Basic Circuitry

This Module about electricity, magnetism, and electromagnetism will be introducing the basic concepts
needed in the study of the x-ray imaging system and its various components. Since the main function of
the x-ray imaging system is to convert electric energy into electromagnetic energy i.e., x-rays; in which
the study of electricity, magnetism, and electromagnetism is particularly important. Electrostatics is the
science of stationary electric charges. Electrodynamics is the science of electric charges in motion.
Electromagnetism describes how electrons are given electric potential energy (voltage) and how
electrons in motion create magnetism. Magnetism has become increasingly important in diagnostic
imaging with the application of magnetic resonance imaging (MRI) as a medical diagnostic tool. This
module will describe the nature of magnetism by discussing the laws that govern magnetic fields. These
laws are similar to those that govern electric fields; knowing them is essential to understanding the
function of several components of the x-ray imaging system. Electromagnetic induction is a means of
transferring electric potential energy from one position to another, as in a transformer.

ELECTROSTATICS

Electrostatics

 The study of stationary electric charges

Matter has mass & energy equivalence. Matteralso may have electric charge!

Electric Charge

 Positive or negative
 It has potential energy
 Smallest Units: electron & proton
 Fundamental Unit (SI): coulomb (C)
 1 C: 6 x 1018 electron charges
The electric charges associated with an electron and a proton have the same magnitude but opposite signs.

Electrified

 The object that has too few or too many electrons

Electrification

 The process of adding or removing electrons from an object

 It is created by contact, friction or by induction

Electric Ground
  One object that is always available to accept electric charges from an electrified object is the
Earth.
 The object that behaves as a reservoir for stray electric charges

Electrostatic Laws

 Electric field radiates out from positive charge

 Electric field radiates toward a negative charge
 Unlike charges attract
 Like charge repel
 Uncharged particles do not have electric field

Figure 1-3: Electric fields radiate out from a positive charge (A) and toward a negative charge (B).
Like charges repel one another (C and D). Unlike charges attract one another (E). Uncharged
particles do not have an electric field (F).

Electric Field

 The lines of force exerted on charged ions in the tissues by the electrodes
 It causes charged particles to move from one pole to another
 Positive charge: points outward
 Negative charge: points toward

Electrostatic Force

 The force of attraction between unlike charges or repulsion between like charges
 Directly proportional to the product of the charges
 Inversely proportional to the square of the distance between them. That means that it is stronger
when two objects are close but decreases rapidly as the objects separate.

Coulomb’s Law

 The electrostatic force is directly proportional to the product of the electrostatic charges &
inversely proportional to the square of the distance between them
 Formula: F = k(QaQb/d2)
Electric charge distribution is uniform throughout or on the surface!
 Electric charge of a conductor is concentrated along the sharpest curvature of the surface!

Electric Potential

 Sometimes called voltage

 SI Unit: volt (V)
 1 V: 1 J/C or 1 potential energy/unit charge

ELECTRODYNAMICS

Electrodynamics

 The study of electric charges in motion

Electrical Engineer

 Work with electric current

Physicist

 Concerned with electron flow

Four Electric States of Matter

 Conductor, Insulator, Semiconductor, Superconductor

Conductor

 Any substance through which electrons flow easily

 Characteristics:
o Variable resistance
o Obeys Ohm’s law
o Requires voltage
 Examples: copper (Z=29), aluminum (Z=13) & water

Insulator

 Any material that does not allow electron flow

 Characteristics:
 o Does not permit electron flow
o Extremely high resistance
o Necessary with high voltage
 Examples: glass, rubber & clay

Semiconductor

 A material that in some conditions behave as an insulator & as a conductor

 Characteristics:
o Can be conductive
o Can be resistive
o Basis for computers
 Examples: silicon (Si-14) & germanium (Ge-32)

Superconductor

 Any material that allows electrons to flow without resistance

 Characteristics:
o No resistance to electron flow
o No electric potential required
o Must be very cold
 Examples: niobium (Nb-41) & titanium (Ti-22)

Resistance decreases as the temperature of material is reduced!

William Shockley (1946)

 He demonstrated semiconduction

Superconductivity (1911)

 The property of some matter to exhibit no resistance below a critical temperature

Table 1-1: Summary of the Four Electrical States of Matter

State Material Characteristics
Niobium No resistance to electron flow
Superconductor
Titanium No electric potential required
Must be very cold
Copper Variable resistance
Conductor Aluminum Obeys Ohm’s law
Requires a voltage
Semiconductor Silicon Can be conductive
 Germanium Can be resistive
Basis for computers
Rubber Does not permit electron flow
Insulator
Glass Extremely high resistance
Necessary with high voltage

Electric Circuits

 The path of electron flow from the generating source through the various components & back
again

Increasing electric resistance results in areduced electric current!

Electric Current/Electricity

 The flow of electrons through a conductor

 Direction: always opposite the electron flow
 It is measured in Amperes (A)
 1 A: 1 C/s or 1 electric charge/second

Electric Potential

 It is measured in volts (V)

 1 V: 1 J/C or 1 potential energy/unit charge

Electric Resistance

 It is measured in ohms (Ω)

Ohm’s Law

 The voltage across the total circuit or any portion of the circuit is equal to the current times the
resistance
 Formulas: V = IR; R = V/I; I = V/R

I R
Two Basic Types of Electric Circuits

 Series & Parallel Circuits

Series Circuit

 All circuit elements are connected in a line along the same conductor

Rules for Series Circuit

 The total resistance is equal to the sum of the individual resistances.

 The current through each circuit element is the same and is equal to the total circuit current.
 The sum of the voltages across each circuit element is equal to the total circuit voltage.

Parallel Circuit

 Elements are connected at their ends rather than lying in a line along a conductor

Rules for Parallel Circuit

 The sum of the currents through each circuit element is equal to the total circuit current.
 The voltage across each circuit element is the same and is equal to the total circuit voltage.
 The total resistance is the inverse of the sum of the reciprocals of each individual resistance.

Table 1-2: SYMBOLS & FUNCTION OF ELECTRIC CIRCUIT ELEMENTS

Circuit Elements Symbol Function
Resistor Inhibits flow of electron

Battery Provides electric potential

Capacitor Momentarily stores electric charge

Ammeter Measures electric voltage

Voltmeter Measures electric potential

Turns circuit on & off by providing
Switch
infinite resistance
Increases & decreases voltage by
Transformer
fixed amount (AC only)
Variable resistor
Rheostat
Allows electron to flow only in one
Diode
direction

Direct Current

 Electrons that flow in only one direction

Alternating Current (AC)

 Electrons that flow alternately in opposite direction

 60-Hz current

Waveform

 The graphic representation of a wave

 x-axis: time
 y-axis: amplitude of electric current
 AC: sinusoidal
 DC: straight line

Electric Power

 It is measured in watts (W)

 1 W: 1 A (current) x 1 V (voltage)
 Formulas: P = IV = I2R
 P = IV where P is the power in watts, I is the current in amperes, and V is the electric potential
in volts; alternatively, P =IV =IIR therefore, P= I2R where R is resistance in ohms.

Question:

If the cost of electric power is 10 centavos per kilowatt-hour (kW-hr), how much does it cost to operate
a 100-W light bulb an average of 5 hours per day for 1 month?
Answer:

Total time = (30 days/mo) (50hr/day)

= 1,500hr/mo

Total power = (1,500hr/mo) (100 W)

consumed =150,000 W-hr/mo

= 150 kW-hr/mo

Total cost = (150 kW-hr/mo) (10 centavos/kW-hr)

= Php1,500/mo

Question:

An x-ray imaging system that draws a current of 80 A issupplied with 220 V. What is the power
consumed?

Answer:

P = IV

= (80 A) (220 V)

= 17,600 W

= 17.6 kW

Question:

The overall resistance of a mobile x-ray imaging system is 10Ω. When plugged into a 110-V receptacle,
how much current does it draw and how much power is consumed?

Answer:

P = IV

= (11A)(110 V)

= 1210 W

or P = I R
= (11A) 10

= 1210 W

MAGNETISM

About 1000 bc, near the village of Magnesia(what is now Western Turkey), shepherds and dairy
farmers discovered magnetite, an oxide of iron (Fe3O4). Magnetite is a rodlike stone, when suspended
by a string, would rotate back and forth; when it came to rest, it pointed the way to water therefore it
was called a lodestone or leading stone. Of course, if you walk toward the North Pole from any spot-on
Earth, you will find water.

Magnetism is imaginably more difficult to understand than other characteristic properties of matter,
such as mass, energy, and electric charge, because magnetism is difficult to detect and measure. We can
feel mass, visualize energy, and be shocked by electricity, but we cannot sense magnetism.

Magnetite

 Oxide of iron (Fe3O4)

 Lodestone or leading stone

Magnetism

 The fundamental property of some forms of matter

 It has no smallest unit

Any charged particle in motion createsa magnetic field!

Electron Spin

 A property created when electrons behave as if they rotate on its axis

 It is neutralized in electron pairs
 It creates a magnetic field
The lines of a magnetic field are always closed loop!

