Diagnostic Radiology and Imaging For Technicians

Diagnostic Radiology
and
Imaging for Technicians
Diagnostic Radiology
and
Imaging for Technicians
AN Shastri
M.Sc. (Physics) Nagpur University, Maharashtra, India
B.E. (Electrical Communications Engineering)
Indian Institute of Science, Bengaluru, India
Fellow of the Institute of Engineers (India),
Kolkata West Bengal, India
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Diagnostic Radiology and Imaging for Technicians

2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval
system, or transmitted in any form or by any means: electronic, mechanical, photocopying,
recording, or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and author will
not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters
are to be settled under Delhi jurisdiction only.
First Edition: 2008

ISBN 978-81-8448-214-0
Typeset at JPBMP typesetting unit
Printed at Rajkamal Press
Dedicated to my wife
Shaila
who gave all the encouragement
to write this book
Foreword
The rapid advances in the field of radiology

in the past few decades have been
remarkable, largely contributed by the
exponential leap in the technological
aspects of invention of faster and better
imaging systems. Scientific research has led
technological developments in imaging
which has progressed leaps and bounds
whereby it has been difficult for surgical
techniques to keep pace. Imaging science
has kept pace with these cutting edge
technological innovations with develop-
ment of landmark systems for diagnostic and therapeutic imaging.
Static imaging has become a thing of the past with more emphasis
on dynamic approaches whereby technological advances represent
the dynamic pathophysiological changes which occur in the human
body.
A large quantum of todays clinical work in radio-imaging still
depends to a large extent on established imaging techniques which
have stood the test of time. This means, we, as radiologists,
radiographers and technicians, should have an extensive and in-
depth knowledge of the mechanics and functioning capabilities of
our systems so as to eke out the maximum from each of these
systems. To keep in touch and routinely upgrade ourselves on the
technological aspect of imaging means to have a comprehensive
data bank on these technical aspects of imaging.
I have personally known and have worked with Mr. Shastri
for the last three decades, especially on the evolving nature of
technological advances in the field of radiology. In our country,
Foreword viii
we definitely lack a definitive and concise book which encompasses

to a great extent the physics and technical advances in radiology.
This book has achieved these expectations to a great extent and
provides an excellent insight into this rapidly developing and self-
innovating field. This book primarily represents an up-to-date
textbook which provides a birds eye view into the basic physics
and technical advances in the field of radiology.
I firmly believe that this excellent monogram on radiology will
be of great value and guidance to the biomedical engineers,
radiographers as well as postgraduate students in radiology. I say
so after having gone through the book in great details. Mr Shastri
has taken pain to explain in the simplest forms, the newer
technologies in radiology with great ease and lucid explanations.
I am sure this great effort from an Indian author will be accepted
globally!
Dr. Mukund S. Joshi

MD FAMS (INDIA)
Consultant Radiologist
Jaslok Hospital
Mumbai 400 026, India
Preface
When I began my teaching career, I painstakingly compiled the

teaching material from various sources such as application notes
and product data sheets. Fortunately with my technical background
and work experience, I was able to access the valuable technical
information. This motivated me to take up the effort of writing a
textbook on Radiology.
This book is written for the undergraduate students
undertaking a course in biomedical engineering as well as for
upcoming radiologists.
This book covers Basic Physics and Principles of Radiology,
Engineering aspects of Radiology such as manufacturing and testing
techniques involved, Applications, Features, Specifications, Market
requirements, Sales and Marketing, Modern Methods of Imaging
and practical aspects of installation in hospitals. I had included
figures and photographs on relevant topic to make the subject simple
and easy to understand.
The general structure of this book is that of textbook with
continuity between chapters.
The intended readers of this book would be biomedical engineers,
radiologists and radiographers, etc. aiming to gain an insight into
the basics of diagnostic radiology.
A.N. Shastri
Acknowledgements
I owe a great debt of gratitude to M/s Siemens Limited, where I

learnt different aspects of this subject, which include R&D, QC,
Manufacturing and Sales & Marketing. I received technical training
on various modalities of Radiology in their technical school at
Erlangen, Germany. I also thank the present management of
Siemens Ltd., for providing me the current specifications and data
sheets of various radiological equipments. I am grateful to my
seniors for guiding me through my assignments and sharing the
valuable information with me from time to time. This approach
has created an interest in the subject and gave me confidence.
I was brought up in a professors family. I was lucky enough to
get guidance and help from my parents in early part of my career.
Later I developed the habit of sharing the technical knowledge
with others. This helped me in teaching the basics during my
assignment as Technical Training Manager for Sales & Service
Engineers and led to the lecturing at various institutes in the
capacity of visiting faculty.
I thank Prof (Mrs) Meeta Bhowmick, Head of the department
of Biomedical engineering, Thadumal College of engineering,
Bandra, Mumbai and Mr L.B. Barretto for giving their technical
help and proofreading of this book.
Contents
1. Introduction .................................................................1
2. Nature and Properties of X-rays ............................4
3. Production of X-rays ............................................... 10
4. X-ray Interaction with Matter .............................. 15
5. Total Radiographic System .................................. 21
6. X-ray Tubes .............................................................. 54
7. X-ray Generators ..................................................... 79
8. X-ray Examination Units ..................................... 125
9. X-ray Image and Beam Limiting Devices ....... 143
10. Radiographic Materials and Processing
Teachnique ............................................................. 160
11. Requirement of Good Radiograph ................... 171
12. Image Intensifiers and Related Systems ........ 178
13. Angiography Techniques and Systems ........... 217
14. Tomography ........................................................... 233
15. Radiation Protection ............................................ 257
16. Bone Densitometry ............................................... 279
17. Digital Radiography ............................................. 285
Index .......................................................................... 295
1 Introduction
Biomedical engineering has grown by leaps and bounds over past

century assisted by the modern advances in science and technology.
We notice new innovations taking place in medical engineering
field. This is coupled with various advances in applications and
engineering fields such as civil, mechanical, electrical, electronics
and information technology. Medical engineering field has two
branches namely, therapeutic and diagnostic. The product
spectrum of both therapeutic and diagnostic equipments is
continuously undergoing change in features and specifications, as
per requirements of end user and desired applications.
Radiology is one of the most important department in hospital.
Department of Radiology forms a backbone of any hospital. Even
today the radiological diagnostic examinations are affordable to
common man. They cover the routine X-ray examinations of chest,
extremities, plain abdomen, gallbladder stones, kidney stones,
pancreas and liver examination, lumbar spine and pelvis, and
special examinations such as GI track studies, intravenous
pyelography. In terms of equipment spectrum, this department is
most expensive. This covers conventional radiology equipment,
dental X-ray, mammography, CT scanners, bone densitometry,
digital radiography, ultrasound and magnetic resonance imaging.
Requirements of the power supply, area, skilled manpower and
operating costs are very high for this department. Hence it is utmost
important to plan out the department based on these requirements
and disease pattern in that locality. Involvement of hospital
management, administration, personnel from engineering
department is essential during planning stage. We will limit our
discussions to Radiology department covering radiology
equipment, dental X-ray, mammography, CT scanners, bone
2 Diagnostic Radiology and Imaging for Technicians
densitometry and digital radiography and other allied

infrastructure to support the Radiology field.
HISTORICAL BACKGROUND
The day of 8th November 1895 will be remembered as most
important event in the history of Medical Imaging. On this very
day, a new invention was made by a physicist, Wilhem Conrad
Roentgen, from University of Wurzburg, Bavaria, Germany. He
saw with his own eyes, a faint flickering greenish illumination upon
a bit of cardboard, painted over with fluorescent material in
carefully darkened room. In that room a Crooks tube was simulated
internally by sparks from induction coil, but carefully covered by
a shield of black cardboard. In the darkness, his eyes were watching
luminous phenomena. The rays emerging from Crooks Tube
penetrated cardboard shield, fell upon luminescent screen, thus
revealing their existence and making visible in darkness.
Illumination was seen on fluorescent screen due to these invisible
rays, the line of shadow across it. The source of these rays was
Crooks Tube. These invisible rays were found to have a very high
penetrating power. These rays penetrated cardboard, wood, and
cloth with ease, they would pass through thick plank or book,
lightning the fluorescent screen placed on the other side. It was
also observed that denser materials such as metals were lesser
penetrable. Same experiment was tried with humans and it was
observed that flesh was transparent and bones were opaque. The
discoverer interposed his hands between the source of rays and
luminescent screen, saw the bones of his hand as a shadow on the
screen.
These rays later on were named after their inventor, Roentgen and
also called X-rays. The first official lecture by Dr. Conrad Roentgen
On new kind of Rays was delivered on 23rd January 1896 in
Wurzburg Germany. Dr. Roentgen was awarded the Nobel Prize
for Physics in 1901. This was the most important milestone in the
history of medical imaging.
Max Gebbert an instrument mechanic and medical equipment
specialist, recognized the significance of this discovery and
launched along with Dr. Conrad Roentgen, Reineger and Schall
the first diagnostic equipment. Later Siemens Medical Engineering
Group company was formed, which introduced new X-ray
diagnostic equipments and tubes.
Introduction 3
The historical developments in radiology are listed below:

1895 Discovery of X-rays on 8th Nov. 1895 by Dr. Wilhem
Conrad Roentgen
1896 First patent for an X-ray unit for diagnosis by Reiniger,
Gebbert, Schall for investigations of bones
1901 Nobel prize in Physics to Dr. Wilhem Conrad Roentgen
1904 Patent for use of Tungsten as anode material in X-ray tube
First High tension Rectifier for X-ray Application
1906 First contrast filled image of renal system
1910 Introduction of Barium sulfate as contrast media for
Gastrointestinal diagnosis
Publication of theory of Radioactivity by Marie Curie
1915 Introduction of moving grid for making the shadow of grid
invisible by Potter and Bucky
1919 Patent for a shock proof and radiation protected housing
1923 Patent for the first double focus tube; First device for serial
spot-filming
1924 Radiological Visualization of the Gallbladder and Bile Duct
Radiographic Vascular Imaging
1929 First heart catheterization by Forssmann on himself
1935 Introduction of Linear Tomography
1938 X-ray Collimator with light localizer
1940 Introduction of Image Intensifiers, First Rotating Anode
Tube with 100 mm disc
1945 Visualization of coronary arteries
1946 Automatic Exposure unit
1953 Cut film changer with 6 exposures per second for
Angiography
1955 Introduction of X-ray Image Intensifier Television Units
1967 Introduction of first CT Scanner by EMI for head and neck
region
1969 X-ray tube with Graphite anode for high heat capacity
1970 Application of Mammography
1972 Introduction of first generation CT Scanner
1975 Real Time Digital Subtraction Angiography
1980 Introduction of fourth generation CT Scanner
1985 Widespread application of interventional techniques with
X-ray support
1988 Introduction of Digital Radiography
1989 Introduction of Spiral CT for fast volume scanning
Nature and Properties

2 of X-rays
When the fast moving electrons are suddenly stopped by matter

in any form, X-rays are produced. This phenomena takes place in
very high vacuum tube (diode).
Since we are discussing electrons, we require source of electrons
which are obtained by Thermeonic Emission from filament of the
thermeonic tube. These electrons are possessing very high kinetic
energy given by equation
1
Kinetic energy = mv 2
2
where m is a mass of electrons and v is the velocity of electrons
achieved by very high potential difference between anode and
cathode of X-ray tube.
These electrons are suddenly stopped at Anode and their kinetic
energy is converted into Heat and X-ray radiation. This phenomena
is known as Bremstrahlung (which means Radiation due to sudden
braking).
The efficiency of production of X-rays is very low, only about 1%
of the energy is converted into X-rays and 99% of this energy is
transformed into heat. Since this large amount of heat generated
in Anode of X-ray tube, the material of Anode should have high
melting point. It was also observed that higher the atomic number
of anode material, the X-ray yield is more. Therefore the material
should have higher atomic number and high melting point.
Tungsten is a natural choice which will be suitable for this purpose
since it has melting point of 3400C and atomic number 74.
The construction and working of X-ray tube will be discussed in
X-ray Tube chapter. We will now discuss properties of X-rays and
how X-ray image is obtained.
Nature and Properties of X-rays 5
1. X-rays pass through the matter

X-rays are attenuated while passing through the matter. The
amount of absorption depends upon density of the medium
through which they pass. Higher the atomic number of medium
greater is the absorption of X-rays. It is given by following formula:
I = (Io)ex
Where I is the intensity of the radiation at a distance x when incident
beam is passed through the medium having absorption coefficient
as (which is related to atomic number) and Io is the incident
intensity.
As explained in this equation there will be exponential decay of
X-ray energy as the beam passes through the medium. In order to
overcome this exponential decay, the X-ray energy levels are
increased in logarithmic increments. This will be discussed in detail
in chapter X-ray Controls. It is also observed that higher the
X-ray tube voltage more is penetration. It is given by formula
= 12358/E
where wavelength is in Armstrong units and E in KeV.
Hence for 125 kV across the X-ray tube = 0.1 Armstrong
approximately.
and for 40 kV across the X-ray tube = 0.3 Armstrong
approximately.
2. X-rays propagate linearly from source of X-rays

As the distance between the source and object is increased, the
intensity of X-ray radiation is reduced to the square of distance.
(Inverse Square Law). Area the beam covers at the farthest position
is 4 times than that at half the distance. Therefore intensity per
unit area is reduced four fold, if distance is doubled. If the distance
is increased by 3 times, intensity is reduced by factor 9 (Fig. 2.1).
For example Increase in distance by factor 2 will reduce intensity
by and by 3 will reduce by 1/9.
3. They produce secondary radiation in all matter through

which they pass
The secondary radiation consists of scattered radiation which has
more importance in Image Quality because it reduces the contrast
Fig. 2.1: Inverse square law
of X-ray image and deteriorates the quality of image. Hence the

X-ray equipment which successfully filters the scattered radiation
is considered better. The ratio of scattered radiation to primary
radiation is greater if
Larger the volume of the object through which X-rays pass.
Harder the X-rays (more X-ray tube voltage)
Lower the density of Transradiated matter.
The Attenuation is defined by equation:
Attenuation = Absorption + Scatter
For better image quality, we require minimum scatter. But one
should also note that harder the X-rays more is the penetration in
the matter and less the absorption. Hence optimum potential
difference is essential to achieve required penetration with least
scattered radiation and absorption to obtain image with good
quality.
4. X-rays cause metallic salts to emit light

The luminescence obtained depends upon the chemical properties
of luminescence material and size of crystals in the luminescence
material. Smaller the size of crystal better is the Resolution.
(Adjacent locations can be separated better). The type of
applications with various luminescence materials is as follows:
Table 2.1: Applications of luminescence materials
Luminescence Material Application

Zinc Cadmium Sulfide Fluoroscopy with
fluorescent screen
Cesium Iodide Image Intensifier fluoroscopy

Calcium tungstate and Luminous Intensifying Screens
Salts of Rare Earths (Gadolinium
Oxysulfide, Lanthanum Oxybromide,
Yttrium Oxysulfide)
The applications of these are discussed in detail in chapter How

the X-ray image is obtained. The fluorescent screen used by
Dr. Roentgen was Barium Platino-Cyanide. This material is no
longer used in modern X-ray equipments and is replaced by Zinc
Cadmium Sulfide.
5. X-rays blacken photographic films

The normal photographic film if exposed to light, processed
chemically in dark room (developed in processing room) blackens
the Silver Bromide particles by reduction to metallic silver. The
processed film after development is called Negative. In negative,
blackened portion means more radiation has fallen on film and
bright areas are called shadows. Since light can not penetrate
through the base material, photographic film is coated on only one
side which faces incoming light in camera. In case of X-rays, since
they can penetrate through the base material, the X-ray film is
coated with silver bromide emulsion from both sides. The type of
image obtained is known as Radiographic Image and this
technique is known as Radiography.
The amount of blackening of film depends upon total number of
X-ray photons striking film and having interaction with silver
bromide crystals. In conventional photography, it is proportional
to light photons reaching the film which in turn is proportional to
aperture and exposure time. In Radiography it is proportional to
the tube current and exposure time. Tube current is measure of
number of electrons striking the Anode material of X-ray Tube.
These electrons after interacting with anode material generate
X-rays. The product of tube current and exposure time is mAs is
often called Quantity of X-rays.
The Quality of X-rays depends upon its penetrating power which

is proportional to the accelerating voltage or potential difference
between anode and cathode (kVp). We have already seen that 99%
of the energy is converted into heat and only 1% is converted into
X-rays. The energy converted into heat is called Heat Units given
by equation.
Heat units = (kVp) (mA) (sec)
The anode material should withstand the temperature rise, which
depends upon construction of anode, metallurgy (thermal
conductivity and atomic number).
6. X-rays cause gases to become electrically conductive

This property is used for measurement of the X-ray dose with the
help of therapeutical and/or diagnostic Dosimeter (for measuring
surface dose during fluoroscopy or radiography). Automatic timers
working on the principle of ionization of gases is another use of
this property. This will be discussed in chapter Control Circuits
of X-ray Generators.
7. X-ray photons are not deflected or accelerated by magnetic

or electric field
In vacuum their original direction of propagation is not altered.
They cannot be focused as in case of light rays.
8. X-rays produce biological effects and are harmful to human

tissues
X-ray quanta absorbed in human tissue might destroy living cells.
The nucleus of a cell is highly sensitive to radiation of any form. A
direct hit will damage the nucleus (Genetic changes) or destroy it.
Indirect destruction of the cell might be caused by biochemical
reaction which are triggered by the ionization ability of the
absorbed quantum. The dead cell which will be removed by healthy
body. Therefore damages caused by radiation below a certain
magnitude of dosage is reversible. If the safe levels are exceeded,
the damage is irreversible and can cause Radiation Sickness or death
in severe cases. Persons working in ionizing radiation field must
therefore follow rules of Radiation Protection.
In the field of Therapy, the ability of X-ray Radiation to destroy

Cancer cells is used to our advantage. Tumors tissue is irradiated
with calculated dose, which in turn will destroy the Tumor
eventually. The quantum energy for this field have application
ranges up to 300 KeV and this application is known as Deep Therapy.
Since X-ray radiation is harmful to human tissues, it is necessary to use
this mode of diagnosis only when required and essential. Moreover this
type of radiation should be applied to patient in controlled manner by
adequate measures of Radiation Protection. This is dealt in detail in chapter
Radiation Protection.
3 Production of X-rays
We have seen that when fast moving electrons collide with matter
X-rays are produced. The most efficient means of generating
X-rays is X-ray tube. In X-ray tube fast moving electrons, emitted
by filament, with kinetic energy depending upon the accelerating
potential between Anode and Cathode, are suddenly stopped at
the anode which is also called the target. After striking the target
material the kinetic energy of Electrons is converted to heat (99%)
and radiant energy (1%).
The accelerating potential has direct relationship with penetrating
properties of X-ray radiation, higher the voltage more is the
penetration. Normal operating voltage in a diagnostic
X-ray tube is 25 kV to 150 kV.
This range is divided in following ranges:
Range Organs in the region
25 to 40 kV Mammography
40 to 55 kV Periphery (Limbs)
57 to 90 kV Torso (Chest and Abdomen)
Above 90 kV Skull (High kV Technique)
The X-ray tube has two electrodes namely Anode (Target) and
Cathode enhoused in glass housing evacuated by vacuum.
INTERACTION AT THE ANODE

The primary electron is accelerated towards the anode. Target does
not appear as solid block of material for this primary electron. The
distance between the nuclei and electrons of the anode material
are wide enough for primary electron to move within this space.
The accelerating field between anode and cathode ceases at the
surface of anode and the kinetic energy of primary electron is of
Production of X-rays 11
prime importance. Although matter seems to be empty space, the

electric fields of positively charged atoms and negatively charged
electrons are in orbit are in existence, which affects the path of
primary electron. There are four possible interactions of primary
electron with anode atom.
1. Effects near the orbiting electron
2. Effects near the nucleus
3. Collision with orbiting electrons
4. Interaction with Nucleus.
1. Effects near the orbiting electron

The primary electron loose kinetic energy in all these events until
its total energy is used up. The probability of the accelerated
primary electron entering the anode goes into the interaction with
anyone of electrons orbiting in nucleus is very high. Tungsten with
atomic number 74 has 74 electrons. When such process takes
place the primary electron transfers the kinetic energy to orbiting
electron. The orbiting electron cannot keep this transferred energy,
gives impulse to atomic structure which in turn start mechanical
oscillations. The amplitude is increased if the temperature of anode
is increased. Unfortunately 99% of this energy is transferred into
heat.
2. Effects near the nucleus

