Radiology Exam 2 Notes

Dr. Osher

Basics of Attenuation
4 Factors that Affect Attenuation
Kilovoltage
Density
Atomic Number (Z)
Electrons per Gram of Tissue

F-Factor Conversion
F-Factor converts exposure (X) and absorbed dose
(D)
Roentgen to Rad conversion factor
D= f x X
At diagnostic X-ray energies, f-Factor for soft tissues is
close to 1.0
f-Factor for bone is 4 at Low kvP
F-factor for bone is 1 at High kVp

Absorbed Dose (D)

Absorbed Dose
Measures the amount of radiation energy absorbed (E) per
unit mass (M) of the absorbing mediummust be specified
Absorbed Dose is NOT source related
Absorbed Dose= E/M
Units
Gray (Gy)SI system
RadsNon SI system
1 Gray= 1 Joule of energy/kg
1 Rad= 100 ergs of energy/gram
1 Gy= 100 rads
1 rad=10 mGy

Linear Transfer Energy

Linear Transfer Energy (LET)
Energy absorbed by the medium per unit length of
travel (keV per micrometer)
LET is proportional to Particle Charge squared
LET is inversely related to particle Kinetic Energy
Photons, electrons, gamma, and X-rays= Low LET
Neutrons, protons, and alpha particles= High LET

High LET=increase in biological damage

Neutrons are used in cancer therapy

Dose Equivalent
Dose Equivalent (H)
Attempts to quantify biologic damage from deposition of
radiation in the tissues
Dose Equivalent=absorbed dose x quality factor
H=D x QF
X-Rays, Gamma Rays, Electrons, Beta particles have a Quality
Factor= 1.0
Neutrons and Protons= 5.0
Alpha Particles=10.0

Quality factor depends on the LET value

1 rad= 1 rem in diagnostic Radiology
Quality factor may be as high as 20 for alpha particles and
heavy nuclei

Dose Equivalent
Dose Equivalent
Units
Sievert (Sv)SI system
Rem (radiation equivalent man)non SI
1 Sv= 100 Rem
1 Rem= 10 mSV

Interactions With Film

A Latent Image Is formed
Heavily Irradated areas turn black
Ionic Ag+ is reduced to metallic Ag
Image then needs to be developed

Complete attenuation of X-rays leaves the film clear

No radiation passes through

Partial attenuation/transmission= Film is grey

Some Radiation Passes Through

No Attenuation=Black
On the film, the Emulsion Layer is the active layerdouble-sided film

Interactions with Film

Emulsion layer contains crystalline silver-halide grain
Bromine and Iodine are Halides
There are about 109 grains/cm2

Can be sensitized to radiation or light to hold a latent

image
After this occurs, the image must then be developed

In the Silver-Halide Crystal

Sensitivity speck=Electron Trapping Hole
Makes the crystal more sensitive to radiation

Interactions with Film

Atomic arrangement inside of the hexagonal film crystal is cubic
Sensitivity speck is AgS surface defect
Is a non-rigid crystal with a negative surface chargehere
electrons and atoms may migrate
Absorbed photons liberate halide electrons within the grain
Bones=Radiation is absorbedbecause bone is a dense material
Soft TissueRadiation is scattered or penetrated
This is the basis of imaging

Lots of RadiationBlack
Little Radiation--Clear

Matter Interactions
PenetratePhotons pass through unaffected
No Deposition of Energy

AbsorbedPhotons transfer energy to absorbing

medium
Energy deposited into bodyBAD

ScatteredPhotons change direction and possibly

lose energy
May or may not deposit energy

Photon Interactions within the

Silver Halide Crystal
Photoelectrons and Compton electrons are produced that
migrate throughout the crystalthey dislodge other electrons
Some are trapped by the sensitivity speck Ag+
Reaction
Br- + photon Br0 + ee- + Ag+ Ag0Black
Knocks electron off bromine and moves towards the sensitivity
speck
Interacts with Ag0turns silver black

Sensitivity speck ultimately becomes electronegative

Electrons are attracted to the sensitivity speckSilver atoms
migrateSensitivity Speck turns black.
8-11 Ag atoms initially

Photon Interactions within

the Silver-Halide Crystal
In each crystal, less than 10 silver atoms are deposited at the sensitivity
specklatent image center
Sensitivity Speck=Latent Image Center

This is not apparent microscopically, and these are ultimately developed

into black grains
Crystals that have not been irradiated will remain crystalline and inactive
The Development process converts the silver ions into metallic silver
grainsturns black
Developer solution makes the electrons available to silver on the film randomly
Developer room should be dark
Increased temperatures=faster developing

Exposure to Processing
Processingtransforms the Latent Image into
Manifest Image

Sensitized grains are chemically reduced in the

developer via the addition of electrons
This is a Catalytic Reaction
In time, all the crystals will be reduced to black grains
Sensitized crystals are the first to be reduced

Light does the same thing to film as X-rays do

Film Development
Converts Silver Halide Crystals with latent image centers into flecks of
silver
Over time, all of the underdeveloped silver halide will be reduced to silver
Time and temperature are critical
Ag+1 must be removed from Gelatin via Fixation prior to viewing the film in light

Developer= NaCO3 or KCO3

Developerbasic (pH 10-11)
Swells Gelatin binder and softens emulsion

Fixer=Acetic Acid
FixerAcidic
Provides acid media for hardener and helps to neutralize developer
pH=4.0

Fixing Bath
Removes all unexposed silver from emulsionclears unexposed film
Aluminum chloride hardens the emulsion
Total fix time=2x clearing time
Once cleared, we can view the film in light

Auto-processertypical processing time is 90s

Water stops the bath: put in for 50-60 seconds

Earliest time to look at filmonce it has hit the clearing time

Turnaround assembly with master roller
Where film changes direction
If this is damaged you get cuts and marks in film

Processing
Temperatures
Automatic Processing occurs at temperatures much
higher than manual processing
Manual processing= 68F optimum
Automatic processing= 80-84F
If the temperature is too high, there is Film Fog and
Overdevelopment
Film Fog=Unexposed crystals that turn black by processes
other than X-Ray exposure process
Increase Film fog=Decreases contrast

On Film:
Brown stains=Chromatic Stains
Indicates a washing problemH2S formation

Lines=Pi Lines

Film Processing
Problems
Chromatic Stainsyellow-brown from residual fix on
film
Inadequate wash
H2S Production
Black FilmOverdevelopment
Clear FilmNever Exposed

Automatic Processing time=90s

Manual Processing Time=1hr

Basic Steps in Film

Processing
Wetting
Swells emulsion
Manual15sec/AutomaticN/A

Development
Catalytic Reduction of Sensitized Silver
Basic pH
Manual5 mins/Automatic22 seconds

