RADIOLOGY NOTES

Radiologic Units
Roentgen (R)- also Gya or air kerma Unit of radiation exposure or intensity on air Overall exposure 100 R= 1Gya 100 mR=.001 Gya To convert R to Gya multiply R times 0.01 Rad- also Gyt or gray Is the radiation absorbed dose Quantity of radiation received by the patient To convert Rad to Gyt multiply rad times 0.01

Rem- also Sv (sievert) Is the radiation equivalent man Radiation received by tech To convert Rem to sievert multiply Rem by 0.01
Curie (Ci) also Bq (Becquerel) Quantity of radioactive material Has nothing to do with x-rays To convert curie to Becquerel multiply curie by 3.7X1010 1R= 1 Rad= 1 Rem 1mGya= 1 mGyt= 1mSv

Volt- the unit of electric potential (V) Causes electrons to move in a conductor Ampere- the unit of electrical current Measure the filament current Farad- is the amount of charge per volt that can be stored on a metal plate.

Watt- SI unit of power

Newton- unit of force Coulomb- unit of electrical charge

Power- work/time- is the rate of doing work Electrical power- P: VI

Acceleration- the rate of change of velocity with time. It is how quickly or slowly the velocity is changed. A=Vf -Vo T Thermionic Emission- is the release of electrons from a heated filament. Boiling off of electrons from the filament. When the tungsten filament gains enough heat (therm), the outer shelf electron (ions) of the filament atoms are boiled off from the filament. Photoemission- the emission of electrons from the photocathode.

X-ray Interactions
X-rays interact at various structural levels through five mechanisms:
1. 2. 3. 4. 5. Coherent scattering vs. Bremsstrahlung. Compton effect. Photoelectric effect vs. Characteristic interaction. Pair Production. Photodisintegration. Bremsstrahlung Characteristic

Coherent Scattering:
Is of little importance to diagnostic x-rays. X-rays with energies below 10 KeV interact with matter by coherent. Is also called Classical Scattering or Thompson Scattering. The incident x-ray interacts with a target atom, causing it to become excited, and the atom releases this excess energy. The excess energy is scattered with the same energy as the incident x-ray. The scattered go in a different direction of the incident x-ray. The result is a change in direction of the x-ray without change in energy. There is no energy transfer, and therefore no ionization. Involves low-energy x-rays and contributes slightly to image noise. Contributes to patient dose. Low energy Photon.

X-ray Interactions Contd

Compton Effect:
Important for diagnostic radiology. Also called Compton Scattering. Incident x-ray or Photon interacts with an outer-shell (e-) and ejects it from the atom, ionizing the atom (making the atom negatively charged) The ejected (e-) is called Compton (e-). The incident x-ray or Photon continues in a different direction with less energy. This interaction makes backscatter radiation which has an impact on image quality due to causing radiation fog. Compton scattering reduces image contrast, no useful information. Creates serious radiation exposure, hazard to workers.

The Compton Effect occurs between moderate-energy x-rays and outer-shell (e-). It results in ionization of the target atom, change in x-ray direction, and reduction in x-ray energy. The wavelength of the scattered x-ray is greater than that of the incident x-ray. Contributes the most to tech dose High energy Photon The Photon exits patient and contributes to fog or radiation to worker.

X-ray Interactions Contd

Photoelectric Effect:
Important for diagnostic radiology. Incident Photon interacts with an inner shell, K shell, ejecting the (e-) form the orbit. The Photon is totally absorbed and the ejected (e-) is called Photoelectron. Then another (e-) from an outer shell fills that space, this causes characteristic x-rays. Characteristic x-rays or interactions: - An outer (e-) from an outer shell fills the vacancy, forming characteristic x-rays. - It behaves the same as scattered radiation and do not contribute to diagnostic x-rays.