If the primary electron comes close to nucleus, it will be activated
by positive charge of the nucleus. Due to its kinetic energy, electron
wants to transverse in straight direction, but due to field inside
atomic structure electron changes direction with deceleration and
losses energy. This loss of energy is converted into electromagnetic
energy by generation of quantum. This deceleration process is
called Brems Strahlung (Fig. 3.1). (Brems Strahlung is a German
word which if split means Brems is braking and Strahlung is
radiation), hence radiation due to braking.
The energy quantum is given by equation:
1 2 2
E= m (V1 V2 )
2
where V1 and V2 are the velocity of electrons before and after
deceleration. Although it is mass related the quantum of radiation
does not have any mass and is given by energy unit as
Electron-volt.
Fig. 3.1: Brems Strahlung
Example: If the anode voltage is 100 kV and electron speed is

reduced to half after interaction with nucleus, then energy of
photon will be 75 KeV. This quantum travels with the speed of
light. If the electron looses its speed to zero then quantum of energy
will be same as that of primary electron, which will be maximum
energy attained by quantum. Most of these electron-nucleus
interactions will take place at a distance from nucleus. A constant
anode to cathode voltage will result in wide range of quantum
energies for other primary electrons. Hence we achieve continuous
Electromagnetic spectrum of Brems Strahlung (Fig. 3.2).
Fig. 3.2: The continuous spectrum of X-rays

produced by Brems Strahlung
3. Collision with orbiting electrons

This might result in removal of that electron from its shell. Let us
assume that primary electron collides with electron from the K
Production of X-rays 13
shell. The primary electron has to overcome the binding energies

of the electron in atom to its nucleus. Remaining of the energy is
shared by both electrons which leave the place of collision. (1st
and 2nd step) in Figure 3.3. The vacant place on the K shell has to
be filled with another electron in order to satisfy the energy balance.
This is done by transition of electron from L shell (3rd Step). Now
L shell has higher energy than K shell electron. This difference in
energy will be transformed into Electromagnetic Energy producing
quantum, which leaves the place of electron jump with a speed of
light. Since vacancy from K shell was filled by electron from next
higher level, the quantum is called K (4th Step).
Fig. 3.3: Characteristic radiation

A similar jump from M to K shell will produce K quantum of higher

energy than K, due to larger difference in energies between K and
M shell as compared to that of K and L shells. If the primary electron
removes an electron from L shell to M shell, similar process will
take place resulting into production of L or L.
Normal values for Tungsten:
K = 59 KeV
K = 68 KeV
L = 8.4 KeV
L = 10 KeV
The K and L radiation reveal the characteristics of the target
material. Therefore this type of radiation is known as Characteristic
Radiation (Fig. 3.3).
Since the target material is tungsten, the binding energy of K
electron to the nucleus is 70 KeV. Therefore below 70 KeV the K
radiation is not observed and above 70 KeV the percentage of
characteristic radiation is always increasing upto 28% at 150 kV.
The characteristic radiation of L electron is less than 10 KeV and
these low energy quanta are of not any use.
4. Interaction with nucleus

The Kinetic energy of primary electron is too small to have any
interaction with nucleus and hence no effects are noticed.
X-ray Interaction
4 with Matter
We have used terminologies like transmission, reflection and

absorption in case of light photons. In case of X-ray radiation
terminologies used are penetration, scatter, and absorption. We
know that attenuation of the X-ray beam is a joint result of
absorption and scattering of X-ray beam in matter. The X- ray beam
will interact in complicated way with electric fields of atom of
matter through which they are made to pass. This quantum does
not possess mass but energy or penetrating power. Hence we
consider X-ray quantum to be Corpuscle which will react only in a
direct collision with orbiting electron in atom of matter and will
have no effect on nucleus of this atom due to its energy being very
small as compared to large mass of nucleus.
Penetration
If the quantum, while passing through matter, does not interact
with electron of the atom in matter, it will leave unharmed without
any change in direction. This phenomena is called penetration.
Example 1: Material of low density such as wood is not rich in
electrons. Hence there will be no interaction and most of primary
X-ray photons will penetrate through wooden sheet, resulting into
high penetration.
Example 2: Material of high density such as metal is rich in
electrons. Hence interaction with electrons and most of the X-ray
photons will encounter resistance for passing through such matter
and hence low penetration.
Scattered Radiation
There are three different means by which X-ray quantum can be
scattered based on bonding energies of orbiting electrons in atom
of matter.
1. Classic Scatter (Fig. 4.1)

In case of collision of low energy quantum with electrons which
are elastically bound with nucleus, they cannot overcome the
binding energies of electron to nucleus. For a short period, electron
may take quantum energy and hence oscillates with frequency of
quantum. Then electron returns to its own level of energy and
excess energy will be radiated off as a quantum with exactly the
same energy as the incident photon. But the new quantum, called
Secondary Photon, propagates into different direction than
incident quantum. Hence there is a change in direction with same energy.
Fig. 4.1: Classic scatter
2. Compton Effect (Fig. 4.2)

If the quantum reacts with electrons orbiting in outer shell of an
atom having low binding energy, some energy of primary quantum
is transferred to electron and in turn in kinetic energy which enables
the electron to travel through surrounding matter.
The remainder of energy is radiated off as a secondary quantum
of lower energy Eq given by equation:
Eq = Eq E kinetic
where Eq is the energy of incident photon and E kinetic is kinetic
energy of recoil electron.
It propagates at different direction than primary quantum. Hence
there is change in direction with reduced energy. This is called Compton
Scattering.
X-ray Interaction with Matter 17
Fig. 4.2: Compton effect
3. Photoelectric Effect (Fig. 4.3)

We now consider the quantum with higher energy. If such quantum
strikes electron orbiting in a shell closer to nucleus where binding
energies are higher, some of the energy is used up to overcome the
binding energies of the electron to the nucleus and remainder gives
the electron necessary kinetic energy to escape. The vacancy created
by such phenomena is filled by an electron from higher electron
energy level (higher electron shell) with the emission of its excessive
energy in the form of characteristic radiation K, K, K etc. This
radiation is characteristic of the atomic structure of the matter
(material) through which the primary X-ray quantum passes and
has the same characteristic amount of energy.
The kinetic energy is given by the equation.
E kinetic = Energy of incident photon Binding energy of electron
The frequency of this secondary quanta is lower and direction of
propagation different than incident primary quanta.
Fig. 4.3: Photoelectric effect

Absorption
Transfer of the total energy of primary quantum into energy other than
electromagnetic energy is called absorption.
(a) Effects described earlier does not always take place in pure form.
In photoelectric effect an electron is ejected from K shell, and if
its place is refilled by electron from L shell, it produces K
quantum. This K quantum in turn may liberate electron from
M shell. Vacancies of L and M shell have to be filled by L or L
and M radiation which in turn may be absorbed by similar
process. Hence the energy of primary quantum is absorbed totally.
This is absorption within structure of an atom.
(b) As described in (a) if K and other secondary radiation escapes
the atomic structure and their energy is absorbed in neighboring
atoms, this also can be considered as absorption due to transfer
of the energy within restricted volume of matter.
Magnitude of Absorption: If the material has higher density, more
will be the number of atoms in unit volume and if the material has
higher atomic number Z, it denotes the number of electrons
surrounding nucleus. Hence heavy material comprises of more
number of electrons in unit volume than lighter material and if
primary quantum encounters such heavy material all energy is
absorbed. Hence absorption increases with atomic number Z of the
material. This property is used for filtering the unwanted X-ray radiation
or Shielding of X-ray radiation in undesired direction.
Since X-ray photons cannot be focused or their path cannot be
altered and they are harmful to human tissues, the only way to
control the X-ray radiation to the desired area is by using proper
shielding.
Film density (blackening of film) obtained depends upon total
quanta which reach the film and is termed as quantity of radiation
or intensity (Refer properties of X-rays). The absorption coefficient
is proportional to the atomic number Z. Higher value of Z more is
the absorption. Hence to achieve proper shielding, material such
as steel or lead is used.
For X-ray diagnosis we require energies more than 40 kV. Hence for
X-ray photons below 40 kV are called soft X-rays and they do not
contribute to latent image on X-ray film. (Except in Mammography
applications where detection of breast cancer is done. Since the
X-ray Interaction with Matter 19
organ is soft tissue we require energies between 25 to 40 kV). If

human cells are subjected to soft X-rays, they are absorbed which
is not desired. These soft X-rays are filtered out by absorption filters
fitted at the ray port at tube shield (source of X-rays). The amount
of soft radiation also depends upon the type of voltage waveform
applied between anode and cathode. Pure DC voltage will have
only one energy and produce harder X-ray radiation than
fluctuating voltage at 50 Hz.
Image Formation (Fig. 4.4)

As studied earlier, a single primary quantum might encounter
penetration, absorption or scatter. Penetration will predominate
in matter with low Z, absorption in high Z and scattering can be
encountered. Human body mainly consists of tissues, blood and
bones. Tissue comprises of high amount water in which Oxygen
predominates with atomic number Z = 8 while as bone comprises
of calcium with Z = 20. Hence bones absorb more primary radiation
as compared to tissues.
Fig. 4.4: Image formation

Table 4.1: Chemical composition of muscle, fat, bone: wt.%
Component Atomic Number Muscle Bone Fat

Hydrogen 1 10.2 6.4 12
Carbon 6 12.3 27.8 72.9
Nitrogen 7 3.5 2.7 -
Oxygen 8 72.9 41 15.9
Sodium (Na) 11 0.08 - -
Magnesium (Mg) 12 0.02 0.2 -
Phosphorus (P) 15 0.2 7.0 -
Sulphur (S) 16 0.5 0.2 -
Potassium (K) 19 0.3 - -
Calcium (Ca) 20 - 14.7 -
The above mentioned table gives information regarding the

penetration and absorption values. Since most of the weight
percentages in case of muscle and fat are having constituents with
low atomic number Z, they will contribute to penetration for
primary X-ray photons.
Penetration and absorption are major contributes to obtain the
image on X-ray film because X-ray photon will affect photographic
emulsion. But the scattered radiation from their source take all
possible directions and tend to ruin the image by producing foggy
image which reduces contrast of radiograph.
Total Radiographic
5 System
DIAGNOSTIC X-RAY EQUIPMENT

It is an assembly of functional elements including an assembly of
electrical devices necessary to energize for predetermined period
X-ray tube, devices for support and positioning the patient. Hence
the Radiographic System constitutes of following major
components:
(A) X-ray Generator
(B) X-ray Examination Unit
(C) X-ray Tube
(D) Accessories and Attachments
The total radiographic system comprises not only the radiographic
equipment as described above, but also additionally X-ray
Cassettes, Films, Screens, Film processors, Processing chemicals,
Grids, Beam limiting devices, Display systems ranging from View
boxes to Television Monitors, Recording devices such as magnetic
recorders, Film or CCD cameras, Film projectors, etc. Hospital can
buy the best equipment available in the market, but it will be useless
if the above mentioned accessories are not selected as per
requirements or film processing is not carried out with utmost care.
Hence each of these items play an important role in achieving
desired image quality. Now we will discuss briefly each major
component mentioned above.
(A) X-ray Generator

It converts electrical energy into radiant energy by applying suitable
voltages to X-ray tube.
Functions:
1. Selection of required mode of diagnosis such as fluoroscopy or
radiography for predetermined period.
2. Selection of voltages and currents applied to the X-ray tube to
achieve fluoroscopic or radiographic image and display of
parameters selected.
3. Selection of auxiliary devices.
Fluoroscopy Technique (Fig. 5.1): There are two types of fluoroscopy
techniques known as direct and indirect fluoroscopy. In case of
direct fluoroscopy, fluorescent screen is used for viewing in
darkened room. When X-rays fall on this screen, light is given. The
amount of light output or brightness depends upon the tube current
and voltage between anode and cathode. When part of body (organ
under examination) is introduced between X-ray tube and image
plane (screen) that part of body is exposed to X-rays, which absorbs
certain amount of radiation depending upon thickness, density and
atomic number of the organ under examination. The amount of
penetrating X-rays strike the fluorescent screen and it gives light.
Since this light output is very low, it can be viewed in darkened
room. Thus inner parts of body could be visualized with this
technique. In this technique the dark areas on the screen are indicating
radio opaque substance such as bones and bright areas indicate radio
Fig. 5.1: Fluoroscopy technique

Total Radiographic System 23
transparent substance in body. The tube current selection is between

1 to 4 mA and tube voltage is between 40 to 90 kilovolts peak (kVp).
Higher the tube voltage more is penetration and higher the current
more is the brightness (quality and quantity of X-ray photons).
Hence there should be proper selection of kVp and mA with the
help of switches so that they can be varied as desired.
In case of indirect fluoroscopy, Image Intensifier Assembly is used,
which converts the amount of X-ray photons into electrons. These
electrons can be focused on output screen and much more brighter
image can be obtained. The current requirement will be lower to
the order of 0.5 to 1 mA. This image being brighter, hence can be
viewed on Television Monitor in normal room light. This technique
will be covered in Image Intensifiers.
Radiography Technique (Fig. 5.2): When X-rays fall on
photographic emulsion, it becomes black after processing. There
are two types of radiography techniques known as direct and
Fig. 5.2: Radiography technique

indirect radiography. In case of direct radiography image is obtained

on X-ray film loaded in cassette placed below the patients body
under examination. Higher the exposure time and tube current,
more number of X-ray photons are available from the tube. Since
both these quantities have same effect (normally their product as
mAs) determines the blackening of film. Tube voltage determines
the penetrating power of these X-ray photons. If the tube voltage
is increased, the penetrating power will be more and hence more
X-ray photons will be reaching film resulting in more blackening
of the film. Therefore to obtain a good radiographic image, proper
selection of exposure time, tube current and voltage is essential
depending upon the organ to be exposed. In this case the bright areas
means more absorption (radiopaque substance such as bones) and black
areas means more penetration (radio transparent substance) in the body.
The tube voltage selected depends upon location of organ in the
patients body and mAs depends upon the desired blackness or
contrast on the film.
Classification of X-ray generators: X-ray generators are classified
as Single-pulse, Two-pulse, Six-pulse, Twelve-pulse, Multi-pulse
and DC generators, based on the wave shape of voltage applied
across X-ray tube. The more the number of pulses is preferred
because the voltage waveform is with low ripple which in turn
means voltage across the tube remains high in one AC cycle (Refer
Chapter 7). Therefore the amount of harder X-rays are more than
softer X-rays, which is desired for Radiation Protection.
Major Subassemblies
(A) X-ray generator
The X-ray generator has three major components namely high
tension transformer with or without high tension rectifiers, filament
transformer and control console. The high tension transformer is a
step up transformer to increase the voltage to desired value from
line voltage to be applied across X-ray tube. The filament
transformer is a step down transformer because the filament
voltage is around 6 volts at current of several amperes. These both
transformers are enhoused in one assembly called HT transformer
assembly. The control console selects the desired voltages for
filament and anode-cathode voltage as well as exposure time with

the timer circuitry. It also selects the diagnostic mode (Fluoroscopy
or Radiography) as described above, and displays the parameters
selected.
(B) X-ray examination unit
X-ray unit is designed depending upon the applications. These units
can be further subclassified as portable, mobile, hand operated
stationary unit, motor operated stationary unit, dental X-ray unit
for dental applications, Orthopantograph for orthodontics to get
radiograph of complete jaw, Mammography unit for obtaining
Mammogram and Angiography unit for obtaining Angiogram.
These different type of units will be discussed later.
(C) X-ray tube
As discussed earlier, X-ray tube converts electrical energy into
radiant energy. The X-ray tube has two electrodes namely Anode
(Target) and Cathode housed in glass housing evacuated by
vacuum. The different type of tubes will be discussed in following
chapter.
(D) Accessories and attachments
These accessories and attachments can be classified as normal ones
for routine diagnostics or for special examinations.
I. Routine Diagnostics
They are X-ray Viewing Box, Developing tanks, Safe light in dark
room, Cassettes, Intensifying screens, Lead aprons, Lead protection
screens, Chest stands, Vertical bucky wall stand, etc.
X-ray Viewing Box: This is used for viewing X-ray film in radiology
department, wards, ICU, operation theatres. They are incorporating
minimum two tube lights housed in MS housing powder coated,
fitted with white acrylic sheet to reduce glare and provide uniform
illumination. Roller clips are provided to hold the film firmly.
Developing Tanks: A manual film processing unit comprising
thermostatically temperature controlled tank for developing, fixing
and washing (1 each) for developing of films of all sizes. The casing
is of robust material of mirror finish stainless steel of 316 grade.
It has single welded joint in the body height of tank and polished
to avoid corrosion. All welding joints are fold pressed welded to
avoid leakage of chemicals used.
Safe light: This is used in darkroom. It incorporates low wattage
bulb with unbreakable plastic red colored filter, housed in metal
housing powder coated.
Cassettes: It is a container having a cover which is transparent to
X-ray beam and opaque to light in which film is loaded for
radiography. The unexposed films are loaded in dark room, taken
to main radiology room for exposing and later brought back to
dark room for developing the films. They are made of aluminum
for light weight. Four corners are connected with nonmetallic
construction to give protection covers. Lead protection spray is
given on the inside rear flap of the cassette to eliminate fog effect
on the X-ray film. High grade foam material is pasted inside to
give film a uniform contact with intensifying screen. The
recommended sizes are 17 14, 15 12, 12 10, 10 8,
5 7.
Intensifying screens: It is a layer of suitable material used in direct
radiography to intensify the action of incident X-ray radiation up
on a radiation sensitive emulsion. Depending upon type of film
used the suitable compatible intensifying screen is pasted in the
cassette. As discussed earlier the material used is any one of the
following:
Calcium Tungstate, Luminous Salts of Rare Earths(Gadolinium
Oxisulphide, Lanthanum Oxibromide, Yttrium Oxisulphide).
These chemicals are deposited by sedimentation process on
Polyester layer.
Lead apron: Coat type aprons and hand gloves fabricated from
multiple leaded vinyl fabric having lead equivalence of minimum
0.5 mm lead is used by radiologist during radiological studies to
protect from soft X-rays due to scattered radiation. Apron covers
from shoulder to knees. It is light weight, durable and provided
with waterproof cloth lining stitched on vinyl fabric. It is approved
by controlling agency like AERB.
I. Lead protection screen: It is a major radiation protection devices
used for safe guarding the technician standing near the control
console behind the lead protection screen, so that unnecessary
X-ray exposure is avoided. As the name implies, it uses 2 mm lead
sheet sandwiched between phenol bonded laminated sheet with

teak wood finish. A lead glass window, incorporating 2 mm
equivalent lead glass of minimum size of 7 7 at a convenient
height for viewing the patient, is provided. The complete assembly
is mounted on metal frame and provided with castor wheels so
that it can be positioned in desired location.
X-ray chest stand: It is often called auxiliary workstation used for
mounting cassette for chest X-ray. About 30% of workload is on
X-ray stand for examinations such as medical check-up, TB patients
lung field, shoulder, or preoperative examination of patient, prior
to surgery is performed on this unit. It can be wall mounted or
floor mounted. It accommodates all sizes of cassettes. In floor
mounting vertical chest stand, the design incorporates rigid L
channel structure on a stable platform to allow patient to stand
with rubber matting. The cassette tray is height adjustable, moves
vertically up and down on two stainless steel rods with facility to
lock cassette holder in desired position for taking chest radiographs.
The cassette holder up and down movement is approx. 2.
Vertical bucky wall stand: In case of vertical bucky stand, the
construction is similar to X-ray chest stand. Additionally it includes
the grid with self centering plate marked for cassette and measuring
position. It is used for taking radiographs for chest, spine with
catapult bucky using cassettes upto 14 17. Handgrips are
provided for patient support. The use of catapult bucky is discussed
later in this chapter.
II. Special Examinations

They are Angiographic injectors and Serial Film changers. These
will be dealt in separate chapters.
MARKET REQUIREMENTS
The development of Radiological System depends upon the need
of the end-user. Hence any product before introduction in market
is subjected to market study, which covers overall requirements of
the end-user such as features, applications, etc. The equipment is
designed and developed based on these inputs. Prototype unit is
produced by manufacturer, kept under field trial in the hospital
for few months. Further modifications to suit end-users
requirements, based on feedback received during field trial are

carried out by the manufacturer. Atomic Energy Regulatory Board
certification is obtained by manufacturer before introducing the
Radiological System in market.
There are different types of Radiology systems based on the desired
applications and usage. They require certain infrastructure such
as electric power, room space, water supply, temperature and
humidity constraints, etc. which are listed below.
1. Dental X-ray (Fig. 5.3)