Stop Bath
Ends Development
pH7.0
Manual30 seconds/AutomaticN/A

Fixation
Clears unexposed halide and hardens gelatin
Acidic pH
Manual5-15 mins/ Automatic22 seconds

Basic Steps in Film

Processing
Washing
Removes Chemistryremoves fixer
Manual20 mins/ Automatic20 sec

Drying
Removal of water
Manual30 mins/ Automatic26 sec

Sooo
Manual Processing time1 hour
Automatic Processing time90 seconds

Film Handling and

Storage
General Considerations
Improper handling
Heat and Humidity
Light
Radiation
Shelf Life

Film Handling and

Storage
Improper Handling
Can cause marks or spurious film imagesArtifacts
Film pressure is sensitiveshould avoid
Creasing Film
Rough Handling of film
Dirt on Hands or process rollers
Static electricity in dry environments

Heat and Humidity

Film is sensitive to increased temperatures
Typically produces a fog (Heat= Fog)

Storage Temperatures less than or equal to 20C (84F)

Refrigeration prolongs shelf life

Store in a cool dry place

Increase humidity greater than 60%=Fog is produced
Decrease Humidity less than 40%= increased static risk

Film Handling and

Storage
Light and Radiation
Avoid low-level diffuse light
Safelight must also match film type

Darkroom/storage bin near X-ray room

Lead-line storage bin
Keep loaded cassetes away from X-ray unit

Unprocessed film fogs at about 0.2 mR

Shelf Life
Each film box has an expiration dateTypically not greater than 1 year
Aging of film results in
Loss of speed and contrast
Film age fog

Should store boxes upright to minimize film warping and sticking together

Image ReceptorsFilmScreens
Intensifying Screens
The ability of Crystals of certain inorganic salts (phosphors)
to emit light when excited by X-raysFlourescence (glow)
Emitting Light=Flourescence

Intensifying screens absorb X-ray photons and emit many

more visible light photons which expose film
The ability of crystals of inorganic salts to continue to emit
light after being excited by X-rays is Phosphorescencethis
is the Afterglow in Intensifying ScreensNOT desirable
Afterglow=Phosphorescence

Primary Determinants
of Film Density
Primary Determinants of Film Density
Milliamperage x Time (mAs)
kVpprofound effect: to the 4th power
Inverse square Lawtarget film distance
Screen-Film System

Intensifying Screens
The primary function of Intensifying Screens is to Decrease Dose
Reduces patient dosage 20-50X
Shorter Exposure Times
Facilitate radiology of thick body parts which otherwise require high
exposures
Decreases risk of motion blurring

Screen-film Advantages
Exposure without screens is the sharpest..but
Long exposures are unsafe (ALARA)
Increases chance of patient motion

Flexibility of kVp and contrast adjustment

Decreases tube mA and exposure times
Decreases tube heat and Increases tube life

Intensifying Screens
4 basic layers
Base made of plastic or cardboard
Reflective titanium dioxide or absorptive layerchanges the speed
characteristics of the screen
Affects amount of light that hits the screen, which affects the
development of the film

Phosphor Layer of varying thicknessActive Part

Protective plastic cover layer
Intensification (Intensifying Factor)ratio of exposures to provide the
same film blackening effect
Intensifying Factor= Exposure without screens/Exposure with screens
Is usually a positive number
Typical IFs range from 30 to 50
Greater conversion to light=faster the exposure

Intensifying Screens
Absorption efficiencypercentage of X-ray Photons
absorbed by the screen
Increase Absorption Efficiency=Increase the thickness
of the screenFluorescent layerphosphor layer

Conversion EfficiencyHow many light photons are

produced by each absorbed X-ray
Ratio of Light Liberated : X-ray Energy Absorbed

Crystalline Calcium
TungstateOriginal Screen
Phosphor
CaWO4 (Calcium Tungstate) produces light in the
blue spectral region
This can be used with standard X-ray film
CaWO4 is quick to glow and has minimum afterglow
3-5% conversion efficiency
Mechanism of absorption is almost entirely via
photoelectric reactions

Calcium Tungstate
Intensifying Screens
Calcium Tungstate Screen speed increases with
Doubling the number of screensbecause film is double-sided
Increasing the thickness of the Phosphor Layer
More photons are absorbedemitting more light per unit time

Increased size of phosphor crystals

Use of reflective backings

**All of these methods increase absorption efficiency of the Calcium Tungstate screen.
Increase screen light diffusion= Decrease image sharpness
Greater speed=faster, but at expense of image sharpness
Speed of the Calcium Tungstate screen is INVERSELY related to its ability to record detail
Higher Speed= LESS detail
Light spread within the screens reduces image sharpnesslateral spreading of light

Intensifying Screens
The Speed of a Calcium Tungstate screen is
INVERSELY proportional to its ability to record detail
Higher speed= Less Detail
Less speed= More Detail

Thinner phosphor layer and smaller phosphor

particles are proportional to greater image sharpness

Rare Earth Elements

Gadolinium Oxysulfide
Lanathanum Oxybromide
Yttrium Oxysulfide
Rare Earth ScreensThe X-ray to light conversion
efficiency of rare earth phosphors is significantly
GREATER than Calcium Tungstate

Rare Earth Phosphors

Principle advantage is SPEED
Conversion efficiency for Rare Earth Phosphors is 20%
Calcium Tungstate is 5%

Must use special color matched filmorthochromatic

Gadoliniumemits Green light
Lanthanumemits Blue light
Gadolinium and YttriumBlue-green

Fraction of X-Ray Beam

Absorbed
Phosphor Speeds via Absorption Efficiency
Single Slow CaWO4 screen 5%
Pair of CaWO4 screens20%
Pair of CaWO4 fast screens= 40%
Pair of Lanthanum rare earth element60%

Lanthanumincreases conversion efficiency

Increase in Number=Sharper Image
If Green-emitting screens are used, they should be matched
with a film that is sensitive not only to blue light, but to green
light as well Orthochromatic (green-sensitive film)

Spectral Matching
Calcium Tungstate screens emit blue and blue-violet
light
Rare earth screens emit UV, blue, green, and red
All silver halide films respond to violet and blue
lightbut not to green, yellow, or red
Radiographic films are either Blue-Sensitive or GreenSensitive
Blue-sensitive requires AMBER safelights
Green-Sensitive requires RED safelight

Film Types
2-Basic Film Types
Screen FilmsThin Emulsion
Have higher contrast
Short scale
Low Latitude

Non-Screen FilmsThick Emulsion

Lower contrast
Long Scale/Lattitude
Enhanced X-ray sensitivity

Screen Film vs NonScreen Film

Screen Film
Enhanced light sensitivity
Higher Contrast
Short Gray Scale/Lattitude
Double/Single Emulsions
Double EmulsionsUsed with 2 screens
Double Screens=2X speed of single screen
Disadvantage of Double ScreensCross over detail
Single EmulsionsCheaper, better detail, but slower