Magnetic Moment

 A nuclear magnetic dipole created when magnetic field is created by spinning electric charge
 The basis of MRI
 Dipolar/Bipolar

 A magnet that has two poles

 Poles: north & south pole

Magnetic Dipole

 The small magnet created by the electron orbit

Magnetic Domain

 An accumulation of many atomic magnets with their dipoles aligned

 In Ferromagnetic Material: randomly oriented

Magnetic Permeability

 The ability of a material to attract the lines of magnetic field intensity

Magnets are classified according to the origin of the magnetic property!

Three Principal Types of Magnets

 Naturally occurring magnets

 Artificially produced permanent magnets:
 Electromagnets

Natural Magnet

 A magnet that gets its magnetism from the Earth

Permanent Magnet

 A magnet whose magnetism is induced artificially

 A bar or horseshoe-shaped magnet
 Example: compass

Electromagnet

 A coil or wire wrapped around an iron core that intensifies the magnetic field

All matters can be classified to the manner in which it interacts with the external magnetic field!
Four Magnetic States of Matter

 Nonmagnetic, Diamagnetic, Paramagnetic, & Ferromagnetic

Nonmagnetic

 Unaffected by magnetic field

 Example: wood & glass

Diamagnetic

 Weakly repelled from both poles of a magnetic field

 Example: copper, water & plastic

Paramagnetic

 Weakly attracted to both poles of a magnetic field

 Example: Gadolinium (Gd-64): contrast agent in MRI

Ferromagnetic

 It can be strongly magnetized

 Example: alnico (Al-12, Ni-28, Co-27) & iron (Fe-26)

Table 1-3: Four Magnetic States of Matter

State Material Characteristics
Unaffected by a magnetic
Nonmagnetic Wood, glass
field
Weakly repelled from both
Diamagnetic Water, plastic
poles of a magnetic field
Weakly attracted to both
Paramagnetic Gadolinium
poles of a magnetic pole
Ferromagnetic Iron, nickel, cobalt Can be strongly magnetized

Magnetic Susceptibility

 The degree to which a material can be magnetized

Wood

 Low magnetic susceptibility

Iron

 High magnetic susceptibility

Hysteresis

 A condition wherein some materials that are very susceptible are also reluctant to lose their
magnetism

Pole

 The magnetically charged end of a material

 North & south poles

Magnetic Laws

 Like magnetic poles repel

 Unlike magnetic poles attract
 Imaginary lines of magnetic field leave the north pole
 Imaginary lines of magnetic field enter the south pole

Magnetic Induction

 The process of making ferromagnetic material magnetic

Magnetic Lines of Induction

 The imaginary magnetic field lines

Soft Iron

 An excellent temporary magnet

Ferromagnetic objects can be made into magnets by induction!

Magnetic Force

 The force of attraction between unlike poles or repulsion between like poles
 Directly proportional to the product of the magnetic pole strengths
 Inversely proportional to the square of the distance between them

Magnetic Field Strength

 SI Unit: tesla (T)

 Older Unit: gauss (G)
 1 T: 10,000 G
 ELECTROMAGNETISM

Luigi Galvani (1700’s)

 He observed that a dissected frog leg twitched when touched by two different metals

Alessandro Volta

 He Contributed on the development of battery

 Voltaic Pile: precursor of modern battery
o A copper-zinc plates like a Dagwood sandwich
 Modern Battery: carbon rod (+) & zinc cylindrical can (-)

Source of Electromotive Force

 Any device that converts some form of energy directly into electric energy

Ferromagnetic objects can be made into magnets by induction!

Hans Oersted (1820)

 He demonstrated that electricity can be used to generate magnetic fields

Any charge in motion induces a magnetic field!

Right Hand Rule

 It determines the direction of the magnetic field

Solenoid

 A coil of wire

Electromagnet

 A current-carrying coil of wire wrapped around an iron core

 It intensifies the induced magnetic field
 Advantage: magnetic field can be adjusted or turned on & off

Electromagnetic Induction

 An electric current is induced in a circuit if some part of that circuit is in a changing magnetic
field
  e.g. radio reception

Michael Faraday

 He observed the current in a changing magnetic field

Faraday’s Law

 The Faraday’s First ElectromagneticLawstates thatany change in the magnetic field of a coil of
wire will cause an emf to be induced in the coil.

FARADAY’S FIRST LAW

The magnitude of the induced current depends
on four factors:
1. The strength of magnetic field
2. The velocity of the magnetic field as it
moves pass the conductor
3. The angle of the conductor to the magnetic
field
4. The number of turns in the conductor

Varying magnetic fieldTRANSFORMER

intensity induces an electric current!

Electromagnetic Devices

 Electric motor,
 Electric Generator &
 Transformer

Electric Motor

 Electric current produces mechanical motion

 The type of motor used with x-ray tubes is an induction motor

Induction Motor

 A type of motor used with x-rays tubes

 It powers the rotating anode of an x-ray tube
An induction motor powers the rotating anode of an x-ray tube.

Electric Generator

 Mechanical motion produces electric current

 Commutator Ring: switches the direction of current through the loo
 Transformer

 It changes the intensity of alternating voltage & current

 It works on AC only
 There are no moving parts.
 It transfers energy from one circuit to another.
 There are no electrical connections between the two circuits.
 DC: induces no current in the secondary coil

Transformer Law

 The change in voltage is directly proportional to the ratio of the number of turns (windings) in
the secondary coil (Ns) to the number of turns in the primary coil (Np)
 Formula: Vs/Vp = Ns/Np

Transformer Types According to Voltage Level

 Step-up Transformer
 Step-down Transformer

Step-up Transformer

 Turns ratio greater than 1

 Primary Side: low voltage, high current
 Secondary Side: high voltage, low current

Step-down Transformer

 Turns ratio less than 1

 Primary Side: high voltage, low current
 Secondary Side: low voltage, high current

ransformer because the voltage is increased or stepped up from the primary side to the secondary side. When the turns rati
Transformer Law Effect on Current
 A change in current & a change in voltage are inversely related
 Formula: Is/Ip = Np/Ns = Vp/Vs

Types of Transformer According to their Construction

 Closed-core,
 Autotransformer &
 Shell-type

Closed-core Transformer

 A square core of ferromagnetic materials built up of laminated layers of iron

 It helps to reduced energy losses caused by eddy current
 Result: greater efficiency

Autotransformer

 It consists of one winding of wire & varies in voltage & current by self-induction
 It is located in the operating console that controls the kVp

Shell-type Transformer

 It confines more of the magnet field lines of the primary winding

 Rationale: the secondary is wrapped around it & there are essentially two closed cores
 Advantage: more efficient than closed-core transformer

POWER LOSSES

Four Different Categories of Power Losses

 Copper Loss
 Core Loss
 Stray Loss
 Dielectric Loss
 Transformer losses are created by the current flowing in the coils and the magnetic field alternating in the co

COPPER LOSS

 Also called as “Ohmic Loss” or “Variable Loss” or “Resistive Loss” or “Winding Loss”
 It is located in the operating console that controls the kVp
 Power loss due to resistance of the conductor

CORE LOSS

 is known as “Magnetizing current Loss” or “Constant Loss”

 caused by the generated alternating flux in the transformer core
 Sub-type: Eddy Current Loss and Hysteresis

Eddy Current Loss

 Current that opposes the magnetic field that induced it, creating a loss of transformer efficiency
 Caused by the changing magnetic field in the transformer core
 It can be reduced by using core thin lamination

Hysteresis Loss
 Current that opposes the magnetic field that induced it, creating a loss of transformer efficiency
 Caused by the changing magnetic field in the transformer core

STRAY LOSS
  Caused by the magnetic leakage flux which produces in the metallic part of the transformer such
as a transformer tank, winding, etc.

DIELECTRIC LOSS

 Caused by the insulating material and insulation such as transformer oil. It rarely occurs as
compared to the core and copper losses.
 A the insulated degenerates the efficiency of the transformer is decreased.
 THE X-RAY IMAGING SYSTEM

X-RAY TUBE FAILURE

 Factors Affecting X-ray Tube Life

 Increased:
o Minimum radiographic factors – mA, kVp & exposure time
o Faster image receptors
 Decreased:
o Excessive heat

Three Ways of Heat Dissipation

 Radiation
o The transfer of heat by the emission of infrared radiation

 Convection
o The transfer of energy from one area of an object to another

 Convection
o The transfer of heat by the movement of a heated substance from one place to another

Causes of Tube Failure

 A single excessive exposure

o Causes: pitting & cracking
 Long exposure time causes excessive heating of the anode
o Results: damage to the bearings on the rotor assembly
o Causes: warping & rotational friction of the anode
 Vaporization of the filament:
o Causes tungsten to coat the glass/metal enclosure
o Causes: arcing
 “ The most frequent cause of abrupt tube failure is electron
arcing from filament to enclosure due to vaporized tungsten! “

THE X-RAY CIRCUIT

 The x-ray circuit can be divided into three portions:

1. The low-voltage, or primary, circuit contains most of the devices found on the control
console.
2. The filament circuit varies the current sent to the filament to provide the required mA
value.
 3. The high-voltage, or secondary, circuit includes the high voltage transformer,
rectification system, and x-ray tube.