When dentist wants to assess the tooth decay and root canal of the
patient, intra-oral radiography is performed with the help of this
equipment. It incorporates X-ray generator with stationary anode
tube with optical focal spot dimension of 0.8 0.8 mm, giving
7 mA @ 70 kV and timer from 0.03 to 3.2 seconds, mounted on wall
or on trolley with spring counterbalanced articulated arm
depending upon space available. X-ray films of 2 3 or 3 4 or
4 5 cm format size are held in the jaw by the patient. The unit
consist of cone, exposure timer, control panel and exposure release
switch. The tube head rotates in vertical and horizontal plane for
Fig. 5.3: Dental X-ray (Courtesy Siemens)

better patient positioning. A 20 cm cylindrical cone is used as beam

limiting device. This cone is specially designed to give radiation
protection to adjacent organs such as nose, eyes, etc. Since this
equipment consumes very low power, it can be energized with
single phase line voltage and is light weight, it can be
accommodated in small space. It is normally installed in dental
department next to dental chair.
2. Orthopantograph (Fig. 5.4)

This is stationary X-ray unit for combined orthodontic radiography.
A complete scan of the jaw is taken with the help of this equipment
by moving the X-ray source (tube head) around the jaw and
exposing the complete jaw. Since it requires movement depending
upon the construction of jaw of the patient, which may vary from
patient-to-patient, the movement mechanism can be adjusted as
per need and is motor operated to achieve uniform speed.
Fig. 5.4: Orthopantograph (Courtesy Siemens)

The X-ray film is kept in the mouth by patient and the X-ray source
(tube head) moves around the jaw and complete jaw is exposed.
The exposure parameters are 9 to 16 mA, 60 to 90 kV with exposure
timing of 5 to 25 seconds.
The X-ray tube head incorporates stationary anode X-ray tube with
focal spot dimensions of 0.5 0.5 mm. This equipment requires
separate room due to its large size and radiation hazards.
3. Portable/Mobile X-ray (Figs 5.5 and 5.6)

These type of equipments are moved from one location to another.
They use only radiography mode. There are two subclassifications
Portable and Mobile. Portable X-ray is an equipment which can be
dismantled in various subassemblies and carried in any
Fig. 5.5: Portable X-ray (Courtesy Siemens)

transportable vehicle to the destination and assembled to take

radiograph. While as mobile one can be moved on castor wheels
within the premises of hospital such as wards, casualty, operating
theatres without dismantling.
Portable
These equipments are used when radiologist is visiting patient,
railway or road accidents, military base hospitals located in border
area. Under these conditions the dismantled unit can be transported
by rail or road or helicopter or parachute dropped and assembled
at site. They can be energized with AC mains or battery or with
Diesel Generators. Hence such equipment should be compact, light
weight, and should be so designed that interconnections between
different modules are made with simple plug in connectors in short
time. The mechanical assembly of the unit should also be simple
without usage of special tools. As regards the power supply
requirements these equipments can be energized by 240 volts,
50 Hz, 1 phase, 5/15 amperes power. If this supply is not available
then it could be switched on with alternate power supply of DG of
the capacity of 1.5 to 5 KVA. Normally this DG set is available at
accident site.
Mobile X-ray
Since this equipment is moved from one location to another
frequently during the normal working schedule of the hospital it
should be
# Easily maneuverable on ramps, between beds in wards, lifts,
plaster rooms and operation theatres. Hence width, weight and
height of this equipment should not exceed certain limits.
# Equipments should be able to produce radiographs with good
diagnostic information at 60 to 100 mA and 40 to 100 kV, with
power rating of approximately 3.5 KVA. These equipments are
energized on power socket of 240 volts, 50 Hz, 1 phase, 5/15
amperes available on these locations. Since the output power is
limited, shorter exposure times with larger tube currents could not
be achieved, hence thicker body parts and moving organs like heart,
kidneys could not be diagnosed thus limiting the diagnosis to
location of fractures.
Fig. 5.6: Mobile X-ray (Courtesy Siemens)
# POWER SUPPLY: Hospitals are not planned to provide uniform

and adequate power to operate such equipment with consistent
results from one location to another. The power sockets located far
away from the main distribution transformer will offer higher
mains impedance and larger mains drops when under use. Cost
of installing special line, with lower mains impedance at various
locations described above, would turn out to be very costly. The
voltage drops would result in lower kV across X-ray tube than
selected on the control panel and we will get underexposed
radiograph with limited information. Normally the line impedance
is around 1 ohm and these generators are designed to such value.
Use of extension chords increases line impedance and hence should
be avoided.
Innovative designs with capacitor discharge technology or battery powered
mobile unit with usage of inverter technology were introduced in the
market to overcome this problem.
Capacitor Discharge Unit

In such generators, voltage from power line is stepped up by
transformer, rectified, and stored in capacitor which retains the
energy during radiographic exposure.
Thus voltage across the capacitor will be independent of mains
fluctuations and line impedance. It will solely depend upon number
and value of the exposures taken. Hence the performance of the
unit is consistent irrespective of line voltages till the capacitor
voltage is reduced beyond the operable limit, which can be
displayed on control panel, so that unit can be plugged in to mains
to recharge the capacitor. The capacitor mentioned above is a bank
of capacitors in parallel to obtain higher value. Such generators
use grid controlled X-ray tube and operate at constant tube current
for short exposure time (Fig. 5.7).
Fig. 5.7: Capacitor discharged X-ray generators
Advantages
1. Small, compact, light weight units can be easily maneuvered
through hospitals.
2. Charging of capacitor does not require special line, only
charging time is a function of line resistance.
3. Shorter exposure time is possible for radiographs of chest, lungs,
and small body parts, heart, thus ensuring radiographs with
enough information for proper diagnosis. It is most suitable
for usage in ICU, NICU, wards, OT.
Disadvantages
Since we have a power source as charged capacitor bank, the output
is limited to 30 to 50 mAs at 40 to 100 kV. Hence it is inadequate for
heavy body parts like spine, abdomen, etc. Hence as long as short
exposure times are used, capacitor charge is maintained this unit
is appropriate for use in ICU, NICU, wards, operation theatres.
Battery Powered Unit (Fig. 5.8)

Development of high capacity rechargeable batteries have led to
the introduction of this unit. Lead acid or nickel cadmium batteries
are used. Lead acid batteries are commonly used in automobiles
and are cheaper than Ni-Cd batteries, but have disadvantage that
they cause corrosion to nearby electronic parts. This was overcome
with introduction of sealed lead acid batteries. A standard wall
mains socket can be used to charge these batteries. The voltage
from battery is fed to inverter operating at 500 Hz, which will
convert DC to AC. This AC voltage is fed to primary of HT
transformer through exposure timer. Voltage at secondary of HT
transformer is stepped up, rectified and fed to X-ray tube. Since
the batteries can hold the charge for long time, voltage across tube
is held constant. This type of unit is ideal for usage during frequent
power failures. The X-ray tube in this unit is supplied power from
constant power source at constant line resistance. The constant mA
applied to X-ray tube allows the use of smaller focal spot as
compared to capacitor discharge unit, thus improving the image
quality.
Fig. 5.8: Battery powered X-ray unit

Disadvantages
1. The weight of the unit is increased due to batteries which may
hamper the maneuverability.
2. Periodic charging of batteries is required.
3. Maintenance of batteries is required.
4. Batteries have limited working life, hence replacement cost is
to be taken into consideration.
Recently the High Frequency Multi-pulse X-ray generators have been
introduced in the market. They overcome all the above mentioned
disadvantages and have replaced both capacitor discharge and
battery powered X-ray units. These generators are covered under
chapter Modern X-ray Generators.
Now we discuss the stationary equipments which are not intended
to be moved.
4. Simple Radiographic System (SRS) or Basic Radiographic

System (BRS)
(A) Simple radiographic system (SRS)

These are used in casualty and emergency rooms for trauma cases.
Immediate attention round the clock is required for the patient
brought to hospital in emergency. Mostly such cases are accident
cases requiring immediate X-ray examination to assess the injury
and subsequent hospitalization or medication. These cases include
fractures of skull, peripheries and spine. Potter bucky is a device,
for supporting and imparting motion to X-ray grid. Normally, a
Potter bucky table with floor to ceiling tube stand for radiographs
with catapult bucky for X-ray films up to 14 17 size, is used for
such cases. The patient is made to lie down on horizontal bucky
table and radiograph is taken. The modified version of this table is
Table with floating table top, parking with electromagnetic brakes.
This modification enables to transfer trauma patient from stretcher
to table (Fig. 5.9).
(B) Basic radiographic system (BRS) (Figs 5.10 and 5.11)

The World Health Organization (WHO) has brought out a concept of
Basic Radiological System (BRS) to be used in rural areas. The
design of this unit incorporates variation of kV, mAs parameters
only. This enables for radiographer to operate the unit with
minimum time and can cater to patient needs in case of emergency.
The film focus distance (tube head and image plane positioning) is
kept fixed to enable to take quick radiographs. These units
incorporate High Frequency multi pulse X-ray generators giving
power output of 2 to 10 KW.
1. X-ray tube 2. Floor to ceiling column stand

3. Floating table top 4. Cassette tray
5. Catapult bucky with grid 6. Footswitch bar for locking
movements of table.
Fig. 5.9: Potter bucky table with floating table top (Courtesy Siemens)
Fig. 5.10: Basic Radiographic System (BRS)

with mobile trolley (Courtesy Siemens)
Fig. 5.11: Basic Radiographic System (BRS) without

mobile trolley (Courtesy Siemens)
5. Hand Operated Radiographic/Fluoroscopy Unit (Fig. 5.12)

These systems are used in rural and cottage hospitals for bed
strength up to 150 beds for routine fluoroscopy and radiography
examinations. The X-ray system consists of multi position hand
operated table offering minimum 5 positions (Vertical, Horizontal,
trendelenberg at minus 15 degrees to horizontal, 30 degrees and
45 degrees to horizontal).
The table is furnished with sun mica table top, Catapult bucky and
scattered radiation grid with ratio of 8:1, and accessories such as
hand grips, foot rest, compression cones, immobilizing device, and
ray guard. 40 KW X-ray tube is mounted on floor to ceiling column
stand with double slot light beam collimator. Tube can be moved
up and down on column stand as well as can have different angular
positions. Spot film device is mounted opposite to the tube which
incorporates conventional fluorescent screen for fluoroscopy. For
routine fluoroscopy, patient is made to stand on foot rest, tube is
under couch and fluoroscopic image is seen in dark room on
fluorescent screen. The unit is powered by 10 to 20 KW X-ray
generator.
Spot film device: It is a device capable of moving along the length and
breadth of X-ray examination table, suitably counter balanced,
incorporating X-ray fluoroscopic screen and capable of being used in
conjunction with a X-ray tube, for combined purpose of screening or spot
radiography with semi automatic or automatic movable radiographic
cassette, and is provided with all the necessary safety devices, indicators
and controls for easier operation.
This device incorporates fluorescent screen along with lead glass
to filter out X-ray radiation reaching the eyes of observer, scattered
radiation grid with ratio 6:1, cassette tray for radiography in case
the radiologist wants to record the event during fluoroscopy. The
Spot film device (SFD) can be swiveled out for over couch
examinations. The distance between SFD and X-ray tube is fixed
of the order of 70 cm. Hence SFD is a device which brings cassette
from its parking position in radiation free location to record the
Fig. 5.12: Hand operated radiography / fluoroscopy

unit (Courtesy Siemens)
event on that spot. It is provided with accessories such as

compression cone, diaphragm plate, etc. This device has
applications like GI Track studies (location of ulcer in stomach or
duodenum). Generally 4 exposures in sequence are taken to record
movement of radiopaque substance such as Barium meal in GI
Track. The SFD provided without programming.
6. Motor Operated unit for Radiography and Fluoroscopy

(Fig. 5.13)
This type of system is also called R/F system and is normally
furnished with two X-ray tubes, one for over couch radiography
(Biangulix 30/50 KW ratings) mounted on floor to ceiling column
stand for over couch bucky radiographs, chest X-rays and other
major radiographic work like intravenus pylography, planigraphy;
and other for fluoroscopy permanently installed under couch
(Pantix 20/40 KW rating). Since Pantix design of X-ray tube has
only one focal track, switching over from fluoroscopy to
radiography technique, the optical focal spot does not shift its
position.
The X-ray table is motor operated and can be parked in any position
between vertical, horizontal and trendelenberg. It can be tilted and
parked in desired position with heavy patient without straining
the operator, which is an advantage over hand operated system.
The SFD provided is semiautomatic, programmed for examination
sequence but cassette movement is manual or in case of high end
tables (more costly) SFD is fully automatic, programmable exposure
sequence with sensing of cassette size and with motorized
movement of the cassette. SFD is provided with accessories such
as compression cone, diaphragm plate, etc. These tables can also
be attached with shiftable table top assembly for easy entry and
positioning of the patient. This system is powered by 50 KW X-ray
Generator preferably Multi-pulse. Catapult bucky is furnished with
12:1 grid for over couch radiography.
These systems find market in district hospitals, teaching
institutions, modern hospitals with bed strength of more than 250
beds. It is used for applications such as GI track studies, intravenus
pyelography (examination of renal pelvis), cholangiography
(visualization of gallbladder, bile ducts), cystography (visualization
of urinary bladder), myelography (examination of the
subarachnoid space by lumbar puncture), planigraphy etc.
Fluoroscopic image can be obtained on fluorescent screen or image
intensifier output screen. It has become mandatory to use image
intensifiers in developed countries due to lesser radiation risks as
compared with conventional fluoroscopy with fluorescent screen.
For specifications of Image Intensifier refer to Image intensifier.
Fig. 5.13: Motor operated R/F System (Courtesy Siemens)
Remote controlled R/F tables: During the fluoroscopic or

radiographic examinations it is necessary that nursing and
operating staff to be near the patient. In order to avoid radiation
hazards to the medical staff, remote control units were developed.
Medical staff is present in adjacent room behind the lead glass
screen to observe the patient but away from radiation area, but
control the table movements remotely. These units are having 30
degrees trendelenberg, designed for routine diagnostic
examinations and have provision for peripheral and cerebral
angiography with program controlled detachable film changer
(AOT or PUCK), variable FFD, fully automatic frameless under
table SFD, Image Intensifier TV system with separate remote control
console for selection of parameters for examination in adjacent
observation room. It is furnished with 70 KW X-ray generator. The
cost of the system is much higher than normal motor operated
system.
7. Body Section Radiography Unit

X-ray photons from tube follow a linear propagation and inverse
square law. Normally X-ray beam is perpendicular to the object
plane. But there are overlapping organs in human body, which
can be eliminated by oblique projection. This results in distorting
the image.
Planigraphy Unit (Fig. 5.14)

This unit incorporates X-ray tube assembly fixed on column stand
along with planigraphy rod so that both X-ray tube and cassette
tray in Potter bucky are synchronously moved in horizontal plane
parallel to each other but in opposite direction. (F1 to F2 for X-ray
Tube).
This movement is achieved by motor, fitted at the base of column
stand achieving planigraphy angle from 8 degrees to 40 degrees.
The layer height adjustment is 0 to 25 cm achieved either manually
or by motor. The planigraphy attachment is normally fitted on
Fig. 5.14: Planigraphy

Bucky Table. From figure 5.14, one can conclude that points A and
B in patient are exposed and cast a shadow on image plane
(Cassette) as A1, B1 in position 1 of cassette and A2, B2 in other
extreme position of the cassette. While as Point C does not cast a
shadow on the film loaded in cassette tray. This arrangement
ensures blurring of the patient organ beyond planigraphy plane.
Thus resulting information on the film cassette for correct
radiograph of the desired plane to locate the tumor in that plane.
Series of such planigraphy examinations are carried out with
different position of planigraphy plane, by adjusting layer height
adjustment, to assess the exact size and location of tumor in patients
body.
Modified version of planigraphy is Tomography. Planigraphy
examination is restricted to one plane while tomography is at
various angular projections due to movement of X-ray tube and
Image plane in arc. This subject is dealt in detail in chapter
Computer Tomography.
8. Image Intensifier Television Units

Conventional fluoroscopy with Zinc Cadmium fluorescent screen
in dark room has many disadvantages. The CONE vision of eye is
such that it takes eye to get adapted to darkness almost half an
hour. Moreover the patient is afraid of darkness, especially if the
patient is child or lady. The tube current is of the order of 3 mA.
This is cumbersome procedure. In Image Intensifier TV system,
these drawbacks are not present.
This system has following advantages:
(a) Examination is done in room light.
(b) Image brightness is higher as compared to conventional
fluoroscopy for same dose.
(c) Image clarity is better.
(d) Image can be viewed by more than one person at various
locations, it can be recorded and transmitted to desired location.
(e) Since the examination is carried out in room light, full co-
operation from patient is available and examination can be
performed in shorter duration.
Thus reducing radiation hazards.
Applications:
A. GI Track studies with R/F tables,
B. Mobile C-Arm Image Intensifiers for Surgery in Orthopedics,
PCNL and URS procedures in urology, Pacemaker implantation
(Fig. 5.15).
Fig. 5.15: Mobile C-Arm Image Intensifier (Courtesy Siemens)
C. Angiography Systems.
This subject is dealt in detail in chapter Image Intensifiers.
9. Angiography Systems
The word angio is a greek word meaning blood and graphy is to
measure the flow. Since the blood is translucent to X-ray photons,
contrast medium is added to blood, so that blood will become
opaque to X-rays. Thus angiography is visualization of blood
vessels by injecting contrast medium solution in bloodstream and
capture the flow on film, the diagnostically important phases of
circulation of blood. This technique is applied in four different

forms such as:
1. Peripheral angiography for diagnosing blood clots in limbs.
2. Cerebral angiography for diagnosing blood clots in brain.
3. Renal angiography for Renal Arteries and veins including
temporary opacity of kidneys following injection of positive
contrast medium into renal arteries through catheter placed
with its tip either in aorta close to renal arteries or directly into
renal artery.
4. Cardio angiography for visualizing of the heart cavities and
blood vessels near heart.
The above mentioned applications demand different type of
X-ray systems because the organs have different locations,
movement time and functions in human body. These units are
discussed in Chapter Angiography Techniques.
10. Mammography Units (Fig. 5.16)
Fig. 5.16: Mammography unit (Courtesy Siemens)

Mammography is examination of female breast for detection of or

for diagnosing cancer without contrast media using low X-ray tube
voltage between 25 to 40 kV at a higher mA value upto 300 mA.
The unit constitute of mammography stand provided for
mammography in standing, sitting position with compression
device and biopsy attachment. The X-ray generator is using high
frequency multi pulse waveform applied to X-ray tube with
molybdenum rotating anode with focal spot 0.6 0.6 mm. The
built in automatic exposure timer enhances the accuracy of timing.
11. Radiological System for use in Mobile Van

In order to conduct rural health development program, a mobile
van furnished with essential diagnostic equipments visits the rural
area and cover up the population for the diseases such as Bronchitis
or TB. This van is furnished with simple diagnostic apparatus for
blood check up, eye, ENT, and one 100 mA (10 KW) X-ray system
similar to BRS unit with chest stand, operating on portable DG if
the desired electrical power is not available in rural area. Such
equipment should be rugged, vibration proof and should be able
to perform efficiently in tropical conditions with extreme limits in
temperature and humidity and also should be dust proof.
Specifications of the above mentioned equipments are discussed
in detail in chapter 8.
INFRASTRUCTURAL REQUIREMENTS
We have seen various types of radiological systems. Their
performance and final image quality can be guaranteed provided
proper infrastructure requirements are provided. If adequate
attention to infrastructure is not provided, it will result into
malfunctioning of the equipment and poor image quality. These
requirements are electric power, space, water connection for
darkroom, air conditioning, Humidity and Temperature control,
etc.
The most important is Electric Power. The electric power generated
in power plant is transmitted by transmission lines and distributed
to the locality with three phase step down transformer and made
available at 415 volts, 3 phase, 50 Hz. This power supply consists

of alternating currents which are out of phase with each other by
120 degrees. Three phase supply with star connection and neutral
is most commonly used. The two types of voltages available are
phase to phase 415 volts and phase to neutral 240 volts.
Power Ratings of X-ray Generator

