COURSE TITLE: MEDICAL IMAGING TECHNIQUES AND DATA

ANALYSIS
COURSE CODE: BIO3005
COURSE TYPE: LT
MODULE NO. 2_PART 1
COURSE INSTRUCTOR: DR. N. VIGNESH

EMPLOYEE ID: 100589

DESIGNATION: ASSISTANT PROFESSOR

DEPARTMENT: SCHOOL OF BIOENGINEERING AND TECHNOLOGY

X-rays
• X-rays were discovered by the German Physicist Wilhelm Konrad Rontgen in 1895.

• X-rays are widely used in visualizing the internal anatomy of humans.

• Radiological examination is one of the most important diagnostic aids available in the medical practice.

• It is based on the fact that various anatomical structures of the body have different densities for the
X-rays.

• When X-rays from a point source penetrate a section of the body, the internal body structures absorb
varying amounts of the radiation.

• The radiation that leaves the body has a spatial intensity variation.

• The X-ray intensity distribution is visualized by a suitable device like a photographic film.

• A shadow image is generated that corresponds to the X-ray density of the organs in the body section.
Chest radiograph
• Capability to penetrate matter coupled with differential absorption observed in various materials.
• Ability to produce luminescence and its effect on photographic emulsions.
• X-ray picture is called a radiograph.
• Chest radiographs are mainly taken for the examination of the lungs and the heart.
• Because of the air enclosed in the respiratory tract, the larger bronchi are seen as negative contrast.
• Pulmonary vessels are seen as a positive contrast against the air-filled lung tissue.
• Different types of lung infection are accompanied by changes in the location, size and extent of the
shadow.
Angiography
• Heart examinations are performed by taking frontal and lateral films.
• The evaluation is performed partly by calculating the total heart volume and partly on the basis of any
changes in shape.
• For visualization of the rest of the circulatory system and for the special examinations of the heart, use is
made of injectable, water-soluble organic compounds of iodine.
• A contrast medium is injected into an artery or vein, usually through a catheter placed in the vessel.
• Larger organs of the body can be examined by visualizing the associated vessels and this technique is
called angiography.
• The examination is designated according to the organ examined.
• Coronary angiography means examination of coronary vessels of the heart. Cerebral angiography – brain
examination.
• The entire gastro-intestinal tract can be imaged by using an
emulsion of barium sulphate as a contrast medium.
• It is swallowed or administered to diagnose common
pathological conditions such as ulcers, tumours or
inflammatory conditions.
• Negative and positive contrast media are used for
visualizing the spinal canal, the examination being known as
myelography.
• The central nervous system is usually examined by
pneumography
 Nature of X-rays

• X-rays are electromagnetic radiation located at the low wavelength end

of the electromagnetic spectrum.

• The X-rays in the medical diagnostic region have wavelength of the

order of Angstrom.

• They propagate with the speed of light and are unaffected by electric
and magnetic fields.