Schematic Diagram of an X-ray Imaging System

THE X-RAY CIRCUIT SECTIONS

OPERATING/CONTROL CONSOLE

 Control unit
 provides for control of line compensation, kVp, mA, and exposure time.
 are based on computer technology.
 Controls and meters are digital, and techniques are selected with a touch screen. Numeric
technique selection is often replaced by icons indicating the body part, size, and shape
OPERATING CONSOLE

 Operating consoles are based on computer technology. Controls and meters are digital, and
techniques are selected with a touch screen. Numeric technique selection is often replaced by
icons indicating the body part, size, and shape

CONTROL CONSOLE CIRCUIT

OPERATING CONSOLE

 The console will have controls for:

o mA and time or mAs
o kVp
o Focal Spot Size
o Line Voltage Compensator
o Automatic Exposure Control (AEC)

Line-Voltage Compensator

 At the bottom left is the controls for line voltage compensation.

 This functions to automatically adjust for any fluctuations in incoming voltage supply. A
uniformly consistent and accurate voltage supply is required for predictable radiographic results.

Autotransformer

 The autotransformer is designed to supply voltage of varying magnitude to several different

circuits of the x- ray machine including both the filament circuit and high voltage circuits.
 The autotransformer has only one winding and one core.
 The single winding has a number of connection or electric taps
kVp Selector

 Most consoles will have one or two knobs that change the taps on the autotransformer for major
and minor kVp.
 Setting the desired kVp will determine the voltage applied to the step-up transformer in the high
voltage section of the machine.
 kV major (in increments of
 10) and kV minor (in increments of 2)

mA Selector

 The tube current, the number of electrons crossing from the cathode to anode per second is
measured in milliapmeres (mA).
 The quantity of electrons is determined by filament temperature.
 Voltage is provided by taps of the autotransformer. This voltage is reduced with precise resisters
to a value corresponding to the mA stations available

mA Control

 Tube current is usually not continuously variable, usually only currents of 50, 100, 150, 200 &
300 mA and higher are provided.
 The voltage is then delivered to the filament transformer. The filament transformer lowers the
voltage so it is called a step down transformer.
 The selection of the small or large filament is connected to the mA selection or as a separate
control.

Exposure Timers

 For any given radiographic examination, the number of x- rays reaching the image receptor is
directly related to the tube current and the time that the tube in energized.
 The timer circuit is separate from the other main circuits.
 It consists of a mechanical or electronic device whose action is to make and break the high
voltage across the tube on the primary side of the high voltage section.

Other functions on the Control Console

 The console will also have the exposure button or buttons.

 The prep button is depressed to prepare the tube for exposure.
 The rotor will spin up to 3400 RPM.
Exposure Button

 A green light will let you know that the machine is ready to make the exposure.
 The exposure button is then depressed and the exposure is initiated.
 The button must be held down until the exposure is complete.
 The exposure control buttons are referred to as a “Dead man Switch”
 After the buttons are released, the rotor motor reverses and the rotor reduces speed.
 During the exposure you will hear an audible tone so you will know that the exposure is in
progress.

HIGH VOLTAGE SECTION

 The high voltage section converts low voltage from incoming power to kilo- voltage of the
correct wave form.
 It consists of three primary sections:
o High voltage step up transformer
o Filament Transformer
o Rectifiers ( Diodes)
 All components immersed in oil.

High Voltage Transformer

 The high voltage transformer is a step- up transformer.

 The only difference between the primary and secondary waveforms is the amplitude.
 The turn ratio for most x-ray high voltage transformers is between 500 and 1000.
 Incoming Volts converted to output:
o Kilovolts.

Voltage Rectification

 Transformers operate with alternating current.

 Remember that x-ray tubes operate on direct voltage (electron moving in one direction).
 The process of rectification prepares the current for x-ray production by ensuring that it flows
in the right direction, in this case from the filament to target.
 To convert AC to DC we use rectifiers.

Self-Rectification

 A reference to the fact that electrons cannot flow from anode to cathode in an x-ray tube
 X-ray tube serves as the vacuum tube rectifier
 Same waveform as half-wave
 60 pulses/second
Half-Wave Rectification

 The voltageis not allowed to swing negatively during the negative

half of its cycle
 Diodes: 0, 1 or 2
 60 pulses/second
 Disadvantages:
o It wastes half the supply of power
o It requires twice the exposure time

Full-Wave Rectification

 The negative half-cycle corresponding to the inverse voltage is reverse

 Diodes: 4
 120 pulses/second
 Advantage:
o Exposure time reduced in half

Primary or Low-Voltage Circuit Devices

 Primary Coil of the High-Voltage Transformer

o The primary coil of the high-voltage transformer is the final component of the primary,
or low-voltage, circuit. The low voltage entering the primary coil is stepped up to high
kilovoltage in the secondary coil by means of mutual induction.

 Exposure Switch
o The exposure switch is a remote control switch that functions to start the x-ray exposure
(the timer terminates the exposure).

Primary or Low-Voltage Circuit Devices

 kV Selector
o This is used by the radiographer to choose the kilovoltage, often as kV major (in
increments of 10) and kV minor (in increments of 2). In doing so, the appropriate
number of coils on the autotransformer are selected by the movable contact.

 Timer
o Timers function to regulate the length of x-ray exposure. Very simple timers such as the
mechanical, synchronous, and impulse timers are rarely used in x- ray equipment
manufactured today because they do not permit very fast, accurate exposures.

HIGH VOLTAGE GENERATOR

 Responsible for increasing the output voltage from the autotransformer to the kVp necessary for
x-ray production.
X- RAY TUBE SECTION

 Where thermionic emission is happening.

 Where x-rays are produced
 FLUOROSCOPY

FLUOROSCOPY

 refers to the use of an X ray beam and a suitable image receptor for viewing images of processes
or instruments in the body in real time.
 to provide real-time dynamic viewing of anatomic structures while the x-ray tube is energized.
 Invented by Thomas A. Edison in 1896.

Plain Radiography

 good Signal to Noise Ratio (SNR), poor Temporal Resolution

Fluoroscopy

 poor SNR, good Temporal Resolution

Fluoroscopic Equipment

 Components:
o High Voltage Generator
o X-Ray Tube (XRT)
o X-Ray Image Intensifier (XRII)
o Video Camera

The Fluoroscopic Imaging Chain

The Fluoroscopic Imaging Chain

 Large spot 1-1.2mm (0.3-0.6mm for radiography)

 Low current 1-3mA (200-800mA for radiography)
 Long exposure ~10 mins (<1sec radiography)
 XRII converts:
o low intensity X-ray photon fluence to high fluence of Visible Photons
 Input Phosphor converts: X-Rays to Light
 Most commonly used phosphor: CsI(Tl) crystals grown in a dense needle-like structure -
prevents lateral light spread
 Photocathode converts: Light to Electrons
 Light photons strike a very thin bi- or multi-alkali photocathode
 Electrons:
o Released through photoelectric effect
o Repulsed from photocathode
o Accelerated towards anode by 25-30 kV
 Electron beam focused by electrodes onto a thin powder phosphor e.g. ZnCdS:Ag (P20)
 Photoemission – is electron emission that follows light stimulation.Output Phosphor
converts: Electrons to Light

Intensification - two mechanisms:

 Electronic (or Flux) Gain

o ratio of the number of light photons at the output phosphor to the number of x-rays at the
input phosphor
o KE gained by electrons from acceleration (~50 photoelectrons typically)
 Minification Gain
o reduction of large X-ray image at Input Phosphor (e.g. 40 cm) to a smaller diameter
Output Phosphor (e.g. 2.5 cm) 402/2.52 = 256
 Brightness Gain
o (Electronic Gain).(Minification Gain)
 Optical System couples XRII to video camera
 includes:
o Collimating Lens - to shape the divergent light from the Output Phosphor
o Aperture - to limit the amount of light reaching the video camera
o Lens - to focus the image onto the video camera
o Video Camera captures the XRII output image, and converts it to an analogue electrical
signal that conforms to a recognized video format (e.g. NTSC/PAL/SECAM)
o Older Video Cameras - Photoconductive target scanned by electron beam
o Modern Video Cameras - Charge-Coupled Device (CCD)

Photoconductive Video Cameras

 Resistivity of the photoconductive target changes based on the amount of light striking it
 Creating a Latent Image of the XRII output phosphor
 As the Electron Beam is scanned rapidly across the target, its intensity is modulated by this
latent image
 The resulting small current is integrated across a large resistance and converted to a voltage
that is amplified
 Fundamental characteristics include:
o LAG
 Describes the Speed of response of the video camera to a changing signal
 High lag can result in blurred images of moving objects, but noise will be
reduced through Temporal Integration
o SIGNAL-TO-NOISE RATIO (SNR)
 Cameras with low SNR contribute to increased noise levels in fluoroscopic
images - temporal integration can reduce this
 Maximum SNR is achieved when a video camera is operated near its maximum
signal level - important that Aperture set accordingly
 AUTOMATIC PROCESSOR

4 Steps of Processing

 Developing – formation of the image

 Fixing – stopping of development, permanent fixing of image on film
 Washing – removal of residual fixer
 Drying – warm air blowing over film

Systems of the Automatic Processor

1. Transport System
2. Temperature control system
3. Recirculation system
4. Replenishment system
5. Dryer system
6. Electrical system