Rating or X-ray power output of Diagnostic X-ray generator is
calculated in kilowatts (KW) as follows:
Power output P = (k I V)/1000
Where P is power output in kilowatts (KW), I is average tube
current, V is peak value of anode to cathode voltage and k is factor
associated with waveform of voltage V.
The values of k for different waveforms are
For single X-ray generators : 0.73
For two-pulse with filament stabilizer X-ray generators : 0.8
For six-pulse generators : 0.95
For twelve-pulse generators : 0.98
For constant potential (DC) : 1.0
Example:
Two pulse, 300 mA@100 kVp generator P will be 24 KW
Two pulse, 500 mA@100 kVp generator P will be 40 KW
DC, 500 mA @100 kVp generator P will be 50 KW.
The factor k depends up on voltage waveform applied to the tube.
In full wave rectified single phase equipment, in the high tension
secondary circuit, transformer voltage starts at zero volts at the
beginning of cycle, builds up to a positive peak, then falls down to
zero volts, goes further down to negative voltage peak and again
rises up to zero volts. The negative half of cycle is rectified by high
voltage rectifiers and the rectified voltage varies between zero to
peak voltage. This fluctuation is called Ripple which is defined as
percentage of variations in voltage against peak value. The value
for ripple is 48% for two pulse waveform, 13.5 % for six pulse
waveform and 5% for twelve pulse waveform. For DC ripple is
zero. When we have less ripple, the anode to cathode voltage is
more constant allowing the primary electrons to bombard the
anode with more uniform kinetic energy, thus obtaining same
quality of radiation. The load of X-ray tube is considered as resistive

load. This resistance is reflected to primary by the ratio of high
tension transformer. If the ratio of HT transformer is 400, at 500
mA tube current, the HT primary current will be 200 Amps. Hence
it is important that HT primary winding and wiring for energizing
HT primary of the transformer should be able to withstand this
current.
There are various factors which influence the power rating such
as size of the conductor supplying power and its chemical
composition (copper or aluminum), capacity of distribution
transformer (KVA), and equipment design parameters. Normally
copper conductors are preferred against aluminum because
aluminum is subjected to corrosion. The distribution transformer
should be of higher capacity than the total load requirement of
Radiology department. It should be located close to Radiology
department, laundry, CSS and D and kitchen which consume
maximum power. We know that any electrical appliance draws
current from power supply. Such load causes drop in voltage due
to mains resistance. Thus Mains Resistance is extremely important
which can be reduced by locating high consumption equipment
close to the power source so that shorter lengths of wiring is used.
The design of X-ray generator incorporates Mains Compensation
Circuit, which caters for line voltage fluctuations. However for load
regulation, one should know power requirement in terms of
current, so that sufficient power is available at maximum settings
and there are less drops in the wiring. For 40 KW generator
minimum power supply requirement will be 50 KVA (considering
0.8 as power factor) preferably 65 KVA. One should calculate the
total requirement of all the equipments in the radiology department
which may come up to 200 to 300 KVA including Computer
Tomography scanner, automatic film processor and other
diagnostic X-ray units. Hence the distribution transformer should
be installed close to Radiology department.
In case of failure of mains power supply from electricity board, the
hospital should have back up diesel generator set to cater for major
equipments which need to function round the clock. The power
requirement should be calculated depending up on the equipment
list which should be kept on round the clock for any emergency.
The switch over from mains to DG set should take place
automatically with the help of electronic circuitry so that process
oriented equipments will not have any interruption of power
supply. The DG set should have specifications as per BIS 4722. In
case the equipment requires voltage stabilizer or UPS (uninter-
rupted power supply) same should be provided in consultation
with vendor and should be planned along with installation of the
equipment.
Earthing
As per electrical rules, metallic components which do not form
part of the operating circuit of installations and equipments
operating at rated voltage above 1 kV, should be earthed if they
are likely to come into contact as a result of faults or arcing with
components which are at high voltage. There are 2 classifications
namely.
Protective Earthing
It is direct earthing of a conducting component of a machine or
installation which does not form a part of the operating circuit, in
order to protect a personnel from a dangerous voltage, under fault
conditions. For example Metal Housing of assembly such as Control
Console, X-ray Motor operated Table and X-ray tube shield.
System Earthing
It is the earthing of an installation of an installation component,
forming part of the operating circuit. For example earthing of the
high voltage windings of voltage transformers which can be
undertaken at the protective earthing device of their frames or
tanks.
Following steps must be taken.
1. All exposed metal parts of X-ray equipment should be properly
earthed.
2. Proper marking of earthing terminal of the equipment as per
BIS 2032 should be followed and the earthing conductor
terminated on equipment must have green color.
3. All parts of earthing conductor must be corrosion proof.

4. The connection between the earthing conductor terminals and
the parts to be connected to earth conductor shall have low
resistance.
5. Enclosure housing should have smooth finish without any burr,
sharp edges, fins and moving parts so that accidentally if the
wire touches housing there is no chance of damage to insulation
and leakage of electric current.
Wiring and Wiring Terminals

Wiring and interconnecting wire must be so selected to have current
carrying capacity more than possible maximum current that of
circuit of the equipment. A proper protection should be
incorporated while connecting the different assemblies of X-ray
equipments, internal connections between different components.
Cables employed for such wiring should be flexible, preferably
with adequate insulation. In case exposed bare wire is used,
exposed part should be protected with suitable cover. Adequate
thickness of insulation of each individual conductor is required in
case if the conductors are cabled as wire bunch. Such bunch should
be passed through a single opening in metal wall within enclosure
of the equipment with insulated rubber washer to avoid any shock
hazards. In case the connection is soldered, mechanical security
should be insured. In case the connection is secured by mechanical
components, they must withstand mechanical stresses occurring
in normal usage. In this case use star washer is recommended.
Avoid part of enclosure of X-ray equipment as a current carrying
medium.
Live metal parts which are not insulated must be secured to the
mounting surface and prevented from shifting from their original
position. If a barrier or linear insulating material is used, the
material chosen should be moisture resistant. A desired spacing
must be maintained from these parts to earth (anode connection).
In case of spacing through air, adequate distance between live metal
connection and enclosure should be maintained to avoid arcing.
Recommended distance is more than 10 mm.
BIS 7620 specifies clearances (Table 5.1) between not insulated
live-metal parts of opposite polarity, and between not insulated
live-metal part and not insulated earthed or exposed metal part

other than enclosure.
Table 5.1: Clearances
Potential difference Minimum clearance Minimum clearance

in volts in mm in mm
through air through transformer oil
0 to 50 1.6 1.6
51 to 150 3.2 1.6
151 to 300 6.4 1.6
301 to 600 12 1.6
These clearances are not applicable to switches, lamp holders,

relays, terminal strips, tube sockets and potentiometers. The
equipment should withstand leakage current test and earth
resistance test (earth resistance should not be more than 0.2 ohms)
as specified in BIS 7620.
Space Requirement
One should assess the amount of floor space required for the
equipment in terms of length, breadth, height, peripheral area, any
other equipments required in conjunction with the main equipment
and its space requirement, weight, etc. before finalizing on
equipment. One should also have specific plan for location of the
equipment, its layout for radiation protection. The vendors, if asked,
will provide the desired information in terms of prerequisites for
installation. After receiving this information one can arrive at a
conclusion whether all requirements have been taken into account
during planning at the proposed site. Many times the room requires
certain alterations and then civil work is involved.
Civil Work
Depending upon the check list and installation drawings given by
vendor the civil engineering department can suggest alterations
to suit the site plan. Since these equipments fall under radiation
equipments, Atomic Energy Regulatory Board (AERB), the
controlling authority in radiation protection in India, have issued
certain guidelines to be adhered failing which approval from AERB
would be a problem and the persons present during examination
will be at radiation risk (Fig. 5.17 as recommended layout plan for

motor operated R/F system installation).
Other important criteria is to ensure the proper foundation for the
heavy equipment by properly grouting the equipment and/or
providing base plate of thick mild steel on which the installation
of the unit is carried out. The foundation is allowed to cure for
specified period before installing the unit. Most of the installations
for stationary X-ray systems need this procedure due to their large
weight. For example the motor operated table weighs almost a ton
or CT scanner weighs several tons. If this procedure is not carried
out, the equipment may vibrate during its working, resulting into
artifacts in image. In case of floor to ceiling column stand same
procedure is followed. Additionally both the floor and ceiling rails
Fig. 5.17: Recommended layout plan for motor operated R/F system
Note:
1. Lead protection screen of 1.5 mm lead equivalence with viewing
window of lead glass with 1.5 mm lead equivalence.
2. Window or ventilator at a height of six feet from finished floor level.
3. Entrance door lead lined with 1 mm of lead sheet with proper
overlapping at all joints.
4. Wall of 9 thickness of brick and ceiling 15 cm of concrete at a height
of 3 meters from floor leel.
5. All interconnections between X-ray tube, console and table concealed.
have to be parallel to each other and their level is checked with

spirit level. Since this work requires special skills the installation
of equipment is entrusted to vendor so that image quality of system
is guaranteed.
Water Connection
In order that the dark room should function trouble free, a
continuous water supply is required in dark room.
Air Conditioning, Humidity and Temperature Control

Now-a-days most of the X-ray generators are incorporating the
electronic circuitry, microprocessors and demands on temperature,
humidity are quite stringent. It is appropriate to provide air
conditioning to the diagnostic rooms (Preferably Split AC plants
so that noise level is low). This will ensure comfortable dust free
atmosphere and longer life of the equipment. One should also
consider the power requirement for AC plant during planning of
power supply.
6 X-ray Tubes
As discussed earlier, X-ray tube converts electrical energy into radiant

energy. The electrons emitted from filament (Cathode) of the X-ray
tube obtain kinetic energy due to high voltage between cathode and
anode, are attracted towards anode (Target) and strike the anode
surface on a small area called focal spot. The focal spot is the geometric
area on the target face in which electrons emitted by filament are concentrated
with the help of the focusing cup and accelerating force kV.
The focal spot size depends on the amount of energy target can
handle. In order to obtain good quality radiographic image without
any blur, a smallest possible source of radiation is desired (Fig. 6.1).
But this means large concentration of electrons in this small area
which will result into high thermal loads. As these are conflicting to
each other, compromise must be made between size of focal spot
and magnitude of tube current (thermal load) it can handle.
Fig. 6.1: Blur due to size of focal spot

X-ray Tubes 55
The Line focus Principle (Fig. 6.2)

X-rays are generated from focal spot on anode, the radiation emerging
from focal spot is in conical shape. The object lies close to image
plane is located far away, almost a distance of 1 meter, from X-ray
tube for over couch radiography. The distance between object and
image plane is kept as minimum as possible to avoid enlargement.
The anode surface is kept at an angle with respect to axis or geometry
of the tube. It helps in resolving conflicting requirements of focal
spot as mentioned above and anode. Different tubes have different
anode angle, the smaller the anode angle smaller the size of focal
spot and geometric blurring is reduced. Hence focal spot as seen
from the object will be projection of the actual area in the object
plane.
This area is called Apparent or Optical focal spot. Hence the
dimensions of the optical focal spot are dependent on
(a) Size of the filament and its location in the filament cup, which
will give the stream of electrons.
(b) The anode angle.
Note: The apparent (effective) focal spot is smaller in size than actual
focal spot and depends on size of filament (a) and anode angle
Fig. 6.2: Line focus principle
It can be seen that apparent focal spot, which decides the blur or
geometrical unsharpness, is much smaller than actual focal spot,
area on which the primary electrons from filament are striking. Hence
the actual focal spot determine the tube ratings and optical focal
spot determine the geometric unsharpness or image quality.
Reduction in Anode Angle

Smaller the anode angle (also called Target Angle), smaller will be
the optical focal spot resulting in to smaller solid angle of cone of
radiation. Hence for given film focus distance (FFD), as we reduce
the anode angle, the size of radiation field is reduced (Table 6.1). For
radiography of lungs, spine or abdomen, we require FFD of 115 cm
and film size of 15" 17". Hence mostly the target angle lie between
15 to 19 degrees except in case of Mammography the angle is more
than 19 degrees because the object size can be large and shorter
FFD.
Table 6.1: Size of Image at different anode angles keeping FFD constant
Anode angle Size of radiation field at FFD = 1 m

9 30 cm
10 33 cm
12 40 cm
15 51 cm
17.5 58 cm
Heel Effect (Fig. 6.3)

X-rays come out of the X-ray tube head assembly from ray port. If
fluorescent foil is kept on the ray port it will be observed that X-
ray intensity on the anode side diminishes and at cathode side the
beam intensity is more. On the anode side some of the X-ray photons
are absorbed in the anode material resulting lower intensity radiation
towards anode. This effect is called Heel Effect (Figs 6.3 and 6.4). It
is more predominant with roughening of anode surface. This is taken
into consideration while positioning the patient. Since X-rays
produce ionization, the components in the tube head towards
cathode are subjected to more radiation and are more susceptible to
failures.
X-ray Tubes 57
Fig. 6.3: Heel Effect
Fig. 6.4: Radiation pattern due to Heel Effect

Anode
We now discuss the design of Target of the X-ray tube. It is noticed
that higher the atomic number of the target material, better is the
efficiency of generation of X-rays. Moreover, since the heat generation
is about 99%, we require the target with higher melting point. Hence
the choice is Tungsten, which has atomic number as 74 and melting
point of 3600 degrees Kelvin.
There are two types of X-ray tubes namely Stationary Anode and Rotating
Anode type.
Stationary Anode X-ray Tube (Fig. 6.5): In this tube anode is
stationary. The Tungsten target material is made up of inch square
as an anode face at the center of the tube embedded in copper stem
so that heat generated can be transferred to the surroundings most
efficiently. The target of tungsten is subject to bombardment of stream
of electrons.
Cathode
The Cathode consists of pure tungsten filament wire (directly heated
cathode) in the form of coil of 1/8th inch in diameter and inch
long, set in cup shaped holder called Focusing Cup. Focusing
cup support extends outside the tube assembly for appropriate
connections of filament leads. The filament is heated to desired
Fig. 6.5: Stationary Anode X-ray tube

X-ray Tubes 59
temperature, so that required quantity of electrons are available as

and when desired, by applying the required voltage to filament
through filament transformer. Cathode is directly heated type. The
electrons form a stream beamed in right direction in exact size and
shape to impinge on target (focal spot). The focal spot size thus
depends upon dimension of filament, diameter and length of filament
and location of filament inside the filament cup (Fig. 6.6 A to C). If a
very narrow beam of electrons is required, a negative voltage is given
to filament cup so that focused electron beam is impinging on target.
This technique is used in Ultrafine Focus Tube (Fig. 6.6 D).
The material of filament is pure tungsten. Thoriated tungsten is not
used because it may emit gasses when heated and it will affect the
vacuum inside tube. The two electrodes anode and cathode are
housed in glass housing duly evacuated to vacuum of the order of 1
microbar. The glass for housing is PYREX glass, due to its higher
melting point and good glass to metal sealing property. During heavy
exposures metal powder from anode gets deposited on glass wall
thus reducing dynamic impedance of the tube. In order to avoid this
reduction in dynamic impedance of the tube, the glass envelope is
larger in diameter in the center of X-ray tube.
Fig. 6.6A: Filament cup

Fig. 6.6B: Effect of filament depth setting in filament cup
Fig. 6.6C: Effect of filament heating from central/peripheral turns
Fig. 6.6D: Effect of field lines on electron focusing

X-ray Tubes 61
Limitations of Stationary Anode X-ray Tube

Following requirements are to be satisfied.
1. In order to obtain a clear radiograph with good image quality,
smallest possible focal spot should be used.
2. In order to withstand thermal load associated with a good quality,
and high power radiograph, the focal area should be large enough
to drain the heat generated.
3. If the radiograph of stationary object such as foot is to be taken,
one can select larger exposure time with smaller value of tube
current. But if radiographic image of moving organ such as lung
or heart is to be obtained without blur, a shortest exposure time
at larger value of tube current is selected to get the required
blackening on the film.
4. Blackening of the film is proportional to dose or product of tube
current and exposure time. For example we require 100 mAs for
desired blackening. This can be achieved increasing the tube
current and proportionate reduction in exposure time to reduce
motion unsharpness or dynamic blurring.
But there are limitations to shortest exposure time that can be applied
at high tube currents. Since with high tube currents, due to finite
time taken for heat to transfer from actual focal spot, localized heating
occurs, which may vaporize front surface of focal spot before heat is
transferred to the rear of focal spot or anode assembly.
Hence these requirements are very contradictory, and pose limitations on
both focal spot size and tube loading (mA). Therefore a compromise between
exposure time and focal spot size is achieved. The commonly available
stationary anode tubes are DSA-1, DSA-2 and DSA-3 manufactured
by M/S Bharat Electronics in India.
Their specifications are as follows (Table 6.2):
Table 6.2 : Specifications of stationary anode tubes DSA-1 and DSA-2
Specifications DSA-1 DSA-2

Maximum kV 85 100
Output 15 mA@ 85 kV 25 mA@ 100 kV
Maximum mA 30 mA 50 mA
Heat units 26000 HU 40000 HU
Focal spot size 1.8 1.8 mm 2.8 2.8 mm
Filament heating 3 to 7 V/3 to 4.2 A 4 to 8.5 V/3 to 4.2 A
Inherent Filtration 1.5 mm of Al 1.5 mm of Al
Weight 330 gm 500gm
The limitations of stationary anode X-ray tube arises from the melting
of tungsten forming the focal spot. If this small piece of tungsten
embedded in copper to form a stationary anode is replaced by a disc
of tungsten, free to rotate such that edge of the disc is placed opposite
to cathode, large loading per unit of focal area can be achieved.
These type of tubes are called Rotating Anode Tubes.
Rotating Anode X-ray Tube

In case of rotating anode type the anode is in the form of disc, rotated
around 2800 revolutions per minute. Since the anode is rotated at
this speed the actual focal spot is formed by the belt on the anode
disc and has large area as compared to stationary anode tube, hence
has larger area to dissipate heat. Thus these tubes can be loaded to
higher radiographic settings.
If the anode rotates during radiographic exposure, the thermal load
is spread over a ring of tungsten, while the focal spot as seen by the
patient remains stationary and therefore optical or apparent focal
spot is small and actual focal spot over which the thermal load is
spread will be large.
2 2
Focal spot area = (d 1 d 2 )
4
where d1 and d2 are external and internal diameters of the track
formed by focal spot. For a length of filament 6 mm and mean diameter
of 80 mm, d1= 82 mm and d2 = 78 mm the actual focal spot size will
be 502.4 sq mm (Fig. 6.7).
Hence much higher thermal loading can be applied per unit of
focal area in rotating anode X-ray tube.
Loading is related to diameter of the focal track, mass of the anode
and speed of rotation.
This increased loading makes possible in three ways namely:
1. Considerably greater load in terms of mA per unit time for a
given focal spot.
2. Reduction in focal spot size for a given mA load per unit time.
3. Reduction in time for a given value of mAs for given focal spot.
X-ray Tubes 63
Fig. 6.7: Actual area of focal track of rotating anode disc
Rotating anode assembly: This consists of Target disc and rotor body.
(A) Target Disc

As discussed earlier the material is Tungsten. But it is very brittle.
Due to continuous bombardment of primary electrons, the focal track
is roughened resulting in to reduction of useful beam of X-ray
photons in the direction of patient. In order to overcome this
shortcoming, the target material is Rhenium Tungsten alloy with
4% Rhenium. This anode is known as RT anode. Since the anode is
rotating at high speed, it is important to reduce its weight and it
should be dynamically balanced to avoid wobbling. Hence anode
disc is compound anode constituting base of Molybdenum sintered
together with a disc of Rhenium-Tungsten disc. This gives
advantages such as less weight, less roughening process of target
material. This anode is known as RTM anode. Transfer of heat from
focal spot takes place by conduction and radiation from surface of
anode. In order to drain out heat from surface of anode, the rear side
of anode disc is attached with additional layer of Graphite (Carbon).
Such anode is called RTMC anode. Typical RTMC anode has
Rhenium-Tungsten alloy of 1.3 mm thick, Molybdenum 5 to 11 mm
thick and Graphite layer as 9 mm thick. This type of metallurgy is
incorporated in structure of anode used for heavy radiology
applications such as over couch radiography, angiography, etc.
However in case of mammography applications, the material for

anode is Molybdenum, due to its better radiation output in the range
of 20 to 40 kV (soft X-rays) at 250 to 300 mA required for diagnosis of
early detection of breast cancer.
Target Diameter: The diameter of the disc depends up on the loading
capacity of anode. In case of anode disc which is solid material the
heat transfer is possible only by means of conduction from focal
track to molybdenum stem and by radiation to surroundings. Larger
the size of disc better is heat capacity or increase in tube ratings. The
diameter varies between 55 to 125 mm for tube ratings from 11 to 100
KW tubes (7000 to 450000 Joules).
Speed of Rotating Anode

