Life & Death of a Photon (part 1)

The Alabama Blues Brothers

Imaging factors and technique are starting to come together for me. Topics such as mA, time, and kVp don’t seem so complicated in the beginning, but they do get a little more complicated as the study continues.  Let’s take a look at how x-rays are produced and what happens to them from that point…

The Creation of an X-Ray

In the x-ray tube, the filament (small or large) is heated through the process of applying electrical current.  These filaments are located on the negatively charged cathode side of the tube.  These filaments are made of tungsten.  As they are heated, electrons from the tungsten atoms are boiled off through a process called thermionic emission.  These electrons that are boiled off form a cloud around the filament called a space charge.  The focusing cup around the filaments has a negative charge and forces the negatively charged electrons in the space charge to remain together. 

While thermionic emission is taking place, the rotor on the anode (positively charged) side of the tube spins the rotating anode target up to speed.  After the anode target (also made of tungsten) is spinning at full speed, kVp (kilovoltage) is applied across the tube from the cathode to the anode.  The application of this voltage creates a highly negatively charged cathode and a highly positively charged anode.  The high positive charge of the anode strongly attracts the negatively charged electrons that have formed on the cathode side of the tube.  When this potential difference occurs, the electrons that have been created in the space charge race from the cathode to the anode side of the tube.  Tube current is the term used to describe the flow of electrons from cathode to anode.  As electrons race from the cathode side of the tube, they crash into the rotating anode target.  The interactions during this ‘collision’ are where x-rays are formed.

The interactions between the speeding electrons and the tungsten atoms that make up the anode target are the source of x-ray photons.  There are two possibilities for the creation of an diagnostic radiation when the electrons interact with the tungsten atoms:

1. Bremsstrahlung (Brems) Radiaton

Brems radiation is created when the incoming electron passes close to the nucleus of the target tungsten atom.  The positive charge of the nucleus attracts the incoming electron causing it to change course and lose some speed.  When the electron slows down and changes course, it loses some of its energy.  This energy is lost by the electron in the form of heat and an x-ray photon.  The path that the x-ray photon takes is totally random.  The amount of energy the x-ray photon has depends on how much interaction it had with the tungsten nucleus.  The closer the electron passes to the nucleus, the more energy it will scrub off in the form of heat and the x-ray photon.  Heterogenous or polyenergetic are terms used to describe the varying energies of Brems Radiation. Isotropic is the term used to describe the path photons take when they are created.  They travel in all directions from the source. 

2. Characteristic Radiation

Incoming electrons may enter the tungsten atom and collide with an inner-shell (K-Shell) electron, causing the inner-shell electron to be ejected from its orbit around the nucleus.  This makes the tungsten atom unstable.  Electrons from the outer shells cascade in to fill the holes.  The energy difference created by the outer shell electron falling into the K-shell creates another x-ray photon.  Electrons from outer shells of the tungsten atom may also be ejected by the incoming electron.  These ejections also cause a cascade of electrons to fill the hole, but the energy of the x-ray photons created by those cascades are very low energy and not useful for diagnostic purposes.  Characteristic radiation differs from Brems radiation because the photon emitted when the outer shell electron drops in to fill the empty spot in the K shell is a known and fixed amount of energy.  The radiation created by this process is homogenous, but like Brems radiation, it is also isotropic.

The process of creating x-ray radiation is very inefficient.  99% of the energy harvested from the process is in the form of heat, while only 1% comes in the form of x-ray photons.  Since the generation of x-ray photons is isotropic (spreading in all directions), a lot of the radiation is absorbed by the protective lead lining of the x-ray tube.  The diagnostic portion of the radiation exits the tube through the tube window.  The collimator in the tube is used to shape the beam leaving the tube to the desired dimensions. 

