ELECTROMAGNETIC RADIATION

Electromagnetic radiation (EM radiation) has no mass, is unaffected by either electrical or magnetic
fields, and has a constant speed in a given medium. Although EM radiation propagates through
matter, it does not require matter for its propagation. Its maximum speed (2.998 X 108 m/sec) occurs in a
vacuum. In other media, its speed is a function of the transport characteristics of the medium. EM
radiation travels in straight lines; however, its trajectory can be altered by interaction with matter. This
interaction can occur either by absorption (removal of the radiation) or scattering (change in trajectory).
EM radiation is characterized by wavelength (A), frequency (v), and energy per photon (E). Categories of
EM radiation (including radiant heat; radio, TV, and microwaves; infrared, visible, and ultraviolet light;
and x- and gamma rays) comprise the electromagnetic spectrum (Fig. 2-1).EM radiation used in
diagnostic imaging include: (a) gamma rays, which emanate from within the nuclei of radioactive atoms
and are used to image the distribution of radiopharmaceuticals; (b) x-rays, which are produced outside
the nucleus and are used in radiography and computed tomography imaging; (c) visible light, which is
produced in detecting x- and gamma rays and is used for the observation and interpretation of images; and
(d) radiofrequency EM radiation in the FM region, which is used as the transmission and reception
signal for magnetic resonance imaging (MRI). There are two equally correct ways of describing EM
radiation-as waves and as particle-like units of energy called photons or quanta. In some situations EM
radiation behaves like waves and in other situations like particles.
Ionizing vs Nonionizing Radiation
EM radiation of higher frequency than the near-ultraviolet region of the spectrum carries sufficient energy
per photon to remove bound electrons from atomic shells, thus producing ionized atoms and molecules.
Radiation in this portion of the spectrum(e.g., ultraviolet radiation, x-rays, and gamma rays) is called
ionizing radiation. EM radiation with energy below the far-ultraviolet region (e.g., visible light, infrared,
radio and TV broadcasts) is called nonionizing radiation. The threshold energy for ionization depends on
the type of matter.
I.

INTRODUCTION
A.

Basic Model of a Neutral Atom.

Electrons(-) orbiting nucleus of protons(+) and neutrons. Same number of
electrons as protons; net charge = 0. Atomic number (number of protons)
determines element. Mass number (protons + sneutrons) gives mass in
terms of 1/12th mass of Carbon atom.

B.

Definition of Ionizing Radiation.

Ionization vs. Excitation: Excitation transfers enough energy to an orbital
electron to displace it further away from the nucleus. In ionization the
electron is removed, resulting in anion pair (the newly freed electron(-) and
the rest of the atom(+))
Ionizing Radiation: Any electromagnetic or particulate radiation capable of
producing ion pairs by interaction with matter. Scope
limited to X and gamma rays, alpha particles,beta particles
(electrons), neutrons, and charged nuclei.

Particularly important biologically since media can be altered (e.g., ionized

atom in DNA molecule may be altered, thereby causing cell death, or a
change in cell reproduction, division, or mutation).
II.

TYPES OF IONIZING RADIATIONS

A.

General Characteristics
Particulate vs. Electromagnetic Radiations: Particulate Radiations are subatomic particles with mass (e.g., alpha and Beta particles, electrons,
neutrons). EM Radiations (X-rays and gamma rays) have no mass and no
charge.
High vs. Low Energy Radiation: Absorption of radiation is the process of
transferring the energy of the radiation to the atoms of the media through
which it is passing. Higher energyradiation of the same type will
penetrate further. Usually expressed in KeV or MeV (103 or 106 electron
Volts). 1 eV = 1.6 x 10-19 Joules = 1.6 x 10-12 ergs
High vs. Low Linear Energy Transfer (LET) to absorbing material: LET is
measured by the ionization density (e.g., ion pairs/cm of tissue) along the
path of the radiation. Higher LET causes greater biological impact and
is assigned a higher Quality Factor(QF). Example QF values: X, gamma,
and beta have QF = 1; alpha QF=20; thermal neutrons QF=3; "fast" neutrons
(>10 KeV) QF = 10; fission fragments QF>20.