Below 70 kVp no characteristics Above 70 kVp 15% of the beam Low energy Photon Contributes the most to patient dose

X-ray Interactions Contd

Pair Production:
Interaction between the x-ray and the nucleus. This interaction causes the x-ray to disappear and 2(e-) appear, 1 positive charge, positron, and 1 negative charged. Pair Production does not occur in x-ray imaging. The incident Photon must have at least 1.02 MeV.

Photodisintegration:
Interaction between high-energy x-ray and the nucleus. X-ray is absorbed by the nucleus and a nuclear fragment is emitted. Does not occur in diagnostic radiology.

Target Interactions

Bremsstrahlung Interactions:
In the diagnostic energy range, most x-ray interactions are bremsstrahlung. The diagnostic energy range is 30 to 150 kVp. Below 70 kVp (with tungsten target), 100% of the x-ray beam consists of bremsstrahlung interactions. Above 70 kVp, approximately 85% of the beam consists of bremsstrahlung interactions. Below 70 kVp 100% bremsstrahlung. Above 70 kVp 85% bremsstrahlung. More produce for diagnostic x-rays.

Characteristic Interactions:
Characteristic interactions are produced when a projectile electron interacts with an electron from the inner shell (K-shell) of the tungsten atom. The electron must have enough energy to eject the K-shell electron from its orbit. When the K-shell Below 70 kVp no characteristic. Above 70 kVp 15% characteristic.

When rotor is pushed:

X-ray Production

Cathode Side Filament current heats up the filament. This heat boils (e-) off the filament, also called thermionic emission. These (e-) gather in a cloud around the filament (space charge). The negatively charged focusing cup keeps the (e-) cloud focused together. The number of (e-) in the space charge is limited (space charge) Anode Side The rotating target begins to turn rapidly, quickly reaching top speed.

When exposure button is pushed:

Cathode Side High negative charge strongly repels (e-). These (e-) stream away from the cathode and towards the anode (tube current). Anode Side High positive charge strongly attracts (e-) in the tube current. These (e-) strike the anode. X-rays(1%) are produced and also heat (99%). Line Focus Principle describes the relationship between the actual focal spot and the effective focal spot. Anode heel effect: - Greater effect on the anode side. Greater up to 45%.

X-ray Production
When rotor is pushed:
Cathode Side Filament current heats up the filament. This heat boils (e-) off the filament, also called thermionic emission. These (e-) gather in a cloud around the filament (space charge). The negatively charged focusing cup keeps the (e-) cloud focused together. The number of (e-) in the space charge is limited (space charge) Anode Side The rotating target begins to turn rapidly, quickly reaching top speed.

When exposure button is pushed:

Cathode Side High negative charge strongly repels (e-). These (e-) stream away from the cathode and towards the anode (tube current). Anode Side High positive charge strongly attracts (e-) in the tube current. These (e-) strike the anode. X-rays(1%) are produced and also heat (99%).

Line Focus Principle describes the relationship between the actual focal spot and the effective focal spot. Anode heel effect: Greater effect on the anode side. Greater up to 45%.

X-ray interaction
X-rays interact at various structural levels through five mechanisms:
1. Coherent scattering vs. Bremsstrahlung. 2. Compton effect. 3. Photoelectric effect vs. Characteristic interaction. 4. Pair Production. 5. Photodisintegration. Bremsstrahlung Characteristic

Film
Supercoat- prevent danmage to the emulsion Emulsion- radiation-sensitive and light-sensitive layer of the film Consists of silver halide crystals in gelatin Silver halide crystals are composed of silver bromide and silver iodine AgBr 90%-99% AgI 1%-10% Adhesive layer- is between the emulsion and the base, and adheres one layer of the film to the other Base- is polyester (plastic) gives the film physical stability Films can be double or single emulsion

Intensifying screen-reduces patients exposure, but also decreases detail.