Screen Film vs NonScreen Film

Non-Screen Film
Exposed directly without screens
Has enhanced X-ray sensitivity

Has a thicker emulsion than screen films

Lower contrast
Long Gray Scale/Lattitude
Greater Detail than screen film
But!!! Requires 20-50X more exposure

Digital X-Ray
Radiographic Basics
A digital image is an image that has been converted into numerical
values for transmission or processing
A detector must be used initially to acquire the image information
Scan an area line by line
Array detectioninfo received from entire area at once

Planar X-Ray Imaging

Image formation is based on differential attenuation of the X-ray beam
by body tissues that differ in
Thickness
Density
Chemical MakeupAtomic Number

** Painting by numbers**

Digital Radiography
Like digital cameras
Images can be taken, immediately examined,
deleted, corrected, and croppedcan be sent to a
network of computers
With digital imaging, the main change is the image
receptorit is no longer film based
Has the potential to increase patient dosepresents a
problem
Digital=No film: increased patient dose

Basic Digital Acquisition

Systems
Direct vs. Indirect Detectors
Direct (DR) Systems
X-Ray information directly converted to electrical
chargethen stored in a capacitor ready to read
Uses Selenium or SiliconeIs expensive
Can see photo instantly

Indirect (Analog) SystemsIs a 2 part process

Scintillator converts X-ray photons to light
Photodetector converts light proportionally to electrical
charge/signals
Still have to process

Digital Radiography
Digital Radiography replaces film with a Reusable Detector
Cassette-Based Systems
Use photostimulable storage phosphor (PSP) imaging plate (IP)
inside cassette
Once exposed, plate is taken into a reader
Is Indirect Digital (Computed Radiography)

Cassette-Less Systems
Detector and Reader is apart of same unit
Direct digital Radiography (TFT)no light produced

**Almost all office-based systems are indirect computed

radiology**
Indirect CR= Scintillator and Photodetector=Cassette-Based
system=Latent image

Computed Radiology
Many similarities exist between Computed Radiology
and Screen-Film receptor imaging
Both use image receptors that is an X-ray sensitive
plate in a protective cassette
Both use scintillator plates that emit light with X-ray
exposure
Either can be used interchangebly with any x-ray
imaging system
Both carry a Latent Image that must be made visible
via processing

Digital Computed
Radiology
The response to x-rays in screen film systems is the release of
light by the intensifying screen
The response to X-ray interaction in Digital Computed
Radiography PSPs is both
Immediate Release of Light
TRAPPING of electrons in a Higher Energy metastable state
Barium + Europium is used in Digital Computed Radiography (CR)
Flouresce during exposure
Screens store and trap energy

Trapped electrons in metastable state return ground energy level

by release of light over timeor earlier when exposed to intense
infrared laser light (processing)
Photostimulable Phosphor (PSP)

Computed Radiography
CR Plate
Cassette contains a photostimulable phosphor plate (PSP)
that can be used to store and release image formation in a
usable way
Barium Fluorohalide and Europium Activators

Latent image created at F centerselectron meta-stable

stated produced by X-rays
K-edge attenuates best between 35 and 50 kVP
CR plates are more sensitive to low energy scatter

Computed Radiography= Photostimulable Storage

Phosphor (PSP)

Photostimulable Phosphor
Image Aquisition
PSP stores absorbed X-ray energy in crystal
structuretraps
Energy deposited causes local electrons to be elevated
from a ground state energy level to a stable trap
F-center and Europum +2 and +3
Electronic latent image

Number of electrons trapped is proportional to the

number of X-ray photons incident on IP

Latent Image Formation

in CR
X-rays exit patient and react with phosphor to
produce Europium electron holes with a higher
energy state
50% of holes reform to release light by phosphor
flourescenceelectrons fall back into valence level

Image processing occurs when CR plate passed

through laser-light scanner
Electron holes reform and release light
Light released proportional to X-ray intensity

Latent Image Formation

in CR
PSP absorbs some of X-ray energy as valence electrons
stored in high energy traps to create a latent imagethis
creates Europium holes

When the latent image is scanned by a laser beam, the

trapped electrons return to the valence band with the
emission of light
Europium holes recompose and release light
Light released is proportional to X-ray intensity

Light viewed by PMPwhose output constitutes the

signal

PSP Image Acquision

Exposed IP read by intense laser light of low energy
Trapped electrons stimulated and significant numbers
return to its lowest energy state in phosphor
Simultaneous release of photostimulated
luminescence of higher energy
PSL intensity is proportional to # of released electrons
PSL filtered from laser light and converted to
corresponding output voltage by PMT

Laser Scanning the CR

Plate
CR plate crystals release trapped X-ray wavelength energy
by emitting photons of light energy when scanned by
laser light
Intensification
Amount of light released is proportional to the amount of Xray energy trapped

CR plate is erased when exposed to high intensity sodium

discharge lampall trapped energy is released when this
happens
If the X-ray unit and processor are in the same room, the
exposure will interfere with laser scanning

Main advantages of
Digital Radiography
Linearity of response of digital IRs over exposure ranges that are orders of
magnitude greater than latitude of any film.
Separation of image acquisition from image processing and image display
Windowing
Edge enhancement
Noise reduction
Computers are used to post process image

Overall benefits of digital signal storage, communication, and analysis

Film, chemistry, or darkroom is not needed

**Lattitude= # of grey tones

CR Tolerance of
Overexposure
In conventional radiography, excessive exposure yields black film
this leads to decreased contrast
Extended CR density range means that imaging plate does not have
a Dmax curvehas a straight line
CR imaging plate continues to record the exposure way beyond the
limits of film

Image brightness can be adjusted independent of exposure level

Auto-adjust histograms correct over-exposure
Computer can bring densities down into visible range

Up to 2x overexposures are tolerated, but image quality suffers

gives low contrast

Spatial Resolution
Spatial resolution is the ability of a system to resolve
a small high contrast object
Spatial frequency is expressed in line pair per mm
(lp/mm)
More paired lines=sharper image

Advantages of CR/DR
vs. Film
Range of Exposures leading to acceptable Optical Densities is limited with film
Exposures below toe are clear; above shoulder are opaque
Large dynamic range eliminates retakes for over and under exposure

Post-processing of image displayAbility to manipulate image quality after exposure

Contrast, edge enhancement and noise reduction

Windowing
Post-processing abilitybiomechanicals, magnification, sharpening
Long-term cost savings
Space-savingno darkroom, file storage
Digital domainPACS capable and printable
High DQE FPD systems are safer
Higher DQE= better image quality per dose