Transport System

 Film fed on feed tray in darkroom

 Entrance rollers grab film and draw it into developer
 Entrance rollers separate slightly, film passes between rollers activating microswitch controlling
replenishment of chemicals
 When film completely in developer tank bell ring or light flicks on – safe to turn on light
 Orientation of film when placed in processor important- transversely along side rails of feed tray
 Transport system carries film through developer, fixer, wash tank and dryer
 Rollers
o Transport rollers – front and back positions in racks, 1inch in diameter
o Turnaround Assembly – 3 inch roller
master roller
o Planetary Rollers surround master roller
 Transport Racks
o Support rollers and turnaround
assemblies
o Can be removed for cleaning
 Drive Motor
o Electric motor & a system of gears
chains, sprockets, belts and pulleys
provide power & motion in transport
system

Temperature Control System

 Maintains developer, fixer & dryer temperature

Processing Temperatures
 Developer 35° C
Fixer 35 ° C
Wash 32-35 ° C
Dryer 57 ° C

Recirculation System

 Controlled by recirculation pumps that agitate solutions to keep them mixed to maintain
constant temperature
 Circulation of water required to wash residual fixer (12 litres per minute)

Replenishment System

 Fixer & developer levels drop as films processed

 system replaces lost chemicals
 Microswitch of entrance rollers starts replenishment pump – stops when film exits entrance
rollers
 Placing films transversely stops excess waste of chemicals
 Typical replenishment rates: 60-70 mls of developer, and 100-110 ml of fixer for for every 14
inches of x- ray film (per 35 x 43cm crosswise fim)

Dryer System

 Dries the film before its removal for viewing

 If not dry, difficult to hang on viewing box
 Consists of blower, ventilation ducts, vented dryer tubes & exhaust system
 Blower draws in air from room and passes it over heating coils
 Heated air enters ventilation ducts & dryer tubes & then blows over film
 Moist warm air vented

Electrical System

 Electrical circuits to power drive motors and temperature control system

 Requires qualified technician to work on system

Processing Rates

 Amount of time it takes a film to go through processor – ranges from 45-210 seconds
 Film manufacturers determine temperatures and replenishment rates

Processing Times
 Developer 20-25secs
Fixer 20
Wash 20
dryer 25-30

Daylight Automatic Processors

 Enable film to be processed without need for darkroom

 Special cassettes
 Increase in department efficiency, no need for special darkroom staff
 Disadvantages – cost, mechanical breakdowns

Maintenance

 To maintain quality attention needed in 3 areas:

1. Quality control
2. Processor cleanliness
3. Basic operation

 Need to regularly monitor:

o Temperature of developer
o Replenishment of film area
o Speed of development cycle (dwell time)
o Film drying temperature

 Areas of concern:
o Oxidation build up on gears, rollers, tanks
o Crossover guides – wash daily
o Algae build up in wash tank – wash weekly
o Dirt and dust build up in dryer
o Structural frame, panels & lid
o Entry & feed tray area- clean feed tray
o Oxidisation build up in replenisher tanks

Daily Check Up

 Before starting:
o Remove lid, check chemistry levels
o Shut wash tank water valve, stand pipe in
o Turn on water to desired flow rate
o Check for seized rollers (water to free)
o Power on
o Observe agitation and replenisher pumps operating
 o Wait for developer temperature to reach set point

QC

 Daily QC performed and recorded.

 This process will be discussed in full next year

Developer

\Fixer

Processor
Faults

 Longitudinal Scratches - ? Guide plates in the racks

 Pie Lines – marks caused by chemicals partially drying on rollers – marks at repeated intervals
equal to diameter if roller
 White or black spots – breakdown of hard surface of roller
 Drying Marks – seen in reflected light – dull longitudinal lines in direction of travel – dust or
dirt blocking air in drying tubes
 PRINCIPLES OF EQUIPMENT MAINTENANCE

MAINTENANCE

 A collective of technical and management actions appropriate for retaining an

item/part/equipment in, or restoring it to a given condition

Importance of Equipment Maintenance

 Continuous Service
 Extend machine life
 Cost efficiency
 Safety
 Conserve the environment
 Meets legal Requirements

Categories of Equipment Maintenance

1. Preventive Maintenance
2. Predictive Maintenance
3. Reactive Maintenance
4. Scheduled Maintenance

Preventive Maintenance

 All actions carried out on a planned, periodic, and specific schedule to keep an item/equipment
in stated working condition through the process of checking and reconditioning.
 These actions are precautionary steps undertaken to forestall or lower the probability of failures
or an unacceptable level of degradation in later service, rather than correcting them after they
occur.
 It makes repair unnecessary
 Advantage:
o Planned – time and cost
o No emergency
o Increases machine lifespan and accuracy
 Disadvantage:
o Initially expensive to set up
o Is very labor intensive.
o May be unnecessary

Predictive Maintenance

 The use of modern measurement and signal processing methods to accurately diagnose
item/equipment condition during operation
Corrective Maintenance

 The unscheduled maintenance or repair to return items/equipment to a defined state and carried
out because maintenance persons or users perceived small deficiencies or small failures.
 A failure in the system
 The worst kind
 Advantage:
o Maximum productivity
o Cost not incurred until a breakdown
o Less work interruption
 Disadvantage:
o Abrupt work stoppage
o Shortens machine life
o Leads to multiple equipment failure

Scheduled Maintenance

 Routine procedures that are performed usually weekly or monthly

 Usually done by the radiologic technologists
 Simple ways of equipment maintenance
 Advantage:
o May minimize repairs
 Disadvantage:
o May interrupt work in the early morning

X-ray Tube Warm Up

 At the beginning of each exam session or any time the x-ray unit has been turned off for two
hours or longer, it is necessary to warm up the machine before making full exposures

1. Switch on the breaker and High Voltage Generator

2. Turn on the X-ray Machine (Control Console)
3. Adjust the technical factors, 80 kVp; 3.2 mAs
4. Activate the rotor, and make one exposure
5. Pause for 20 seconds.
6. Increase kVp by increments of 10.
7. Repeat until reaching 110 kVp.
8. If you expect to use more than 120 kVp, after 110 kVp add 5 kVp. Make the exposure
and pause for 20 seconds. Repeat until it reaches 125 kVp
 THE PATIENT CARE PARTNERSHIP- UNDERSTANDING EXPECTATIONS, RIGHTS
AND RESPONSIBILITIES

BRIEF HISTORY OF THE PATIENT CARE PARTNERSHIP

 The American Hospital Association’s (AHA) Management Advisory presented A Patient’s Bill of
Rights that was first adopted by the AHA in 1973
 It was revised and approved by the AHA Board of Trustees in October of 19992

PATIENT BILL OF RIGHTS 1992 (AHA)

1. Considerate and respectful care;
2. Be informed completely and understandably;
3. Refuse treatment
4. Have an advance directive (e.g., a living will, health care proxy), describing the extent of care
desired;
5. Privacy
6. Confidentiality
7. Review his or her records (access to his/her health care information);
8. Request appropriate and medically indicated care and services;
9. Know about institutional business relationships that could influence treatment care;
10. Be informed of, consent to, or decline participation in proposed research studies;
11. Continuity of care
12. Be informed of hospital policies and procedures relating to patient care, treatment, and
responsibilities.

 The AHA recently replaced the Patient’s Bill of Rights with The Patient Care Partnership-
Understanding Expectations, Rights, and Responsibilities.
 The Patient Care Partnership- Understanding Expectations, Rights and Responsibilities includes
the essentials of the Bill of Rights in plain-language and reviews what patients can/should
expect during a hospital stay

WHAT TO EXPECT DURING YOUR HOSPITAL STAY:

 High quality hospital care
 A clean and safe environment
 Involve in your care
 Protection of your privacy
 Help when leaving the hospital
 Help with your billing claims
HIGH QUALITY HOSPITAL CARE
 First priority is to provide you the care you need, when you need it, with skill, compassion, and
respect
 Patient tells their caregivers if they have concerns about their care or if they have pain
 The right to know the identity of caregivers
 Whether they are students, residents, or other trainees

A CLEAN AND SAFE ENVIRONMENT

 Hospitals use special policies and procedures to avoid making mistake in care
 Free from neglect and abuse, and
 Right to information about anything unexpected that occurred during the hospital stay

INVOLVEMENT IN YOUR CARE

 It elaborates on patient discussion/understanding of their condition and treatment choices with
their physician,
 The patient’s responsibility to provide complete and correct information to the caregiver
 Understanding who should make decisions for the patient if the patient cannot make those
decisions (including “living will” or “advance directive”)

ADVANCE HEALTH CARE DIRECTIVE/LIVING WILL

 Preserves a person’s right to make decisions regarding their own health care
 Names the individual authorized to make all health care decisions for them
 Can include specifics regarding DNR, DNI, and other end-of-life decisions

PROTECTION OF YOUR PRIVACY

 Respects the confidentiality of patient’s relationship with their doctor and other caregivers
 Sensitive information about patient’s health and health care that are part of that relationship
 Patients will receive a notice of privacy practices that describes the ways that we use, disclose,
and safeguard patient information and that explains how you can obtain a copy of information
from our records about your care.

