Retelature review

X-rays are a form of electromagnetic radiation, discovered by a German physicist named

Wilhelm Roentgen in 1895. During the 1870s, and 1880s, many universities were
investigating the conduction of cathode rays through the Croukes tube.
There were many different croukes tube; most of them were able of producing x-rays.
Wilhem Conard Roentgen was doing his experience in his physics laboratory at
Wurzburg University in Germany.
In his dark laboratory he placed the croukes tube in carton box in order to visualize better
the effect of cathode rays Paul (2009). This allowed for electrical currents to build up
inside of the glass tube. There was in several feet, a plate coated with barium
platinaciamide: fluorescent material. Roentgen noted that the plate glowed regardless
distance from croukes tube and had a little doubt about origin of the stimulus of the glow
and he called this light x-light (Stewart, 2004)
He continuing his experience; by bringing the plate closer to croukes tube the glow
increased. He determined that a new kind of rays responsible of florescence, were from
croukes tube and he called x-rays, because of their mysterious nature Paul (2009). On
Friday November 1985 Roentgen made his first note after repeating his experiences
(Carlton, 2006).
Roentgen continued his experience to determine properties of x-rays by placing different
objects between the tube and fluorescent screen. He found that the brightness of the
fluorescent differed with each object and indicated that the x-rays penetrated some
objects easily than other (Thomas, 1990)
This chapter will describe x-rays production, Radiations protection and safety of X-rays
and discovery of x-rays

According Donald and Paul (1981) in order to produce x-rays the tube requires a high
potential difference across it and current flowing through it.
X-rays for medical diagnostic procedures are produced by accelerating electrons with a
high voltage and allowing them to collide with a metal target, in a highly evacuated glass
tube (Statkiewicz, Visconti, Ritenour, 1993). X-rays are produced when the electrons are
suddenly decelerated upon collision with the metal target. These x-rays are commonly
called brehmsstrahlung. If the bombarding electrons have sufficient energy, they can
knock an electron out of an inner shell of the target metal atoms. Then electrons from
higher states drop down to fill the vacancy, emitting x-ray photons with precise energies
determined by the electron energy levels. These x-rays are called characteristic x-rays.
http://hyperphysics.phy-astr.gsu.edu/hbase/quantum/xtube.html
img.tfd.com/dorland/thumbs/tube_x-ray.jp

The x-rays used in medicine are produced by x-ray imaging system. The x-ray imaging
system is composed with three main components: the operating consol, the X-ray tube,
and the high voltage generator (Stewart, 2004).

A diagnostic x-ray generator has a role of producing power capable to accelerate the
stream of electrons from cathode to the anode. It is composed of numerous basic
electrical devices. To establish x-ray circuit these devices will be connected in sequence
capable of accelerating electrons to the speed necessary to cause the production of x-rays
photons within x-ray tube, (Carlton, 2006).
Richard and Arlen (2006) explain that operating consol is a part of x-ray generator
located on the low voltage side of the circuit to protect operators from high voltage shock
hazards.

An x-ray tube is a vacuum tube that produces X-rays.

The main parts made X-ray tube are: cathode (negative charged) with filament, and the
anode (positive charged) (WHO, 2004).The cathode emits electrons into the vacuum and
the anode which is usually made by tungsten, molybdenum or coppery collects the
electrons and electrons from the cathode collide with the anode material, and accelerate
other electrons, ions and nuclei within the anode material. The energy generated is
emitted, as X-rays. A high voltage power source, for example 30 to 150 kilovolts (kV)
generated by x-ray generator, is connected across cathode and anode to accelerate the
electrons (Thomas, James, Robert, 1990).
http://en.wikipedia.org/wiki/X-ray_tube visited on 24th June 2010 14:30

Radiations protection and safety of X-ray

Biological effect of ionizing radiation
Even at very low x-ray doses the energy disposed by ionizing radiation may be sufficient
to damage or destroy cells (Paul, 2009)
Exposure of organ to the x-rays results in interaction to atomic level of irradiated organ
or tissue. This interaction results in form of ionization and disposition of energy in tissue
(Adler and Carlton, 1994). The disposed energy can result a breakage of large molecule
or relocation of an atom within molecule. this change may cause molecule function
impairment or cease to function, which can result in serious impairment or cell death.
This change in molecule can be corrected by attraction of free electrons by ionized atom.
Also molecule can be mended by repair enzymes, and tissue can regenerate, and recover
from radiation injuries (Stewart, 2004).
Exposure to x-rays affects different tissue and may result in probability for radiation-
induced diseases in persons exposed and their descendants. Among health effects are
cancer induction, genetically determined ill health, no specific life shortening,
developmental, abnormalities, and degenerative diseases (WHO,2004).