Film Processing
Developing
Converts the latent image into a manifest (visible) image Changes the silver ions of exposed crystal into metallic silver Temperature around 93o to 95o F

Component Developing agent (reducing)

Chemical Phenidone Hydroquinone

Function Reducing agent; produces shades of gray rapidly Reducing agent; produces black tones slowly

Activator Restrainer

Sodium carbonate Potassium bromide

Helps swell gelatin; produces alkalinity, controls pH Antifog agent; protects unexposed crystals from chemical attack

Preservative

Sodium sulfite

Controls oxidation; maintains balance among developer components Controls emulsion swelling and enhances archival quality

Hardener

Glutaraldehyde

Sequestering agent

Chelates

Removes metallic impurities; stabilizes developing agent

Solvent

Water

Dissolves chemicals for use

Fixing
Removes remaining silver halide from emulsion and hardens gelatin Stops the developer action
Component Activator Fixing agent Chemical Acetic acid Ammonium thiosulfate Function Neutralizes the developer and stops its action Removes undeveloped silver bromine from emulsion

Hardener Preservative Buffer

Potassium alum Sodium Sulfite Acetate

Stiffens and shrinks emulsion Maintains chemical balance Maintains proper pH

Sequestering agent
Solvent

Boric acids/ salts

Water

Removes aluminum ions

Dissolves other components

Washing
Removes excess chemicals Temperature 5o F ( 3oC) below the developer, or 90o F

Drying
Removes water and prepares radiographs for viewing Removes 85% to 90% of moisture, leaving 10% to 15% of moisture

Processing Systems
Tanks An automatic processor has three tanks: one for developer solution, one for fixer solution, and a wash tank for water. These tanks are made of stainless steel to prevent corrosion, and they provide a surface that is cleaned easily. The developer tank is the deepest, followed by the fixer tank, and then the wash tank. Considering that a film moves through the processor at a constant speed, it spends most of the time in the developer tank, somewhat less time in the fixer tank, and the least time in the wash tank. Vertical Transport System Automatic processors use a vertical transport system that advance the film through the various stages of film processing. All rollers in a processor move at the same speed. A film is introduced into the processor on the feed tray. The feed tray is a flat metal surface with an edge on either side that permits the film to enter the processor easily and correctly aligned. As the film enters the processor from the feed tray, the first roller assembly that it encounters is the entrance roller assembly. The entrance roller assembly consists of rollers

Overdeveloping excessive radiographic density. Due to higher developer temp (chemical fog). Due to over replenishment.
Film should go in lengthwise.

Normal temp: 93F 95F. Too high can cause:

Loss of contrast Higher densities Chemical Fog

Exposure Process
1. 2. 3. 4. Expose x-rays Stimulate Stimulating laser Read Light emission Erase Intense light

1. Exposure: The 1st of a sequence of events that results in an x-ray-induced image-forming signal. 2. Stimulate: Stimulation of the latent image results from the interaction of an infrared laser beam with the Photostimulable Phosphor (PSP). 3. Read: The light signal emitted after stimulation is detected and measured. 4. Erase: Prior to reuse, any residual metastable electrons are moved to the ground state by an intense light.

Lead Aprons:
0.25mm 50kVp attenuate 97% 75kVp attenuate 66% 100kVp attenuate 51% 0.5mm 50kVp attenuate 99% 75kVp attenuate 88% 100kVp attenuate 75% 1.00mm Provide close to 100% attenuation at most kVp. Rarely used due to weighing 12-24lbs.

Conversions

Grids:
Grid ratio = Height width of interspaces. No grid = 1 X original mAs 5:1 grid = 2 X original mAs 6:1 grid = 3 X original mAs 8:1 grid = 4 X original mAs 12:1 grid = 5 X original mAs 16:1 grid = 6 X original mAs *To get new mAs when changing grids: Old mAs = old grid factor New mAs new grid factor Grid ratio No grid 5:1 6:1 8:1 12:1 16:1

1 2 3 4 5 6

Screen Speed mAs Conversion Factor:

Screen Speed 50 100 200 400 800 mAs 4 2 1 0.5 0.25

Old screen speed factor New screen speed factor

Old mAs x (new mAs)

Conversion contd
Magnification Factors:
As OID , magnification MF = SID/SOD Ex. MF = 44/35 MF = 1.257 *For every 1 of OID , 7 of SID to magnification.