Disadvantages of CR/DR
vs. Film
Potential for safety abuse
High initial costhigh repair costs
Image degrades rapidly (25% in 8hrs) via Heat/Cosmic
Radiation
CR has a greater sensitivity to scatter
Spatial resolution is less than film
Loss is exponentialthere is nothing after 3 days

DIACOM
Digital Imaging and Communication in Medicine
Allows equipment made by different manufacturers
to communicate in the digital environment
Protocol that allows the exchanging and storage of
medical data, both images, and text

Radiographic Quality
Radiographic QualityThe fidelity which the anatomic structure being
examined is imaged on the radiograph
Resolutionthe ability to image 2 separate objects as being distinct

Contrast ResolutionThe ability to distinguish anatomic structures of

similar subject contrast
Spatial Resolutionthe ability to image small objects that have high
subject contrastbone/soft tissue interface
Films are designed with differing speeds and inherent contrastand is
light sensitive
Film screens designed for chest vs extremities respond differently to equal
amounts of radiation

Optical Film Density

Optical Density is used to measure film blackening
OD=log10(Io/It)
Io=light intensity incident on film
It= light intensity transmitted through film

Light Transmittance Formula

For every 0.3 change in optical density, the %T inversely changes
by a factor of 2.0
%T= (It/Io)

Optical Density is proportional to number of photons reaching

film
Can be measured using densitometer
Increase in OD= Decrease in transmittance

Optical Film Density

Useful range of ODs from 0.3 to 2
0.3= 50% transmittance
2.0= 1% transmittance
Above 2.2 needs a hot light

Characteristic Film
Curve
A Characteristic Film Curve plots relation between
exposure and OD
Y-axis=OD; X-axis=log exposure
Every 0.3 increase doubles the exposure (because the log
of 2 is 0.3)
Base + Fog= OD without exposure
Typical range= 0.1-0.2 OD units

Film speed is inversely related to exposure

Increase Film Speed=Decrease Exposure
Decrease Film Speed=Increase Exposure

Film Contrast
Film contrast is an inherent property of a film determined by the
slope of the straight line portion of the Characteristic curve
Increased slope= Increased inherent film contrast
Decreased slope= Decreased inherent film contrast

High Contrast film-Low latttitude= Short Gray scale film-Screen film

Low Contrast film-High Lattitude= Long grey scale film-Non-Screen
film
Wide Lattitude= Increased Grey tones
High Contrast= Low latitude
Increased slope=Increased Film Contrast

Film and Image

Receptor Latitude
LatitudeRange of exposure over which the image
receptor responds with ODs in the diagnostically useful
range
With wider latitude, mAs can vary more and still result in
diagnostic image
Wider latitude= greater margin of error

Latitude is inversely related to film contrast

Low Lattitude= High Contrast
High Lattitude= Low contrast

Fewer grey tones= Increase in contrast

Characteristic Film
Curve
Film GammaMaximum slope of curve
Average Gradientmean slope between 2 specified
Optical Densities
Usually 2.0 and 0.25 above the base + fog density

Film LatitudeRange of Grey tones

Film Latitude is INVERSELY proportional to contrast

Windowing
Windowing is a digital concept
An important feature of digital imaging is the
computers ability to mathematically bring density
differences into the visual range
Because range of stored densities is much wider than
the visual range, any digital image is only a small part
of the total data obtained by the computer
Each image on the monitor is only a window of the
total range of data
Windowing=gray scale expansion or compression

Windowing
Window Level (density)the value of each pixel is changed by addition or
subtraction
Increase window level=Increase image density
Window level controls density

Window width (controls contrast)each pixel value is changed by multiplication or

division
Increase window width= decrease in image contrast
Window width controls contrast--detail

Extremely wide window width requires the computer to ignore fine contrast
differences in order to display the entire range of data
Extremely narrow window width requires the computer to ignore a large amount of
data outside the chosen range
Window width controls the visibility of detail

Radiographic Contrast
Film Contrast
Subject Contrast
Fog and Scatter

Image Contrast Resulting from

Patient Interactions
Image Contrast from Patient Interactions=Subject
Contrast
Thickness Differences
Density differences
Atomic Number differences
Quality of Radiation--kVp

Subject Contrast
Anatomic Part Thickness
Differing thickness of same material will attenuate Xray beam differentlyBasis of Contrast
Thicker parts=increased attenuation
Thinner parts= decreased attenuation
Magnitude of difference is proportional to degree of
contrast

Subject Contrast
Density Differences
Greater Density of a tissue results in greater beam
attenuation
Water and IceWater is 9% more dense than ice
Atomic Number difference
Increase Atomic Number=Increase in attenuation
Higher atomic numbered tissues attenuate more X-rays
Results from photoelectric attenuating absorptions in
patient
True at Lower kVps

Radiation Quality (kVp)

Increasing kVp= Decrease in Subject contrast
Decreasing kVp= Increases Subject contrast
Changing mAs does NOT affect subject contrast

Fog and Scatter

The ultimate effect of Fog and Scatter is to reduce radiographic contrast
Fog and Scatter DECREASE Contrast

Film FogAn unwanted density arising as a result of silver halide grains in

the film emulsion being developed even though they were not exposed to
light and/or X-rays thru the actual exposure process
Common Film Fog Causes
Excess storage temperature and humidity
Keep temperature at or below 68 degrees F

Excessive development time or temperature

Safelight fog
Film is especially sensitive after exposure

Film Age Fog

Background Radiation

Scatter Radiation
Scattered Radiation that reaches film produces
unwanted density
Increased Scatter Radiation (Compton Scatter)
results in overall darkening of the film areas
Decreases Contrast and Image Detail

Scatter Radiation increases with..

Increasing part thickness
Increased field size
Increased energy kVp of X-rays

Fog and Scatter

Techniques and Devices used to minimize the effects
of Fog and Scatter
Cones
Aperture Diaphragms
Collimating Shutters
Grids
Optimizing kVp

Image Detail
Image Detailability of the film to record each point
in the object as a point on the film
With cassette-screen combos, this point for point
reproduction is never perfect

Image Detail is Primarily Influenced by

Geometric SharpnessFocal Spot Blur
Mottle
Resolution

Edge Unsharpness
Randoms
Source Image Distance= Distance between focal spot and
image
Object Image Distance= Distance between object and Image
Umbra=Image you see
Penumbra= Edge sharpness
Increase Penumbra= Increase Contrast and Decrease edge
Sharpness
Is larger toward the Cathode

Shorten SID= Penumbras get larger=Lose edge sharpness

Object Distortion
Object Thickness
Thick objects are distorted more than thin objects

Object Position
If object plane and image plane are not parallel,
distortion occurs

