Exam Review:

ABR- board exams

ABR certification, state licensure (FL included), eligibility: NEED a campemp residency,
EXAM- part 1: written (during grad school), part 2: specialty written (post residency), part 3:
specialty oral. Maintenance of certification: every 10 years another ABR exam, continuing
education.
Radiation Sources
-atomic: bremsstrahlung, charged particle into high z material, as it decelerates ejects photons
(Xray)
-continuous/linear spectra (Kramer) Emax/3=Eavg
-nuclear: nuclei (p and n) in excited state- relaxes into a lower energy state. Loss of EM radiation, a
gamma ray.
-discrete peaks
particles: a+2: discrete 5MeV, +/-: continuous 2MeV (produces a beta + and an antineutrino/beta and a neutrino), no: 0-1 MeV, p: 200 MeV accelerated for proton therapy
Photon Interactions with Matter
Radioactivity: Bq = decays/ sec, but 1 decay doesnt necessarily mean 1 particle
Absorded Dose: Gray (Gy) = (Energy Deposited)/Mass = J/Kg
Effective Dose or Whole body dose:
-Takes into account tissue weighting factors
- Unit is the Sievert (Sv); Sv = Wr * Gy
Exposure: Coulomb per mass = C/Kg
-Measure of charge created in mass air
-unit is Roentgen ( R ) = 2.5*10^-8 C/Kg
- photoelectric, - compton, K- pair
production
This graph illustrates energy dependence of
photon interactions. at low energies PE

prevails, middle energies compton and PP at higher energies (remember PP requires a 1.022
MeV threshold to occur which explains its domination in the higher energy realm)
Clinical- Diagnostic & Therapeutic
diagnostic- apply low levels of radiation to image and diagnose internal problems, mainly worried
about stochastic side effects. contrast lower energies, ~20-140 keV
therapeutic- apply higher levels of radiation to treat an existing condition, mainly worried about
deterministic effects. High Lethal doses, minimize tissue attenuation, lower contrast, higher
energies.
Machine Produced Xrays
Bremsstrahlung= radiative component of stopping power.
radiative
total

TZ
800

T= kinetic energy, z= atomic number

remainder of energy gets lost in the form of HEAT. (thermal energy)

radiative= primary concern with the production of xrays, collisional= primary concern for tissue
and dose
characteristics of Xrays: Emax is equal to the potential
difference or KE of electrons, F=qv (force on an
electron when in a field)
characteristic xrays- when electron de excite from
higher excited energy levels and drop back down to a
lower energy shell, they emit characteristic xrays.
These xrays are a function of the material. appear in
discrete peaks superimposed on the continuous
bremmstrahlung spectrum. (see image to L)
intensity: # of xrays produced, a value of quantity
Linear Accelerators
accelerated electrons along the length of a linear tube
electron gun shoots the electrons into tube and conducting material
the first plate is set with positive charges, this
forces the negatively charged electron to
accelerate towards that positive conducting
material interface. Once it is close to the
interface the polarity switches and it becomes

negative and the next segment becomes positive again forcing the electron to speed away from
that positive charge (like OPPOSES like) towards the negative. illustrated in pic above. ** we now
use microwaves to force electrons through the tube. in region of wave peaks the e- experiences a
positive field and it pushed forward, towards the peaks of the waves on the outside the electron
experiences a negative field and pushes away into absorbing medium.
microwave source: Klystron, Magnetron
bending magnets: bend the beam and direct the beam within the gandry

270 degree rotation (using bending magnets) of electrons to transmission target (thicker so it can
avoid allowing e- through) , slower e-: smaller radius, faster e-: bigger rad

Radiation Biology (HIntenlang Lecture 4) - Dan

- The body has essentially one of two types of responses to radiation : stochastic or deterministic.
Deterministic effects are quantitative, guaranteed radiation effects based on certain
threshold limits. For example, we know that , say, 50 Gy applied to a tumor x amount of
times will kill the tumor. OR a dose applied of 1-2 Gy will result in skin burns.
Stochastic radiation effects deal with those possible effects for which no certain outcome
is known, or can be applied to a population of people. For example, small amounts of
radiation administered to patients in imaging type procedures may or may not cause cancer.

The cancer rate will vary from person to person.