*The 1 is the actual object, the .257 is the degree of magnification, move the decimal 2 places = 25.7%.

To know the image magnification and actual width:

Image size = SID Object size SOD

To determine image width:

Image width - SID Actual width SOD

When magnification factor is known and wanting to know the actual size:
MF = Image size Object size

SID factors:
Old mAs = old D2 New mAs new D2

mAs:
mA x S = mAs ex. 500x = 42 x=0.084s

Conversions contd

Density Maintenance Formula:

Use to determine new mAs values when changing distance. mAs1 = mAs2 D21 D22

Inverse Square Law:

I1 = D22 I2 D21

Changing from single Phase to ______:

Single phase 3 phase, 6 pulse Reduce mAs by Ex. X old mAs = new mAs

15% Rule:
*To density : Multiply kVp x 1.15 *To density: Multiply kVp x 0.85 *To maintain density: If you kVp by 15%, mAs by 2. If you kVp by 15%, mAs by 2.

Single phase 3 phase, 12 pulse Reduce mAs Ex. X old mAs

Dose Limits
National Council on Radiation Protection and Measurements
mSv Occupational exposures A. Annual A. Cumulative A. Lens of eye A. All other Public exposures A. Public exposures A. Lens of the eye A. Skin, hand, feet Embryo-fetus exposures A. Equivalent dose limit A. Total gestation rem mrem

50mSv/0.05Sv 10 mSv X age 150mSv/0.15Sv 500mSv/0.50Sv 1 mSv 15 mSv 50 mSv

5 rem 1 rem X age 15 rem 50 rem 0.1 rem 1.5 rem 5 rem

5000 mrem

100 mrem 150 mrem 5000 mrem

0.5 msv/month 5 mSv 1 mSv

0.05 rem 0.50 rem 0.1 rem

Student under 18 years

100 mrem

Dose Limits contd

10 rad can cause menstrual changes in women and decrease sperm count in men. 200 rad Temporary infertility. 500 rad Sterility.

Radiation to pregnant woman

High risk examinations: Pelvis, hip, femur, lumbar, cvstograms, urograms, upper GI, BE.

1st trimester
During 2nd-10th week of pregnancy fetal anomalies can be produced: Skeletal and organ anomalies. Mental retardation. Neurological anomalies. More than 25 rads can cause spontaneous abortion.

Grid Cutoff
Grid cutoff is the lowering in the number of transmitted Photons that reach the IR due to misalignment of the grid. This will lower density. The higher the grid ratio the higher the chance for grid cutoff.

Upside down focused grid

Upside-down
The grid is placed upside-down. This appears radiographically as significant loss of density along the lateral edges.

Off-level
When the grid or tube is angled. This results in loss of density across the entire image. Can happen with both focused and parallel.

Off-focus
Occurs when SID is outside the recommended focal range, it can be greater or lesser. Loss of density at the Periphery of film.

Off-level focused grid

Off-center
Also called lateral decentering. Occurs when x-ray beam is not aligned from side to side. Loss of density overall.

Radiographic Quality

Radiographic Quality contd

Density:
The amount of overall blackness produced on the image after processing. Too white, insufficient density. Too dark, excessive density. Controlling Factors: mAs = Density Influencing Factors: kVp = Density *Too dark high density SID = Density (shorter SID, greater density) *Too light Low density Grid = Density Speed = Density Collimation Density

15% rule: changing kVp by 15% will have the same effect on radiographic density as doubling the mAs or reducing mAs by 50%. To density: 80kvP X 1.15 = 92kVp To density: 80kVp X 0.85 = 68kVp To maintain density when kVp, divide mAs by 2. To maintain density when kVp, multiply mAs by 2.