B.

Characteristics of Common Radiations

Alpha Particles (or Alpha Radiation): Helium nucleus (2 neutrons and 2
protons); +2 charge; heavy (4 AMU). Typical Energy = 4-8 MeV; Limited
range (<10cm in air; 60m in tissue); High LET (QF=20) causing heavy
damage (4K-9K ion pairs/m in tissue). Easily shielded (e.g., paper, skin)
so& an internal radiation hazard. Eventually lose too much energy to
ionize; become He.
Beta Particles: High speed electron ejected from nucleus; -1 charge,
light 0.00055 AMU; Typical Energy = several KeV to 5 MeV; Range approx.
12'/MeV in air, a few mm in tissue; Low LET (QF=1) causing light
damage (6-8 ion pairs/m in tissue). Primarily an internal hazard, but high
beta can be an external hazard to skin. In addition, the high speed electrons
may lose energy in the form of X-rays when they quickly decelerate upon
striking a heavy material. This is called Bremsstralung (or
Breaking) Radiation. Aluminum and other light (<14) materials and organoplastics are used for shielding.

Note: Beta particles with an opposite (+) charge are called positrons. These
quickly are annihilated by combination with an electron, resulting in gamma
radiation (see Pair Production below).
Neutrons: Neutron ejected from a nucleus; 1 AMU; 0 Charge; Free neutrons
are unstable and decay by Beta emission (electron and proton separate) with
T of approx. 13 min. Range and LET are dependant on "speed": Slow (<10
KeV), "Thermal" neutrons, QF=3, and Fast (>10 KeV), QF=10.
Shielded in stages: High speed neutrons are "thermalized" by elastic
collisions in hydrogenous materials (e.g., water, paraffin, concrete). The
nuclei which are "hit" give off the excess energy as secondary radiation
(alpha, beta, or gamma). Slow neutrons are captured by secondary shielding
materials (e.g., boron or cadmium).
X- and Gamma Rays: X-rays are photons (Electromagnetic or EM radiations)
emitted from electron orbits, such as when an excited orbital electron
"falls" back to a lower energy orbit; Gamma rays are photons
emitted from the nucleus, often as part of radioactive decay. Gamma rays
typically have higher energy (Mev's) than X-rays (KeV's), but both are
unlimited.
No mass; Charge=0; Speed = C; Long range (km in air, m in body); light
damage (QF = 1); An external hazard (>70 KeV penetrates tissue);
Usually shielded with lead or concrete (see equation for shielding
effectiveness).
Photon Interactions: Three types of indirect ionization caused by EM radiation.
Photoelectric effect: Can occur at low energies ( < .5 MeV); incoming
photon ejects an electron. Compton effect: Occurs at medium energies (.5 5 MeV); incoming photon ejects an electron and a photon with longer
wavelength. Pair production: Requires high energies ( > 1.02 MeV, usually
> 5 MeV); incoming photon ejects an electron and a positron, but positron
quickly encounters an electron and annihilates to two 0.51 MeV gamma rays
(E=Mc2).

Characteristics of X-Rays

X-rays are invisible.

X-rays are electrically neutral. They have neither a positive nor a negative charge. They cannot
be accelerated or made to change direction by a magnet or electrical field.
X-rays have no mass.
X-rays travel at the speed of light in a vacuum.
X-rays cannot be optically focused.
X-rays form a polyenergetic or heterogenous beam.

The x-ray beam used in diagnostic radiography comprises many photons that have many
different energies.
X-rays travel in straight lines.
X-rays can cause some substances to fluoresce.
X-rays cause chemical changes to occur in radiographic and photographic film.
X-rays can be absorbed or scattered by tissues in the human body.
X-rays can produce secondary radiation.
X-rays can cause chemical and biologic damage to living tissue.

X-ray Production
The production of x-rays requires a rapidly moving stream of electrons that are suddenly decelerated or
stopped. The source of electrons is the cathode, or negative electrode. Electrons are stopped or
decelerated by the anode, or positive electrode. Electrons move between the cathode and the anode
because there is a potential difference in charge between the electrodes.