HELP WHEN LEAVING THE HOSPITAL

 Patient’s can expect to receive information and, where possible, training about the self-care
you will need when you go home
 Availability of and/or instruction regarding follow-up care

HELP WITH YOUR BILLING CLAIMS

 Hospital staff will help patients by:
 Filing claims with insurance companies,
 Providing patient physicians with required documentation,
 Answering patient questions, and

 Assisting those without health coverage

 PATIENT SAFETY AND INCIDENT MONITORING MECHANISM

BACKGROUND OF PATIENT SAFETY

 The modern patient safety movement began in the last few years of the 20 th century and has
gained momentum through the first two decades of the new century
 Major reports from the United States of America, and the United Kingdom of Great Britain and
Northern Ireland, put focus on the avoidable harm or accidents in health facilities
 Around the same time, a series of observational studies in different countries assessed the
extent of so-called “medical errors” in hospital inpatient care
 Public concern about the level of avoidable harm during patient care, many health care systems
around the world launched programs aimed at improving patient safety
 A of many health systems is to greater empower patients and their families so that they play an
important role in identifying sources of risk and potential harm and helping to design safer
systems

CLASSIFICATION OF PATIENT SAFETY

1. Near miss - an incident that did not reach the patient
 Ex. A unit of blood being connected to the wrong patient’s intravenous line, but the error
was detected before the transfusion started

2. No harm incident - one in which an event reached a patient, but no discernible harm resulted
 Ex. If the unit of blood was transfused, but was not incompatible

3. Harmful incident - an incident that results in harm to a patient

 Ex. The wrong unit of blood was transfused, and the patient died from a hemolytic reaction

REPORTING SEEN AS CENTRAL TO SAFETY IMPROVEMENT

Reporting systems fulfill one or more of five main functions:

 Public accountability
 Response to the patient and families involved
 Communications alert route
 Barometer of risk within health care
 Foundation for learning and improvement
WEAKNESSES OF MOST REPORTING SYSTEMS IN HEALTHCARE
Underreporting

 This depends on the prevailing culture and whether incidents are considered as an opportunity
to learn or as a basis for enforcing individual accountability and apportioning blame

Volume of Report
 In such circumstances there may be insufficient time, resources and expertise dedicated or
committed to carrying out the analysis required

RESPONDING TO PATIENT SAFETY INCIDENT REPORT (Ito ay yung inverted triangle)

1. Future harm Prevented

2. Action plan
3. System insights
4. Causal investigations
5. Report assessed
6. Incident reported

A POSITIVE ENVIRONMENT FOR REPORTING

 Reports are encouraged and valued, and staff are praised for participating
 Education and training have equipped staff with an understanding about how systems fail, how
harm occurs in health care, and how the impact of both can be reduced

 Where there is an atmosphere of blame and retribution, reporting and learning will not flourish.
Patients are likely to be a greater risk in such services because mistakes will not be admitted

IDENTIFICATION AND RECORDING OF INCIDENTS

 It is important that staff are absolutely clear as to what constitutes an incident
 Identifying and recording that an incident has occurred is the very first step in a reporting and
learning process
 Most reporting systems have a clear policy on whether reports are made voluntarily or are
mandatory

The recording or capturing of information about incidents usually takes place in one of four main ways (which
will vary between settings of different resource levels):

 On a paper reporting form with or without addition of later documentation

 On a paper reporting form with information subsequently transferred by a data clerk to an
electric record
 Directly by the reporter into an electronic record
 Into an electronic record after follow-up work that may have involve further information
gathering or investigation before data entry
IDENTIFICATION AND RECORDING OF INCIDENTS
Capture and assemble information in three main domains:

 Description (what happened), including patient characteristics, incident characteristics and

location
 Explanation (why it happened), including perceived causes of the event, contributing factors
and mitigating factors
 Remedial measures (the actions that were taken as a result), including reviewing processes and
procedures, redesign, educational, measures and organizational changes

USES OF INCIDENT REPORTS

 To formulate action (or reduce the risk of) a similar incident in the care setting where it
occurred
 To communicate information that could lead to the prevention of a similar incident elsewhere
in a country’s health system or globally
 To aggregate with other reports to produce larger volumes of data capable of providing the
maximum possible understanding of the problems in the system that led to the harm (or risk of
harm)
 For research, development and improvement
 For public reporting and accountability
 For open disclosure to patients and families

REVIEW AND INVESTIGATION OF INDIVIDUAL INCIDENTS

 Understanding why and how an incident happens involves establishing why and how errors
occur within the context of complex systems and what part human behavior plays in this
process
 A system has been defined as “an interacting combination, at any level of complexity, of people,
materials, tools, machines, software, facilities, and procedures designed to work together for a
common purpose”.
 Ways to understand and engage with systemic risk. Looking at the defenses, at the causes, or at
the interaction
 “When an adverse event occurs, the important issue is not who blundered, but how and why
the defenses failed
 Three ways to understand and engage with systemic risk:
 Looking at the defenses
 At the causes, or
 At the interaction

DEFENSE
 The swiss cheese model: system weaknesses and defenses
 The weaknesses in defenses, latent failures or unseen deficiencies within a complex system that
can result in an incident
 “When an adverse event occurs, the important issue is not who blundered but how and why
the defenses failed”.
CAUSES
 Accidents and incidents can be examined across a wide field to build up a list of the
antecedents or contributory factors to an error that should be looked for in any investigation,
for example:
 Individual operator
 Multi-operator teams
 Equipment
 The organization and its management
 The regulator
 Societal and cultural factors
 In health care, the technique of root cause analysis has become regarded as the gold standard
in investigation

INTERACTIONS
 Incidents and accidents in complex systems are seen to result from more than one, usually
multiple antecedents that interact in a complex way

ASSESSMENT OF PATIENT SAFETY INCIDENT REPORTS (Ito yung chart na circle)

1. Review individually
2. Study in aggregate
3. Investigate fully

REVIEW AND INVESTIGATION OF INDIVDUAL INCIDENTS

 Patients and families should be provided with support and care after an event
 Staff involved in serious incidents should receive counselling and support in the aftermath of
the events that led to the harm

SYSTEMIC INSIGHTS FROM AGGREGATED INCIDENT DATA

 When examining aggregated patient safety incident data, always aim to understand the way the
system is exposing patients to the risk of harm
 Use analyses to identify major sources of risk opening a window onto a problem and enabling a
major review and subsequent strategy to reduce risk and harm
 Addressing system weaknesses on this scale will generally reduce a risk rather than eliminating
it entirely
 Use analyses to probe deviations from best practices in patient safety
 Establish procedures to review aggregated patient safety incident reports in order to identify
new sources of harm, particularly those with serious impact on patients
LEARNING, FORMULATING ACTION AND MANAGING CHANGE
 Staff should understand that devising a solution to reduce risk, or the likelihood of recurrence
of an incident, is a complex task requiring extensive discussion and expert advice
 Action should be based on the principle that technical interventions and their implementation
are two distinct though interrelated processes
 Technical interventions are the specific, evidence-based procedures or technologies that are
capable of making an improvement however. Their successful implementation depends on a
positive social system
 Patient safety alerts, warnings, and advisory notices should be appropriately designed and
piloted, and their communication targeted well
 MAGNA CARTA OF PATIENT’S RIGHTS AND OBLIGATIONS

Right to Good Quality Health Care and Humane Treatment

 Every person has a right to a continuity of good quality Health Care without discrimination and
within the limits of the resources, manpower and competence available for health and medical
care. In the course of such care, his human dignity, convictions, integrity, individual needs and
culture shall be respected.

Right to Dignity

 The Patient's dignity, culture and value shall be respected at all times in medical care and
teaching. Likewise, terminally ill patients shall be entitled to humane terminal care to make
dying as dignified and comfortable as possible.

Right to be Informed of His Rights and Obligations as a Patient

 It shall also be the duty of Health Care Institutions to inform Patients of their rights as well as of
the institution's rules and regulations that apply to the conduct of the Patient while in the care
of such institution. These rights and rules and regulations shall be posted in a bulletin board
conspicuously placed in a Health Care Institution

Right to Choose His Physician / Health Institution

 The Patient is free to choose the services of a physician or health institution of his choice except
when he chooses to be confined in a charity ward. In this case, the attending physician shall be
the consultant under whose service the patient was admitted as appearing in the Doctor's
Order Sheet of the Medical Record, the Patient shall have the right to seek a second opinion
and subsequent opinions, if necessary, from another physician or health institution, and to
change his physician or health institution.

Right to Informed Consent

 The Patient has a right to self- determination and to make free decisions regarding
himself/herself, however, the attending physician shall inform the Patient of the I consequences
of his/her decisions.
Right to Refuse Diagnostic and Medical Treatment

 The Patient has the right to refuse diagnostic and medical treatment procedures, provided hat
the following conditions are satisfied;

1. The Patient is of legal age and is mentally competent;

2. The Patient is informed of the medical consequences of his/her refusal;
3. The Patient releases those involved in his care from any obligation relative to the
consequences of his/her decision; and
4. The Patient's' refusal will not jeopardize public health and safety.

Right to Refuse Participation in Medical Research

 The Patient has the right to be advised of plans to involve him/her in medical research that may
affect the care or treatment of his/her condition. Any proposed research shall be performed
only upon the written informed consent of the Patient.