Chemical changes: DSB, SSB, ect. Biological Changes: skin reddening/burns
DSB- when 2 SSB occur witihin 10 base pairs of each other, require 1-2 hr to repair (THIS is
what causes radiation damage to be seen)
SSB- DNA backbone breaks, takes ~10 min to repair
Surviving Fraction (for high LET- , p, no )= eD/Do

Do~1-3 Gy

4-5 Gy is a LETHAL dose to HUMANS

~0.3-0.4 Gy background radiation/year
Fractionated doses for RT (low LET): Break RT into smaller doses and deliver over
period of about 30 days. this works because healthy cells repair better than tumor cells.
Let healthy cells repair over a day.
Dose Response: depends on dose, type of radiation, response, dose rate, cell type,
hypoxic state. Expect biological response for Low LET to be linear-quadratic function
(linear at first, quadratic later on). For High LET: expect LNT (Linear No Threshold)
response function. Some evidence points to a Linear Threshold (LT) model, as with
cataracts. Radiation Hormesis model indicates benefits at low levels of radiation.
Radiation protection uses most conservative model (LNT) for regulatory purposes.
Email Listserve Major Threads and Themes -Dan
Sadije: I remember there being a lot of emails about a company called Landauer medical starting
to do consulting, but I erased them
Since Dr. Hintenlang told us to keep an eye on major threads or themes in the email listserves, I
thought I would try to pull out some notable threads for us.
GE Essential FFDM QC manual 8. "Test for flexible paddle deflection in compression (thread started
09/25/13, 18 total messages in this thread)
Quick summary: Doug Simpson cites what he thinks is a new QA test for mammography in
the FFDM QC manual 8 which was released in March 2013. The purpose of the test in
question is to ensure that the flexible compression paddle is capable of applying effective
compression to the breast. The test procedure states that we use 2 foam phantoms of
specific shapes and material, and measure the compressed flex-paddle offset from the
breast support tray using machinist's gauge blocks.
Doug comically wonders, Where the %$#^ is the average physicist supposed to get the toys
to perform this test?

Michael Yester responded that he used relatively stiff foam and it worked fine for that test.
Another respondent suggested using an iPhone app for a level instead of having to buy a
telescoping gauge.
Dental Cone Beam CT (thread started 09/24/13, 7 total messages in the thread)

Ira Miller writes, One of my clients recently replaced their dental panoramic units with
what they told me were to be new modern pano units. They are very modern pano
units, they are actually cone beam dental cts. Does anyone have a protocol for testing
one of these. Are they classified as pano units or cts?
The consensus from the discussion was that they are in general classified as CTs, and
most places are just using CT protocols for testing. However, there are variations in
regulations based on individual states and countries. For example, Wisconsin requires
shielding plans submitted for dental CTs. In Ohio, on the other hand, Dental cone Beam
units are considered CTs. The UK has some specific guidelines on these devices.
Revisit: Dose Tracking Software (thread started 09/18/13, 11 total messages in the thread)

Quick summary:
Scott Dube revives a discussion from last year on different dose tracking software
programs utilized for tracking dose to patients in diagnostic imaging, and whether they
are really worth the cost and hassle.
Discussion highlights:
One notable software program from Radimetrics has been purchased and used by many
but a lot of people end up turning off some of the main features of the program, such as
effective dose calculations. The reason for turning this feature off is calibrated based
on a short, thin (150 lb) patient, which is not realistic for many of the patients that are
actually imaged.
Responses are mixed on dose tracking software. Some people seem to really like it and
think it is valuable. Some people think it is mostly just a waste of money (ie. Has a lot of
fancy buttons but doesnt really add much value). The reason for the latter attitude may
be that some governing body has stated that diagnostic imaging does not contribute any
real risk to patients!
Others use inexpensive, free, or in-house software for dose tracking simply to help them
comply with established laws for dose.
Landauer and Premier Healthcare (lots of threads over lots of time)

Summary:
Landauer is a large consulting company which has just entered the medical physics market.
Diagnostic Machines: X RAY Tube
Radioactive sources (non-machine) can be sealed or unsealed and are regulated by the federal
NRC
X Ray sources are machine produced (through Bremsstahlung need charged particles that are
deaccelerating)
Diagnostic X Ray Tubes (20 to 150 kv)
Therapy (MVs)
Accelerated electrons dont have a Bragg Peak, so are only good for skin level therapy
Target material is usually Tungsten, Mammography is lower energy and uses something like
Molybdenum

Characteristics of X-Rays:
-On the picture, the ideal (thick target/Kramer) spectrum would be linear, with low energy Xrays
having highest intensities
- Thin target spectrum would be if you only looked at small sections of the of the thick target
spectrum
-The max E that the lines end on is the Emax of the electrons
-Inherent filtration Low X-rays dont escape the target material