Cathode

Negatively charged electrode

Consists of a filament and a focusing cup. Filament is a coiled tungsten wire that serves as the
source of electrons during x-ray production.
Most x-ray tubes are referred to as dual-focus tubes because they use two filaments; a large and
a small. Only one filament is energized at any one time during x-ray production.
Focusing cup is made of nickel and mostly surrounds the filament to focus the stream of electrons
before they strike the anode.

Anode

Positively charged electrode

Consists of a target and in rotating anode tubes, a stator and rotor.

The target stops the electrons and creates the opportunity for the production of x-rays.
The target of rotating anode tubes is made of tungsten and rhenium alloy.
Tungsten generally makes up 90% of the composition of the rotating target, with rhenium making
up the other 10%.
Rotating anodes generally have a target angle ranging from 6 to 20 degrees.\
Tungsten is used as the material of choice for the rotating targets because of its high atomic
number of 74 and a high melting point of 3370 degrees F.
Anodes rotates from 3,300 rpm to 10,000 rpm.

The components of the X-ray tube include a glass envelope containing a high vacuum.
A cathode or negative electrode which contains a tungsten filament, which when heated
emits electrons in a process called 'thermionic emission'. The cathode also has a
focussing cup to better direct the emitted electrons across the vacuum to hit the target.
The anode or positive electrode is a thick copper rod with a small tungsten target at the
end. Tungsten is required as it has a high atomic number to improve the efficiency of
bremsstrahlung x-ray production (see below), and a high melting point. There is a good
deal of heat generated and hence the need for high melting points and the copper
anode is able to conduct heat away effectively. Some machines have an oil based
cooling system ported through the anode, while others have a spinning electrode to
effectively increase the surface area. Either way, considerable heat needs to be
dissipated. A potential difference, or voltage is applied between the cathode and anode.
The tungsten filament (cathode) is heated by an independent current and the
thermionically emitted electrons are accelerated across the potential difference to a high
velocity before striking the tungsten target. The high vacuum is needed to reduce the
electron/atom collisions which waste accelerating energy. The electrons that hit the
tungsten target undergo sudden deflection because of the interactions with the tungsten
nucleus. The tungsten target is usually angled to direct the resultant xrays towards a
consistent portion or window in the tube wall.
Some additions to this basic set up include the anode hood made of copper and
tungsten that act like blinkers to prevent stray electrons from striking the walls of the
tube. The copper catches the electrons and the tungsten attenuates the photons
produced in the copper. The window is thin and made of beryllium. Beryllium is chosen
because it is a metal which has little effect on the photon beam and can effectively
maintain the vacuum.
X-Ray Production
X-rays are produced by two main mechanisms and come in two varieties - characteristic
and bremsstrahlung xrays
Characteristic xrays

Electrons are the same whether orbiting in shells around the nucleus, or produced
inside an xray generator. When ever their velocity or position is changed, there is a loss
of energy that takes a radiative form (xrays). When electrons travelling at the target
have their direction changed, a spectrum of xrays results. However the electrons
circulating in the atoms can also change.
While most of the electrons have their path changed and little else, some will collide
with electrons. Sufficient energy in such collisions can result in the ejection of an
orbiting electron. 'Sufficient energy' means enough to overcome the bonding energy of
the orbiting electron. The impacting electron will move off with reduced energy, and the
ejected electron will move off in a different direction and speed with the remaining
energy, there is an empty position in one of the shells. The remaining orbiting electrons
will 'pack down' to fill the hole, and when changing orbits will lose energy and emit this
as radiation. The orbiting levels are fixed as a physical property fixing the elemental
identity of an atom, and so the energy emission will be characteristic of that atom. The
energy will be mono-energetic and so appear as a spike rather than a continuous
spectrum. Electrons ejected come from the K, L or M orbits. The other corollary of this
type of interaction is that the atom becomes an ion (it has lost an ejected electron!).
All atoms will produce characteristic radiation but not all are visible in the xray portion of
the electromagnetic spectrum. Elements with higher atomic numbers have their K, L, M
or N shells of sufficient energy to be called 'xrays'. The discrete characteristic radiation
energies are equal to the difference in the energy level of the outer and inner orbital
electrons.
The xray energy is proportional to the atom's Z. Where the incident electrons have
energies less than the electron binding energy, there will be no characteristic radiation
emitted. As the electron energy increases past the threshold level, the maximum level of
characteristic radiation reaches 20% of total production, and then starts to fall to 10% in
the 50-100 keV range and 3% in the 200 keV range. In the megavoltage range,
characteristic radiation is negligible.
Bremsstrahlung xrays
Bremsstrahlung is a German word meaning
braking radiation which describes the process of
xray generation. The high speed electron impacts
on the target and at the atomic level approaches
the nucleus. There is no actual collision between
electron and nucleus because the electron interacts
with the Coulombic nuclear forces and its vector
quantities of direction and velocity are changed.
Since kinetic energy derives from velocity
(KE=1/2mv^2). The change in energy is radiated as
electromagnetic radiation. The amount of energy means a short wavelength within the