• The wavelength of X-ray is directly dependent on the voltage with

which the radiation is produced. Hence, energy of X-ray can be
determined from voltage.
Properties of X-rays
• Because of short wavelength and extremely high energy, X-rays are able to penetrate through
materials which readily absorb and reflect visible light.
• X-rays are absorbed when passing through matter.
• The extent of absorption depends upon the density of the matter.
• X-rays produce secondary radiation in all matter through which they pass.
• The secondary radiation is composed of scattered radiation, characteristic radiation and
electrons.
• X-rays produce ionization in gases and influence the electric properties of liquids and solids.
• Fluorescence phenomenon is observed with X-rays, as seen with visible light.
Production of X-rays
• X-rays are produced whenever electrons collide at very high speed with matter and are thus
suddenly stopped.
• X-rays are produced in a specially constructed glass tube, which basically comprises of
a. A source for the production of electrons.
b. An energy source to accelerate the electrons.
c. A free electron path.
d. A mean of focusing the electron beam.
e. A device to stop the electrons.
Stationary Anode Tube (SAT)
• The normal tube is a vacuum diode in which electrons are generated by thermionic emission from
the filament of the tube.
• The electron stream is electrostatically focused on a target on the anode by means of a suitably
shaped cathode cup.
• The kinetic energy of the electrons impinging on the target is converted into X-rays.
• Parameters in SAT: Tube current (depends on the filament temperature) and the tube voltage
(depends on the primary voltage).
• Cathode block with the filament inside, is made from nickel or stainless steel.
• The filament is a closely wound helix of tungsten wire and the target is a composite of tungsten and
copper.
• Tungsten is chosen as a target due to high
atomic number (74) and high melting point
(3400⁰C).
• To withstand heavy thermal loads.
• Copper being an excellent thermal conductor,
performs the vital function of carrying the heat
rapidly away from the tungsten target.
• The heat flows through the anode to the outside
of the tube.
• Oil is provided as coolant.
• Electrodes have high open voltages on them
and are shielded.
• Shield is shockproof due to earthing
arrangement.
Rotating Anode Tube
• X-ray tube is a limiting factor in generating higher tube voltages and more penetrating
radiations.
• This is primarily due to the heat generated at the anode.
• The heat capacity of the anode is a function of the focal spot area.
• Therefore, the absorbed power can be increased if the effective area of focal spot
widened and it is accomplished by rotating the anode tube.
• Rotation ensures controlled heating of the anode (electron bombardment) and before
excessive heating, new anode target is placed.
• The anode is a disk of tungsten or an alloy of tungsten
and 10% rhenium.
• The anode rotates at a speed of 3,000-3,600 or
9,000-10,000 rpm.
• The tungsten disk has an angular orientation of 5-20⁰.
• The design of anode helps to limit the power density
incident on the physical focal spot, while creating a
small effective focal spot.
• The heat produced during an exposure is spread over
a large surface of anode.
• Increased heat-loading capacity enhances the intensity
and power levels of X-ray.
• The rotor is made from copper and molybdenum.
• Choice of molybdenum is based on melting point
similarity with tungsten.
X-ray machine
• There are two parts of the circuit.
• One of them is for producing high voltage, which is applied to the tube’s anode and comprises a high voltage
step-up transformer followed by rectification.
• A voltage selector switch facilitates change in voltage between exposures.
• The second part of the circuit concerns the control of heating X-ray tube filament.
• The filament is heated with 6-12 V of AC supply at a current of 3-5 A.
• The filament current is controlled by rheostat.
• A preferred method of providing high voltage direct current to the anode of the X-ray tube is by use of bridge
rectifier.
• Moving coil meters are used for making current measurements (mA).
 X-ray classification

• X-ray tubes are classified on the basis of their application for diagnostic or therapeutic purposes.

• For diagnostic applications, it is usual to employ high milliamperes and lower exposure time.

• Whereas, high voltage and relatively lower mA are necessary for therapeutic uses.
High voltage generation
• Voltages in the range of 30-200 kV are required for the production of X-rays and they are
generated by high voltage transformer.
• A high ratio step up transformer is used so that the voltages applied to primary winding
are small in comparison to those taken from the secondary winding.
• The voltage ratio is 1:500.
• An input of 250 V produces an output of 125 kV.
• High tension transformer assembly is immersed in special oil, which provides a high
level of insulation.
 Types of high voltage generation

• Self-rectified circuit (one pulse).

• Full wave rectification X-ray circuit
(two pulse).
• Three phase power for X-ray
generation.
• Six-rectifier circuit (six pulse).
• Twelve rectifier circuit (twelve pulse).
High voltage generation – self-rectified circuit
• It is one pulse X-ray generation system.
• The high voltage is produced by using a step-up transformer whose primary is connected to an
auto-transformer.
• The secondary of the High Tension (HT) transformer is directly connected to the anode of the X-ray
tube.
• This arrangement is termed as self-rectification and it is used in mobile and dental X-ray units.
• These machines have maximum tube currents of about 20 mA and a voltage of about 100 kV.
• Parallel combination of a diode and a resistance is applied in series with the primary coil of the HT
transformer.
• Self-rectification reduces the cost and complexity of X-ray machines.
High voltage generation – Full-wave rectification
• It is a two-pulse X-ray generation system.
• Limitation with self-rectified circuit: reduction in exposure time during non-conducting cycle
(half cycle) of X-ray tube.
• The full-wave rectification circuit produces X-rays during each half-cycle of the applied
sinusoidal 50 Hz mains supply voltage.
• Anode is positive with respect to the cathode over both the half-cycles.
• Full-wave rectified circuits are used in the medium and high-capacity X-ray units.
• These are most commonly employed for diagnostic X-ray examination.
Limitations of single phase X-ray circuits
• The intensity of radiation produced is lower because no radiation is generated during a large
portion of the exposure time.
• When the tube voltage is appreciably lower than the peak voltage, the X-rays produced are of
low energy and get mostly transformed into heat at the anode.
• A considerable part of the radiation produced is absorbed by the filter or the tube housing and
produces a poor quality image.
• The deficiencies of the single-phase system can be overcome by using three-phase power in
X-ray machines.
• Three phase supply can result in steady power to the X-ray tube instead of pulsating power.
High tension cable
• In view of the very high voltages applied to the X-ray tube, it is necessary to use special highly insulated cables
for its connections to the generator.

• The centre of the cable comprises three conductors individually insulated for the low filament voltages and
surrounded by semi-conducting rubber.

