RADIOLOGY NOTES

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

C re S a ring ohe nt c tte :

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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 C pton (e-). om The incident x-ray or Photon continuesin 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 inform ation. 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.

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X-ray Interactions Contd

Photoelectric Effect:
Important for diagnostic radiology. Incident Photon interacts with an inner shell, Kshell, ejecting the (e-) form the orbit. The Photon is totally abs orbed 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

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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.

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Target Interactions

BremsstrahlungInteractions:
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.

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W e ro o isp s e : hn t r uh d

C th d S e a o e id F m n c rre t h a u th fila e t. ila e t u n e ts p e m n T ish a b ils(e -) o th fila e t, a oc lle th rm n e is io . h et o ff e m n ls a d e io ic m s n T e e(e -) g th r inac u a u dth fila e t (s a ec a e hs a e lo d ro n e m n p c h rg ). T en g tiv lyc a e h e a e h rg d fo u in c pk e sth (e cs g u ep e -) c u fo u e to e e lo d c s d g th r. T en m e o (e -) inth s a ec a eislim d(s a ec a e h u br f e p c h rg ite p c h rg ) A o eS e n d id T ero tin ta e b g stotu ra id , q ic lyre c in to s e d h ta g rg t e in rn p ly u k a h g p p e .

X-ray Production

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% .

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X-ray Production
W e ro o isp s e : hn t r uh d
C th d S e a o e id F mn c rre t h a u th fila e t. ila e t u n e ts p e mn T ish a b ils( h et o e -)o th fila e t, a oc lle th r io ice is io . ff e mn ls a d e m n m s n T e e(e -)g th rinac u a u dth fila e t ( p c c a e hs a e lo d ro n e mn s a e h rg ). T en g tiv lyc a e h e a e h rg d fo u in c pk e sth ( cs g u ep ee -)c u fo u e to e e lo d c s d g th r. T en m e o (e h u br f -)inth s a ec a eislim d( p c c a e e p c h rg ite s a e h rg ) A o eS e n d id T er ta gta e b g stotu ra id , q ic lyre c in to s e d h o tin rg t e in rn p ly u k a h g p p e .

W e e p s reb t o isp s e : h n x o u ut n u h d
C th d S e a o e id H hn g t iv c a es n lyre e (e ig e a e h rg tro g p ls -) . T e e(e -)s a a a fro th c th d a dto a sth a o e( b c rr n . hs tre m w y m e a o e n w rd e n d tu e u e t) A o eS e n d id H hp s ec a es o g a c (e ig o itiv h rg tr n ly ttra ts -)inth tu ec rre t. e b u n T e e(e -)s eth a o e hs trik e n d . X y ( %a p d c da da oh a ( -ra s1 ) re ro u e n ls e t 9 9) % .

L eF c sP c le in o u rin ip d s r e th re tio s ipb tw e th a tu l fo a s o a dth e c e e c ib s e la n h e e n e c a c l p t n e ffe tiv fo a s o c l p t. A o eh e e c n d e l ffe t: G a re c o th a o es e re te ffe t n e n d id . G a ru to4 % re te p 5 .

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X-ray interaction X-rays interact at various structural levels through five mechanisms:

Coherent scattering vs. Bremsstrahlung. 2. Compton effect. 3. Photoelectric effect vs. Characteristic interaction. 4/14/12 4. Pair Production.
1.

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.

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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

Hardener

Glutaraldehyde

Controls emulsion swelling and enhances archival quality

Sequestering agent

Chelates

Removes metallic impurities; stabilizes developing agent

Solvent

Water

Dissolves chemicals for use

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Fixing
Removes remaining silver halide from emulsion and hardens gelatin
Component Activator Fixing agent Hardener Preservative Buffer Sequestering agent Solvent

Stops the developer action

Chemical Acetic acid Ammonium thiosulfate Potassium alum Sodium Sulfite Acetate Boric acids/ salts Water

Function Neutralizes the developer and stops its action Removes undeveloped silver bromine from emulsion Stiffens and shrinks emulsion Maintains chemical balance Maintains proper pH 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

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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 4/14/12 the processor at a constant speed, it

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

1. Exposure: 1 of a sequence of events that results -ray x The st in an -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 elect moved to the ground state by an rons are intense light.

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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.

Conversi ons

Grids:
Grid ratio =Height width of interspaces. 1 2 3 4 5 6 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

S creen S peed 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 X Old mAs x (new mAs)

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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 decimal2 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 knowthe actual size:

MF = Image size Object size

S factors: ID
Old mAs = old D2 New mAs new D2

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

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Conversions contd

Density Maintenance Formula:

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

Inverse S quare Law:

I 1 = D22 I2 D21

Changingfrom 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

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Dose Limits
National Council on Radiation Protection and Measurements
Occupational exposures A. Annual A. Cumulative A. Lens of eye A. All other Public exposures A. Public exposures A. Lens of the eye
A.

mSv 50mSv/0.05Sv 10 mSv X age 150mSv/0.15Sv 500mSv/0.50Sv 1 mSv 15 mSv 50 mSv 0.5 msv/month 5 mSv 1 mSv

rem 5 rem 1 rem X age 15 rem 50 rem 0.1 rem 1.5 rem 5 rem 0.05 rem 0.50 rem 0.1 rem

mrem 5000 mrem 100 mrem 150 mrem 5000 mrem 100 mrem

Skin, hand, feet

Embryo-fetus exposures A. Equivalent dose limit A. Total gestation Student under 18 years

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Dose Limits 10 rad can cause menstrual changes in women and decrease contd
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.

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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 thelateral edg . es

Off-level
When the grid or tube is angled. This results in loss of density acrossthe entire im e ag . 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. L of density overall. oss

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Radiographic Quality

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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.

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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.

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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 4/14/12 should always be placed on the side up (opposite the side laid on) and away

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

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Elbow

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

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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.

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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) side Rotate patient 35o to 45o toward affected

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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

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If AP, rotate patient towards unaffected side

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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

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Ankle

Dorsiflex foot, placing ankle at near right-angle flexion Central ray direct perpendicular to ankle joint

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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
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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 4/14/12

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

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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
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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
female Suspended respiration male

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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

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Cervical Spine
*Lateral Central ray: C4 (thyroid cartilage) Distance: 72 Respiration: expiration Angulation: NONE *AP Central ray: C4 (thyroid cartilage) Distance: 48 or 40 4/14/12

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Thoracic Spine
*AP Central ray: between jugular notch and xiphoid process Distance: 48 or 40 Respiration: expiration Angulation: NONE *Lateral
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Lumbar Spine
*AP Central ray: iliac crest Distance: 48 or 40 Respiration: suspended Angulation: NONE *Lateral Central ray: iliac crest Distance: 48 or 40 4/14/12

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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

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Sacroiliac Joints
*AP Patient supine without rotation of the pelvis pubic *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
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Central ray 45o cephaldad entering 1 superior to the symphysis

Body Habitus
Sthenic- 50% Heart- moderate transverse Lungs- moderate length Diaphragm- moderate high Stomach- high, ULQ Colon- spread evenly; slightly dip on transverse colon
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Gallbladder- centered in RUQ

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