The anode disc is mounted on a shaft that broadens into rotor
assembly which is mounted on bearings so that anode rotates freely.
Two pole motor is used for rotation giving synchronous speed of
3000 rpm at 50 Hz and 3600 rpm at 60 Hz supply. But if anode is
rotated at synchronous speed, same spot on focal track will be
exposed in case of single or two pulse generators and the purpose of
anode rotation is not served. In this case anode voltage will be highest
for a small period when it reaches peak in ac cycle resulting in
maximum number of electrons reaching anode surface resulting in
heating of anode disc at that spot diametrically opposite on focal
track and developing hot spots resulting disc to crack. Hence a slip
is introduced to reduce the speed of anode to 2800 rpm for 50 Hz
supply and 3300 rpm for 60 Hz supply. If the power given to rotor of
motor is at 150 Hz, the speed is 8400 rpm. These tubes are known as
Rapid Tubes. The reason for high speed rotation is to allow greater
area of the focal track to be bombarded by stream of electrons per
unit time. Hence increase in effective ratings of the tube by
approximately 60 to 70% can be achieved. However with the
increased speed by 3 times, the wear and tear on the moving parts
will also increase. Moreover it demands perfect balancing of anode
disc to reduce wobbling and vibrations. Wobbling and vibrations
give stress to glass to metal seal resulting in spoiling the vacuum
and making tube gassy. These rapid tubes are therefore more failure
prone and have lesser life span as compared to normal rotating
anode tubes.
In order to reduce wear and tear on the moving parts, bearings are
silver plated to ensure frictionless working. Liquid lubrication is
X-ray Tubes 65
ruled out due to their working in vacuum. Although high speed

rotation increases the tube loading, reduction in focal spot size is
preferred by using smaller diameter of filament wire. In order to
reduce wear and tear on bearings, the anode is rotated only in
radiography technique because heat generated during fluoroscopy
is not appreciable. Rotation of anode is practiced during fluoroscopy
for stress relieved anodes (Pre-cracked to take care of thermal
expansions due to very short term loadings) in Angiography
applications. A braking circuit is incorporated to slow down speed
of anode disc after exposure is made by applying DC voltage to
stator windings, which brings the anode speed to near zero after the
exposure is completed. The rotor body is coated black for faster
dissipation of heat.
Target Angle
It has bearing on rating of tube and field of coverage. Reduction in
target angle will reduce the optical focal spot size and increase tube
loading but will reduce the field size or cone of radiation. Hence one
must be prepared to sacrifice the field size coverage if the target
angle is reduced. We have already discussed the line focus principle
and Heel Effect. Smaller the target angle more predominant will be
Heel Effect.
Focal Spot Size

The resolution of radiographic image depends on focal spot size.
Smaller the focal spot better is resolution. Focal spot size is affected
by various factors like anode angle, placement of filament in filament
cup, and dimensions of filament (diameter, pitch, number of turns
in windings), distance between anode and cathode and tube current
ratings.
Tolerances in focal spot sizes are set by NEMA (National Electrical
Manufacturers Association) are given in Table 6.3.
Table 6.3: Percent tolerances of nominal focal spot
Nominal focal spot size (mm) % Tolerances

< 0.8 + 50
0.8 to 1.5 + 40
> 1.5 + 30
The manufacturer of the tube ensures to produce X-ray tube of higher

focal spot limit permissible to increase power ratings to get maximum
mileage out of tolerance. For example the focal spot size in
specifications is 0.6 mm, but when the tube is installed the focal spot
may measure between 0.6 to 0.9 mm, as per NEMA standards. This
results in lesser resolving power with specified power output of the
tube at lesser manufacturing cost. The X-ray tube ratings depend on
focal spot size, design of anode especially in case of rotating anode
tubes with parameters such as target speed, target diameter, and
target composition.
The focal spot size can be measured with aid of resolution camera or
pinhole camera.
Resolution Camera: Focal spot sizes less than 0.3 mm are measured
with this camera. A star pattern is constructed in a wafer of thin
strips of thin lead strips of 0.025 mm. These lead strips are in the
form of cone of the angle less than few degrees. The star pattern is
used for measurement of resolution in line pairs per mm (0.8 to 15
lp/mm) and focal spot size.
Pinhole Camera: This device is used for measurement of focal spot
size more than 0.3 mm. The device is mounted on the flange of
X-ray tube head. This device is metallic cylindrical assembly of
2.5 cm diameter and 25 cm length. It comprises of thin plate made of
gold with small hole drilled with laser beam at one end of cylinder.
At the other end of the imaging device such as fluorescent screen or
film in cassette can be kept. Normally the tube is energised at 75 kV.
The image can be seen or measured on image plane.
Design of Filament
The filament is housed in filament cup made of nickel with
mechanical slots for exact placement of filament. The contour and
exact location of slots, size and placement of filament in cup, spacing
between anode and cathode will result in to the stream of electrons
and finally the area of bombardment on anode, thus eventually
determine the focal spot size. Filament is manufactured as spiral,
coiled coil winding of fine tungsten wire. The diameter of wire
forming spiral into cylindrical shape will give large surface area for
emission of electrons. The size (gauge) of wire, pitch and number of
X-ray Tubes 67
turns determine the size of filament. Thermeonic emission from

filament is governed by three and half power Richardsons law.
The supply to filament is given by step-down transformer called
Filament transformer. The primary of the transformer is fed with range
of voltages depending upon technique, applications such as
preheating, fluoroscopy or radiography, used from 80 volts to 230
volts. The corresponding secondary voltages are fed to filament to
achieve desired number of electrons or tube current (mA). In order to
reduce the thermal stress on filament following steps are taken. There
are three types of filament voltages namely (a) Threshold of emission
(b) Preheating (c) Boosting.
Threshold of emission: Filament is heated to such a level that when
this level is exceeded, it will start emitting electrons. Hence it is
ensured that filament is warmed up and energizing of tube in cold
condition is avoided.
Preheating: This is normally practiced in fluoroscopy mode. Filament
is heated to such a level, that it gives approximately 0.5 mA of tube
current during fluoroscopy.
Boosting: This is normally practiced in radiography mode. Filament
is heated to such a level that the number of electrons are large enough
for radiography.
Normally the variation of filament voltage is between 4 to 15 V ac for
these requirements.
Almost in all rotating anode tubes cathodes are provided with two
filaments. Small indicated by symbol F1 and Large indicated by F2.
The F1(small) is used for fluoroscopy and detailed radiography of
stationary organs where Geometrical blurring is of importance. F2
(large) is used for imaging moving organs such as heart or lungs by
obtaining higher tube current so that the exposure time could be
proportionately reduced for Dynamic Blurring or Motion Unsharpness
(For details refer chapter on Generators).
In Pantix tube design these filaments are adjacent to each other thus
resulting into single focal track on anode disc (Fig. 6.8A). Thus the
focal spot position does not alter when we switch over from F1 to F2,
but due to use of same focal track the anode gets worn out
faster. Hence these tubes are used for fluoroscopy or lower loading
(20/40 KW).
In Biangulix design the filaments are placed in one line so that there
are two focal tracks for F1 and F2 (Fig. 6.8B). This ensures lesser
wear and tear of the focal track, so that such tubes could be used for
higher loading (30/50 KW), for over couch radiography.
Effect of focusing cup: As discussed earlier the placement of filament
coil inside the cup has major effect on stream of electrons. (Figure
6.6). If it is deep inside the cup or almost above the filament cup the
electrical lines of force will not be parallel resulting in convergent or
divergent beam of electrons respectively, which is not desired. If the
filament cup is kept at negative potential with respect to filament,
focused electrical field is obtained giving narrow beam of electrons.
This technique is used in fine focus tubes. In case of grid controlled
tubes a negative voltage of the order of 2.4 kV is applied to the filament
cup. Due to presence of this negative voltage, electron cloud (space
charge) is formed near the filament cup. If a high positive voltage is
applied for required duration in terms of pulses, this will nullify the
negative voltage and allow the electrons to flow towards anode. The
exposure time is decided by the pulse width. This technique was
initially used in angiography equipments. But there is engineering
limitations to supply negative voltage to the cup. For this purpose
we required four wire connection (Common, small, large and grid)
and better insulation between grid and other three conductors. Since
these connections are made by High Tension cables, which are
subjected to mechanical stress due to positioning of the tube, these
cables were more failure prone and later withdrawn from the supply.
(for details refer chapter on X-ray generators).
Fig. 6.8A: Pantix filaments Fig. 6.8B: Biangulix filaments

X-ray Tubes 69
Fig. 6.9A: Diagram of Pantix double focus tube
Fig. 6.9B: Diagram of Biangulix double focus tube

Filament Characteristics
The filament characteristics for each focus is plotted indicating the
tube current on Y axis and filament current on X axis for different
voltages between anode and cathode. Higher the tube voltage more
number of electrons will be attracted towards anode overcoming
space charge resulting higher tube current. Hence in order to obtain
100 mA tube current at 40 kV, we require higher filament voltage as
that compared to the tube voltage of 100 kV (effect of space charge).
Hence for different tube voltages, the manufacturer of X-ray tubes
gives different curves in one chart. These characteristics are almost
parallel to Y axis if the filament current is higher. At such operating
point on the characteristics one has to be very careful not to exceed
the limits, otherwise tube filament may blow up resulting into major
breakdown which will turn out to be very costly. The cost of X-ray
tube is almost 30 % of the total cost of system.
The Glass Envelope

The anode and cathode assemblies discussed above are enclosed in
glass envelope of Pyrex glass. It is preferred for high melting point,
minimum filtration offered to primary X-ray photons and thermal
coefficient of expansion close to metal thus providing better glass to
metal sealing. The two assemblies anode and cathode are first
enclosed individually in glass and these two jobs are held opposite
to each other on high speed lathe. The glass is melted by glass blowing
technique and brought nearer so that they form glass envelope. This
envelope is evacuated at vacuum. The alignment of anode and
cathode with respect to each other is extremely important. There is
high rejection in this process because glass blowing technique
requires special skill. The glass envelope thus formed is bulging in
the center. This shape is purposely kept to enhance the flow of
electrons towards anode. When the tube gets old due to usage, metal
particles from anode are deposited on the glass envelope due to
continuous bombardment of primary electrons. This reduces the
dynamic impedance of tube and tube draws more current. If the
glass walls are close, the metal deposition would reduce impedance
and tube will become gassy. Hence the bulging shape is given in the
center. This evacuated glass envelope is called Tube Insert
(Fig. 6.10).
X-ray Tubes 71
Fig. 6.10: Rotating anode tube insert
Stator Windings
A two pole induction motor is incorporated for rotating the anode
using rotor as metal cylinder in tube insert and stator winding close
to glass envelope just outside. Stator serves a function of armature
coil of induction motor. It has two coils and hence three leads for
common (O) and winding I and winding II. The stator winding is
energized by power supply from control console.
Shield
The tube insert along with stator windings is assembled in housing
called shield. This housing provides shielding against radiation
and electrical high voltages applied to tube. It is made of aluminum
with internally lead lined from all sides for radiation protection
except ray port from where X-ray radiation is allowed to pass towards
patient. Hence location of focal spot with respect to ray port is
extremely important.
Both filaments are energized through secondary of filament
transformer with connection to cathode receptacle by three core high
tension cable. The three leads are common, large and small focus.
(In case of grid controlled tube the receptacle will have four terminals
one for the grid). The anode connection is made to anode receptacle.
In earlier days anode and cathode receptacles were having separate
designs. But now in order to achieve lesser production cost and

interchangeability, the receptacles are of same design. Only difference
is at anode side all three pins are shorted. These receptacles are
manufactured using high insulation grade plastic material by
injection molding so that no crack is present. A crack will ionize the
gasses and lead to arcing at high voltages. The voltage applied to each
receptacle with respect to ground is at least 62.5 kV, since center point of
secondary of high tension transformer is connected to ground. The
shield is filled with insulating oil which serves the purpose of
cooling and electrical insulation. The oil is tested as per BIS 335
specifications. Shield also incorporates expansion bellows to cater
for expansion of oil when tube is hot after several exposures.
Heating and Cooling Characteristics of X-ray Tube

The major reason of tube failure is over heating of the anode which
arises due to excessive heat generated by repetitive exposures without
taking care of the tube ratings. Each radiographic exposure pumps
in heat given by formula:
HU = kV mA seconds
There is pause between two exposures, when new patient is
positioned for radiographic exposure. This results into cooling of
the anode surface.
Example: Exposure parameters 100 kV, 100 mA, 100 m seconds.
For single phase generator heat units = 1000 HU
For three phase generator it will be 1400 HU due to lower ripple
factor of 13.5 % as compared to 100% in case of earlier case. Hence
for three phase generator, since tube is subjected to continuous
loading, more care should be taken. This example is for single
exposure, but now let us consider the GI track studies with two
pulse generator. Fluoroscopy for 3 minutes at 80 kV, 3 mA followed
by spot filming at 80 kV, 300 mA 0.2 seconds of 4 exposures would
result into
HU = 80 3 180 + 80 300 0.2 4 = 43200 + 19200 = 62400 HU
If a tube with 115000 HU is used then remaining heat units will be
52600 which will not be sufficient for the next examination. Hence
one should allow anode to cool for next few minutes so that the
available reserves are sufficient for the next examination. The amount
of pause time between two examinations would depend up on the
X-ray Tubes 73
total anode heat storage capacity, the amount of heat units pumped
in with each examination and the cooling time between the pause.
For easier calculations one should refer to the tube characteristics.
If there is increase in radiographic parameters such as kV, mAs,
fluoroscopic mA and time, the anode heat capacity could be exceeded
resulting permanent damage to X-ray tube.
Charts for Single Exposure on X-ray Tube

These charts depend upon size of focal spot, speed of rotation and
type of voltage waveform between anode and cathode. The chart is
plotting of maximum dissipation parabola for each kV rating plotted
with tube current in mA on linear scale on Y-axis and exposure time
on logarithmic scale on X-axis. Every X-ray tube is supplied with
exposure charts which should be referred before selecting exposure
parameters.
Example: Chest X-ray at 70 kV 20 mAs.
Now we want lungs to be radiographed. Hence dynamic blurring is
important. Hence choose large focus. The exposure time should be
minimum and tube current maximum. Select 70 kV curve on the desired
focus, anode speed, waveform. Obtain maximum mA from the chart
to obtain minimum time to get 20 mAs. As long as one does not cross
the maximum parabola curve for respective kV the tube is safe.
Determination of Maximum Load

The maximum load curve for rotating anode tube can be divided
into four sections depending up on physical process. The change
over from one section to another is continuous. (Fig. 6.11)
Section I: Even if load duration is short, power should not be increased
beyond value. Temperature drop from focal area to the surroundings,
which is proportional to power, determine the thermal stress. If power
is too high due to thermal stress, surface of focal spot is roughened
amounting into dose reduction.
Section II: Maximum temperature of focal spot determine the load
curve. Drop in maximum permissible load is proportional to 1/ t .
Section III: Long exposure time, heat is distributed from focal spot
to the anode disc and total heat storage capacity of anode disc
determines the exposure time for a given power, proportional

to 1/t.
Section IV: Continuous loading (curve is parallel to X-axis.) anode
disc is adequate to present reaching higher temperature provided
the power input is restricted to 300 Watts during fluoroscopy.
Normal fluoroscopy load is 70 kV @ 4 mA.
Fig. 6.11: Determination of maximum load
Filtration
The standards are set by ICRP and as per IEC 407 (1974) recommends
filtration should be more than or equal to
1.5 mm aluminum equivalent for tubes operating up to 70 kV (dental)
2.0 mm aluminum equivalent for tubes operating between 70 to
110 kV.
2.5 mm aluminum equivalent for tubes operating beyond 110 kV.
Hence X-ray tube units working up to 125 kV including shield should
have minimum total filtration of 2.5 mm Aluminum equivalent. In
case filtration offered by glass envelope and oil column is not
sufficient to reach this minimum value, additional filter is added at
X-ray shield ray port to obtain filtration > 2.5 mm aluminum
X-ray Tubes 75
equivalent. This filtration is essential to filter out soft X-rays coming

out of the tube shield. This soft radiation is more harmful to human
tissues because it will get absorbed in human body thus reacting
with cells. Hence it is desirable to filter out soft radiation. If this
filtration is compromised the image obtained on film will have more
contrast which many vendors practice. But this is not as per norms
and should be checked during the installation and handing over of
the system.
Specifications of Rotating Anode X-ray Tubes

The commonly available rotating anode tubes are:
DRA-1 : Diagnostic Rotating Anode Tube 1, based on Pantix design
(refer Fig. 6.9A) with two focii of output 20 and 40 KW
respectively.
DRA-2 : Diagnostic Rotating Anode Tube 2, based on Biangulix
design (refer Fig. 6.9B) with two focii of output 30 and 50
KW respectively.
They are manufactured by M/s Bharat Electronics in India.
Table 6.4: Specification of DRA-1, DRA-2 tubes
Tube Type PANTIX BIANGULIX

Anode Angle 17.5 Degrees 17.5/16 Degrees
Anode Heat 115000HU 260000HU
Capacity
Anode RTM RTM
Material
Filtration 0.7 mm Al 0.7 mm Al
Speed of 2800 rpm 2800 rpm
Anode
Maximum kV 125 125
Focal Spot
Dimensions F1 (1.2 1.2 mm) F1 (1.2 1.2 mm)
F2 (2 2 mm) F2 (2 2 mm)
KW Ratings F1 = 20 KW; F2 = 40 KW F1 = 30 KW; F2 = 50 KW
Filament F1= { 4-9 V F2=
heating 5-9 A
{ 6-14
5-9 A
V, F1= { 3-10 V,
4-8 A
F2 = {
5-15 V,
4-8.2 A
Weight of 1.7 kg 2.5 kg
tube insert
Damage to the X-ray Tube Due to Improper Operation

Failure of X-ray tube are very expensive, overall cost ranges between
25 to 30% of the cost of total radiography system. If awareness of
damages and their causes are not known, the X-ray tube can be
damaged. We know discuss these factors and how to avoid damages.
These failures and their causes are listed below.
Anode: Major cause is to cross the limit of instantaneous or maximum
heat storage capacity of anode.
Excess heat is produced by crossing the maximum ratings which
cause anode surface to melt. In case of rotating anode tube it is
focal track.
Applying excessive loads on cold target results into thermal stress
in anode disc of rotating anode tube. If the excessive currents of
the order of 500 mA with short exposure time will subject to only
part of focal track and thus generating excessive heat in that part
of anode disc while other part remains at lower temperature.
This results in thermal expansion of heated part and anode disc
may warp or develop crack because colder part of disc does not
expand. It is therefore suggested to warm up the anode disc with
fluoroscopy or small exposure before subjecting to excessive load.
Repeated exposures without considering the cooling
characteristics will exceed the total anode heat storage capacity.
In this case heat generated cannot pass to surroundings.
The end result is Warping of anode disc resulting in dynamic
imbalance, which will in turn make anode disc wobble or vibrate
leading to breaking of glass to metal seal and make tube gassy.
In rotating anode tubes, the bearings play a very important role.
They are made of silver plated stainless steel since volatile
bearings cannot be used in vacuum. Expansion coefficient of
bearings should meet that of anode. When thermal ratings of
tube are exceeded, heat is transmitted by conduction to bearings,
causing expansion and malfunctioning of bearings resulting in
to vibrations. One can estimate the damage by allowing anode to
come back to rest after exposure is completed without anode
braking circuit. If the time taken is half than that of new tube, one
can conclude that there is considerable damage to bearings.
X-ray Tubes 77
Under such conditions either the glass to metal seal may crack
making tube gassy or anode will not rotate at desired speed
resulting in further damage to anode disc.
Housing or Shield
Oil plays important part in receiving the heat by convection from
tube insert to the shield. It is also used as insulating media. If the oil
is overheated then it may break down which will result in inferior
insulating properties of oil and flashing inside the shield. This arcing
may destroy the tube. This can be noticed by looking into the ray
port for the quality of oil. Due to Heel Effect cathode side of the tube
gets more X-ray radiation. This radiation when falls on cathode
socket, it ionizes the media, subjecting to insulation failure and
cracking of socket housing. Hence the socket is designed to withstand
higher voltage than rated voltage. This failure can be noticed by
noticing overheating of the socket terminal. In case of failure of socket,
it should be immediately replaced.
Filament: The major fault is opening of filament. This failure can be
due to excessive heating due to higher currents. Hence the design
and wiring of filament circuit is very important especially to cater to
mains voltage fluctuations. Normally a Voltage Stabilizer is
incorporated in filament circuit. This subject is dealt in detail in
control wiring in X-ray generator.
Another cause could be filament, in heated condition, is subjected to
vibrations caused by movement of tube head such as tilting of table
or planigraphy examination. Under these circumstances, the filament
vibrates and may short few turns resulting in offering different
resistance to power supply voltage which leads to excessive current
and opening the filament.
If the filament is boosted often, then tungsten evaporates and deposits
on glass wall. It reduces resistance of filament resulting in excessive
currents. Normally it is small focus filament is subjected to such
failures.
Hence care should be taken to avoid vibrations. If they are noticed,
immediate remedial measures should be adapted.
Metal deposits on glass envelope