• This, in turn, is surrounded by non-conducting rubber which provides the insulation against the high voltage
also carried by the centre conductors.

• The cable is shielded with a woven copper braiding and it is earthed.

• Final protective layer covering is made using vinyl or some other plastic.

• The grounded metal braid serves as a safety path to ground for the high voltage.

• The effect of cable capacitance is that the energy is stored during the conduction period of the rectifiers and the
energy is delivered to the tube during the non-conducting period.
Collimator
• In order to increase the image contrast and to reduce the dose to the patient, the X-ray beam must be
limited to the area of interest.
• The dosage of X-ray is manipulated using collimators and grids.
• The collimator is placed between the X-ray tube and the patient and it consists of a sheet of lead with a
circular or rectangular hole of suitable size.
• In some cases, collimator may consist of four adjustable lead strips which can be moved relative to each
other.
• The collimator makes sure the X-ray dose at the smallest value and further increases image contrast by
collecting the less scattered radiations.
• Hence, smallest field size and collimator together minimize the loss of contrast due to scattered radiation.
Grid
• Grids are inserted between the patient and the film cassette in order to reduce the loss of contrast
due to scattered radiation.

• A grid consists of thin lead strips separated by spacers of a low attenuation material.

• The lead strips are designed that the primary radiation from the X-ray focus will pass between them
while the scattered radiation from the object is largely attenuated.

• Grids conceal the final details of the image and it is avoided using moving grids.
Exposure timing systems
• A timer is used in X-ray machine to initiate and terminate the X-ray exposure.

• The timer controls the X-ray contactor which in turn, controls the voltage to the primary of the high voltage
transformer.

• Timers vary in their methods of operation – simple mechanical timer to microcontroller based electronic timer.

• The simple mechanical timers are spring-driven (hand-operated type) and electronic timers use thyristors.

• High voltage X-ray generators have very small exposure time and require precise control by electronic timer.

• Electronic and digital timers use of oscillator, counter and associated logic.

• The reference oscillator generates the frequency to an AND circuit and the counter logic acts as an flip-flop
switch to disconnect the oscillator from the counter (termination of X-ray exposure).
Automatic exposure control
• Radiographic practice is based on the selection of appropriate X-ray exposure factors such as patient size, shape, and physical
condition.

• The standard operating procedure involves the introduction of Anatomically Programmed Radiography (APR) by combining all
the primary controls of the generator and the Automatic Exposure Control.

• The use of machine stored parameters results in better quality of radiographs.

• Methods of automatic exposure control: photocell and ionization chamber.

• In the photocell-based method, a fluorescent detector is placed on the exit side of the patient and behind the radiographic
cassette.

• The system monitors the X-ray intensity transmitted through the film screen system.

• Alternatively, an ionization chamber is placed between the patient and the cassette.

• The signal from the chamber is amplified and used to control a high speed relay which terminates the exposure under pre-set
density level.
X-ray visualization
• X-rays cannot be detected or visualized directly by human senses.
• Indirect methods for X-ray visualization include X-ray films, fluorescent screens, X-ray image
intensifier television system.
• X-rays have much shorter wavelength than light, but react with photographic emulsions in a
similar fashion.
• Image of photographic film is proportional to the X-ray intensity.
• Intensifying screens consisting of a layer of fluorescent material and these cover the X-ray
emulsion film in a light tight cassette.
• The screens increase the sensitivity of the X-ray film significantly.
Fluorescent screens
• X-rays are converted into a visual image on a fluorescent screen and it can be viewed directly.
• It facilitates a dynamic radiological study of the human anatomy.
• The fluorescent screen consists of a plastic base coated with a thin layer of fluorescent material,
zinc cadmium sulphide.
• In turn, the fluorescent screen is bonded to a lead-glass plate.
• Zinc cadmium sulphide emits light at 550 nm and it corresponds to green spectrum.
• Fluoroscopy requires imaging in dark room due to the faint intensity of emitted light radiation.
X-ray image intensifier
• Large glass tube with input screen
converting X-ray image into light image.
• The light image is transmitted to
photo-cathode which converts light image
into an equivalent electron image.
• Image intensification takes place because of
the very small output screen size and
electron magnification in the tube.
• X-ray image intensifiers use thin layer of
cesium iodide with high X-ray absorption
than zinc cadmium sulphide.
• The output window which permits to examine the light image is flat and allows for image transfer through large
numerical aperture objective.

• X-ray image intensifier system is coupled to a closed circuit television and video recording facilities.

• The combination of X-ray image intensifiers and TV system must control the X-ray generator to produce
constant density changes.

• This is done by automatic dose rate control, also known as automatic brightness control.