Right to Religious Belief and Assistance

 The Patient has the right to receive spiritual and moral comfort, including the help of a priest or
minister of his/her chosen religion. He/she also has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs, subject to the limitations described in
paragraph 6 of this Section.

Right to Privacy and Confidentiality

 The patient has the right to privacy and protection from unwarranted publicity. The right to
privacy shall include the patient's right not to be subjected to exposure, private or public, either
by photography, publications, video-taping, discussion, or by any other means that would
otherwise tend to reveal his person and identity and the circumstances under which he was, he
is, or he will be, under medical or surgical care or treatment.
Confidential information can be disclosed in the following cases:

1. When the patient's medical or physical condition is in controversy in a court litigation and the
court, in its discretion, orders the patient to submit to physical or mental examination of a
physician;
2. When public health or safety so demands;
3. When the Patient, or in his incapacity, his/her legal representative, expressly gives tlie consent;
4. When the patient's medical or surgical condition is discussed in a medical or scientific forum for
expert discussion for I his/her benefit or for the advancement of science and medicine;
Provided however, that the identity of the Patient should not be revealed; and
5. When it is otherwise required by law.

Right to Disclosure of, and Access to Information

 In the course of the patient's treatment and hospital care, the Patient or his/her legal guardian
has the right to be informed of the result of the evaluation of the nature and extent of his/her
disease. Any other additional or further contemplated medical treatment on surgical procedure
or procedures shall be disclosed and may only be performed with the written consent of the
patient.

Right to Correspondence and to Receive Visitors

 The Patient has the right to communicate with his/her relatives and other persons and to
receive visitors subject to reasonable limits prescribed by the rules and regulations of the
Health Care Institution.

Right to Medical Records

 The patient, upon his/her request, is entitled to a medical certificate and clinical abstract.
He/she has the right to view, and obtain an explanation of, the contents of his/her medical
records from the attending physician, except for psychiatric notes and other incriminating
information obtained about a third party.
Right to Health Education

 Every person has the right to health education that will assist him in making informed
choices about personal health and about available health services. The education shall
include information about healthy lifestyles and about methods of prevention and early
detection of illnesses. The personal responsibility of everybody for his own health should
be stressed.

Right to Leave Against Medical Advice

 The Patient has the right to leave a hospital or any other Health Care Institution
regardless of his physical condition; Provided, that:
 He/she is informed of the medical consequences of his/her decision;
 He/she releases those involved in his/her care from any obligation relative to the
consequences of his/her decision; and
 His/her decision will not prejudice public health and safety.

Right to Express Grievances

 Every Patient has the right to express valid complaints and grievances about the care and
services received and to know the disposition of such complaints, in accordance with
Sections 7-8 of this Act.
 RADIOBIOLOGY

TOPICS OUTLINE
• Human biology
• Fundamental Principles of Radiobiology
• Molecular and Cellular Radiobiology
• Deterministic Effects of Radiation
• Stochastic Effects of Radiation

RADIOBIOLOGY
• The study of the effects of ionizing radiation on biologic tissue
• Ultimate goal: to accurately describe the effects of radiation on humans
• Dose-response relationships: develop to predict the effects & manage accidental exposure
• Diagnostic Radiology: concern with stochastic effects of radiation

DOSE RESPONSE RELATIONSHIPS

• A mathematical &graphic function that relates radiation dose
to observed response
• Used to provide the basis for radiation dose management
activities

Important Applications:
– Used to design therapeutic treatment routines for patient
with cancer
– Provides the basis for radiation control activities
Two Characteristics:
1. Threshold or nonthreshold
2. Linear or nonlinear (S-type)

LINEAR DOSE RESPONSE RELATIONSHIP

• The response is directly proportionate to the dose
• Lower Dose: lower response
• Higher Dose: higher response

NONLINEAR DOSE RESPONSE RELATIONSHIP

• The response is not directly proportional to the dose
• Variable responses from variable doses
• Low dose: variable responses
• High dose: variable responses

THRESHOLD DOSE RESPONSE RELATIONSHIP

• The level below which there is no response
• At DT: the threshold dose
– Intersects the dose axis greater than zero
• Below D T: no response is observed

NONTHRESHOLD DOSE RESPONSE RELATIONSHIP

• Any dose, regardless of its size, is expected to produce a response
• Intersects the dose axis at zero or below
• Indicates that no level of radiation can be considered completely safe

LINEAR-NONTHRESHOLD
• Basis for radiation protection guidelines
• Basis for current dose limits
• The results of extrapolation
• Radiation-induced cancer
• Single-hit chromosome aberration

LINEAR-NONTHRESHOLD
• Stochastic effects of radiation
– Radiation-induced leukemia
– Radiation induced genetic effect/damage
– Radiation-induced malignant disease
– Radiation-induced thyroid cancer
– Radiation-induced life-span shortening
– Chronic lymphocytic leukemia

NONLINEAR-NONTHRESHOLD
• Multi-hit chromosome aberration

NONLINEAR THRESHOLD
• Deterministic effects of radiation
– Radiation-induced cataracts
– Acute radiation syndrome
– Radiation-induced death
– Skin effects from high-dose fluoroscopy

ATOMIC COMPOSITION OF THE BODY

 60.0% Hydrogen
 25.7% oxygen
 10.7% carbon
 2.4% nitrogen
 0.2% calcium
 0.1% phosphorus
 0.1% sulfur
 0.8% trace elements

Note: Radiation interacts at the atomic level

MOLECULAR COMPOSITION
 80% water
 15% protein
 2% lipids
 1% carbohydrates
 1% nucleic acid
 1% other

TISSUE COMPOSITION
  43% muscle
 14% fat
 12% organs
 10% skeleton
 8% blood
 6% subcutaneous tissue
 4% bone marrow
 3% skin

FIVE PRINCIPAL TYPES OF MOLECULES

• SIMPLE MOLECULE: WATER
• MACROMOLECULES:
– PROTEINS
– LIPIDS
– CARBOHYDRATES
– NUCLEIC ACIDS

WATER
• The simplest & the most abundant molecular constituent in the body
• 80% of human substance
• Delivers energy to the target molecules
• Contributes to radiation effects
• End product of catabolism (+CO2)

RADIOLYSIS OF WATER
• Dissociation of water into other molecular products as a result of irradiation
• The principal radiation interaction in the body (indirect effect)
• Final Result:
– Ion pair (H + & OH -)
– Two free radicals (H * & OH *)

EFFECTS OF IRRADIATION OF WATER

• Atom of water (H2O) is irradiated
– H2O + radiation
– HOH + & e-
• The ion pair may rejoin into a stable water and no damage occurs
– HOH + & e-= H2O
• If the ions do not rejoin, the negative ion (e-) will be attached to another water molecule
– H 2O + e- = HOH

EFFECTS OF IRRADIATION OF WATER

• HOH + & HOH - are very unstable and can dissociates into smaller molecules
– HOH + = H + & OH*
– HOH - = OH - & H*
• Formation of
– Ion pair (H + & OH -)
– Two free radicals (OH* & H*)

FREE RADICALS FORMED DURING RADIOLYSIS OF WATER

• HYDROGEN PEROXIDE (H2O2)
• HYDROPEROXYL RADICAL (HO*2)

HYDROGEN PEROXIDE(H2O2)
• Poisonous to the cell & therefore acts as a toxic agent
• The principal damaging product of radiolysis of water
• Formed by combination of two OH*
– OH*+OH*=H2O2
• Formed by combination of two Hydroperoxyl radicals
– HO*2+HO* 2 = H2O2+O2

HYDROPEROXYL RADICAL (HO*2)

• The principal damaging product of radiolysis of water
• Formed by combination of H* and oxygen (O2)
– H*+ O2 =HO*2

PROTEIN
• Organic macromolecules
• Purpose:
– Structure & support (muscles)
– Enzymes
– Hormones & antibodies
Protein = AA—AA—AA—AA.. where AA is the amino acid, and – is the peptide bond.