Due to continuous bombardment of primary electrons on target, it is
over heated resulting in deposition of tungsten particles on glass
wall. This changes dynamic impedance of the tube leading to more
tube current making subsequently tube gassy. When such situation
arises ensure to give lesser voltage to anode with respect to cathode.
7 X-ray Generators
There has been gradual development in the field of electronics over

past century. It has reflected into change in the scenario by
introduction of modern designs of X-ray generators. It started with
single-pulse (using X-ray tube as self rectifying device) X-ray
generator and recently high frequency multi-pulse X-ray
generators. These developments satisfied the requirements of end
user which were based on applications of the Radiographic System
as discussed earlier. While introducing new technology, the main
aim was to cater to the requirements of end user and reduce
radiation hazards. Hence it is important to know how the X-ray
generators work. It is also essential to design and develop the
equipment, which the end user must be able to operate and conduct
first order of maintenance properly. This would avoid unnecessary
service calls for repairs due to operational errors.
There are two techniques used namely fluoroscopy and
radiography. In fluoroscopy technique X-ray beam passes through
patient, falls on fluorescent screen which emits light photons if
X-ray radiation is interacting with fluorescent material. The X-ray
parameters used are 40 to 90 KVp at 0 to 4 mA. Since this
examination is done in darkness, due to low intensity of light
obtained from fluorescent screen, it is also called screening.
In radiography technique, the X-ray beam after passing through
patient falls on film which is exposed for finite time with X-rays.
The blackening of the film depends on number of X-ray photons
reaching the film which in turn depends on product of tube current
(mA) and exposure time (seconds), mAs.
The penetration of X-ray beam depends on anode to cathode
voltage. The quality of radiation depends on the type of high
tension circuit used resulting in high voltage waveform. The function
of X-ray generator is to give appropriate supply voltages to X-ray tube
for desired time. This appropriate supply is for (a) high tension voltage
across X-ray tube (b) filament voltage for emission of electrons to obtain
desired tube current and desired time for switching primary voltage for
desired time. The major parameters are KV, mA and seconds.
Major function of generator are:
(A) To protect X-ray tube from overloading.
(B) Warming up X-ray tube for radiographyAcceleration of
rotating anodeBoosting of filament voltage
(C) Selection of tube, focus and auxiliary equipment
(D) Setting parameters within tube limits by utilizing blocking
circuits.
(E) Responding signals from auxiliary equipment.
(F) Power supply.
1. BASIC CIRCUITS TO OBTAIN VOLTAGE ACROSS X-RAY

TUBE
(A) Single-pulse Generator (Fig. 7.1)

It is a generator giving one positive pulse on the anode of X-ray
tube with respect to cathode per ac cycle because the HT rectifier
is not incorporated in HT secondary circuit. In this case the
generator is working on 240 V, 50 Hz, single phase power supply.
Rectification is carried out by X-ray tube itself. In the positive half
of ac cycle the anode is positive with respect to cathode and
electrons are attracted towards anode, while in negative half the
cathode is positive with respect to anode and tube does not conduct.
Hence the tube is working in self rectified mode.
Fig. 7.1: Single-pulse X-ray generator with inverse voltage suppressor

X-ray Generators 81
In this case the X-rays are generated in positive half of ac cycle. But
when the tube conducts due to its internal impedance, the voltage
across X-ray tube is lower in absolute value as compared to voltage
in negative half cycle. Now let us say that we are using DSA-2
tube with maximum anode voltage of 100 kV. Thus if the positive
half of the cycle is generating 100 kV across the tube, then during
negative half of the cycle, since the tube does not conduct in
negative half, the voltage across tube will be higher than 100 kV. If
it is more than maximum inverse voltage, the tube will get
damaged. The electrons emitted by filament are attracted back to
filament during negative half cycle and due to high voltage they
acquire kinetic energy large enough to damage filament structure
which is not designed for this purpose. This phenomena is known
as Backfire.
In order to prevent backfire, modification in HT primary circuit is
carried out known as Inverse Voltage Suppressor Circuit. It
comprises of a rectifier and resistor connected in parallel introduced
in high tension primary circuit. The diode conducts in positive half
of cycle offering negligible resistance thus generating true ac voltage
across the primary winding of HT transformer. In the negative
half, the diode offers infinite resistance and resistance in parallel
to diode plays important role in feeding voltage to primary in such
a way that this negative voltage is lesser in amplitude than that in
the positive half. The value of resistor is chosen accordingly.
Although this circuit introduces distortion in primary circuit it is
acceptable than producing the negative high voltage and damaging
the tube.
(B) Two-pulse Generator (Fig. 7.2)

In this case the generator is working on 240 V, 50 Hz, single-phase
or 415 volts, 50 Hz, phase-to-phase power supply. Rectification is
carried out at high voltage side with the help of high tension
rectifiers connected in the bridge circuit as shown in the diagram,
thus obtaining two pulses per ac cycle. The anode is always positive
with respect to cathode in complete ac cycle, thus ensuring
utilization of both positive and negative half of ac cycle. The ac
voltage rises from zero to peak voltage and comes back to zero in
each half of ac cycle. The ripple of waveform is 100% offering higher
dose as compared to single-pulse generator.
Fig. 7.2: Two-pulse X-ray generator
(C) Six-pulse Generator (Fig. 7.3)

In this case the HT primary is connected in delta connection and
fed 415 Volts, 50 Hz, three-phase power supply and HT secondary
is in two star connected windings. The two secondary windings
give total six-pulses which are rectified by the HT rectifiers and
hence the anode of tube is fed with six positive pulses. The ripple
is 13% at the X-ray tube thus offering higher dose output than
single- or two-pulse generators.
Fig. 7.3: Six-pulse generator

X-ray Generators 83
(D) Twelve-pulse Generator (Fig. 7.4)

In this case the HT primary is connected in delta connection and
fed 415 Volts, 50 Hz, three-phase power supply and HT secondary
is in star/delta connected windings. HT rectifiers as shown in
circuit ensures generate twelve pulses per cycle, utilizing a 30
degrees phase shift between two secondary windings and a 3%
ripple is achieved ensuring very high dose yield.
In the above four cases we used primary switching technique.
Fig. 7.4: Twelve-pulse X-ray generator
(E) Constant-potential Generator (Fig. 7.5)

Regulating triodes T1 and T2 equalize all voltage fluctuations giving
constant DC output across X-ray tube resulting maximum dose
yield with 0% ripple. The primary of high tension transformer is
kept energized with three-phase supply. The triodes T1 and T2 are
used for switching and this technique is called secondary switching.
Since high tension triodes are used in this circuit, they are very
expensive and the cost of such equipment is extremely high. These
generators were used in angiography systems and CT scanners in
1990. They have been taken over by high frequency multi-pulse
X-ray generators, which are compact, offering same radiation dose
as constant potential X-ray generators at low cost.
Fig. 7.5: Constant potential X-ray generator
(F) High Frequency Multi-pulse Generator

In the earlier discussions it is observed that dose yield is increased
by number of pulses. Now if the HT transformer is energized with
higher frequency of the order of 5 to 6 kHz, than conventional line
frequency of 50 Hz, the number of pulses across the secondary are
multifold and waveform is as good as DC voltage across X-ray tube.
Now we require variable voltages for anode with respect to cathode
ranging from 40 kV to 125 kV. For lower power requirement
(voltage) larger pause time is provided by electronic circuitry and
for higher power shorter pause time is provided. The high voltage
transformer is energized with oscillator circuit working on variable
pause time or frequency which will generate the desired switching
waveform. The high voltage is rectified, smoothened by capacitor,
and applied to the X-ray tube. These generators were introduced
recently in late 1990 and have replaced the conventional X-ray
generators due to their major advantages listed below. The
technology and their circuit will be discussed later in this chapter.
Advantages over conventional X-ray generators working on line
frequency:
1. Higher dose yield factor as compared to two-pulse generator
2. Low skin dose
3. Shorter exposure time
4. Faster regulation of kV and mA
5. Repeatability of exposures
X-ray Generators 85
6. Low ripple and low rise time for kV waveform.

7. Free exposure parameter selection
8. Less space requirement
9. Modular construction of control console
10. kV control independent of mA and line regulation
11. Low installation time
12. Service friendly
13. Modifications in software to suit customers requirements.
These type of generators give optimum image quality with
minimum dose.
Fig. 7.6: Waveforms of X-ray generators

Ripple Factor (Fig. 7.6)

The pulsations or ripple caused by the ac components in the rectifier
output are undesirable in the supply. The amount of ripple
compared with direct component is a measure of purity of rectifier
output and is called Ripple factor. It is defined as follows:
Effective value of all ac components
Ripple Factor =
Average component
Single-pulse Waveform Ripple factor = 1.21(121%)
Two-pulse Waveform Ripple factor = 0.48 (48%)
Six-pulse Waveform Ripple factor = 0.13 (13%)
Twelve-pulse Waveform Ripple factor = 0.03 (3%)
Multi-pulse Waveform or DC Ripple factor = 0 (0%)
We will discuss these circuits and their working. The major
components are:
1. High tension transformer
2. Filament transformer
3. High tension rectifiers
4. Two tube connection
5. HT Cables and Plugs
6. Filament circuit
7. Protection of X-ray tube
8. Timer
9. Mains compensation
1. HIGH TENSION TRANSFORMER

The main purpose of HT transformer is to supply the high voltage
to tube. The maximum voltage required is 125 kV, for X-ray tube
rating up to 125 kV. Hence the windings and the connections should
withstand the voltages more than 125 kV. The primary winding is
at line voltage, but there should be sufficient insulation between
primary and secondary. This primary voltage is stepped up by HT
transformer with ratio of 300:1 or more. It will require large amount
of insulation for achieving 125 kV on secondary. In order to
overcome this problem, the secondary winding is divided into two
equal parts connected in series with center tap grounded so that
the insulation requirement is half, 62.5 kV giving symmetrical
voltages in both half with respect to ground.
X-ray Generators 87
Design: As we have seen earlier the line voltage is 415 V, three-

phase or 240 V, single-phase 50 Hz. The power requirement from
power source is desired HT voltage at tube current and power for
filament around 50 watts. In order to achieve these desired voltages,
they are stepped up for HT and stepped down for filament in two
separate transformers namely HT transformer and filament
transformer. These transformers have four major components such
as primary, secondary windings, bobbin and core.
The design parameters are
(a) size and type of core material
(b) frequency of operation
(c) power handling capacity of transformer
(d) primary and secondary voltages and currents
(e) insulation requirements based on magnitude of voltages. These
are interlayer, inter winding and between windings and earth.
As per electricity rules load above 7.5 KW or 10 KVA should be
connected to three-phase voltage supply which is 415 volts, 50 Hz.
Hence X-ray generators using DSA-single and DSA-2 tubes are
connected to line/neutral power supply at 240 volts, single phase,
50 Hz and those using DRA-1 or DRA-2 tubes are connected to
three-phase power supply at 415 volts, 50 Hz. Let us consider the
design requirements of HT transformer (step up transformer). The
voltage requirement will depend on load. The on load voltage is
always lesser than no load voltage. The difference between them
is decided by voltage drops. Considering this equation in our
application, the voltage across X-ray tube, considered as load, is
given by formula:
The drop across load RL = I RL
= V source-IL RS
where RS is source resistance.
Desired voltage across tube
= Input voltage drop across source resistance
= Input voltage tube current source resistance
The voltage across X-ray tube can be varied by:
(a) Changing kV with no load voltage
(b) Changing kV with tube current mA
(c) Changing kV with change in source resistance RS.
Changing kV with no load voltage is achieved by varying input
voltage of high tension primary. 40 to 90 KVp for fluoroscopy and
40 to 125 KVp for radiography is required across X-ray tube. This

voltage is On Load Voltage. The approximate tube current during
fluoroscopy mode is around 3 mA (as good as no load), while the
radiographic current is several mA depending on KW ratings of
the generator. Hence for same kV settings across X-ray tube for
different mA values, we require different High Tension Primary
voltages (no load voltages).
Example: 40 KW, two-pulse X-ray generator
Now power output P in KW = (k. mA. kV)/1000
Substituting values in this formula we get for 100 KVp,
tube current of 500 mA.
Drop across source resistance RS = Current. Resistance = 0.5 RS
But desired voltage across tube = Input voltage drop across
source resistance
Therefore 100 kV = Input voltage 0.5 RS
Or Input voltage = 100 kV + 0.5 RS.
If the load is reduced to 200 mA
then input voltage will be 100 kV + 0.2 RS.
Hence, as we reduce requirement of tube current from maximum
to lower value, the requirement of input voltage will also reduce.
It will depend on source resistance RS.
Following factors play important role in determining value of
source resistance RS.
(I) High voltage circuit (Transformer winding and leads) : RS1
(II) Impedance offered by switching mechanism of timer : RS2
(III) Voltage selection switches contact resistance : RS3
(IV) Power supply including mains switch and its wiring : RS4
Hence total RS = RS1 + RS2 + RS3 + RS4
For 500 mA load and ratio of High Tension Transformer as 400 the
high tension primary current will be equal to 200 amperes average.
This circuit should be able to handle the current of 200 A with
minimum drops. If the value of RS is 1 ohm, then drop will be 200
volts which is very large and if value of RS as 0.3 ohm the drop
will be only 60 volts. Similarly if the radiographic currents are 300,
200, 100 mA then the HT primary currents will be 120, 80, 40
amperes respectively and drops will be 120, 80, 40 volts respectively
for RS = 1 ohm and for RS = 0.3 ohm they will be 36, 24 and 12
volts respectively.
X-ray Generators 89
These values of voltage drops will be difference between no load

and on load voltages. During fluoroscopy the tube current is only
3 mA continuous, which can be treated as no load. While as in case
of radiography, the currents being of the magnitudes of several
hundred mA, the difference between no load and on load voltage
is large. Designing the HT primary circuits, these factors are taken
in to account and two separate circuits are designed for fluoroscopy
and radiography for selection of tube voltages (kV switches and
their wiring is different). In case of mobile X-ray generators working
on mains supply the power rating being low, there is not much
difference between no load and on load, hence same switch is used
for selection of HT primary voltage, for both fluoroscopy and
radiography technique. This reduces the cost of the unit. We require
several kV values ranging from 40 to 125 kV, because penetration
depends on kV value. Accordingly the number of steps of kV switch
are decided. More the steps, more finer is the variation.
We once again consider the equation:
On load voltage VL = No load voltage Vo IL RS.
Value of IL RS is called mA Ri correction (Fig. 7.7).
The radiographic current is changed by changing resistance in
filament circuit along with change in HT primary circuit. Now
increase in radiographic current means increase in filament voltage
or reduction in filament primary resistance, along with increase in
HT primary voltage by selecting appropriate tap on auto-
transformer winding.
We know discuss value of power supply resistance RS4. The value
of RS4 depends on location of distribution transformer from
Fig. 7.7: mA-Ri correction

radiology department, its capacity, length of conductors, cross

sectional area of conductors from power source to load and type
of conductors from power source to load, type of mains switch
used and type of power supply used (single-phase or three-phase).
The power supply resistance RS4 is also called Mains Resistance.
It indicates line capacity and regulation.
As per installation instructions, one can measure the mains
resistance RS4.
Resistance RS4 = (Voltage drop across load)/(Load current)
= (No load voltage On load voltage)/(Load
current)
= (Vo VL)/IL = (Vo VL)RL/(VL)
If a known load of say 10 ohms is connected across mains voltage
of 415 volts then it will draw a current of 41.5 amperes. Substituting
the values of voltage drop and load current one can calculate mains
resistance. If this value of mains resistance measured is less than
the specified in specifications of the generator given by vendor,
additional resistor is introduced in series to obtain the specified
resistance. In such case
The total resistance = Power supply resistance + Additional
resistance.
But if the calculated mains resistance is more than specified resistance,
then either one should reduce the power of generator by allowing
to work at lower mA value as specified in Table 7.1, till the power
supply is improved by relocating the distribution transformer and/
or improving the wiring. Many times this point is ignored resulting
in higher drops in mains, thus energizing the HT transformer with
lesser voltage which subsequently results in lower kV on load and
affecting image quality.
A classic example is when 24 KW generator is already functioning
very well in the hospital and the radiology department wants the
50 KW generator in another diagnostic room. When this 50 KW
generator is connected to same power supply with higher mains
resistance than specified, its image quality will be not satisfactory.
The end user will always compare the end results from both units
and come with argument that in spite of paying so much, the
50 KW generator is no good. In order to avoid such situation, the
engineer has to lay down prerequisites before starting the
X-ray Generators 91
installation and point out the short comings in quality of power

supply connection by measuring the mains resistance. Temporarily
one can reduce the power output of 50 KW generator to possible
next lower value, by blocking higher tube current exposures, till
the desired mains resistance is available at the site. This observation
should be documented in installation report to avoid further legal
issues and obtaining payment from hospital. We know discuss
different design parameters.
The Bureau of Indian Standards (BIS) have laid down specifications
BIS 7620 (1986) as follows:
Table 7.1: Mains resistance and corresponding momentary output of
X-ray generators
Generator Max. Max. Max. Mains Mains Number
type KVp mA KW Resistance Resistance of
(ohms) (ohms) Phases
240V 415V
Single-pulse 50 7 0.3 1.6
65/85 20/15 1 1 3 1
100 25 2 0.6 2 1
80/90/ 60/50/ 3.8 0.4 1.2 3 or 1
100 40
100 100 8 0.2 0.6 3 or 1
Two-pulse 100 100 8 0.4 1.2 3 or 1
100 160 12.8 0.3 1 3 or 1
100/125 200/100 16 0.2 0.6 3 or 1
100/125 300/200 24 0.5 3
70/100/ 700/500/ 40 0.2 3
125 300
100/125/ 500/400 40 0.2 3
150 /300
Six- and 100/125/ 300/250/ 32 0.5 3
twelve- 150 200
pulse
100/125/ 500/400/ 50 0.3 3
150 300
100/125 1000/800 100 0.2 3
Core and Frequency