According to Richard and Arlene (2006) Biological effects of ionizing radiation may
classified as somatic or genetic effects.
Somatic effects may be visible in irradiated person. The somatic will be demonstrated in
few days to weeks of exposure if a dose is quite high. Among somatic effects are: skin
erythema cataract radiation induced malignancies. These effects are not to be expected in
person exposed in course of work in medical environment.
Genetic effects do not appear in person irradiated but it will appear in descendant of this
person. It may not be visible in child of exposed person but may lie dormant for several
generations and eventually may be eliminated completely from genetic pool. It is unlikely
that a worker can be exposed to enough level of radiation high to cause appreciable
genetic effects.

Types of biological effects

Biological effects of radiations may of type of stochastic or deterministic (no stochastic)
Deterministic effects have a threshold of irradiation under which they do not appear and
are the necessary consequence of irradiation. The damage they cause depends on the
dose: they are sublethal from 0,25 to 2 Sv (WHO, 2004)
Stochastic effects are coincidental and cannot be avoided. They don't have a threshold.
These can be divided into somatic and genetic. Among the somatic effects, secondary
cancer is the most important. It develops because radiation causes DNA mutations
The genetic effects confer the predisposition to cancer to the offspring (WHO, 2004).
Stochastic effects are only type of effects likely to be see in diagnostic radiology; they are
chance effects (Simone, 1993)
http://en.wikipedia.org/wiki/Radiosensitivity on 25th
Radio sensitivity

Radio sensitivity is the relative susceptibility of cells, tissues, organs or organisms to the
harmful effect of ionizing radiation. As it is described by the law of Bergonie and
Tribondeau, formulated in 1906, ionizing radiations are effective against actively mitotic
cells and undifferentiated cells and the cells which have long dividing future (Elizabeth,
1975). X-rays are more effective on cells which have a greater reproductive activity.
Sensitivity of cells depends on their characteristics. Rubin and Casarett(1986) has defined
five basic categories of cells population:

Vegetative intermitotic cells (VIM)

These cells are rapidly divide, they undifferentiated, and they do not differentiate
between division. they are type a spematogonea, erythroblast, crypt cells of intestines,
and basal cells of epidermises. These cells are most sensitive to radiations.

Differentiating intramitotic cells

They are actively dividing , more differentiated than VIM ; and they differentiate
between division. they are: intermediate spermagonia , and myelocytes. they relatively
radiosensitive.

Multpotential

They are irregular dividing, and more connective cells than VIMs and DIMs these cells
are intermediate in radiosensitivity. they are endothelial cells and fibroblasts cells.

Relative post mitotic cells (RPM)

These cells are do not normally divide but retain a capability of division and
differentiation they are prenchymal cells of lever, and lymphocytes.

Fixed post mitotic cells

They do not divide and are differentiated. these cells are muscle cells, some nerve cells,
erythrocytes, and spermatozoa. they are radioresistant.

NB: although lymphocytes are classified as relatively radioresistant by their

characteristics, are very radiosensitive.

Factors influencing response

The effects of factors influencing response are either to diminish the response enhances
response, or elist the response at different time. Therefore the cells exhibiting enhanced
response appear to be more radiosensitive, and those exhibiting diminished response
appear more radioresistant. These factors are grouped as biological factors, physical
factors, and chemical factors (Elizabeth, 1975).

Physical factors

Linear energy transfer: is a measure of the rate at which energy is transferred from
ionizing radiation to soft tissue (Stewart, 2004).Irradiation of the same biologic system
with different radiations will produce different qualities of biologic response (Elizabeth,
1975)

Chemical factors
Chemical factors can change radiosensitivity by enhancing response: they are called
radiosensitizers , and they can influence response by diminishing response: they are
called radioprotectors. Among all chemical fit these criteria, oxygen has been found to
universally enhance radiation response (Elizabeth,1795). Radioprotectors act by reducing
the effect dose of radiation to the cells; fore that reason they termed dose modifying
compound.chemical that contain a sulfhydry group is one group of compound that have
radioprotector propertie (Statkiewicz, Visconti, Ritenour, 1993).