PROTEIN SYNTHESIS
• The metabolic production of proteins
• Used 22 amino acids
• A critical cellular function necessary for survival
• Dependent on nucleic acids
Note: occurs in much more abundance than nucleic acids synthesis

LIPIDS
• Organic macromolecules
• Found in cell membrane
• Purpose:
– Provides fuel for the body by providing energy stores
– Thermal insulator from the environment
Note: lipids can be catabolized into glucose but with great difficulty

CARBOHYDRATES
• Organic macromolecules
• Purpose:
– Provides fuel for cell metabolism
– Provides also shape and stability
• Glucose:
– A simple sugar
– The ultimate molecule that fuels the body
NUCLEIC ACIDS
• The rarest, very complex and very large macromolecule in the body
• Function: growth & development of the cell (protein synthesis)
• Two Principal Nucleic Acids: DNA & RNA
– Important to cell metabolism

DNA
• The most critical & radiosensitive target molecule
• The command center or control molecule for cell function
• Concentrated in the nucleus of a cell
• Contains all the hereditary information that represents a cell or whole individual (germ cell)
RNA
• Molecules that are involved in the growth and development of a cell (protein synthesis)
• Two Types:
– messenger RNA (mRNA)
– transfer RNA (tRNA)

NUCLEIC ACIDS
-DNA
Location: nucleus
Sugar component: deoxyribose
Base component: thymine
Configuration: double helix
-RNA
Location: cytoplasm; nucleus (some)
Sugar component: ribose
Base component: uracil
Configuration: single helix

NITROGENOUS ORGANIC BASES

• One of four different nitrogen-containing attached to each deoxyribose molecule
• Purines: adenine & guanine
• Pyramidines: thymine & cytosine

SEQUENCE OF BASE BONDING

• Adenines bonded to thymines
• Cytosines bonded to guanines
• Nucleotides: the base sugar-phosphate combination

HUMAN CELL
CELL FUNCTIONS
• Absorbs all molecular nutrients through the cell membrane
• Purpose:
– For energy production
– For molecular synthesis (e.g Protein Synthesis)

CELL PROLIFERATION
• The act of a single cell or group of cells to reproduce & multiply in number
General Types:
-- Somatic cells: Mitosis

-- Genetic/germ cells: Meiosis

CELL DIVISION
1. MITOSIS
2. MEIOSIS

MITOSIS
• Somatic cells
• Process of somatic cell division wherein a parent cell divides to form two daughter cells
identical to the parent cell

Four Phases of Cell Cycle

– Interphase
• G1 phase
• S phase
• G2 phase
-- M phase
Four Subphases
• Prophase
• Metaphase
• Anaphase
• Telophase

INTERPHASE
• The period of growth of the cell between divisions
• Cell growth before mitosis
• Chromosomes: not visible

G1 PHASE (11 hrs)

• Pre-DNA synthesis phase
• DNA is in the molecular double helix form
• The gap in cell growth between M & S
• The most time variable of cell phases

S PHASE (8 hrs)
• The DNA-synthesis phase
• DNA: replicated into two identical daughter
• Chromosomes: replicate from a two-chromatid structure to a four-chromatid structure

G2 PHASE (4 hrs)
• The post DNA-synthesis phase
• Cell growth continues

M PHASE (1 hr)
• The most radiosensitive phase in cell cycle
• Fraction of surviving cells is lowest
• Chromosomes
– Become visible, divide & migrate

NOTE
• DNA is in a double helix form during G1 phase
• G1 phase is the most time variable cell cycle
• DNA replication occurs in S phase
• G1-S Phase is the next most radiosensitive phase after M phase
• Late S Phase is the most radioresistant cell cycle
• M Phase is the most radiosensitive cell cycle

METAPHASE
• Nucleus elongates
• Chromosomes:
– Appear & lined up along the equator of the nucleus

PROPHASE
• The nucleus swells/enlarges
• DNA:
– Becomes more prominent
– Begins to take structural form

ANAPHASE
• Chromosomes:
– Each splits at the centromere
– New chromosome migrates toward the spindle
– Two complete sets of chromosomes

• Centromere & Chromatids:

– Connected by a fiber to the poles of a nucleus
– The number of chromatid per centromere is reduced by half

TELOPHASE
• The final segment of mitosis
• Division complete
• Separates the two sets of genetic material
• 46 chromosomes in each new somatic cell

• Chromosomes:
– Characterized by the disappearance of structural chromosomes into a mass of DNA
• Nuclear Membrane:
– The closing off of the nuclear membrane like a dumbbell into two nuclei
• Cytoplasm
– Divided into two
MEIOSIS
• Genetic/germ cells (sperm or ovum)
• The process of germ cell division that reduces the chromosomes in each daughter cell to half
the number of chromosomes in the parent cell
• Cell division that halves the number of chromosomes in each cell

RESPONSE TO RADIATION IS RELATED TO CELL TYPE

RADIOSENSITIVITY CELL TYPE

HIGH Lymphocytes
Spermatogonia
Erythroblasts
Intestinal crypt cells
INTERMEDIATE Endothelial cells
Osteoblasts
Spermatids
Fibroblasts
LOW Muscle cells
Nerve cells

LAW OF BERGONIE & TRIBONDEAU

• Jean Bergonie & Louis Tribondeau (1906)
• Theorized & observed that radiosensitivity was a function of metabolic state of tissue being
irradiated

INCREASED RADIOSENSITIVE INCREASED RADIORESISTANT

Stem cells Mature cells
Younger tissues & organs Older tissues & organs
Tissues with high metabolic activity Tissues with low metabolic activity
High proliferation rate for cells Low proliferation rate for cells
High growth rate for tissues Low growth rate for tissues

PHYSICAL FACTORS THAT AFFECT RADIOSENSITIVITY

• LINEAR ENERGY TRANSFER (LET)
• RELATIVE BIOLOGIC EFFECTIVENESS (RBE)
• PROTRACTION
• FRACTIONATION

LET (Linear Energy Transfer)

• A measure of the rate at which energy is transferred from ionizing radiation to soft tissue
• Another Method of:
– Expressing radiation quality
– Determining the value of the radiation weighting factor (WR)
• Used in radiation protection

• Expressed in: keV/μm

– Kiloelectron volt of energy transferred per micrometer of track length in soft tissue
• Diagnostic X-rays: 3 keV/μm
• As LET Increases:
– Ionization occurs frequently
– Increases the ability to produce biologic damage (RBE)
– Increases the probability of interaction with the target molecule
• Determines the magnitude of RBE and OER

RADIATION WEIGTHING FACTOR

• Factor used in radiation protection that accounts for
differences in biologic effectiveness between different
radiations
• Former Name: quality factor

WEIGTHING FACTOR FOR VARIOUS TISSUES

TISSUE TISSUE WEIGHTING

FACTOR (W1)
GONAD 0.20
ACTIVE BONE MARROW 0.12
COLON 0.12
LUNG 0.12
STOMACH 0.12
BLADDER 0.05
BREAST 0.05
ESOPHAGUS 0.05
LIVER 0.05
THYROID 0.05
BONE SURFACE 0.01
SKIN 0.01

RBE (RELATIVE BIOLOGIC EFFECTIVENESS)

• Ratio of the dose of standard radiation necessary to produce a given effect to the dose of test
radiation needed for the same effect

Diagnostic X-rays: 1
• Lower RBE (less than 1): those radiations with lower LET than diagnostic x-rays
• Higher RBE (greater than 1): those radiations with higher LET than diagnostic x-rays

TWO WAYS OF LENGTHENING THE TIME OF IRRADIATION

1. PROTRACTION
2. FRACTIONATION

PROTRACTION
• The dose is delivered continuously but at a lower dose rate
• Example:
– 6 Gyt (600 rad) in 3 minutes @ 2 Gyt/min (lethal for a mouse)
– 6 Gyt (600 rad) delivered @ 10 mGyt/hr for 600 hrs (the mouse will survive)
OXYGEN EFFECT
• Tissue is more sensitive to radiation when irradiated in the oxygenated or aerobic state than
when irradiated under anoxic or hypoxic state
• Note: diagnostic x-ray imaging is performed under conditions of full oxygenation

OXYGEN ENHANCEMENT RATIO (OER)

• The ratio of the dose necessary to produce a given effect under anoxic conditions to the dose
necessary to produce the same effect under aerobic conditions

AGE
• Radiosensitivity varies with age
• Before Birth: most radiosensitive to radiation effect
• After Birth: radiosensitivity to radiation decreases
• Maturity: most radioresistant to radiation effect
• Old Age: become somewhat more radiosensitive to radiation effect
• Note: very young and very old individuals are more sensitive to radiation

RECOVERY
• The combined processes of intracellular repair and repopulation by surviving cells
• Interphase Death: occurs when the cell dies before replicating

CHEMICAL AGENTS
• Modify the radiation response of cells, tissue, and organs
• Radiosensitizers and radioprotectors
• Pre-irradiation Application: very effective
• Post-irradiation Application: does not alter the degree of radiation response

RADIOSENSITIZERS
• Sensitizing agents
• Agents that enhance the effect of radiation
• Examples:
– Halogenated pyrimidines
– Methotrexate
– Actinomycin D
– Hydroxyurea
– Vitamin K

RADIOPROTECTORS
• Agents that reduces the effect of radiation
• Radioprotective compounds include molecules that contain a sulfhydryl group (sulphur and
hydrogen bound together)
• Not found human application
• Examples:
– Cysteine
– Cysteamine

THEORY OF HORMESIS
• Theory that suggests that very low radiation doses may be beneficial.
• A little bit of radiation is good for us or beneficial
• Less than 100 mGyt (10 rad): no human radiation responses have been observed

EFFECTS OF RADIATION ON CELLS

• No response
– Most effect on cells
– Because of recovery and repair metabolic processes
• Cellular transformation
– May result in stochastic effect at the human level
• Cell death
– May result in deterministic effect at the human level

EFFECTS OF RADIATION ON CELLS

• Chromosome breakage
• Reproductive death (1-10 Gyt)
• Apoptosis (few cGyt)
• Mitotic or genetic death (1-10 Gyt)
• Mitotic delay (0.01 Gyt)
• Interference with function
• Instant death (1000 Gyt)
IRRADIATION OF MACROMOLECULES
• Main-chain scission
• Cross-linking
• Point lesion