Radiographic Quality contd

Contrast:
The degree of difference between adjacent densities. High contrast few densities but great differences among them. Low kVp high contrast short-scale increase contrast black and white Low contrast large number of densitites but little differences among them. High kVp low contrast long-scale grays.

Controlling Factors:
kVp Contrast

Contrast = Short scale (Black and White). Contrast = Long scale (grays).

Foreshortening part is out of alignment Elongation angulation of x-ray tube.

Anatomic Markers 1. For AP and PA projections that include both the R and L sides of the body (head, spine, chest, abdomen and pelvis) an R marker is typically used. 2. For lateral projections of the head and trunk (head spine, chest, abdomen, and pelvis) always mark the side closest to the IR. For example if the left side is closest, use an L marker. The marker is typically placed anterior to the anatomy. 3. For oblique projections that include both R and L sides of the body (spine, chest, and abdomen) the side down, or nearest the IR, is typically marked. For example, for a right posterior oblique (RPO) position, mark the R side. 4. For limb projections use the appropriate R or L marker. The marker must be placed within the edge of the collimated x-ray beam. 5. For limb projections that are done with two images on one IR, only one of the projections need to be marked. 6. For limb projections where both the R and L sides are imaged side by side on one IR, both the R and L markers must be used to clearly identify the two sides. 7. For the AP, PA and oblique chest projections, the marker is placed on the upper outer corner so that the thoracic anatomy is not obscured. 8. For decubitus positions of the chest and abdomen, the R or L marker should always be placed on the side up (opposite the side laid on) and away from the anatomy of interest

Fingers, Hand and Wrist

Usual three positions are PA, oblique and lateral 40 SID Always use at least 60 kVp to get a better picture

Elbow
Oblique rotation may be lateral or medial depending on patient abilities Always center at elbow joint

Humerus
*AP IR 1 above head of humerus Supinate hand to make epicondyles parallel to IR Central ray perpendicular to mid humerus *Lateral Flex elbow 90o and place hand on the hip (AP) Place patient PA and holding affected arm in abdomen and oblique patient as needed.

Shoulder
*AP (external rotation) Patients back to the bucky (board) Supinate the hand and make the epicondyles parallel Central ray perpendicular, 1 inferior to the coracoid process *Grashey (Glenoid Cavity) Patients back to the bucky (board) Rotate patient 35o to 45o toward affected side *Y View Rotate patient 45o to 60o to make the scapula perpendicular to IR If PA, rotate patient towards affected side If AP, rotate patient towards unaffected side

Scapula
*AP Patient upright or supine with arm abducted making 90o with body Flex the elbow an dont rotate body to avoid oblique IR 2 above shoulder and central ray 2 below coracoid *Oblique Patient upright or supine with affected arm across the anterior chest Turn patient away from affected side 15o-25o Central ray perpendicular to lateral border *Lateral (Y View) Rotate patient 45o to 60o to make scapula perpendicular to IR If PA, rotate patient towards affected side If AP, rotate patient towards unaffected side

Foot
Center foot and adjust midline of foot parallel to long axis of IR with foot plantar surface firmly resting on IR Direct 10o posteriorly, entering base of third metatarsal for reduced elongation

Ankle
Dorsiflex foot, placing ankle at near rightangle flexion Central ray direct perpendicular to ankle joint

Knee
Center knee to IR at a level inch below apex of patella Depending on ASIS to table top measurement, direct central ray as follows:
<19 cm- 3 to 5 degrees caudad 19 to 24 cm- 0 degrees >24 3 to 5 degrees cephalad

Femur
*Proximal AP Patient supine Rotate leg 10o to 15o internally, to position femur in true AP IR at ASIS Central ray perpendicular *Distal AP Patient supine Rotate leg 10o to 15o internally, to position femur in true AP IR 2 inches below the knee joint Central ray perpendicular *Proximal Lateral Patient on affected side Upper limb posteriorly Pelvis rolled posteriorly about 10o to 15o IR at ASIS *Distal Lateral Patient on affected side Uppermost limb forward Pelvis in true lateral Flex knee 45o IR 2 inches below knee joint