… to be continued …

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Preparing for the Test

Male Mallard

We have our first Radiographic Imaging (RAD-121) test in the morning.  So far, this class hasn’t been much more than a review of topics we covered in Patient Care & Intro to Radiography (RAD-111) during the first semester.  The first segment of this test covers visual perception topics such as boundary effect, mach effect, threshold detection, and simple optical anatomy.  The next section will be covering topics such as x-ray tube contstruction, functions and construction of the tube parts, the process of x-ray creation, types of radiation, mAs, kVp, and properties of x-rays.  Most of this second section is review.  There isn’t much new information at all here.  The third section revisits mAs, kVp, and SID with reintroduction of the mAs formula, mAs reciprocity, intensity/mAs relationships, intensity/kVp relationships, the inverse square law, and a host of problems solved with all those formulas.  The final section gets into some new material that I posted about yesterday.  The photoelectric and compton effects, as well as attenuation.  The material isn’t as complicated as it sounds, and I’m hoping I’ll do well on the test tomorrow.  The difficult part about tests from this instructor is that a lot of his questions are designed to be confusing, and it takes a good bit of concentration and attention to detail during the test to keep from overlooking things.  There are a few minor details I still need to look over, but they are minor.  I hope I’m ready because I think I’m about finished studying for this one…

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Photoelectric and Compton Effect

Photoelectric Effect

As photons that make up the primary x-ray beam pass into the body, some of them will be completely absorbed by the body, which means they do not pass through to the image receptor.  This complete absorption of the photon happens when it has enough energy to eject an inner-shell electron from the atom it comes into contact with.  The ejected electron is called a photoelectron and the ability to remove these electrons is known as ionization.  This interaction of the x-ray photon and the inner-shell electron of the atom is known as the photoelectric effect.  The ejection of the inner-shell electron causes the atom to become unstable, and an electron from an upper-level shell will drop down into the inner shell to fill the vacancy.  The outer shell electron that falls into the inner shell to fill the void must give up some of its energy to make the transition.  The energy that it gives up is in the form of a secondary x-ray photon.  This secondary x-ray photon is classified as scatter radiation which may exit the patient or interact with other tissue electrons.

Compton Effect

An x-ray photon may not be absorbed as it passes through the body.   It may, however, lose energy when it interacts with atoms in the body tissues.  This process creates scatter radiation and is known as the Compton effect.  When a photon ejects an outer shell electron from an atom, the ejected electron is called a Compton electron or a secondary electron.  The original x-ray photon loses some of its energy and changes direction.  It may continue to interact with other atoms, and it may pass through the anatomic part to interact with the image receptor.  Compton interactions occur within all diagnostic x-ray energies.

Notes:

  • The main difference between the Photoelectric effect and Compton effect is that in the photoelectric effect, the original photon gives up all of its energy when it comes into contact with the inner-shell electron.   In the Compton effect, the original photon only gives up part of its energy when encountering an outer-shell electron.
  • Photoelectric interactions generally decrease at higher kVp.
  • Compton interactions generally increase at higher kVp.

Transmission occurs when when the incoming x-ray photon passes through the body without any interactions with the anatomic structures.  More transmission occurs at higher kVp.

Additional Tidbits

There are a few items of interest that I wanted to post here. I have been looking around the net lately for student radiography blogs, and for blogs of people who are working in the field. I haven’t found a lot of stuff, but when I do find something of interest, I’m adding it to my blogroll on this website. There are a few blogs listed there that never get updated, so I’m probably going to remove those at some point and hopefully replace them with blogs that are updated at least once per week, if not more often.

RADIOGRAPHY STUDENTS continues to grow. It has 162 members from all over the world since it was started. All of those members aren’t highly active, but the forum discussions are starting to pick up. I think this site will continue to grow over time. Some of the participants there are working techs and there are a couple instructors, so the potential is excellent.

TOPICS IN RADIOGRAPHY is one of the better blogs I have found so far, and I just found it this week.  There is a ton of useful information here.

THE RADIOLOGY PORTAL and DAVE’S PLACES IN RADIOLOGY are both excellent resources run by Dave Woeber.

If you have any favorite links for radiography students, please let me know…

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Slow for a Change

Untitled

Oddly enough, I had a slow day at clinical. This was the first day since I have started this rotation that I didn’t stay fairly busy all day. I only logged 8 procedures, but I did pick up another master comp on the foot today. That brings my master comp total to 12, and 9 for this semester (out of the 22 required for the maximum grade.) I spent some time in clinical today studying for an upcoming test on spinal positioning. One of the 8 exams I had today was a c-spine, so I did get to practice that on a live patient. I’ll get to start my pre-comps on the spinal series after we have the test in lab, but I’m concerned that I won’t get to comp any of my spine routines in this orthopedic office. We do a lot of spine x-rays, but the obliques are not part of the standard routine, and those need to be part of the master comp. I’ll be back in a hospital during the second half of the semester, and I should be able to pick up those comps there without any trouble. There are a couple other exams I thought I would see in the orthopedic office that I haven’t seen yet. I haven’t had a clavicle, scapula, AC joints, toe, SI joints, elbow, forearm, humerus, or femur yet. Technically I did have a forearm, but I used it as my master comp for the pediatric upper extremity since the patient was 6-years old. Those are a little harder to come by, so I put it on a pediatric comp rather than a standard one.