-Force on electron in electric field and magnetic field (F=qE+qvXB)

ignore the 6.3 AC volt note

How X-Ray tube works
-A current is put through the filament that heats it up and releases electrons through thermionic
emission. Filament is negatively charged cathode. (Some Xray tubes have short and long filamants
can decide which you want to use. The large gives better penetration depth of X-Rays, the small
gives better spatial resolution)
-The electrons accelerate through vacuum (a cup around filament helps with keeping away electron
back scatter)
- The Tungsten target is the anode, is beveled, it also spins to dissipate heat (so heat doesnt build
up in one spot). The bevel impacts focal spot size. Its beveled to direct X-Rays toward patient.
-X-rays exit through ground glass window, which helps to keep the field more uniform
- The entire apparatus is encased in lead

Design considerations
-

High Z material with high melting point

Appropriate energy for what you want to do

Focal spot size effects heat dissipation and resolution

Beam window- where the X-rays escape

More heat dissipation (cooling oil bath and fan)

Isolation of voltage (Need to keep insulted because lethal amount of voltage involved)

Added filtration (can add Al-about 2mm slab between patient and X-Rays to further get rid of
low E X-rays that would only contribute to dose). With added filtration you get beam hardening
because you take off even more low energy x-rays that you do with just inherent filtration
-

A hardened beam is a better quality beam

Beam quality beam is quantified through Half Value Layer

-

HVL = The thickness of material required to reduce intensity to one half its initial value

Collimators adjustable lead plates around the beam that let you square it out and control size
based on what you want to look at
Heel effect- has to do with the asymmetry of the target (Tungsten) some X-rays are more
attenuated by the target (those that are released closer to the target on the patient plane are less
intense)
Off focus radiation Caused by incorrect voltage or damaged electron cup = electrons going off in
wrong direction

Because we use AC voltage need to use generators and look at waveforms

-

Use transformer to boost voltage

Single phase sine wave, so get forward and backward motion

This is fixed by adding a diode that makes all of the function positive, but still have voltage ripple
-

Three phase use an RC circuit to your Kvp

Newer high frequency units keep kvp relatively constant

Exposure (X) = has to with amount of x-rays emitted from tube

-

Measure in R (C/kg)

X is proportional to ((kvp)^n)(mAs)/d^2

oKvp = max electron voltage, n is ideal two, in real word about 3

omA = miliamps
os = seconds
oCan change intensity by adjusting those values

SPECT (Edmond Olguin)

-Tc-99m is most common radioisotope used. Emits 140 keV gamma ray. Half life = 6hr
-Nuclear medicine uses TRACE amounts of radioisotopes (Th-201 is rat poison)
-Detector:
a)Photomultiplier tube-Converts light energy (created in scintillator detector) into an electrical
signal. Spatial resolution is improved by Hal Anger: 1 large slab of NaI with a bank of PMT behind
it. Light hits more than one tube and a gamma ray interacts with the scintillator, emits light
photons towards the PMT and hit more than one tube. Its the pattern of pulses that come out of
these more than one tubes that allows us to pinpoint the location (ie uses multiple peaks in
different PMT from one event to localize event).

SPECT attenuation effect: More attenuation in the middle of an object as opposed to the edges. (In
image, the lines should really be a straight line at 1, worse attenuation with larger objects). This
happens with myocardial perfusion (illustrates the function of the heart) and requires an
attenuation correction by using CT combined with SPECT

b)Collimator-Lead channels that allow us to determine photon trajectory and creates spatial
resolution. This collimator is necessary for SPECT. 1/10,000 photons actually pass through the
collimator and hit the detector. In SPECT, the collimator only gives us spatial resolution, NOT used
to prevent scatter. The collimator spatial resolution is proportional to: Rc proportional to d/l, The
collimator efficiency (Ec) is proportional to (d/l)^2 You want to minimize distance from source to
collimator (ie you want the detector as close to the patient as possible) See below