Chest
*PA 72 in SID Shoulders rotated forward Deep second inspiration *Lateral Always left lateral Arms above head

Abdomen
*Supine
Center midsagittal plane to grid Center IR at level of iliac crests, ensure that pubic symphasis will be included Suspended expiration *Upright (KUB) center midsagittal plane to grid device center IR 2 inches above iliac crest to include diaphragm

Pelvis
Rotate feet and lower limbs medially 15 to 20 degrees Center IR approximately 2 inches superior to pubic symphysis and 2 inches inferior to ASIS Suspended respiration
female male

Hip
Rotate affected limb 15 to 20 degrees medially Central ray direct perpendicular to a point 2.5 inches distal on a line drawn perpendicular to midpoint of line between ASIS and pubic symphasis Suspended respiration

Cervical Spine
*Lateral Central ray: C4 (thyroid cartilage) Distance: 72 Respiration: expiration Angulation: NONE *AP Central ray: C4 (thyroid cartilage) Distance: 48 or 40 Respiration: suspended Angulation: 15o 20o cephalad *Odontoid Central ray: Middle of open mouth Distance: 48 or 40 Respiration: suspended Angulation: NONE *Swimmers (only if C7 is not visible in lateral view) Central ray: C7-T1 Distance: 48 or 40 Respiration: suspended Angulation: 5o caudal if shoulder cant be depressed *Oblique Central ray: Distance: 48 or 40 Respiration: suspended Angulation: LPO- 15o cephaldad RAO- 15o caudad

Thoracic Spine
*AP Central ray: between jugular notch and xiphoid process Distance: 48 or 40 Respiration: expiration Angulation: NONE *Lateral Central ray: T7 (inferior angle of scapula) Distance: 48 or 40 Respiration: expiration Angulation: NONE *Oblique Central ray: T7 Distance: 48 or 40 Respiration: suspended expiration Angulation: NONE Rotation: 45o

Lumbar Spine
*AP Central ray: iliac crest Distance: 48 or 40 Respiration: suspended Angulation: NONE *Lateral Central ray: iliac crest Distance: 48 or 40 Respiration: expiration Angulation: NONE *L5-S1 (Spot) Central ray: 2 posterior, 1 superior ASIS Distance: 48 or 40 Respiration: suspended Angulation: 5o-8o caudal

Sacrum and Coccyx

*AP Sacrum-patient supine and central ray 15o cephaldad centering 2 superior to pubic symphysis (at ASIS) Coccyx- patient and central ray 10o caudad centering 2 superior to pubic symphysis *Lateral Sacrum- patient laying on the side with knees and hips flexed, central ray 3 posterior and 2 inferior to ASIS Coccyx- patient laying on the side with knees and hips flexed, central ray 3 posterior and 2 inferior to ASIS

Sacroiliac Joints
*AP Patient supine without rotation of the pelvis Central ray 45o cephaldad entering 1 superior to the pubic symphysis *Oblique Both sides need to be done, LPO-RPO LPO shows right joint (side farther from IR) RPO shows left joint Elevate patient 25o -30o Central ray perpendicular, entering 1 medial from the elevated ASIS

Body Habitus
Sthenic- 50% Heart- moderate transverse Lungs- moderate length Diaphragm- moderate high Stomach- high, ULQ Colon- spread evenly; slightly dip on transverse colon Gallbladder- centered in RUQ Hypersthenic- 5% Heart- axis nearly transverse Lungs-short, apices at or near clavicles Diaphragm-high Stomach-high, transverse, and in the middle Colon-around periphery of abdomen Gallbladder-high, outside, lies more parallel Asthenic- 10% Heart- nearly vertical and at midline Lungs-long, apices above clavicles Diaphragm-low Stomach-low and medial, in the pelvis when standing Colon-low folds on itself Gallbladder- low and nearer the midline Hyposthenic- 35% Between sthenic and asthenic