Fluoroscope

Many different types image receptors are used in modern

diagnostic radiology. They all have in common that they form an image by
absorption of energy from the X-ray beam (after transmitting through the
body). The main characteristics will be discussed on the example of the
direct exposure film.
Direct-Exposure Film
Direct exposure film has a relatively low absorption efficiency
for photons in the diagnostic range, however it is still used in
many combinations of image receptor systems.
Direct exposure film material has special design of two
photographic emulsions with protective layers between to
optimize the absorption efficiency .
Correct exposure is important to produce a reliable image on the
film. Over- or underexposure will result in loss of contrast and
therefore possibly in loss of diagnostic information.

The proper film exposure can be obtained from the

so-called characteristic curve of the film material.

The blackening of the film after X-ray exposure is expressed in

terms of its optical density:

D = log10(I0/I)
where I0 and I is the light intensities before and after passing through
the exposed film material.

The objective of this section is to correlate the optical

density D (amount of blackening) with the received X-ray, exposure.
This can be obtained with a simple model for the absorption process.
A single emulsion of film material initially contains G silver-bromine
grains per unit area, the average cross section of the grain is b. After
irradiation with a flux of N X-ray photons per unit area a total number of g
grains per area are sensitized.

The number of sensitized grains per incoming X-ray photon is:

with X as the received X-ray dose and k a conversion constant.

The sensitized grains develop into a silver speck with an

average cross section a after the film development. If light hits one of
the silver specks in the developed film, it is completely absorbed (black
spot).
film
body

X-Ray
source

Dark
Light

To relate the number of sensitized grains to the optical density

D the absorption of the light in the film material of thickness t can be
described as:

Using this relation the optical density can be calculated to:

This relation is known as Nuttings Law !

Maximum optical density for an area on the film is obtained
when all grains are sensitized:
g=G

The correlation between the optical density D and the

maximum number of sensitized grains results in a relation between
the optical density D and the received dose X :

This is displayed in the figure.

The curve relating the optical density

to the film exposure dose is called the
characteristic curve of the film material.
In the center part of the curve the relation
between optical density and the logarithm of the
dose is approximately linear:

For a small contrast in dose X= X1-X2 the associated

change in optical density is:

The constant F is known as the film-gamma and ranges

between 2-3. It corresponds directly to the slope of the linear section
of the characteristic curve.

For low exposure or high exposure the characteristic curve

levels out, exposure differences do not translate into differences in
optical density (blackening).

A film with an optical density of D 0.5 appears

overall light, a film with optical density D 2 appears
overall black.

To achieve best contrast the film must be exposed hi such

a way that the region of interest in the patient cause film doses
which are in the center part of the characteristic curve.

Additionally the contrast can be affected by the energy

absorption efficiency of the image receptor material which in
general decreases with energy.

Efficiency and / or sensitivity of film material

The sensitivity of film material depends on size and

density of grains, emulsion thickness and X-ray absorption
efficiency.

The figure shows a typical X-ray absorption efficiency

for a double emulsion film as a function of energy.

The efficiency drops rather rapidly

with increasing energy and is mainly
determined by the interaction probability of
the photons with the film material
(attenuation coefficient ) and the thickness
of the material t.

An important goal is to maximize the efficiency of the image

receptor material.

The noise in the image may limit the contrast.

The noise in the receptor image arises from several sources:

fluctuations in the number of absorbed X-ray photons per unit area

fluctuations in the absorbed photon energy
fluctuations in the number of silver halide per unit area of emulsion

The first and the last are the main sources for noise
(quantum mottle and random darkening).

To calculate the effect of quantum mottle we replace:

with A as area, as interaction efficiency, and N as

number of incident photons.

The resulting expression for the noise in the optical density of the image is:

The noise due to quantum mottle is proportional to the

slope of the characteristic curve of the receptor material!

To determine the noise due to random darkening the

influence of granularity fluctuation (g A)1/2 in the number of
developed grains (g A) in area A for the fluctuation in optical
density DG needs to be calculated:

after substituting for g.

Fluctuations therefore depend directly on fluctuations in grain size!

The figure shows that the quantum mottle

corresponds directly to the film-gamma and the random
darkening due to the granularity distribution directly to the
characteristic curve.

Alternative Image Receptors

Intensifying Screens in front of the photo emulsion convert X-rays
into visible light. The film material is more sensitive to light photons
than to X-ray photons. This increases the energy absorption
efficiency e by more than one order of magnitude, but the resolution
decreases due to additional noise components.