xray band.
As the electron is not destroyed, it can undergo multiple interactions, and even initial
interactions will vary from minor to major energy changes depending on the actual angle
and proximity of attack, and the point of 'impact' on the nucleus. As a result,
bremsstrahlung radiation will have continuous spectrum where the maximum energy
relates to the entire KE of the electron but will be infrequent. The energy spectrum
without filtration is a straight line that matches the formula

where
IE = intensity of photons of energy E
k is a constant,
Z is the atomic number of the target,
Em is the maximum photon energy which is numerically equal to the
applied kilovolts peak (kVp).
The average energy of a bremsstrahlung-derived beam is approximately 1/3 of the
maximum energy (or kVp).
The direction of bremsstrahlung xrays is decidedly horticultural. Where the energy (kVp)
of the incident electron beam is around 100 keV, bremsstrahlung production has a
spatial orientation described as 'anisotropic', that is equally in all directions.
The probability of bremsstrahlung production is proportional to the Z^2 of the target
material, and the efficiency of production is proportional to the target material Z and the
tube voltage.
Kad ti pise u ispitnim priprema za MR - Sto se tice MR
pripreme i obavljanja, znas i sama da se kontrast daje
jako retko, i da veoma mali broj ljudi ima alergiju na
njega, najbitnije je obratiti paznju na relativne i
apsolutne kontraindikacije, posebna paznja u radu sa
decom (potrebna sedacija- da ne bi dolo do
pokretanja). Trudnice u prvom trimestru ne smeju u
MR jer prilikom pregleda dolazi do zagrevanja dela tela
koji se posmatra i zato ako se pregleda abdomen
postoji opasnost od zagrevanja amnionske tenostibeba se kuva (pod navodnicima- ne mogu sad da ih
nadjem). Ako se koristi kontrast kao i kod CT bitno je
da se kontrast uhvati kada je prisutan u organizmu, verovatno su ti poznate- venska, arterijska