Biological factors

As Elizabeth (1975) says, biologic factors that influence cells radiosensitivity are cell
cycle and intracellular repair. In cell cycle, the position of the cell in the cell cycle at the
time of irradiation, is one of biologic factor that has a greater influence on cellular
response. Experimental findings indicate that the cells are more radiosensitive when
irradiated in phase G2 and in M and are less sensitive in G1 and least sensitive during
DNA synthesis. In general M is considered to be the most radiosensitive phase in cell
cycle and S the most resistant. Low dose affects cell in cell cycle G2 and M, delay their
progress through mitosis for a given period of time. Higher dose affect all cell cycle
phases and produce a longer mitosis delay. Other biological factor that influences
response is capability of cell to repair subletal damage.

Principles of radiation protection

Radiation protection can be divided into occupational radiation protection, which is the
protection of workers; medical radiation protection, which is the protection of patients;
and public radiation protection, which is protection of individual members of the public,
and of the population as a whole.

There are three factors that control the amount, or dose, of radiation received from a
source. Radiation exposure can be managed by a combination of these factors:

1. Time: Reducing the time of an exposure reduces the effective dose proportionally.
2. Distance: Increasing distance reduces dose due to the inverse square law.
3. Shielding: Adding shielding can also reduce radiation doses. The effectiveness of
a material as a radiation shield is related to its cross-section for scattering and
absorption, and to a first approximation is proportional to the total mass of
material per unit area interposed along the line of sight between the radiation
source and the region to be protected. In x-ray facilities, the plaster on the rooms
with the x-ray generator contains barium sulfate and the operators stay behind a
leaded glass screen and wear lead aprons. Almost any material can act as a shield
from x-rays if used in sufficient amounts.

There are four major ways to reduce radiation exposure to workers or to population:

• Shielding. Use proper barriers to block or reduce ionizing radiation.

• Time. Spend less time in radiation fields.
 • Distance. Increase distance between radioactive sources and workers or
population.
• Amount. Reduce the quantity of radioactive material for a practice.

http://en.wikipedia.org/wiki/Radiation_protection

Radiographic protection feature

Radiographic protection features are design to reduce patient dose during x-ray
examination. Some of the are associated with x-ray imaging system. Among these
radiographic protection features are:

protective housing :when x-rays are produced they are emitted isotropically. In
diagnostic x-ray we use x-rays which pass through a special section of x-ray tube called
window these x-rays are called useful beam.leakage radiations result in unnecessary
exposure to a patient and radiographic technologist. To reduce the leakage radiation the
protective housing is designed so that it reduces leakage radiation at a level of less
100mR/hr at 1m when operating at maximum conditions. Protective housing protect
against accidental electrical shock and provides mechanical support (Stewart C, 2004).
Control panel which indicate the condition of exposure and positively indicate when the
x-ray is energed.( David, Dowsett, Patrick, Kenny and Eugene, 2006).
Source-to-image receptor distance indicator can be as simple as a tape measure
attached to the tube housing, or as advanced as labers. ( David, Dowsett, Patrick, Kenny
and Eugene, 2006).
Collimation has shutters attenuate useful beam as attenuated by protective housing. It
must provide light localized and variable aperture rectangular. Cone and diaphragms may
replace the collimator for special examination.( David, Dowsett, Patrick, Kenny and
Eugene, 2006).
Positive beam limitation: are adjusted so that with any film size in use and at all
standard SIDs the collimator shutters automatically provide an x-ray beam equal to the
image receptor.( David, Dowsett, Patrick, Kenny and Eugene, 2006).
Beam alignment: radiographic tube should be provided with a mechanism to ensure
proper alignment of x-ray tube and image receptor.( David, Dowsett, Patrick, Kenny and
Eugene, 2006).
Filtration is designed to absorb lower energy x-rays, in order to reduce exposure to the
patient’s skin and superficial tissue (Statkiewicz, Visconti, Ritenour, 1993).
Operator shield radiographer should expose while is in inside protective barrier; this is
the reason exposure control is fixed to operating consol. And radiographic technologist
will be in examination room only if protective apparel is worn.( David, Dowsett, Patrick,
Kenny and Eugene, 2006).
Shielding materials

Shielding reduces the intensity of radiation exponentially depending on the thickness.