Object Shape

Image Detail: Sharpness

Focal Spot (Geometric) Blurring
Factors which increase magnification decrease
sharpness
Sharpness is optimized by decreasing beam penumbra
Decrease penumbra= Increase sharpness
Minimizing object-film distance (OFD)
Maximizing Source image distance (SID)
Decreasing focal spot size

Shorten SID=Increase size of penumbras=Lose edge

sharpness

Object Motion
Movement of the patient can cause image blurring
Short exposure times minimize chance of motion blurring
Utilize film screenspreferably double screens

Radiographic MottleRandom fluctuation or unwanted

variation of film density following a uniform exposure
AKA: Noise

Types of Mottle
Radiographic Mottle
Screen Mottle
Quantum Mottle

Film Grain

Radiographic Noise
Factors
Film Graininessnot significant
Structure MottleCaused by defects in screen
phosphor layers
Clumping of phosphor or coating variations
Not significant

Quantum MottleMost important source of

Mottle/Noise

Quantum Mottle
Occurs with very short exposure times
Result of statistical fluctuation in number of photons
per unit area of the X-ray beam
Percent of fluctuation per square mm increases as the
average number becomes smaller
Grass Seed Analogy

+/- Square root of average number of photons= %

fluctuation (is a standard deviation)

Screen Speed vs. Noise

Speed vs Noise= How many photons are needed to yield the same
optical density?
Conversion efficiency

If screens are made thicker (faster)then

Resultant noise the same
Same photon numbers with decreased exposure time

If a more efficient phosphor is used

Fewer photons are absorbed in screen to yield the same optical density

Increase Conversion Efficiency= Quantum Mottle

Use of High mAs and Low kVp settings, and slower image
receptors= reduction in quantum mottle

Radiographic Technique
Radiographic Technique
Combination of Settings selected on the X-ray machine control panel that
produce a high-quality radiographic image
Factors influencing Technique
Patient Factors
Image-Quality Factors
Optical Density
Contrast
Image detail and distortion

Exposure-Technique Factors
mAs, kVp, SID are principle factors

Thickness of Part
Body CompositionPrimarily soft tissue, bone, or both
Patient HabitusSthenic, hypo or hyperstenic, asthenic
PathologyRadiolucent or opaque

Controlling Optical
Density
Optical DensityDegree of blackening on the finished
radiograph
mAsDirect proportionality
mAs=Optical Density
SID=via inverse square law
Problematic when varied
Usually fixed at 90cm for mobile, 100cmtable,
chest studies

kVpdisproportionate Optical Density effect

Beam intensity at patient=kVp2
B.I at image receptor= kVp4 or 5

180 cm

Principal Radiographic
Image Quality Factors
Optical Density
Controlled bymAs
Influenced by
kVp
Distance
Thickness/mass/density
Development time/temp
Image Receptor
Collimation
Grid Ratio

Principal Radiographic
Image Quality Factors
Contrast
Controlled by kVp
Influenced by
mAs
Film factors
Development time/ temp
Image Receptor
Collimation
Grid Ratio

Principal Radiographic
Image Quality Factors
Detail
Controlled by--Focal Spot size
Influenced by
SID
OID
Motion
All factors related to density and contrast

Distortion
Controlled byPatient Positioning
Influenced by
Alignment of tube
Anatomic part
Image receptor

Basics of Subject
Contrast
ChestHigh Subject Contrast
Lunglow mass density
Bonehigh mass density
Mediastinal Structuresintermediate
Can use High kVP and Low mAs combinations

AbdomenLow subject contrast

Use low kVp and high mAs combos

Extremities
Intermediate to high subject contrastbut kVp must be
lowered due to part thickness

Exposure Technique
Pearls
The primary control of Optical Density is mAs
Changes are proportional

The mAs value must be changed by approximately

30% to produce a visible change in Optical Density
The kVp setting must be changed by approximately
4% to produce a visible change in Optical Density
KvP is the major factor for controlling radiographic
contrast

Altering Radiographic
Contrast
Given an acceptable Optical Density level, contrast
adjustments are made by varying kVp15% Rule

5% Rule for Minor Adjustments

Generally 30% change in mAs

Variable-kVp Technique
Chart
Uses fixed mAs and variable kVp
kVp generally varies with thickness of anatomy by 2 kVp/cm
Generally uses lower kVp, therefore short scale contrast and higher
patient dose
Fixed kVp technique chart is best
For each anatomic part there is an optimum kVp

Changing kVp affects

Penetration
Scatter Radiation
Patient Dose
Contrast
Conversion efficiency of screens

The simplest method to increase or decrease Optical Density is via

mAs!!

Principles of Radiation
Safety
The Overarching Principle
All unnecessary exposure must be avoided and all
absorbed doses be kept As low as is Reasonably
Achievable
ALARA PrincipleICRP 9 and NCRP 22

Results of Irradiation of Macromolecular Solutions

Main-Chain Scission
Cross-Linking
Point Lesion

Irradiation of Macromolecular
Solutions
Main Chain Scission
Produces many smaller molecules
Viscosity decreases

Cross Linking
Side Chains become sticky
Viscosity increases

Point Lesions
Disruption of single chemical bonds
No grossly apparent changes
Considered to be primary mechanism of cellular damage from low
doses of radiation
Accounts for late effects of radiation

Major Forms of DNA

Damage
Main Chain Scissionone side rail
Main chain scissionboth side rails
Main Chain Scission with cross linking
Rung breakage causing base separation

Point mutationchange/loss of triplet code

Primary mechanism of damage from Low doses of
radiation

RadiationMajor
Effects on DNA
DNA is more sensitive than RNA or cellular proteins
DNA is not as abundant

Damage often irreversible can result in

Cell death
Altered metabolic activitycancer
In germ cells, DNA damage may not be expressed until
generations later

Radiolysis of Water
80% of the body is water
Free Radical Formation
Very unstableradicals can disrupt molecular bonds

Hydrogen Peroxide Formation

Very Toxic

Effects are enhanced when Oxygen is PresentOxygen

effect
Principle Action of Radiation on Humans is Indirect
Primary result of by products from the radiolysis of water

Factors Affecting
Radiosensitivity
Factors Affecting Radiosensitivity
Oxygen Effect
Age
Gender
Male susceptibility > Female

Recoveryafter sub-lethal dose

Chemical Agents
Radioprotectors and Radiosensitizers

Factors Affecting
Radiosensitivity
Oxygen Effect
Biologic Tissue is more sensitive under Aerobic
conditions
OER= anoxic dose/aerobic dose
OER is LET dependent
Greatest for low-LET, max @3.0
About 1.0 for high-LET radiations

Factors Affecting
Radiosensitivity
Law of Bergonie and Tribondeau
Stem Cells are Radiosensitive
Greater Maturity of cell= Increased Resistance
Decrease age of tissues/organs= Increased
Radiosensitivity
Increased Metabolic Activity= Increased
Radiosensitivity
Increased Cell proliferation rate= Increased
Radiosensitivity
Increased Tissue Growth Rate= Increased
Radiosensitivity