faza i postkontrastna kod CT, kod MR se posmatraju T1 I T2 sa ili bez kontrastta Pazi isto kod
srca- na pejsmejker i vestacke valvule.
pristup za hematuriju i koliku mislim da bi prvo trebalo uraditi nativni abdomen u potrazi za
kalkulusima koji mogu dovesti do kolika i mikro/makrohematurije, a zatim uraditi intravensku
urografiju ili uretrocistografija ako postoji sumnja na karcinom ili neku drugu patolosku promenu.
Priprema za CT je nate to jutro+ specijalna dijeta par dana u nazad, izbegavanje mahunarki
wink emoticon
Sindrom zlostavljanog deteta- najociglednije se uocava serijski prelom rebara u posteromedijalnom delu, nastaje zbog stvaranja poluge preko transferzalnih procesusa. Ovi prelomi
nastaju zbog stiskanja deteta, dokaz vidljiv posle 2 nedelje kada se uocava kalus kao znak
zarastanja. Metafizijalne frakture ugla- shake (pod navodnicima) mehanizam- su sitne frakture
koje nastaju zbog treenja udova deteta. Frakture kod sindroma zlostavljanja deteta se mogu
javiti i u predelu skapule, sternuma, klavikule, spinoznih nastavaka wink emoticon
72. Strano telo u elucu- metoda izbora je UZ- kako bi se deca sto je moguce manje zracila
RTG-om, sto se tice metala on se lepo vidi na UZ, dok se plastika ne vidi dobro. Da bi se
plastika bolje uocila potrebno je napuniti zeludac, plastika ce otici na povrsini i tako se moze
utvrditi strano telo. Aspirirana strana tela- kao sto verovatno i znas, deca sve/ stalno stavljaju
ruke u usta, tako da deci ne davati kikiriki i klikere. Ukoliko se aspirira strano telo dovodi do
hiperinflacije tog dela pluca, zaepljen bronh. Suspekcija za aspiraciju- lezanje na boku- NEMA
pada hemidijafragme.
73. Ezofagealna atrezija- nedostatak dela organa ili lumena + stvaranje traheoezofagealne
fistule i samim tim postoji opasnost od pneumonije i aspiracije pojedene hrane. Duodenalna
atrezuja- najee zahvaen D2 segment- RTG karaktreistika- DOUBLE- BUBLE znak.
76. Najei tumori kod dece su leukemije.Zatim su sledei tumori CNS, pa abdominalni tumori.
Vilmsov tumor- dobro reaguje na terapiju, tumor gornjeg pola bubrega- metastazira u pluca,
raste kao lopta- razmie sve. Neuriblastom- prati somatske ganglije, tumor nadbubrezne zlezde,
javlja se oko krvnih sudova, mogu se uociti kalcifikati u tumoru, metastaza- kosti, jetra, pluca.
Hepatoblastom- tezina bolesti zavisi od stadijuma. Teratomi- cisticna masa sa kalcifikatima.
Cisticni tumor jajnika- velika cista, superponira okolne organe, mogu ascites, ljudi misle da je
dete trudno.
vezano za 76. dijagnostika moze CT, MR, ali se preporucuje upotreba UZ zato sto glava deteta
nije okostana do zatvaranja fontanela, mogue vriti i tako dijagnostiku. OBAVEZNO znatiPleuralni izliv, ve 5 ml se dobro vidi na UZ, dok za RTG pleuralnog izliva potrebno je oko 150
ml za dijagnostiku.

77. Vezikouretralni refluks moe biti jedan od razloga hidronefroze(dilatacija pijelo-kalisnog

sistema). Naziva se jos i refluksna nefropatija- koja usled nastanka oziljaka moze progredirati u
hronicnu bubrenu insuficijenciju. Dijagnostika- mikciona uretralna cistourografija.
to se tie CNS kongenitalnih anomalija- Hidrocefalus je bitan- reavanje hidrocefalusa pomocu
Ventrikulo- peritonealnog anta, takoe takoe se spominju i horioencefaline ciste.Moe
takoe nabrojati i patoloke promene koje si u proloj poruci navela. Dijagnostika pomou UZ
kada je velika fontanela otvorena. Meduloblastom- tumor zadnje lobanjske jame- dodaj ako ga
gore nisam ranije zapisao
Neonatalna intrakranijalna hemoragija- krv- bela, hiperdenzna. Moe se javiti kod tekog
poroaja ili ako je bilo zlostavljanja trudnice ili ako je dolo do saobracajne nezgode pa je
moguc pritisak na glavu ploda. Nastaje kao posledica traume ili asfiksije i znatno ree
kodnovoroenadi koja imaju hemoragijske poremeaje ili kongenitalne vaskularne anomalije.
Traumatske epiduralna,subduralna i subarahnoidna hemoragija, najee su posledica
kraniopelvine disproporcije (kada obim glave prevazilazi karline mere), prolongiranog
poroaja, prebrzog poroaja, karline prezentacije ploda, ili mehanike pomoi pri poroaju
(forceps, vakum ekstrakcija).