The selection of core material depends on operating frequency.
For conventional transformers, the operating frequency is 50 Hz,
the CRGO (cold rolled grain oriented) core is used. It contains mild
steel sheets forming E and I laminations. High frequency multi-
pulse generator operates on several Kilo Hertz frequency and core
used is ferrite material compressed to form in E and I type.
(Fig. 7.8). The cross-section of core for each limb is in stepped
construction (Fig. 7.9). The coils are wound on the bobbins having
rectangular or cylindrical shape. Core is inserted in bobbin.
Fig. 7.8: E and I core Fig. 7.9: Stepped construction
Windings
The coils are wound on bobbin made of bakelite or plastic molded
material having good insulation properties. These windings are
also in stepped shape (Fig. 7.10). The layer close to core is having
maximum number of turns and the layer away from core is having
lesser number of turns so that insulation level is built up along
with voltage resulting outermost layer having highest voltage and
will be at a maximum distance from core.
The spacing between the core and bobbin and between winding
and sides of bobbin are not filled up with insulation. When
transformer is impregnated in oil, the oil column fills up this
spacing and offers better insulation. These coils are wound on high
X-ray Generators 93
Fig. 7.10: Stepped winding for HT transformer
speed winding machines. The wire gauge of HT secondary is

around 44 SWG, having very small cross-section, depending on
the maximum secondary current as design parameter. Since the
diameter is very small, more number of turns per layer could be
accommodated. The wire used for winding has enamel insulation
which can withstand potential difference of about 2 to 2.5 kV. For
interlayer insulation condenser paper is used. These coils are
wrapped with condenser paper insulation after winding so that
no bear ends are available for corona discharge and only the start
and end leads are taken out from paper insulation. This paper can
withstand several kV potential difference, after impregnation
process. Primary and secondary are separately wound and matched
for their resistances and pair is formed having similar resistances.
These matched coils are selected and assembled on a core. Then
transformer is subjected to ratio test by supplying 220 volts to
secondary and measuring the primary voltage. Normally the ratio
varies between 300 to 500 depending on design of the transformer.
The assembled transformer is subjected to drying cycle in oven at
a temperature of about 80 degrees C for approximately six hours
so that the windings will not have any moisture. Then the
transformer assembly is inserted in tank and this tank with
transformer is filled with insulating oil under vacuum
(Impregnation process). The quality of oil is checked before filling
and it should adhere to BIS 335 specifications. After oil filling at

high temperature, the tank is allowed to cool down to room
temperature. When normal room temperature is reached, the tank
is fitted with top plate with rubber gasket to avoid oil leakage
during transportation.
Coils of the transformer get hot during their loading (Radiography).
This makes the oil hot, which circulates due to convection between
the open spaces provided in design so that additional insulation is
provided. This oil circulation also helps in removing any carbon
particles in case of temporary short or over current in windings.
Thus oil acts as insulator as well as heat carrier to the tank housing.
Since oil can expand, the oil level is kept approximately 20 mm
below the top plate and a breather is provided. During installation
engineer checks the oil level and if it is below the desired level
more oil of the same properties is added. Since oil is filtered during
impregnation, manufacturer provides small quantity from the same
batch for this purpose.
Connections of windings: They are connected to terminals with special
care. Sharp points or edges lead to corona discharge at high voltages
and hence are avoided. These connections are properly secured by
appropriate mechanical hardware so that even during
transportation there will not be any chance of loose contact due to
vibrations. A special care is taken for portable/mobile systems. If
soldering technique is used, it should be ensured that the outer
surface of soldered joint should be smooth. Additionally these are
covered with condenser paper wrappings so that they are not
exposed. During process of impregnation, the insulating properties
of condenser paper is increased multifold. Hence chance of flash
over is reduced to minimum. But if due to short or over current if
the coils are overheated, they may tend to burn creating carbon. If
the fault is not very severe the carbon particles get washed away
due to circulation of oil by convection.
2. FILAMENT TRANSFORMER
The filament transformer is a step down transformer with primary
energized with almost line voltage and the step down ratio depends
on the desired filament voltage on load decided by tube ratings.
Since the secondary voltage is low, but the current is high, a special
X-ray Generators 95
care is taken while connecting filament leads to filament. The high

tension transformer is wired with center tap grounded. Hence
filament is at half the maximum voltage across the tube with respect
to earth. Therefore the insulation requirement is similar to high
tension secondary supplying voltage to anode with respect to
cathode. Hence the manufacturing technique is similar to high
tension transformer.
In case of low power X-ray generators used for mobile/ portable
applications, the X-ray tube, HT and filament transformers are
housed in one single unit. It is called single tank generator or mono
tank generator (Fig. 7.11).
Fig. 7.11: Single tank generator
3. HIGH VOLTAGE RECTIFICATION

Ideally pure dc voltage gives maximum dose yield. The power
supply in radiology department is either 240 V, 50 Hz, single phase
or 415 V, 50 Hz, three phase ac. In order that HT transformer output
for both half of ac cycle are equally useful, rectification of voltage
is achieved to ensure that anode is always positive with respect to
cathode and phenomena of backfire is avoided.
Earlier days vacuum tube diodes were used for this purpose, but
they had drawbacks such as, separate supply for filament and
anode to cathode voltage, aging of the tube and replacement cost
very high. Later these were replaced by solid state selenium rectifiers.
They are manufactured of selenium oxide deposited on aluminum
disc. Each disc is a cell or diode of about 60 V rating. These diodes

are stacked in series and encapsulated in a bar of insulating material
like bakelite and terminated with conductive discs so that the
complete assembly has a ratings of around 2.5 kV. Number of such
selenium rectifier bars are connected in series to form an arm of
HT rectifier bridge circuit, depending on the total DC voltage
required across X-ray tube. These rectifiers offer high forward
resistance and act as protection against surges and life of X-ray
tube is enhanced. Due to convection currents in oil, the impurities
are drained out, it has self healing property. In case if individual
diode is shorted then other rectifiers take over. But due to its higher
forward resistance, these rectifiers dissipate more power and
voltage required are of larger magnitude. Hence these rectifiers
are replaced by silicon rectifier. Silicon rectifiers have advantages
such as low forward resistance, inverse voltage up to 1000 V, and
can tolerate temperature up to 390 degrees C as against 266 degrees
C for selenium. A care should be taken while replacing rectifiers
from selenium type to silicon type in existing HT transformer
assembly due to their different forward resistance. These silicon
rectifiers are connected in series to form an arm of HT rectifier
bridge circuit. In order to protect these rectifiers against surges,
filter circuit is introduced across each diode. Connection from HT
coils to bridge rectifier terminals is made with thick single strand
wire of short length to reduce voltage drop and flashing with
ground. These connections are anchored and soldered to avoid
loose contact. Any loose contact will result in arcing.
4. TWO TUBE CONNECTION (Fig. 7.12)

If the radiographic system is utilizing more than one X-ray tube,
as in case of R/F system, a switch over from over couch to under
couch tube is required. This is accomplished by high tension change
over switch. Two switches per tube are required, one for filament
and another for anode supply connection. These switches ensure
that only one X-ray tube is energized at a time. The filament and
HT transformer supplies energy to any one of the tube selected
through these two switches. Switch has three set of contacts for
common, small and large focus. Switch utilized for anode
connection has all three terminals shorted. Switches are operated
electromagnetically by energizing the coil with specified voltage.
X-ray Generators 97
The switch assembly is mounted on top plate of HT transformer

and immersed in oil because their contacts operate at full high
tension. The switching contacts are assembled on non conducting
material and safe distance is kept between coil terminals and these
contacts.
Thus the high tension transformer assembly will accommodate
(a) HT transformer with bridge rectifier circuit (b) Filament
transformers for both small and large focus (in case of dual focus
tube) (c) High tension tube change over switches. (d) High tension
sockets to connect X-ray tube to the HT transformer assembly with
HT cables.
High tension transformer assembly

Fig. 7.12: Two-tube connection
5. HT CABLES AND PLUGS

They are required for connection between X-ray tube and high
tension transformer assembly for stationary radiographic systems.
These cables carry voltages of the order of 75 kV with respect to
ground at generator load of 50 to 100 KW resulting the current of
the order of 1 to 2 amperes. They are subjected to mechanical and
electrical strain to a large extent specially in case of R/F or
planigraphy installations. Safety measures are incorporated in
designing and manufacturing process of these cables. Due to high
power ratings, the installation requirement is major concern. The

filament leads may carry current of the order of 6 amperes resulting
into voltage drops restricting the length of cables to 16 meters.
Cables offer capacitance of 200pf/m between internal conductor
and shielding. Due to this cable capacitance, the waveform across
X-ray tube is smoothened thus reducing ripple. Both anode and
cathode cables are alike and can be interchanged in case of failure
of one conductor in cathode cable. They use O type terminals and
for proper recognition of common terminal notch is provided
(Fig. 7.13). The terminal pins are split radially to get firm connection
between plug and socket. Notch matches recess in socket. The plugs
and sockets are injection molded with high density polypropylene
without any blow holes so that they can withstand high voltage of
the order of 75 kV with respect to earth. The three conductors are
covered with rubber insulation to withstand at least 5 kV between
them and 75 kV between them and metallic screen meshing which
surrounds the cable under plastic sheath, which is connected to
casing or housing via aluminum spacers and ring nuts. However
this should not be used as ground or earth lead. Mechanical strain
occurs during movement of the tube particularly at the sleeves at
the tube end. Hence the cables should be flexible. Incorrect plugging
in sockets without using the required jelly may lead to voltage
sparks and bad contact.
Fig. 7.13: HT cable terminal
Measurement of High Tension Voltages

There are two methods adopted namely with the help of
Oscilloscope and indirect measurement with special filters and
ionizing chamber.
X-ray Generators 99
(a) Oscilloscope method: Tube voltage is measured directly with

voltage divider circuit 100 kV = 1 V connected in HT secondary
circuit. In generators with automatic kV control during
exposure, potential dividers for measurement of actual kV value
are incorporated in secondary circuit. In other circuits using
two tube configuration HT measuring plugs are used. Due to
strong electric and magnetic field in this HT assembly,
compensating components are connected in parallel to precision
non inductive resistors used for measurement. Since the value
of resistors is large, current flowing through dividers is
negligible in comparison with fluoroscopic current.
(b) Indirect method: In this method the voltage is determined by
measurement of quality of radiation with the help of special
filters introduced in path of X-ray beam and resultant radiation
assessment is done on X-ray films or with electronic measuring
devices using ionization principle.
X-ray Tube Current (mA)

The tube current in X-ray tube is resultant of emission of electrons
from filament, their flow towards anode due to high accelerating
potential difference between anode and filament. This process is
reversible under following conditions.
(a) Anode is heavily loaded, becomes red hot and start emitting
electrons.
(b) Alternating voltage applied to tube in self rectifying circuit,
resulting in attraction of electrons towards filament during
negative half of ac cycle. These operations destroy the filament
as discussed earlier in phenomena Backfire.
Filament emission curve: When filament is heated, electrons are
emitted, higher temperature results in higher tube current. In case
the accelerating voltage is not available, electrons accumulated near
filament form a cloud called Space Charge. Temperature of filament
depends on square of filament current. Hence filament
characteristics is dependent on tube and filament current for a
particular kV value. If the kV is increased for a particular filament
current If, tube current, I tube, increases. This will result in
reducing space charge.
Since the X-ray tube is high voltage diode, certain precautions are
taken to safeguard its working such as 3 to 5 seconds warming up
time of filament from cold condition to maximum value. The time
required from switching over from fluoroscopy to radiography,
boosting time, is around 1 second (Fig. 7.14). Hence filament should
be kept in warmed up state, when the filament of tube is selected
so that, preparation time is reduced.
Fig. 7.14: Basic heating
Rotating anode tube is normally twin foci, and only one filament
at a time is used depending on applications and requirement of
end user (geometric and movement unsharpness). Hence there are
two types of filament heating namely Standby and Fluoroscopic
heating.
Standby heating serves as warm up and it is below the threshold
of emission. Filament temperature is too low to liberate electrons
even if maximum kV is applied to tube. Filament is heated to such
a level that when this level is exceeded, it will start emitting
electrons. Hence it is ensured that filament is warmed up and
energizing of tube in cold condition is avoided. If the fluoroscopic
examination is to be performed, the filament is heated for higher
temperature above that of threshold of emission (Fig. 7.15).
After application of desired fluoroscopic kV, electrons are
accelerated towards anode resulting in fluoroscopic current, which
can be varied depending on brightness desired on fluorescent
screen. Since the requirement of fluoroscopic current is not more
than 4 mA in twin focus tube normally small focus is used for this
examination for obtaining minimum geometric blurring.
During fluoroscopic examination if the radiologist discovers some
X-ray Generators 101
Fig. 7.15: Threshold of emission

findings for which permanent record is required, radiographic
exposure is taken on X-ray film loaded in cassette in SFD. Selection
of focus in such cases depend on the object thickness and may
demand higher power output which small focus may not be able
to deliver and hence the focus is switched to large one. Therefore
both foci should be heated to standby heating. If standby heating
is above threshold of emission then both foci will contribute to
tube current and focal spot area will increase resulting in poor
geometric blurring. Hence this is avoided by switching the desired
filament only.
During radiography mode the requirement of tube current is
multifold. Hence filament is heated to such a level that the number
of electrons are large enough for radiography. It requires filament
to reach desired temperature to get the required tube current.
Normally this time duration is 1 second. This state is known as
boosting. During preparation time, only the focus used for exposure
is boosted and kept at elevated temperature during boosting and
exposure time. It is brought down after exposure to preheating.
6. FILAMENT CIRCUIT
The filament of X-ray is energized through the filament
transformer. In case of single tank generator, due to proximity of
filament transformer with X-ray tube, direct connection is made,
but in case of dual focus tube used for higher power output system,
connection is made through high voltage cable. In a table below
radiography is performed on large focus.
Table 7.2: Different steps of filament heating
Serial Number Generator status Small focus F1 Large focus F2

1 ON Basic heating Basic heating
2 Fluoroscopy ON Variable Basic heating
fluoroscopic
heating
3 Preparation Small focus OFF Boosting of
Radiography filament
4 Radiography ON Small focus OFF Radiographic
heating
However the adjustment and settings are made on primary side of

filament transformer with adapting to the primary with line voltage
(Figs 7.17 and 7.18). Normally the voltage of filament primary is
varied from 55 to 140 volts. If the ratio of filament transformer is
14:1, then secondary voltage will be varying between 4 to 10 V.
This ratio depends on ratings of filament. A separate transformer
is required for each filament, for dual focus is T3 for small and T4
for large. Refer to Figure 7.16 where the tube current I tube is
plotted against variation of filament current If. It is observed
that for small variation of filament current results in large variation
in tube current is achieved because the characteristics becomes
almost parallel to Y-axis.
This is an alarming situation where a small incremental change in
filament current results in very large variation in tube current,
which may result in exceeding limits of X-ray tube. Therefore a
special care should be taken in designing filament circuits.
Generally the power supply to filament transformer is through
directly from auto transformer (Fig. 7.17) or Isostat through voltage
stabilizer (Fig. 7.18) or constant current supply.
(I) Auto Transformer

In this case the voltage from auto transformer windings is given to
the filament transformer through regulating resistors. This circuit
scheme is less expensive since it requires less components. But
during X-ray exposure, current flows through HT secondary and
hence through HT primary, which brings down voltage of auto
transformer, (On load voltage), which in turn results in lesser
voltage for filament, thus reducing tube current. This further results
in lesser load on mains and increase in tube voltage. Hence
stabilization of tube voltage is not achieved which in turn may
affect the image quality.
Introducing additional pumping voltage during exposure to
encounter the drop in voltage during exposure overcomes
Fig. 7.16: Filament curve
Fig. 7.17: Filament circuit

this drawback. However this introduction of pumping voltage,

through voltage drop across pump resistor, which is shorted during
exposure, is unreliable for full range of kV for higher range of tube
current values. Introduction of regulated power supply for filament
(voltage stabilizer) has solved this problem.
(II) Voltage Stabilizer

The stabilizer is energized through voltage from auto transformer.
It works on a principle of saturable core. The output of the stabilizer
is always constant irrespective to the changes in line voltages and
loading of the source. The voltage ranging from 80 to 120 V are
Fig. 7.18: Filament circuit with stabilizer

used for preheating and basic heating. The large focus is kept at
standby heating and small focus is kept at preheating voltages.
The voltage for radiography is kept at higher value around 220
volts for boosting. These voltages vary as per length of HT cables.
These voltages are fed to filaments through transformers T3/T4,
relay contacts and filament dropping resistors. For fluoroscopy T3
is energized through resistor R fluo. When fluoroscopic relay is on
and the relay contacts are opened up. T4 is energized through
resistor RLF for basic heating. Relay fr is not energized and supply
to T3/T4 is made through normally closed contact of relay fr.
During boosting stage relay fr is energized and the normally closed
contacts of fr open and normally open contacts close. As per
selection of focus small or large, transformer T3 or T4 is energized.
Stabilized power supply to filament gives constant potential to
filament enabling the fixed number of electrons emitted from
filament. Now the anode voltage variation is from 40 to 125 kV.
This results in different tube currents at different voltage settings
due to space charge cloud near filament. In order to overcome this,
a variable resistor is introduced in series with filament resistor
called Space charge resistor, whose value is minimum at lowest kV
and maximum at highest kV, thus ensuring the filament primary
current to be constant. Since it is difficult to achieve resistor values
for all kV steps the kV steps are grouped together for some steps
such as 40 to 55 kV resistor value Space Charge Resistor SR1, 57 to
66 kV resistor value Space Charge Resistor SR2 and so on.
Techniques
Isowatt Technique
If the power given to X-ray tube is constant throughout the kV
range, then this technique is known as ISOWATT technique. It is
used in single pulse mobile units, wherein as the kV value increases
the tube current decreases in the same order to maintain the same
power.
Example: 50 mA@50 kV, 44 mA@56 kV, 37 mA@67 kV, 31 mA@81
kV, 25 mA@100 kV
Register Technique
The tube current is kept constant during the exposure for different
values of kV. In order to preselect quantity of X-ray or mAs value,
one should choose the tube current mA and exposure time.

Ex. 300 mA and 0.4 seconds for 100 kV. Here the operator should
refer to tube chart for 100 kV, decide the required mAs and select
respective mA and seconds value keeping in mind the maximum
ratings of the tube. The mA value selected is known as Register.
The end user must consider the motion unsharpness and blooming
of focal spot with respect to quality of image desired, if large focus
is selected. There could be several combinations for one mAs value
and kV value. These X-ray generators using register technique with
free selection of kV, mA and seconds and selectable constant tube
current, have disadvantage that end user must determine the tube
load and exposure parameters for each examination, which is
lengthy cumbersome process. In order to make job of radiologist
easier, the installation engineer reselects three mA values per focus
so that there will be total six registers. They are allotted as possible
mA value at maximum kV, average mA value at average kV and
maximum mA value at highest possible kV.
Falling Load Technique

In this type, the exposure starts at maximum allowed KW for
selected focus as initial load. The tube load is rapidly reduced after
beginning the exposure following maximum power curve till
desired mAs is reached, where exposure is terminated. This reduces
the exposure time thus reducing dynamic blurring and radiation
hazards. The continuous reduction of power ensures that safe limits
are not exceeded. (anode temperature < 2300 deg C). This
temperature is reached in short time and then the load is reduced
in such a way that heat units pumped in per unit time are dissipated
to surroundings, ensuring that focal track is not overloaded.
Exposure termination is achieved by mAs relay. It is therefore
possible to program automatic exposure device for anatomical
areas.
Example: Exposure parameters 100 kV @ 25 mAs for moving organ.
This can be achieved at 5 KW load at 50 mA at 1 second or at
25 KW load at 250 mA at 0.2 seconds. We can compare the two
radiographs. It will be noticed that with lesser exposure time
radiograph is better one than the one with larger exposure time
which shows the blurring effect. Hence shorter exposure is
preferred. Starting the exposure at highest load has few

disadvantages such as
(a) Instantaneous heating of focal spot to maximum value with
every exposure results in lowering of tube life. In order to
safeguard the tube the initial load is reduced to 85%.
(b) Due to instantaneous heating on a smaller area, the focal track
gets very hot, thus emitting electrons which are attracted back
to anode resulting in increase of focal spot known as Blooming
of focal spot.
The falling load principle used in modern generators reduces
filament current after the start of exposure. This results in lowering
of tube current and hence increase in tube voltage unless kV
compensation is applied. This can be achieved by step less
compensation of kV by regulating triodes in the secondary.
The initial value is calculated from the maximum power handling
capacity of focus for 10 millisecond and desired kV. The current
regulation is achieved by introducing triac in the filament primary
circuit. If the actual value of tube current is higher than desired,
the triac blocks ensuring filament control.
Determination of actual value: Actual value is compared with desired
(nominal) value. But the actual value of kV and mA is possible
when tube is conducting, also we require correct filament
temperature prior to exposure during preparation mode. Hence
primary filament current is used in place of actual value of tube
current. This is achieved by using optocoupler which senses the
actual current and gives the feedback to the filament controller to
regulate the voltage fed to filament transformer (Fig. 7.19).
Tube current measurement: Since voltage stabilizer is used in most
of filament circuits, its waveform not being sinusoidal, the
measurement is done with rms meter. If filament is operating with
inverter circuits, since the inverter operates at high frequencies,
the direct method of measurement is not possible. Since analog
rms actual value of filament current for preparation is necessary
for current regulation, this value can be used for possible
measurements. Software programs automatically correct the initial
value after the exposure with modern generators using
microprocessor. The measurement of tube current is important
during installation and calibration of tube. The mA meter used is
Fig. 7.19: Filament control by triac
moving coil type as shown in Figure 7.20. For two-pulse generators,

a precision rectifier is added in HT primary circuit. The use of
moving coil instrument as mA meter indicates the arithmetic mean
value and is directly proportional to dose rate. Such measurements
are necessary for X-ray generators using register technique. In case
of falling load technique, measurement of mAs value is important.
Moving coil instruments are accurate for measurement for time
greater than 1 second and therefore not useful in this case. Moving
coil meter without return spring but with damping is used to over
come this problem. In both cases the reading is maintained after
measurement and this reading can be erased by allowing current
in opposite direction.
Fig. 7.20: Tube current measurement