Factors Affecting
Radiosensitivity
Cell Sensitivity to Radiation
Very Sensitive
Lymphocytes
Erythroblasts
Myeloblasts
Spermatogonia/Oocytes

Sensitive
Epithelial Cells
Endothelial Cells

Least Sensitive
Bone
Nerve
Brain
Muscle

Factors Affecting
Radiosensitivity
Chemical Effects
RadiosensitizersHalogenated Pyrimidines
Methotrexate
Gemcitibine
Hydroxyurea
Vitamin K

Radioprotectors
Contain SH group
Compete with Oxygen for free radical binding
Cysteine
Cysteamine
Protective effect

Radiation Effects
4 Types of Serious Radiation Effects
Acute (Non-Stochastic) Effects
Seen after high, brief exposures
Whole body dose of a few Sieverts may lead to death in
several months

Degenerative Damage to organsNon-Stochastic

Stochastic effectsrandom or conjectural
Carcinogenesis or genetic effects
Expressed in offspring
Effects can arise at low doses
Severity is independent of dose

Teratogenic Effects from in utero exposures

Dose Response Curves

Deterministic Effects
Nonstochastic Effects
Occurs with higher doses
Greater than 0.5 Gy (50 rads)

Generally results from cell death and/or organ atrophy

Characterized by a threshold dose
After threshold, severity of the response is dependent on
the dose

Dose Response Curves

Stochastic Effects
Severity of the effect is independent of the dose
Radiation dose only affects the probability of effect
occuring
As dose increases, the chance of occurrence increases
Stochastic EffectsNon deterministic effects
Occur with lower doses
Less than 0.5 Gy (50 rads)

Carcinogenesis and genetic primary effects

Random or probalistic effects
Severity of response is independent of irradiating dose
Usually no threshold to damage

Dose Response Curves

Acute Deterministic Effects
Acute Radiation Syndromes
Local Tissue Damage
Skin
Gonads/sterility

Hematologic Depression
Cytogenic Damage

Acute Effects of Whole

Body Radiation
Acute Radiation Lethality
Mega-radiation level
LD 50/30 for humans 300-400 rads
Not an issue in diagnostic radiology

4 stages
Prodrome (N/V)
Latent
Manifest syndrome
Recovery or Death

Stage 3 manifests as
Hematopoetic
GI
Cerebrovascular syndromes

Acute Effects of Whole

Body Radiation
Acute Radiation Effects
SkinContinual renewal system
2% total replacement/day
50% for intestines

Epidermal basal stem cell damage occurs the earliest

Non-linear threshold
200 rads

Moist desquamation=clinical tolerance of patient

Earliest sign of radiation injury= Erythema
SED50= 600 Rads

Continued radiation produces epilation and moist desquamation

Denudation and ulceration ultimately occurs with continued
irradation
300-1000 rads results in erythema followed by desquamation

Acute Effects of Whole

Body Radiation
GonadsTestes
Immature spermatogonia divide rapidly
Spermatogonia are amongst the most radiosensitive cells in the body
10 radsaffect numbers of spermatozoa
Genetic damage can occur at 10 rads

200 radstemporary sterility may occur

Commences at 2 months
May last as long as 12 months

500 radspermanent sterility

**Significant Damage with 10 rads
Recommendations to patients who have received 10 rads or more to
testesRefrain from sex for at least 2-4 months (preferably 6 months)
to decrease risk of genetic mutations

Acute Effects of Whole

Body Radiation
GonadsOvaries
Oocyte in mature follicle are most radiosensitive
Pre-puberty irradiation results in
Germ Cell Death
Ovarian Atrophy

Post-puberty irradiation results in

Delay/suppression of menstration (as little of 10 rads)
Temporary Sterility200 rads
Permanent sterility500 rads

Acute Effects of Whole

Body Radiation
Hematologic Depression
Depression of blood cell numbers in peripheral circulation
Lymphocytes are the most radiosensitive
Along with spermatogonia are the most radiosensitive cells in the body

Granulocyte and platelet counts are also affected

Cytogenic Damage
Damage is usually manifested during the next cellular mitosis
Non-Threshold dose response
2 Typessingle hit and multi hit aberrations
Damage difficult to identify with low doses: less than 5 rads
A hit usually disrupts many molecular bonds and produces visible
chromosomal damage
Almost every type of chromosomal aberration can be radiation induced

Acute Effects of Whole

Body Radiation
Cytogenic Damage
Single-Hit Chromosomal Aberrations
Occurs at very low radiation doses
Linear, nonthreshold dose-response
In G1 phase of cell cycle produces chromatid deletion
Replicated during s-phase of mitosis

Visualized at metaphase, two acentric fragments are

seen
Isochromatid fragments

Multi-hit chromosomal aberrations are considered to

be the most significant in terms of latent human
damage

Late Effects of
Radiation
Late Risk Estimates
Absolute Risk
Slope of linear, dose response
Cases/106 persons/rad/yr

Excess Risk
Observed casesexpected cases

Relative Risk
Observed/Expected (unexposed) cases

Principal Early Effects of Radiation

Exposure on Humans
Death
Whole Body100 rads

Hematologic Depression
Whole Body25 rads

Skin Erythema
Small Field300 rads

Epilation
Small Field300 rads

Chromosome Aberration
Whole Body5 rads

Gonadal Dysfunction
Local Tissue10 Rads

Long Term Effects of

Radiation
Somatic Damage
Cataract Formation
Thyroid Nodularity and CA
Lifespan shortening
Cancer Induction
Fetal Effects

Genetic Mutations

Long Term Effects of

Radiation
Cataract Formation
Lens radiosensitivity is age-dependent
Greater effect and shorter latent period with older age

Occupational doses to eye are too low to require lens shield

routinely
Not true of fluoroscopy

Threshold, non linear dose

Acute Threshold2 Gy
BEIR V suggests from 0.6-1.5 Gy

Fractionated Thresholdas high as 10Gy

Latent period reported from 5-30 years15 year average
May be dose related8 years following 2.5-6.5 Gy doses

Long Term Effects of

Radiation
Non-Specific Lifespan Shortening
At worse, decrease of 10 days/rad
Linear, non-threshold dose response
High dose grpshistopathological aging
Decreased parenchymal cells
Decrease in number of fine blood vessels
Increased density of connective tissue

Low to medium dosedeath from Cancer

Long Term Effects of

Radiation
Radiation Carcinogenesis
Sources of Human Data
Radium dial paintersbone tumors
Uranium minerslung CA
A-bomb survivors in Japanincidence of leukemia and others
Early dentists and radiologistsskin tumors, leukemias
Radium salt injections for Spond and TBbone tumors