The shields use in x-ray examination room are: lead glass, lead sheet, concrete ,and
concretes block, gypsum wall board, barium plaster, transparent lead acrylic. (David,
Patrick, Kenny and Eugene, Johnston, 2006). The common protective devices are lead
aprons, and lead gloves. Special devices include lead glass and thyroid shields and
gonadal shielding (Richard and Arlene, 2006)..

x-ray safety
As with other medical procedures, x-rays are safe when used with care. Radiologist and
x-ray technologists have been trained to use the minimum amount of radiation necessary
to obtain the needed results. The amount of radiation used in most examinations is very
small and the benefits greatly outweigh the risk of harm.
X-rays are produced only when a switch is momentarily turned on. As with visible light,
no radiation remains after the switch is turned off.
http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray

safety procedures

Except for patients who cannot be moved out of the room, only the staff and ancillary
personnel required for the medical procedure or training shall be in the room during
the radiographic exposure. Other than the patient being examined will protect by
protective materials and well positioned..

Gonad shielding of not less than 0.50 millimeter lead equivalent shall be used
woman patients, who have not passed the reproductive age, during radiographic
procedures in which the gonads are in the useful beam, except for cases in which this
would interfere with the diagnostic procedure and man as well.:

When a patient or film must be provided with auxiliary support during a radiation
exposure: Mechanical holding devices shall be used when the technique permits, if
not, the human holder shall be protected and No individual shall be used routinely to
hold film or patients

Procedures and auxiliary equipment designed to minimize patient and personnel

exposure commensurate with the needed diagnostic information shall be utilized. The
speed of film or screen and film combinations, minimum exposure required to
produce images of good diagnostic quality, grids.
http://www.idph.state.ia.us/eh/diagnostic_ray_guide.asp
 References

Adler Carlton, 1994.Introduction to Radiography and Patient Care, Saunder, Missouri. P

110,112,117.

David J.Dowsett, Patrick A. kenny and R. Eugene Johnson, 2006. Physics of Radiologic Imaging,
2nd ,MPG books, Bodmin, Cornwall.p 676

Donald T. Graham, Paul Cloke,1981.Princeple of Radiological Physics, 4th Edition,

Elsevier, China. P 119.
Elizabeth Latorre Travis,1975. Primer of Medical Radiology,…..,United States. P
47,50,53,67,72,77

Paul Swetens, 2009. Fondamental of Medical Imaging, 2nd Edition, UK. P 27

R.Arlen M,2006. Principle of Radiographic Imaging:An Art and Science, 4th Edition, Thomson
Delmar Learning, United States. P 35,91,0155,0157

Simone Plaut, 1993. Radiation Protection in X-ray Department, Biddles LTD, Gwildford and Kings
Lynn, Great Britain. P.19

Statkiewicz-Sherer, Visconti, Ritenour, 1993. Radiation Protection in Medical Imaging

Radiography, 2nd Edition, Mosby. p 171

Stewart C.Bushong,2004.Radiographic Science for Technologists: physics, Biology, and

Protection,8th Edition,Mosby. P 7,109,568.

Thomas S.Curry,III,James E.Dowdey, Robert C. Murry,JR,1990. Christen's physics of Diagnostic

radiology, 4th edition, lea and febiger, united states. P 1,10

WHO, 2004. Basics of Radiation Protection, Malty

WHO, 2004. Basics of Radiation Protection: How to Achieve ALRA: Working Tips and Guidelines,
Malty. p 8
Questionnaire

IDENTIFICATION

AGE
DEPERTMENT
CLASSLEVEL

QUESTIONS

1. Production of X-rays

a. x-rays are produced by:-x-rays tube

-diagnostic generator

-control panel

-all of them

-don’t know

b. After x-ray exam, x-rays are still in examination room

Yes

Non

Don’t know
 2. Radiation protection

a. Cell population radiosensitivity

radiosensitivity The most Intermediate Relatively Radioresistant

Cell population sensitive radiosensitive radiosensitive

Vegetative intermitotic cells

e.g.spematogonea, erythroblast
Differentiating intramitotic
cells
e.g. intermediate spermagonia,
and myelocytes
Multpotential
e.g. endothelial cells and
fibroblasts cells
Relative post mitotic cells
e.g. parenchyma cells of lever,
and lymphocytes
Fixed post mitotic cells
e.g. muscle cells, some nerve
cells

b. Biological effects of x-ray radiation

The types of biological effects are

Stochastic effects and deterministic effects. Yes Non

Stochastic effects are dose independent. Yes Non

Deterministic effects are dose dependent. Yes Non

c. Principle of radiation protection

major ways to reduce radiation exposure to workers or to population from source are:

time

distance

Shielding
All above

Time and distance

Time and shielding

Shielding and distance

3. Shielding materials

Which Shielding materials do you know:

Lead glass

Lead aprons

Lead gloves

Gonads shields

Thyroid shields