matter, 381-388
electron-energy transfer, 113 intercavity probe, 399
high voltage, 114 lateral blur, 399, 400

input circuit, 113 linear array transducer, 396-397

output circuit, 113 matrix size, 323
Transient equilibrium mechanical scanner, 396

molybdenum-99, 93-95 motion mode, 407, 408

radioactive equilibrium, 92-95 parenchyma pattern, 394
technetium-99m, 93-95 phased array transducer, 397-398
Transverse magnetization effect, 471-472 power, 379-381
 Index 655

pulse diameter, 385-388 contrast, 292

pulse generator, 373 function, 290
pulse production, 374 horizontal blur, 295-296
reflection, 382-385 interlacing, 291
refraction, 384, 404 picture tube, 291-292
resolution, 463 plumbicon tube, 289-291
reverberation, 404-405 vertical blur, 293-295

ring-down artifact, 405, 406 video principles, 289-292

scan converter, 373 vidicon tube, 289-291
scan generator, 373 Viewbox luminance, 12
scan line density, 400-402 Viewing condition, 9-13
scan pattern, 395 Viewing distance, 13
scatter reflection, 394 Vignetting, fluoroscopy, 299
shadowing, 403-404 Visibility, noise, 303-305
specular reflection, 393-394 Voltage, 32-33
time-gain compensation, 391-392 Voltage waveform, x-ray production,
tissue boundaries, 393 117-120
tissue characteristics, 393-394 constant potential, 117-118, 120
transducer, 372 single-phase, 117-118, 120
adjustable transmit focus, 387, 388 three-phase, 119, 120
Volume acquisition, magnetic resonance
dynamic receive focus, 387-388
fixed focus, 387 imaging, 481—483
focusing, 385-388 Voxel

unfocused, 385-387 computed tomography, 365

transducer scan method, 395-406 magnetic resonance imaging, 424
Voxel size
velocity, 376
wavelength, 376-377 magnetic resonance imaging, 496
Ultrasound pulse noise, 496
amplitude, 379
intensity
W
spatial characteristics, 380-381
temporal characteristics, 380-381
length characteristics, 377 Water, contrast, 174
temporal characteristics, 377 Watt, 52
Waveform, defined, 35
Underprocessing, 241
film, 222 capacity, 136
heat

Unsharpness, blur, 257-258 production, 128

heat
in x-ray production, 117

radiographic density, 247

V
three-phase, 119
Velocity, ultrasound, 376 Wavelength, 26
Video camera tube, image integration, photon energy, relationship, 26
316 ultrasound, 376-377
629-630
Well counter,
Video system, fluoroscopy, 289-296
blur, 293-296 Windowing, digital image, 330, 333
656 Physical Principles of Medical Imaging

Wrap-around artifact, magnetic resonance electron energy, 101

imaging, 525-526 kinetic, 101
Write once read many, digital image, 336 potential, 101
voltage waveform, 117-120
constant potential, 117-118, 120
X single-phase, 117-118, 120
three-phase, 119, 120
X-ray X-ray spectrum, 165
energy, 18, 19 X-ray tube, 97-101, 111-125
exposure patterns, 587-590 anode, 97-99
X-ray beam design, 99
filtration, 165-167 focal spot, 99

quality, 164-165 cathode, 99-100

X-ray circuit, 34 computed tomography, 345-346
beam hardening, 346
X-ray equipment, quality assurance, 125
X-ray generator, radiographic density, collimation, 346
244 compensation, 346-347
X-ray image, contrast, 171-175 filtration, 346-347
contrast-producing materials physical envelope, 100
characteristics, 174 focal spot area, 131-138
development stages, 171, 173 function, 97
factors, 171, 172 heat capacity, 128, 129-130
image contrast, 174-175 heat production, 127-129
object contrast, 172, 174 heat rating, 138

subject contrast, 174 housing, 100-101

types, 171-175 KV production, 111-115

X-ray machine, basic circuit, 112 radiographic density, 247

X-ray photon, quantum noise, 305 rectification, 115-117
X-ray production, 97-109 single exposure ratings, 133-134
Bremsstrahlung, 102-104 transformer principles, 113
kilovolt peak, 104 X-ray tube housing, heat capacity, 139—
production process, 102 140
spectrum, 102-104 Xenon, radionuclide, 81
characteristic radiation, 104-107
kilovoltpeak, 106-107
molybdenum spectrum, 105, 106 Y

production process, 104—105

tungsten spectrum, 105, 106 Ytterbium, radionuclide, 81
efficacy, 109
kilovolt peak, 109
waveform, 109
efficiency, 107-108
anode, 108 Z/A ratio, 67
kilovolt peak, 107-108 Zinc, radionuclide, 81