Typically is a non-threshold dose response

Below 4.0 Svmortality is linear for all cancers except leukemia
Leukemia mortality is linear-quad

Stochastic Late Effect

Childhood risks are approximately double those of adults

Long Term Effects of

Radiation
Thyroid Carcinoma
High sensitivity for Radiation Cancer
Well established late consequence of both internal and external
radiation
Cancer arises from Follicular Epithelium
Mortality much less than medullary thyroid CA
Kids and females are susceptible

4/100000 natural incidence5% fatal

Females roughly 3X susceptible to both radio and nonradiogenic thyroid CA
Increased risk for children in first 5 years
Radiation risk approximately 2.5/106/rad/yr
0.04 per 100000/rem effective equivalent dose

Long Term Effects of

Radiation
Radiation Induced Leukemia
Linear non-threshold curve dynamics
4-7 year latency/20 year at risk
3:1 relative risk likely
1.5 cases/106 persons/rad/yr absolute risk

Solid Tumors
3:1 solid tumor/leukemia ratio
May be higher than this
Linear, non-threshold dose response curve dynamics
Average Latency=20 years or more
4-7 years= 3X increase of getting a solid tumor

Lung CArelative risk up to 8:1

Non-threshold dose response
Absolute risk of 1.3

Breast Cancerrelative risk reported 2.5 to 10:1

Absolute Risk approximately 6.0

Long Term Effects of

Radiation
Bone CancerLow sensitivity to radiation
Absolute Risk is approximately 0.11 cases

Liver CancerAssociated with IV Thorotrast used in

Angiography
15-20 Year Latent Period

Skin CancerThreshold dose response with 5-10 year

latent period

Genetic Mutations
Linear non-threshold curves
No-dose rate effect
Genetic effects cumulative

Doubling dose from 5-150 rads

Major Conclusions of
Megamouse Experiments
The doubling dose for genetic mutations is subtantially higher in mice as
compared to Drosophila
Mammalian systems are more sensitive to radiation
Doubling doseradiation needed to double that of spontaneous or natural
population rate

Substantial dose-rate effect exists in humans

The same dose administered over a period of time typically results in fewer
mutations than in an acute exposure
Chronic irradiation is considerably less effective in inducing mutations in
spermatogonia and oocytes
This dose-rate effect appears to be greater in females

The absolute frequency of radiation induced genetic mutations appears to

be very low

Genetic Risks
Most mutations are harmful
Any dose of radiation entails some genetic risk
# of mutations produced is proportional to dose
Linear extrapolation from high dose=valid estimate of low dose
effects

Risk estimates of mice are not too far off from humans

A dose of 1.0 rem per generation increases the natural or

spontaneous mutation rate by approx. 1%
Normal incidence11000/million live births
Doubling dose is about 2 sv

Long Term Effects of

Radiation
Fetal effects

Fetal tissues are damaged by low doses of radiation

First Trimester is the most sensitive period
General growth retardation occurs
Increased incidence of childhood
leukemia/malignancies
Maturity of fetus at time of exposure determines
magnitude and kinds of damage
**1st trimester is most sensitive

Long Term Effects of

Radiation
Fetal effects
Maturity of fetus at the time of exposure determines the
magnitude and kinds of damage

Fetal exposure in first 2 weeks

Preimplantation period
High DoseTypically results in spontaneous abortion and
death
Low Doseincreased incidence of spontaneous abortions
by only 0.1%
Normal population rate for spontaneous abortions ranges
from 25-50%

Long Term Effects of

Radiation
Fetal Exposure2nd to 8th week
Period of major organogenesis
Temporary growth retardation
Earlysevere skeletal anomalies
Latercongenital abnormalities

Fetal Exposure8th to 15th week

Fetal Period
Functional CNS disorders
Mental Retardation
4% chance of occurrence/0.1 sv

Structural CNS disorders

Microcephaly

Permanent growth retardation likely

Exposure Reduction
Timeminimize
Distancemaximize
Shieldingemploy
Primary Beam
Directly comes out of the x-ray tubewhat hits the
patient

Secondary BeamScatter Radiation

Exposure Time
Exposure Time
Exposure= Exposure rate x Time

Exposure rate at a distance or location must first be

determinedhave to define the distance and
location
Distance
Scatter is generally 0.1% of beam entrance skin
intensity at 1.0 meter
Inverse Square Law

Factors Affecting
Scatter
Factors Affecting Scatter
Thickness of Body Part
Orientation of Body part and tube
Field Sizeirradiated voxel2
kvP or dose rate
Use of Grid

Minimizing Scatter
Beam LimitationCollimation
Cones and cylinders

Maximize distance from source of scatter

Most effective means of protection via the inverse square
law
6ft dead man switch if in room

Fast exposure/minimize exposure on time

Gridsto block forward scatter and improve image
contrastmixed bag

Beam Restricting
Devices
Aperture Diaphragm
Film size and SID are constant
Proper design1cm smaller on all sides of the
radiograph

Cones and CylindersCircular Fields

Conesfield size larger than film
Cylinderssmall circular field size

Variable aperture collimator

Can only be off by 2% of SID

Collimation
Purpose of Collimation
Lowers patient dose by restricting the volume of
irradiated tissues
Improves image contrast by decreasing scatter
Increased Collimation
Patient dose decreases
Scatter radiation decreases
Radiographic contrast increases
Radiographic density decreases
Increased Field Size= **Patient dose increases

Grids and Scatter

Only allow radiation of narrow angles to pass
through

Grids ARE NOT for Patient Safety

**Grids are mandatory
Generally employed for kVps greater than 70 or body
parts greater than 12cm

Shielding
Barriers, aprons, and the patient
Structural Shieldingtype of radiation must be considered
Primary beam radiationis the actual beam directed at you?
Secondary radiation2 types
Scatter Radiationpatient major source
Leakage radiationemanates from the tube head in all directions

Structural Barriers
Barrier thickness is generally determined for the highest
energy level employed by the x-ray unit

Tenth-Value Layer (TVL)

1TVL=3.3HVLs

Shielding
Structural Barriers
Primary1/16 lead typical
Secondary1/32 lead typical
Building materials such as concrete, gypsium, or lead
acrylic also used

Lead glass with 1.5mm lead equivalent

Often not required for mobile or low kVp X-ray
machines
./

Minimizing Patient
Radiation Exposure
ALARA principle
All unnecessary exposure must be avoided and all absorbed doses must be kept as low as is
reasonably achievable

Protecting the Patient

Minimize patient movement
Keep exposure short
Use double screens (ideally rare earth)
Electronic timers

Use lead apron shields

Exposure factorsmaximize kVp while minimizing mAs
Limit x-ray beam size
Minimize repeat studies
Do it right the 1st time
Processing quality assurance

Identify patients who are pregnant and possibly pregnantX-ray only if necessary
Filtration

The Pregnant Patient

What are Radiation Risks
What are the risks of not performing the exam?