Image intensifiers convert X-ray photons to electrons by photo

electric effect on a photocathode. The electrons are focused
onto by electrical fields on a fluorescent screen where they form
an intensified image which can be recorded on film or viewed
with a TV camera.

Xeroradiography is a dry non-silver photographic system, which

produces images on paper (Xerox copies). It is slower than
standard film receptors (which may result in higher doses) but has
better resolution and better energy absorption efficiency e

lonography replaces the photographic film by a

position sensitive ion chamber. The X-rays induce by
ionization of the gas electron clouds which can be detected by
an electrode with good spatial resolution.

X-Ray Transmission Computed Tomography

Several problems exist with conventional radiography techniques:

inability to distinguish soft body tissue because of limited contrast

(see example blood-muscle); this can be fixed by the use of liquid
contrast medium which has to be injected.

inability to resolve spatially structures along the X-ray propagation

axis resulting in loss of depth information (flat picture), because
the three-dimensional body is projected on to a two-dimensional
receptor.

Computed tomography (CT) techniques allows sectional imaging .

It is based on the principle that an image of an unknown object can
be obtained if one has an infinite number of projections through the object.

Two scans through the body gives an image in x- and y-direction

(side view and front view). With increasing number of scans over a 360
angle range provides a set of images which allow to construct the three
dimensional structure of the body.

For X-ray tomography a planar slice of the body is defined and

X-rays are passed along this plane in all directions. To produce a
tomographic image typically 100 to 1000 scans are required.
To store the multitude of images and process the data requires computer.

The two-dimensional
image corresponds to a three
dimensional section of the
patient with the third dimension
being the slice thickness which
is typically a few millimeter
thick.

The resulting spatial resolution is 1 mm, a density discrimination

(contrast) of better than 1% can be obtained with this technique.

Present CT machines have an rotatable X-ray source.

This allows to scan the patient who is located along the
rotational axis from all sides and angles. The image receptor
system is designed as a stationary ring of detectors around the
patient which receive the portions of the fanned X-ray beam.

Each data point acquired by the detector array is a

transmission measurement through the patient along a given line
x between source and detector pixel.

Each data point therefore follows the basic equation:

The attenuation coefficient p represents the sum of all attenuation

coefficients along the line x:

From the image information the projection P(x) of the image is calculated:

Because the attenuation

coefficient corresponds directly to
the density of the body tissue along
the projection axis x, the projection
corresponds to the density.

From a complete scan along different axes (x, ) the cross

sectional density along the slice can be constructed using Fourier
analysis methods.

From the image information the projection P(x) of the image is calculated :

The projection is directly proportional to

the summed attenuation coefficient and to
the length x through the body.
Because the attenuation coefficient
corresponds directly to the density of
the body tissue along the projection axis
x, the projection corresponds to the
density.

From a complete scan along different axes (x, ) the cross

sectional density along the slice can be constructed using Fourier
analysis methods.

The resulting CT image is a two-dimensional matrix of numbers

with each number corresponding to a spatial location in image and patient
along the plane of the slice. The matrix is constructed from 512x512 pixels.
Each pixel has a value (up to 4096=12 bits) which corresponds to the
level of gray (darkness, attenuation). This number is called CT number and
contains the physical information ( attenuation density ) about the
corresponding body section.
As the attenuation coefficient ranges between =0 (air) and =1 (metal
inlet) the attenuation is scaled to a maximum of 4096. The CT therefore
corresponds to a two-dimensional map of attenuation across the body slice.
The CT number CT is normalized to the attenuation of water:

If the attenuation coefficient for a given pixel is equal to water, the CT

number=0, soft tissue material has CT number in the range of -100 to +100,
dense tissues like bones have high CT numbers from 300 to 3000.
CT numbers are rescaled attenuation coefficients!

Typical Radiation Doses in Radiographic and in CT Examinations

The radiation dose received in CT is considerably

higher than that of conventional screen radiography.

To compare the two types of X-ray exposures the received

dose D of X-ray radiation is converted to integral dose DI, which
corresponds to the total amount of energy deposited in the body
tissue of mass m:

In radiographic examinations the dose is not distributed evenly but

drops from the entrance dose at the skin D0 towards deeper layers.
The integral dose is described by:

For the skull 0.33 cm1, A 256 cm2, the typical entrance dose
is D0 4.8 mGy. This yields for the integral dose:

DI = 3.7J

The integral dose in a seven slice head CT is about

twenty times higher than the integral dose of a single X-ray
exposure.