I also haven’t had a chance to dig deeper into the problem I posted about yesterday. I’m gonna send an email to one of my instructors over the weekend and ask some of those questions so I can get a better understanding of what’s going on there…

I’ll be spending time this weekend preparing for my first test in the imaging class. I understand all the concepts very well, but there is a good bit of detail I need to prepare for…

Have a good weekend…

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Manual Exposure Technique

La Pieta

I did a few experiments in clinical today.  In my quest to learn and understand manual exposure techniques, I have learned a few important items.  The biggest thing I have learned recently is a small tidbit of information that is invaluable to me.  The digital processors (CR) will tell you if your image is exposed properly or not.  With this bit of information, a tech can easily correct techniques and update technique charts that aren’t producing quality images.  In my current clinical assignment, I’m seeing some fairly frequent underexposures with the techniques that are being used.  I now have the tools to understand why these exposures are bad and how they can be corrected.

The problem begins with the fact that my clinical site has not been using digital for very long.  It’s been less than a year since they converted from film.  The tech I’m working with told me that they didn’t have to modify their technique charts much at all after the switch.  This immediately created a red flag for me.  We have been taught that digital takes more exposure than film to produce good images.  I was curious if the unchanged techniques were affecting the exposures, and I think they are.  The digital processor reports an “S” number for each image to indicate its exposure level.  I found the following list of proper S numbers for various exposures posted in the room where the processor is located, and I can only assume that the list is accurate and that my ‘median’ target number is also accurate:

  • Skull - 100 to 400 (250 median)
  • Chest - 200 to 600 (400 median)
  • Abdomen - 100 to 400 (250 median)
  • Extremities - 75 to 200 (140 median)
  • Spine - 100 to 400 (250 median)

The median number just represents the middle of the ‘acceptable range’ of S values.  I suppose the median is the true target though.  S numbers above the median represent underexposure and numbers below represent overexposure of the x-ray image on the digital receptor.  With this knowledge in hand, I started making a few notes on some of the exposures that came up next.

L-Spine (AP) - Large Patient - 80 kVp / 75 mAs - S=1005
L-Spine (LAT) - Large Patient - 80 kVp / 225 mAs - S=333
L-Spine (AP) - Average Patient - 80 kVp / 75 mAs - S=318
L-Spine (LAT) - Average Patient - 80 kVp / 225 mAs - S=459
L-Spine (AP) - Large Patient - 80 kVp / 75 mAs - S=515
L-Spine (LAT) - Large Patient - 80 kVp / 225 mAs - S=340

As you can see, the technique chart in use for these two exams is 80 kVp with 75 mAs for the AP view and 225 mAs for the lateral view.  I didn’t see any technique adjustments for the varied sizes of the patients coming through.  This explains why the S values for the average size patient were closer to the median (250) than they were on the large patients, but in any case, all of the images were relatively underexposed, with the first AP view being extremely underexposed.  My assumption is that if the technique used is correct for the patient, the S number should fall as close to the 250 median on these L-Spine exams as possible.  The digital system can correct for improper exposures, but corrections introduce ‘noise’ or ‘grain’ into the image, and more severe corrections increase that amount of noise in the image. 

My current objective is to determine how to correct the problem so I can experiment with a solution at clinical.  These exposures that are being made are obviously not a concern at my clinical site, because the doctors are satisfied with what they are getting.  The problem is that, in my stage of learning, I want to learn how to do it properly.  So, I’m using these examples for my own benefit to learn what should be done to hit the target exposure after seeing quite a few underexposures.  There are a few unknowns here, so any comments or suggestions would be appreciated…

Question:  Is the S number in a direct relationship with the exposure level?  For instance, would doubling the mAs on that first exposure from 75 to 150 bring that S number down from 1005 to approximately 500?  This, I do not know. 