Radiation Pregnancy Risks

Reasonably suspected fetal risks
Childhood cancer
Small Head Size
Malformation/skeletal malformation
Mental retardation
Spontaneous abortion

Suspected Fetal Risks

Mental Retardation
Rapid neuronal development of cerebral hemispheres
greatest between 8-16th weeks
Linear non-threshold model
Questionable risk below 1.0 rad

Risk is approx 0.4% per fetal rad

After 15th week, risk is 0.2% per fetal rad with doses
greater than 50 rads

Suspected Fetal Risks

Childhood Leukemia/Malignancy
Increased risk with in utero doses of about 2.0 rad
Relative increased risk per radapprox 4X the risk if
irradiation occurs in the first trimester

Estimating Patient Dose

3 General Indicators
Skin Dose (ESE)most often reported
Gonadal DoseGSD
Bone Marrow dosetarget organ for leukemia

Protecting the
Operator/Staff
Understand what You are doing
Personnel Monitoringmonitor any person likely to receive in one year a dose in excess of 10% of their occupational
dose limits
Time, Distance, and Shielding
Structural Barriers
Minimize Scatter Radiation
Avoid Primary Beam
Never stand in Primary Beam
Avoid holding patient
Use lead gloves
Have mother hold child
Wear apron
Ignorance is greatest enemy

Occupational Dose
Monitoring
Maximum Permissible Dose (MPD)
Assume linear non-threshold model
Largest allowable rad dose that is not expected to
result in significant effects
In any given year, can exceed annual dose limits
provided not over lifetime 5(N-18) in rems
Less than 18 years oldnot employed in radiation
occupation
Max 0.1 rem of whole body radiation

Occupational Dose
Monitoring
Maximum Permissible Dose
Specified for
Whole body radiation exposure
Partial body radiation exposure
Organ Exposure
General Population

Cumulative/lifetime limit changed to 1 rem (10msv)

times age
Monthly fetal doses established
General organ standards set at 500 msv (50 rem)
occupational

Effective Dose (E)

Effective Dose
Most medical procedures result in a non-uniform dose
distribution within the patient
Effective Dose quantifies the risk from partial body
exposure to that from an equivalent/uniform whole body
dose
Quantity devised to account for the fact that exposures to
people are not typically spatially uniform
Head, legs, arms unprotectedeven with aprons
That dose which would have been given to entire
unprotected body to produce same health risk as the nonuniform dose received while wearing the apron

Annual Occupational
Dose Limits
Whole Body
NCRP 91/Occupational 5 rems (50 msv)
ICRP 602 rems (20 msv)
Public0.5 rems (5.0msv) infrequent; 0.1 (1.0 msv)
frequent

Lifetime
NCRP/ICRP1 rem (10msv) x age

Annual Eye Lens

NCRP/ICRP15 rem (150 msv)

Annual Occupational
Dose Limits
Skin/Hands/Feet
NCRP/ICRP 50 rem (500msv)

Total Fetal
NCRP0.5 rems (5 msv)
ICRP0.1 rems(1.0 msv)

Film Badges
Provides permanent record
Monthly or quarterly
Control badge for air kerma and or background
radiation
Inexpensive
Latent image fades with timefilm should be
developed within 1-2 months
Heat can affect film and give false recordings

Thermoluminescent
Dosimeters
Thermoluminescent Dosimeters
Use non-metallic crystalline solids
Lithium Fluoride (LIF) is most common

Radiation Excited LIF to metastable state

Stability restored when heatedemitting light
quantitatively proportional to X-ray energy absorbed

High Dynamic range10mrad to 1000 rad for X-ray

and Gamma radiation

Lead Safety Garments

Aprons
0.5 mm lead typical for a primary beam
0.25mm lead for secondary beam radiation

0.5 mm lead apron reduces exposure by at least a

factor of 10

Lead glovesat least 0.25mm

Thyroid shield and eye goggles for fluoroscopy

Lead Safety Garments

Thyroid shields and lead garments are recommended
when monthly collar badge readings exceed 4msv
(400mrem)
Badges worn outside shield on left collar or clipped
onto left side of thyroid shield
C-arm fluroscopywhen X-ray tube is above the
table
Mobile Shields for ancillary personnel who must be
in room but are not performing patient side work

The Pregnant Worker

The Pregnant Worker
May continue to work, but should wear an extra badge at
the abdomen beneath the apron
Some workers chose to change badge every 2 weeks

Should not exceed 0.5 msv (50mrem) in any one month or

5.0 msv (0.5 rem) over an entire pregnancy
Remedial action is greater than 0.3 mSv (30 mrem)
Declaration of pregnancy must be in writing and is voluntary
Employer not required to restrict the dose to embryo/fetus
to 0.5 rem until the written declaration
Revocation at any time in writing
Monitor required if likely to exceed 10% of pregnant worker
limit 0.5 rem/yr and/or 1% ALI

The Pregnant Worker

Special wrap around apron with 0.5mm lead
equivalent in front and 0.25mm in back is
recommended
Special aprons exist with 1.0 mm lead equivalent
patch over the pelvis for extra protection to
conceptus
Lap apron can be worn beneath regular apron

Fluroscopy and Basic

Operator Safety
Typical Fluroscopic Exposure
To personnel, at table side, no apron
2mGy during fluroscopy (200 mrad/hr)
30 mGy during boost mode (high dose rate)3000
mrad/hr
Rule of Thumbscatter to unshielded personnel 1 foot
from patient is 1/100 of the patients skin exposure
1/1000 at 1 meter

Fluroscopy and Basic

Operator Safety
5X dose reduction on the intensifier side with lateral
fluroscopy
Distance and Positioning
Once step back from the table can cut exposure rate by
a factor of 4
Move image intensifier closer to patient
Less patient exposure
More scatter intercepted by tower
Sharper images
Lateral FluroscopyStand on l.l side

Fluroscopy and Basic

Operator Safety
Fluroscopic Shielding
0.5 mm lead apron attenuates scatter by a factor of 20
For high work load and or tube above table, thyroid
collar and lead goggles
Wrap around adds protection
Patient: gonads, eyes, thyroid

Use shielded rooms when possible

Dose Equivalent
Dose Equivalent
Units
Sievert (Sv)SI system
Rem (radiation equivalent man)non SI
1 Sv= 100 Rem
1 Rem= 10 mSV

Units of Radiation
Deposition and Safety
Absorbed Dose
1 Gray= 1J of energy/kg
1 Rad=100 ergs of energy deposited/gram
1 Gray=100 rads
1 Rad= 10 mGy