• The exposure control circuits drive the voltage and current of the generator (XG).

• If the image intensifier is switched to a higher magnification, the current in the X-ray tube is increased in
inverse proportion to the diameter on the X-ray screen.

• At the same time, the lead diaphragm output size between the patient and the X-ray tube is reduced to cut down
on the area of patient exposure.

• Diaphragms and photo-camera can be opened up, if the light output is not sufficient.
• In video fluoroscopic X-ray systems, the detector embodies the key technology.
• The CCD (charge coupled device) camera offers improvements in image quality.
• The introduction of selenium as a photoconductor produces image in digital format.
• Optical image is provided by the cesium iodide input screen, and it is directly detected by
a high resolution amorphous silicon photo-diode matrix and a thin film transistor array.
Dental X-ray machines
• X-rays are the only media available to detect location of the teeth, their internal condition and the degree
of decay at an early stage.
• Since the object-film distance is low, and the tissue and bone thickness are limited, an X-ray machine of
low power is adequate to obtain the radiograph with sufficient contrast.
• Most dental units have a fixed tube voltage, in the region of 50 kV, and a fixed tube current of 7 mA.
• The system combines the high voltage transformer and X-ray tube in a small case.
• No high voltage cables are required.
• Third electrode called grid between anode and cathode electrodes release electrons at high velocity in a
self-rectified circuit.
• Ratio of soft to hard X-rays decreases.
Portable X-ray unit
• Portable and mobile X-ray units are necessary during surgical procedures.
• A portable unit can be dismantled, packed into a small case and conveniently carried to the site.
• The tube head is constructed that X-ray tube and the high voltage generator are enclosed in one earthed
metal tank filled with oil.
• The X-ray is a small stationary anode tube type, operating in a self-rectifying mode and connected
directly across the secondary winding of the transformer.
• The X-ray machine contains fewer components such as mains voltage compensator, combined voltage
and current switch and time selector.
• Current supply is limited to 15 A.
• Maximum radiographic output is in the range of 15-20 mA and 90-95 kV.
Physical parameters for X-ray detectors
• Detector quantum efficiency (DQE): The DQE describes the efficiency of a detector (the
percentage of quanta for a given dose that actually contributes to the image). It is a function of
dose and spatial frequency.
• Dynamic range: Range from minimum to maximum radiation intensity that can be displayed in
terms of either differences in signal intensity or density differences in conventional film.
• Modulation transfer function: how the contrast of the image component is transmitted as a
function of its size or its spatial frequency.
• Contrast resolution: It is the smallest detectable contrast for a given detail size that can be
shown by the imaging system with different intensity or the whole dynamic range.
Digital radiography
• In both radiography and fluoroscopy, there are definitive advantages of having a digital image
stored in a computer.
• This allows image processing for better displayed images, the use of lower doses, avoiding
repeat radiography and opening up of the possibility of digital storage with a PACS (Picture
Archiving and Communication System).
• It helps in remote image viewing and these have vast possibilities of image-related processing.
• Digital X-ray imaging systems consist of X-ray imaging transducer, Data collection and
processing and data display, storage and processing.
Digital radiography
Conventional radiography
Digital subtraction angiography
• Digital subtraction angiography is developed to study the diseases of circulatory system.
• In this technique, a pre-injection image is acquired, the injection of contrast agent is then
performed.
• Images of the opacified vessels are acquired and subtracted.
• This technique enhances contrast and provides increased contrast sensitivity.
• It is applicable for observing small contrast changes in vessels that have been masked by
the large anatomical background signal.
Digital subtraction angiography
Digital mammographic X-ray equipment
• Mammography is an X-ray imaging procedure used for the examination of the female breast.
• It is primarily used for diagnosis of breast cancer and in the guidance of needle biopsies.
• The female breast is highly radiation-sensitive.
• The radiation dosage during mammography should be kept as low as possible.
• It is required to achieve better spatial resolution than other types of film or screen radiographs.
• The X-ray tube has a molybdenum target and a beryllium window.
• Radiographs are taken at 28-35 kV and mammographic units operate at low peak voltages.
Mammography types
• Digital mammography systems work based on two methods broadly
• Indirect detection: It is a scintillator X-ray conversion. Here, a scintillator converts
X-rays into visible light that is in turn picked up by a solid state detector.
• Direct detection: It is an electronic X-ray conversion. Aims for higher resolution. It
employs a amorphous selenium to convert X-rays into electron-hole pairs for sensing by
a transistor array.
• Direct detection converts X-rays into electrical signals.
Left, a dedicated mammography system, right, anode angle in mammography system, an anode
angle of 0 (A) and 16 degrees (B), require a tube tilt of 24 and 6 degrees