Observation:  The technique chart in use does not adjust the kVp for patient part thickness changes. 

Next Step:  My next step will be to figure out what needs to be done to correct these exposures so they come out closer to the median (if the median is the true target number).  I will be asking some questions about the proper procedures and see what I can come up with.  I’ll follow up here when I find those solutions…

On a good note…

I had another very productive day at clinical.  I logged another 35 procedures and completed four more master comps (wrist, pelvis, calcaneus, and ankle). 

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Digital

Art of the Game - 05

We finally got to play around with our new digital processor in lab today.  We did some comparisons between film and digital, and there are some new questions in my mind now that simply don’t make sense at all.  We did a lab to show the relationship between kVp and density, but we did the same exposures on film and on digital (CR).  Our film images behaved as expected… the density increased each time we increased the kVp and left the mAs at the same settings.  The digital images, on the other hand, all displayed with relatively similar densities, but we could see the differences in penetration on our step wedge.  The digital system compensates for improper exposures (LGM).  The big question that I had, that our instructor couldn’t answer (yet) is why can’t we see the unaltered image in the digital system?  There is probably a way to look at the image as captured before the system manipulates it.  If we could see these images, they should look similar to our film exposures with one minor exception.  The detail screen we used for the film exposures was a 50 speed screen and the digital image receptors are 100 speed.  More research to come…

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Bones Flashcards!

Amazon.com: Flashcards for Bones, Joints and Actions of the Human Body: Books: Joseph E. Muscolino

I went to Barnes and Noble for a while earlier this evening.  I was, as usual, browsing through the medical books when I stumbled across this set of flash cards.  I had been looking for a book that specifically covered skeletal anatomy and had never found a decent one that covered the detail we need as radiography students.  This box of flashcards is EXCELLENT.  I purchased it for $28.95 and have been browsing through them this evening.  I wish I had found this earlier, but I can still use it.  Learning skeletal anatomy well enough to pass the tests is one thing, but making it all second nature is another.  These cards will help me do that.  I highly recommend getting a set of these if you are a radiography student…

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A Slow Clinical Day

Alpha and Omega

Friday was a rather slow day for me in clinical.  I had to go on a 2-hour delay since school was on a delay for the weather.  I arrived at clinical at 10am rather than my normal 8:30am on Friday.  After the current weather closings and delays, I’m 9 hours behind schedule on my clinical work for the semester.  In the greater scheme of things, we are allowed to miss two days of clinical without penalty, so I need to find out about making up this time. 

I can remember the days when I loved a snow day.  I still love the snow, but when it interferes with my goals, it’s a annoying :)  I have a lot of work to get done, and I don’t want things beyond my control to get in the way of that. 

My clinical day on Friday wasn’t overly productive.  I only logged 16 procedures, and a majority of them were spines, which aren’t good for anything but experience for me at this point.  10 of the 16 procedures I logged were spines, and two were orbits.  The four procedures that were useful to me were a forearm (which turned into a pediatric upper extremity master comp), an ankle, and two knees.  I didn’t get the comp on either of those though.  Neither of the knee exams were enough views for a master comp, and I had the lateral view of the ankle slightly rotated.  The lateral ankle can be a little tricky sometimes.  Putting the malleoli perpendicular to the image receptor doesn’t always mean that the ankle will be ‘flat’.  I had a small patient with a very small foot, and I did not catch this.  What I did get out of it was some valuable experience though.  I’ll not make that mistake again :)

I met another person who graduated from my program in 2007.  This is the 4th 2007 graduate that I have met who is working in the area.  That gives me some hope that the job market isn’t as tough as they say…

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A Day Off

Well, we got a little snow overnight and this morning, and school is closed. One of the interesting things here is that today was supposed to be a clinical day, and we’re not allowed to go to clinical if school is closed for weather or a holiday. It was snowing when I went to bed last night, so I got up at 7am this morning and checked the school’s website to find the message that classes had been canceled for the day, and then went back to bed for a few hours… The overnight lows tonight are supposed to be below freezing, so there’s a possibility of another cancellation or possible delay for school tomorrow, which is another clinical day for me…

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