c)Scintillator: NaI is used most frequently. Critical issues: 1)Detector efficiency: must have high
enough stopping power to detect photons (high Z material). Detector (intrinsic) efficiency (Ei) =
1-exp(-mu*x) at 150 keV, Ei for 0.25inch NaI is about 0.85, but for the same detector, at 511 keV Ei
is about 0.1 2)Energy conversion efficiency (light output, NaI is about 50%, thus a detected xray of
140 keV will convert to about 70 keV of light). 3)Decay Time: determines how frequently you can
detect photons. System efficiency Es = Ec*Ei. Ei is defined above and Ec is the collimator efficiency
(about 1/10,000)
PET (Edmond Olguin)
Radioactive nuclide emits a beta+ particle and annihilates with a beta- (positron and electron
annihilate) and emit two photons at 180 degrees at 511keV each.
F-18 is used most frequently (110 minute half-life) usually tagged to a glucose analog: F-18
Fluoro-deoxy-glucose (FDG). Excellent because the molecule appears to be glucose and is brought
into the cell but isnt metabolized or excreted by the cell. Thus the radionuclide is placed in the cell
until it decays.
No collimator is necessary for PET. Achieves spatial resolution without collimator, because the
photons are emitted at 180 degrees. If photons hit detector within 10 ns of each other, we consider
that a coincidence event and draw a line between the two detectors to form the trajectory.
Random Coincidence Event is when two separate decays register one coincidence event and create
a wrong trajectory.
Time-of-Flight PET: Uses differences in time of arrival for a coincidence event to help localize the
decay.
PET geometric efficiency (analogous to collimator efficiency for SPECT): (Area of detector)/(Area of

sphere)
PET scintillator materials: NaI NOT used because the attenuation coefficient is low (~.3) but high
conversion efficiency (100%). BGO has excellent stopping power (~.9) but low conversion efficiency
(~12-14%). GSO/LSO is good with both: good stopping power (~.7-.8) with good conversion
efficiency (~40-75%)
PET detector efficiency: (1-exp(-mu*x))^2
2D vs 3D PET - 2D PET uses axial collimators to avoid noise from events outside the region of
interest but 3D PET is currently used because it allows you to use events that emit photons axially.
PET attenuation: exp(-mu*d), where dis the diameter or total distance of the patient/object
(Chao Guo) lecture 9 ,11
Magnification effect:

a+b
SID
Limage
Lobject = a = SOD
Spatial Resolution:
b -> smaller,
get smaller focus spot, better spatial resolution

magnification is different than Spatial resolution

f: point spread function(PSF) width

OID
f= F SOD

but PFS affected by magnification

Better spatial resolution:

1. smaller F,
2. smaller OID
3. max number of points resolved per distance

1
R = 1d = F OID
(units in

mm1 )

Two points blur together

Quantify spatial resolution:

minimum distance between two point but still resolved( not overlap)

d quantify spatial resolution

OID
d = F OID+SOD=1
= F OID

after de-magnification

better measure of spatial resolution means not affected by

magnification

f
OID
OID
d = mag
= F SOD
= F OID+SOD
Spatial resolution measurement
1. Point Spread Function
2. d (minimum distance between two point but still resolvable)
3. R = 1d

Measuring spatial resolution

1. pinhole (PSF)
2. Phantom (line pair test/ section of a star pattern)
3. Edge phantom (ESF edge spread function)

dESF(x)
= P SF (x)
dx

like PSF, ESF could be magnified

Contrast:
Without Scatter C = (P - P)/P where P is the Intensity max and P is the minimum intensity
1
with Scatter C scatter = C noscater(1+s/p
)
1
where 1+s/p
is called the contrast reduction factor

S/P is the scatter primary ratio

Mike
Detectors:

Screen Film

15% conversion efficient

Convenient and cheap
Higher spatial resolution
Dose awareness
Small dynamic range
No post processing
Degridate over time
Take up space for storage

Computed Radiography (CR)

Photostimulable Phospher Tube
Made of BaFBr, BaFI
Wider dynamic range
Reusable cartridges
Digital Radiography (DR)
Indirect
Cesium Scintillator
Produces light which cause a charge
High Detection efficiency
Lower dose needed

Digital Images and Display:

Pixel size X FWHM/2
Image Reconstruction:
Intensity on detector
I (t) = I0eu*

ln(I0/I(t)) = u * X
Matrix and Iterative Method
A 1 x m matrix of unknown Attenuation coefficients X
A m x n matrix of pixel values A
A*X equal an m x 1 matrix G, So A*X=G
Therefore X = Inverse( A )*G

 For Matlab use the pinv function to do the inverse of matrici that dont have
one
Filtered-Back Projection
Traditional Method
Fourier based
the back projection is the convolution of the image and function f
The deconvolution function of f is K( s ) = s
it De-blurs the real image
s is frequency in frequency space
its basically the line y = x but in frequency space
Example:
the real function is a square in the xy plane and a rod extending
in the z axis
then the back projection is function that fall off as
1/sqrt(x^2+y^2) extending from the z axis out towards the xy
plane
In frequency space filters can be applied
Low-pass: removes high frequency, allows low
High-pass: removes low frequencies, allows high
Combination is the Ramp Low pass
Kills very low and high frequencies