MAIN-CHAIN SCISSION
• The breakage of the backbone of the long-chain macromolecules
• Results:
– Reduction of a long, single molecule into many smaller molecules
– Reduces the size of the macromolecules
– Decreases the viscosity of the solution

CROSS-LINKING
• Process of side spurs created by irradiation & attached to a neighboring macromolecules or to
another segment of the same molecule
• Result:
– Increases the viscosity of the macromolecular solution

POINT LESIONS
• Molecular lesions of DNA
• Change or loss of a base
• Not detectable
• Results:
– Minor modification of the molecule
– Malfunction within the cell
– Abnormal gene
• Can be produced by free radicals

EFFECTS OF RADIATION DAMAGE TO DNA

• Visible chromosome aberrations (DNA severely damage)
– Dicentric formation
– Terminal deletion
– Ring formation

• No visible chromosome aberrations

Malignant Disease
-- Due to abnormal metabolic activity (uncontrolled rapid proliferation)
 Genetic Effects
-- Due to damage to germ cells

GROSS STRUCTURAL RADIATION RESPONSE TO DNA

- Main-chain scission with only one side rail severed

-Main-chain scission with both side rails severed

-Main-chain scission and subsequent cross-linking

-Rung breakage causing a separation of bases

• Note: all of these responses are reversible

GROSS STRUCTURAL RADIATION RESPONSE TO DNA

• Change in or loss of a base

• Note: may not be reversible

DIRECT EFFECTS
• If the initial ionizing event occurs on the target molecule (DNA)

INDIRECT EFFECTS
• If the initial ionizing event occurs on a distant, noncritical molecule
• The principal effect of radiation on human
• The energy is transferred to the target molecule
• Amplified when oxygen is present
– Rationale: additional free radicals formed

TARGET THEORY
• For a cell to die after radiation exposure, its target molecule must
be inactivated
• Used to represent cell lethality
• Target: an area on the cell occupied by the target molecule or by a sensitive site on the target
molecule
HIT
• An ionization that inactivates the target
• Occurs when radiation interacts with the target molecule (inactivate)
• Occurs through both direct & indirect effect

CELL SURVIVAL KINETICS

• Very Low Radiation Doses:
– Cell survival is nearly 100%
• High Radiation Doses:
– Fewer cells survive
• Two Models of Cell Survival:
– Single-Target, Single-Hit Model
– Multi-Target, Single-Hit Mode

Note: The lethal effects of radiation are determined by observing cell survival, not cell death.

SINGLE-TARGET, SINGLE-HIT
• It applies to biologic targets such as enzymes, viruses & bacteria
• It applies to high LET irradiation (alpha particles, neutrons)
• Can be described using wet square analogy
• Wasted Hit: when a given square was hit by two or more raindrops

NOTE: irradiation of mammalian cells with high –LET radiation follows the single-target, single-
hit model

POISSON DISTRIBUTION LAW

• When the number of raindrops is equal to the number of squares, 63% of the squares will be
wet, and 37% of the squares will be dry
• If the raindrops had fallen uniformly, all squares would become wet with raindrops
D37
• When the radiation dose reaches a level sufficient to kill 63% of the cells (37% survival)
• A measure of the radiosensitivity of the cell
• Low D37: highly radiosensitive
• High D37: highly radioresistant

MULTI-TARGET, SINGLE-HIT
• It applies to more complicated biologic system such as human cells
• It represents a threshold
• It applies to low LET irradiation (x-rays)
• Can be described using wet square analogy

MULTI-TARGET, SINGLE-HIT
• DQ: the threshold dose
– Large DQ : the cell can recover readily from sublethal
radiation damage
• DO: the mean lethal dose
– Large DO : indicates radioresistant cells

DETERMINISTIC EFFECTS
• Early effects of radiation exposure
• A radiation response in human within a few days to
months
• Produced by high radiation doses
• Biologic response whose severity varies with radiation dose
• Exhibit increasing severity with increasing radiation dose
• Dose-response Relationship: nonlinear, threshold

NUCLEAR POWER ACCIDENTS

• Chernobyl in April 1986
• Three Mile Island, Pennsylvania in March 1970
• Tsunami-induced Nuclear Reactor Meltdown at Fukushima, Japan in 2011
• Note: employment in the nuclear power industry is a
safe occupation

ACUTE RADIATION SYNDROME

• Acute Radiation-Induced Lethality
• Radiation sickness that occurs in human after the whole-body dose s of 1 Gy (100 rad) or
more of ionizing radiation delivered over a short time
• The sequence of events that follow high-level radiation exposure leading to death within days
or week
• Dose-response Relationships: nonlinear-threshold

LD 50/60
• The whole body radiation dose that causes 50% of irradiated subjects to die within 60 days
• It quantitatively measured the acute radiation lethality
• Humans:
– 3.5 Gyt (350 rad)
• Maximum Tolerated:
– 8.5 Gyt (850 rad)
– With clinical support
• 1 Gyt (100 rad): no one is expected to die

• >6 Gyt (600 rad): all those irradiated die unless vigorous medical support is available
• >10 Gyt (1000 rad): even vigorous medical support does not prevent death

MEAN SURVIVAL TIME

• Average time between exposure & death
• Increased whole body dose: decreases mean survival time

• Hematologic Syndrome:
– Dose dependent
– 60 days to 4 days
• GI Syndrome:
– Remain constant
– Constant at 4 days
• CNS Syndrome:
– Dose dependent
– 3 days to hours

SKIN EFFECTS
• Radiation-induced erythema
• Dry and moist desquamation
• Epilation
• Dose-Response Relationship: nonlinear, threshold

SED 50
• The dose required to affect 50% of those irradiated
• Dose: 5 Gyt (500 rad)
• Skin-Erythema Dose (SED):
– Dose of radiation, usually about 2 Gyt (200 rad), that causes redness of the skin

SKIN

POTENTIAL RADIATION RESPONSES OF SKIN FROM HIGH-DOSE FLUOROSCOPY

POTENTIAL RADIATION THRESHOLD DOSE (GyT) APPROXIMATE TIME OF

RESPONSE ONSET
Early transient erythema 2 hours
Main erythema 6 10 days
Temporary epilation 3 3 weeks
Permanent epilation 7 3 weeks
Moist desquamation 15 4 weeks

EFFECTS ON GONADS
• Gonads: produce the germ cells that control fertility and
heredity
• Critically important target organs
• Sensitive to radiation
• 100 mGy (10 rad):
– Minimal detectable response of ovaries and testes to
radiation
• Gametogenesis: formation of gametes

HEMATOLOGIC EFFECTS
• Decrease in the number of all types of blood cells in the circulating peripheral blood
• Stem Cells: pluripotential
• Hematologic depression: 25 rad
• Examples:
– Lymphopenia
– Granucytopenia
– Thrombocytopenia

CYTOGENETIC EFFECTS
• Radiation-induced chromosome aberrations
– Single-Hit
– Multi-Hit
SINGLE-HIT CHROMOSOME ABERRATION
• Occurs when a single chromosome sustain only one hit
• Visualized & recorded during the M phase
• Occurs at very low doses of radiation
• Linear-nonthreshold
• Chromosome Aberration Frequency: two single-hit aberrations per 10 mGyt (1 rad) per 1000
cells

• Irradiation during G1 and G2 phase

MULTI-HIT CHROMOSOME ABERRATION

• Occurs when a single chromosome sustain more than one hit
• Visualized & recorded during the M phase
• Occurs when the radiation dose exceeds approximately 1 Gyt (100 rad)
• Nonlinear-nonthreshold
• Frequency: One multi-hit aberrations per 100 mGyt (10 rad) per 1000 cells

• Irradiation During G1 Phase

– Causes: ring & dicentric chromosomes
– Ring: when two hits occur on the same chromosome
– Dicentric: when adjacent chromosome each suffer one hit & recombine
• Irradiation During G2 Phase
– similar to G1 phase but rarer

RADIATION-INDUCED RECIPROCAL TRANSLOCATION

• Multi-hit chromosome that require karyotype analysis for detection
• Results in:
– No loss of genetic material
– Simply a rearrangement of the genes

STOCHASTIC EFFECTS
• Late effects of radiation exposure
• A radiation response in human not observed for months or years after radiation exposure
• Produced as a results of low doses delivered over a long period
• The incidence of the radiation response increases with increasing doses

• Principal Stochastic Effects:

– Radiation-induced malignancy
– Genetic effects
• Linear, nonthreshold

NOTE
• Our radiation protection guides are based on the stochastic effects of radiation & on linear,
nonthreshold dose-response relationships
• Radiation exposure we experience in diagnostic radiology
– Low LET, low energy, chronic

• Radiodermatitis
– Experienced by early radiologists
• Chromosome damage
• Lifespan shortening (10 days/1 rad or 10 mGyt)

• Radiation-induced malignancy
– Leukemia
– Thyroid Cancer
– Bone Cancer
– Skin Cancer
– Breast cancer
– Lung cancer
– Liver cancer

• Irradiation of the utero (10 rad or 10 mGyt)

– Spontaneous abortion
– Congenital abnormalities
– Mental retardation
– Malignant diseases
– Impaired growth and development
– Genetic mutation
• Doubling dose (50 rad and 250 rad) (0.5 Gyt and 2.5 Gyt)