7. PROTECTION OF X-RAY TUBE

We again consider the equation VL = Vo-(I) Rs. Hence if there is
no tube current flowing then VL = Vo which may damage tube.
Monitoring the tube current is very essential. A current relay
connected in filament primary serves this purpose. It energizes
when filament is boosted, and its normally open contacts are used
in triggering circuit of the timer. Change over from fluoroscopy to
radiography or vice versa, a protection circuit is required. During
Spot film examination, the filament has to switch over from
preheating to boosting. Therefore a 1 second delay is introduced.
Overload Protection: The maximum permissible temperature of
anode disc is around 1800 degrees C and that of focal spot is around
2300 degrees C. When this temperature is exceeded, overloading
of tube occurs. The limit curve expresses power as a function of
time. (refer Figure 6.11) and is applicable to radiography with constant
output. While deciding limits of exposure parameters for individual
exposures this curve is referred. This curve does not apply to repeat
exposures as in case of angiography technique because in
angiography although each exposure is within limits the sum of
all exposures should not cross over the loading limit of tube, failing
which the permissible limits of the tube will exceed resulting in
permanent damage to anode disc of tube.
But we take single exposure in case of simple radiological
examination. The patients preparation time is around 5 minutes
which can be treated as pause between exposures and is sufficient
to cool down the anode disc. Hence under such conditions a single
exposure at constant current is limited by Overload Protection. This
is achieved by using cam discs mounted on kV, mA and time
selector switches in earlier generator circuits. For example in
Figure 7.21, we have blocking with diodes for 300 mA tube current
at 90 kV and 0.4 seconds (based on tube characteristics). If any of
the radiographic kV or time are exceeded the corresponding diodes
will block and blocking relay will not get energized which in turn
will block the exposure triggering of timer through contacts of
blocking relay. Similar such blockings can be achieved by hard
wire programming after referring to tube characteristics for the
tube incorporated in system.
Fig. 7.21: Blocking circuit

Later with advances in electronics, the cams were replaced by
blocking diodes and nowadays with introduction of
microprocessors, ROM and PROM their function is taken over by
these devices. Hence generator will block exposure triggering, if
settings of any of above three parameters exceed the tube limits
and the parameter display starts blinking. The ROM will calculate
the total amount of heat units utilized during previous exposures
and indicate the reserve capacity available.
The correct blackening of film is obtained by Programmable
Automatic Exposure Timer followed by processing films, with
automatic film processor. It measures the dose (mAs) on film. The
operator sets the parameters like kV and mAs. It is important for
two reasons namely:
(a) The operator must be able to estimate the motion unsharpness
due to object motion with longer exposure time and will result
in inferior radiograph, if proper power setting with focus
selection is not utilized.
(b) Exposure time is a parameter in overload protection.

The appropriate exposure time is calculated empirically by
following method. In order to make it sure, two or three times
expected exposure time is given. The output of tube is may be
selected on the basis of specified time, which means reduction in
current and prolonging exposure.
A more appropriate solution is to operate with generator where
exposure power continuously fall (Falling load technique). Initial
power brings the focus to its maximum temperature, power is then
reduced so that temperature is kept same till the end of exposure
by maintaining state of equilibrium in the focal spot between input
energy and heat dissipation. Termination of exposure is achieved
by automatic exposure control. Hence the exposure can be
continued with falling load, if blackening is adequate, while as
with constant power exposure must be switched off on reaching
the limit of curve so that maximum temperature is not exceeded.
Register technique refers to constant tube power at set tube current
with relevant maximum kV and time values. For a particular organ,
we require kV for penetration and mAs for desired blackening.
Therefore set mAs and kV. Based on this and KW output, mA is
known. Use the tube characteristics to determine the value of
time = mAs/mA and check if it is within tube limits. In this way
the mA registers are decided. Accordingly the blocking limits for
kV, seconds are decided for a particular mA value.
In case of mAs timer, if the desired value of mAs exceeds the
maximum permissible value, automatic system switches over to
lower current value with display of parameters for operator to
decide whether it meets requirement of exposure.
8. TIMER
It is a device which controls duration of HT supply to X-ray tube.
There are two basic methods of switching X-ray generator ON and
OFF. Each one has its advantages, but major difference is in method
of switching or connecting high voltage to X-ray tube. These are
Primary switching and Secondary switching depending on the
location of switching mechanism. In primary switching, generator
switches the HT primary voltage On and Off applied to X-ray tube
by closing or opening the circuits on the primary side of the HT

transformer. While in secondary switching, it is carried out on the
secondary side of HT transformer.
Primary Switching
In this case the operating voltages are line voltages. Operating
devices at these low voltages are much cheaper and safer to service.
Since the power handling is in KW, the current rating is very high
of the order of 200 to 300 Amperes depending on the transformer
ratio. Hence the stepwise switching is adopted. Stepwise switching
HT primary by means of Pre-contact through a damping resistor
(Fig. 7.22).
One set of contacts are extended and second set is normal contacts.
The extended contacts close earlier and open later than normal
contacts so that voltage applied to HT transformer primary through
resistor and will have smaller amplitude due to drop in resistor.
When the normal contacts close full voltage will be applied to HT
primary. It is advised that switching on and off of these contacts
should be carried out at zero crossing of ac cycle. Since the voltage
at zero crossing is minimum, there is no current drawn and arcing
at contacts do not take place during breaking or making of contacts.
Fig. 7.22: Stepwise switching with pre-contact

Thus it ensures that there are no surges and this method enhances
the life of contacts. This is also called synchronous switching. In
this case the exposure timings are multiples of 10 milliseconds for
50 Hz supply frequency.
There are various devices used to switch HT primary such as
electromagnetic contactors (power relays), thyratrons, silicon
controlled rectifiers (SCR).
Electromagnetic contactors: The coil of the relay or contactor is
energized with required voltage allowing plunger to move,
enabling the spring loaded contacts to change their position against
spring tension. (Normally open contacts close and normally closed
contacts open). When voltage to coil is removed the reverse action
takes place due to spring tension and contacts are brought back to
their original state. The coil is rated in voltage or ampere-turns. If
power supplied is below their rating, contacts bounce while closing.
This is known as chattering of relay. This results in inconsistent
working and charring or pitting of contacts. In order to avoid
chattering, circuit design incorporates resistors in series to limit
the current and capacitors in parallel of the coil. In order to enhance
life of switching mechanism, contacts should be checked, cleaned
from carbon deposits by conducting regular maintenance. Most of
the conventional X-ray generators use electromagnetic contactors
for switching of exposure.
Thyratrons: They are gas filled triodes and are used as electronic
switches. Once the triode conducts, due to ionization of gas inside
glass envelope, it offers minimum dynamic impedance and acts as
short between anode and cathode. Thus grid looses control after it
starts conducting. The only way to switch off triode is by removing
the anode to cathode voltage. This device is now replaced by SCR
because of its inherent drawbacks such as large size, high cost, low
life, high power consumption and high maintenance.
Silicon Controlled Rectifiers (SCR)

SCR is generally preferred over earlier two devices. Since they are
manufactured in large quantity due to its industrial applications,
they are much cheaper than previous two and do not require high
maintenance. SCR are connected in inverse parallel circuit. The
gates are controlled by solid state timer and electronic memory in
synchronization with mains waveform so that high voltage

transformer will not saturate. At the start of exposure the gate is
energized 1 millisecond prior to the zero crossing. This
1 millisecond time interval is required for preparing SCR to conduct
when anode voltage is positive with respect to cathode. The SCR
will conduct in this positive half of cycle till input voltage comes to
zero. This process is repeated during negative half of cycle through
other SCR (in inverse connection). In this device the gate looses
control when SCR conducts and only way to switch it off is by
removal of anode to cathode voltage. This is done at zero crossing.
Hence even if the timer is off after decided exposure time the SCR
will continue to conduct till anode is positive. Therefore the HT
primary will be energized for time multiple of 10 milliseconds
(Each half cycle in case of 50 Hz supply). Such exposure is known
as synchronous exposure.
In order to overcome this limitation, SCR pulsed commutation
technique is utilized. Along with forced extinction, this technique
provides minimum exposure time in millisecond range. This
technique is used in photo spot cameras, film changers and
automatic exposure controls. It requires special design to prevent
damage to HT transformer. This technique is mandatory with use
of rare earth intensifying screen in conjunction with automatic
exposure controls. DC voltage is applied to a capacitor network
connected to SCR circuit for achieving forced extinction. A
command from control circuit will momentarily discharge the
capacitor to reverse polarity at SCR which will stop conduction of
SCR. Hence the HT transformer is energized at zero phase but
exposure can be terminated as and when required. This non
synchronous switching is accomplished by SCR pulsed
commutation and high speed electronic switching circuit. It reduces
the exposure time to the range of 1 to 2 switching, circuit, thus
enabling use of high speed film changers (up to 12 exposures per
second) and high speed spot cameras.
Secondary Switching
In secondary switching the HT transformer is energized and HT
secondary voltage is rectified and fed to X-ray tube. There are two
methods of secondary switching namely with grid controlled tube
and use of constant potential generator.
Grid Controlled Tube

The X-ray tube filament cup is kept at a high negative bias with
respect to filament voltage roughly around 2 to 3 kV and acts as a
grid. This negative voltage does not allow electrons to reach the
anode, thus blocking the tube current. When the tube is required
to conduct, a positive voltage of same magnitude as bias is applied
to filament cup so that bias is nullified and the stream of electrons
are allowed to reach the anode resulting in tube conduction, hence
exposure. The positive going pulse is obtained in the form of pulse
train from either exposure timer or film changer or shutter open
phase of cine camera in case of cine fluorography.
The prime application is Cine Fluorography in which the tube
currents are around 500 mA at a very short duration of 1 to 2
milliseconds for filming the heart valves and chambers. Normally
cine camera has speed of 90 to 150 frames per second. The grid
control tubes were used in 1970, but had drawbacks. Since the
filament cup requires supply of 2 to 3 kV with respect to cathode,
the HT cable is four core. Insulation requirements on the four
conductors of cable namely large, small focus, common lead and
grid are more stringent. Moreover during this examination HT
cables are subjected to more mechanical strain due to multiple
projections at different angles. This used to result in failures of HT
cables. In order to overcome this drawback secondary switching
with constant potential generators were introduced.
Constant Potential Generator

The HT transformer secondary voltage after rectification is fed to
two high voltage regulating triodes as shown in Figure 7.5. The
grid bias timing circuit ensures that both triodes are biased in such
a way that there is constant voltage potential between the two
triodes. This ensures that voltage across X-ray tube is pure DC
without any ripple. The grid bias circuit is used to initiate and
terminate the exposure with timing as low as 1 millisecond. Due
to regulation in secondary circuit, the performance of system is
independent of voltage fluctuations or changes in primary. This
technique has major shortcoming due to length of HT cables. Cables
with longer length than approximately 30 feet will have voltage
drop and also store energy in its capacitance which will extend the
exposure time due to capacitor discharge of cable capacitance.

Another important limitation is that the two high voltage triodes
should be exactly matched. In case one fails the matched pair has
to be replaced which adds up to replacement cost.
Interrogation Time
It is the time required for generator to react to given impulse and
is calculated as time interval between triggering of exposure to
start of exposure. This time depends on phase in time for zero
phasing 10 milliseconds, the delay in pick up of relay system or
switching mechanism. In the conventional X-ray generators using
electromagnetic contactors it was of the order of 50 milliseconds
and has special importance in serial exposure technique called
Serialography.
Automatic Exposure Control

In order to obtain good quality radiographs and to avoid faulty
exposures the right amount of radiation should pass through
patient which can be determined by accurate actual measurement.
If this procedure is adopted, the dose to patient is also reduced. It
measures the dose rate, integrates dose rate over time and switches
off exposure when correct dose rate is achieved. This measurement
is done after the object with
(a) Ionization chamber
(b) HSE chamber
(c) Multiplier
(a) Ionization Chamber: It uses ionization effect of X-ray radiation.
The commercial name used is Iontomat. It is a dosimeter which
will switch off X-ray exposure after achieving required dose for
proper blackening of film. The amount of blackening according to
sensitivity of film, density selection depending on type of
intensifying screen used, ionization chamber field selection among
the three chambers provided and film blackening adjustment are
the setting and adjustment controls of Iontomat (Fig. 7.23).
The measuring chamber is usually placed in front of the cassette,
between object and film. The amount of ionization current is 0.01
microamperes. The measuring chamber has three measuring fields
Fig. 7.23: Iontomat controls
(dominants) and is normally fitted in catapult bucky assembly and

serial exposure changers with automatic exposure control.
Since we are considering automatic device for exposure control
certain standardization is required namely
1. Cassettes with same absorption value.
2. Intensifying screens of one type for each technique.
3. Films of same quality and used for automatic controls.
4. Automatic film processing machines.
It also allows variations in following parameters.
1. Mains voltage variations
2. Tube voltage and current
3. Focus film distance
4. Field size (Collimation)
5. Filtration (Inherent due to mirror in collimator, offered by table
top, and additional patient support).
6. Thickness and density of patient
7. Grid specifications.
A short exposure time with high tube current will result in larger
film density as in case of chest radiographs, than longer exposure
time and low current in case of lumbar spine exposure. This
phenomena is known as Reciprocity failure. As Iontomat being
automatic exposure timer, works on principle of actual dose
received, films with low reciprocity failure should be used.
During exposure, radiation passes through ionization chamber
which becomes conductive and its ionization current charges
capacitor. After reaching threshold value, amplifier switches off
the signal. Contact in parallel to integration capacitor ensures that
capacitor is not charged before exposure (Figs 7.24 and 7.25).
Fig. 7.24: Main components of iontomat
Fig. 7.25: Iontomat circuit
Disadvantages: Due to use of long shielded cables, the capacitor

discharges prematurely. Hence compensation for cable and
chamber is adjusted with unit. Humidity and insulation of wiring
is also important due to low value of ionization current. Therefore
preamplifier is used to overcome these effects.
Construction of ionization chamber: Since measuring chamber is kept
between object and film, it should be very thin with no absorbing
parts for X-ray radiation. Aluminum is used which also gives
mechanical strength.
(b) HSE Chamber (semiconductor radiation receiver): X-ray radiation
is converted into light by fluorescent screen. Light falls on
photodiodes and is converted to current which flows through

shielded cable to preamplifier. Rest of the circuit is similar to
ionization chamber. Location of chamber is behind the film due to
its construction using absorbing material.
(c) Multiplier (Fig. 7.26): It is a high vacuum tube. Light falls on
input screen, gets converted to electrons which are accelerated by
1 kV potential and further multiplied. The current at output is
measurement of input light. The input light is taken from output
screen of Image Intensifier tube which is proportional to dose rate
of X-ray radiation. The output current is fed through preamplifier
to automatic exposure device.
Fig. 7.26: Multiplier
9. MAINS COMPENSATION (Fig. 7.27)

X-ray generator must be able to adapt different line voltages. The
line voltages available depend on the line resistance and loading
of mains supply at various times during the day. Since the primary
stage of power supply is governed by intermediate or auto
transformer, the mains voltage compensation is extremely
important for operation of electronic components and relays used
in circuitry. Therefore a mains compensation switch is wired in
primary circuit of auto transformer to adapt to the voltage
requirements of X-ray generator.
Example: Mains nominal voltage is 240 volts, use tap of auto
transformer to
Fig. 7.27: Mains compensation circuit
(a) higher voltage for input voltage > 240 volts

(b) lower voltage for input voltage < 240 volts.
10. ROTATING ANODE CIRCUIT (Fig. 7.28)

This circuit consists of the two stator windings used for starting
Ws and running Wr, phase split capacitor C and relay whose
contacts are used in triggering the timer. Resistor R1 is current
limiting resistor and resistor R2 is connected across capacitor C to
ensure the discharging the capacitor C after the exposure so that
the circuit is ready for next exposure. Relay has its contacts in
triggering circuit of timer to ensure that rotating anode circuit has
been given required voltage and anode is rotating.
This relay can be called as interlocking relay so that exposure is
only possible when anode is rotating. For 50 Hz supply the speed
is around 2800 rpm.
Since the relay, resistors R1 and R2 and capacitor C are located in
the control console and the stator windings are in tube head assembly
the connection is made with special 3 core wire which can stand
insulation up to 1000 volts, because the charge on capacitor is
maximum in starting phase of the order of 560 volts. Refer typical
values for THX-1 tube shield with DRA-1- 125/20/40 tube.
Fig. 7.28: Rotating anode circuit
Table 7.3: Rotating anode voltages for THX-1

tube shield with DRA-1 tube
Freq. Voltage Voltage Voltage Current Current Current
Amperes Amperes Amperes
Lead 0-I 0- II I-II 0 I II
Start 50 475 220 560 5.5 2.0 4.8
Running 50 170 60 175 1.4 0.6 1.1
The three terminals of the stator coil brought out on the anode side
are marked as I, II, O. The control circuit must ensure that, between
O and II terminals 220V-5.0 A is present at the time of starting and
50V-1.2 A after 0.8 seconds. The time 0.8 seconds is minimum time
required to gain maximum speed as specified by manufacturer.
This delay is incorporated in designing the rotating anode circuit
and it is normally kept more than 1.0 second. The values indicated
here will change from design of the tube stator windings and may
vary for different tubes.
Modern X-ray Generators

We have noticed that with free selection of exposure parameters
like kV, mA, and seconds there are several combinations possible.
These large number of combinations sometimes confuse the
operator. In case of falling load generators they are restricted to
two parameters kV and mAs and with generators using automatic
Block Diagram of Conventional X-ray Generator
Power Supply : Supplies power to all assemblies

Output Monitor : Receives information from kV, mA, times switch and blocks
exposure
Control ckt : Selects peripheral unit and feeds power according to application
Peripheral unit : Processes signal from unit
RA ckt : Circuit of rotating anode
Timer : Switches on the switching device if exposure is within limits
kV Rad : Radiographic kV selector
kV Fl : Fluoroscopic kV selector
mA Rad : Radiographic current selector
mA FI : Fluoroscopic current selector
Fig. 7.29: Block diagram of X-ray generator with register technique

exposure technique they are restricted to only one parameter kV.
Innovative designs with microprocessor based X-ray generators
introduced Automatic Programming Technique. These factors can
be stored in memory with anatomical programming and called
back as and when required depending up on requirement. The
generator normally has 7 7 = 49 programs, stored in memory.
Radiologist chooses only the anatomical organ such as knee by
pressing organ button for knee on front panel. The X-ray generator
will automatically refer to exposure charts stored in memory for
the desired focal spot and accordingly select exposure parameters
for average patient thickness of 12 cm, FFD 115 cm, grid 8:1, at 60
kV/25 mAs. For any variations in patient thickness (thicker or
thinner) or lesser FFD or grid ratio, corresponding correction can
be applied. For example if the patient thickness is 14 cm then kV is

increased to 66 kV (Two steps ahead).
There are various applications in radiology and becomes
complicated design to cater for all requirements. Moreover this
increases the cost of the system. In order to over come this problem,
manufacturers have introduced Modular Designs. These generators
have been designed in such a way that control console can accept
various modules which can be solid state circuit elements which
are much smaller in size, weight, which in turn makes the control
console compact. They are more service friendly and
documentation is reduced, thus increasing versatility of the
equipment. They can be easily upgraded from lower KW output
to higher by interchanging modules like, HT switching circuit, focus
print of filament. These generators can be time shared between
two or three examination rooms for applications such as over couch
radiography, catapult bucky, or chest radiographs.
High Frequency Generators

We had seen that advancements in electronic devices have changed
the design of generators from open high tension to protected high
voltage from thermeonic valves to solid state silicon diodes. The
introduction of high frequency technique is another milestone in
the development of X-ray generators. Use of high frequency for
generation of high voltage with extremely low ripple results in
high dose yield, low skin dose, sharper pictures with lower
exposure time, consistent radiographic quality in a compact design.
High Dose Yield
The ripple on the tube voltage is low, independent of the tube
voltage set and thus supplies a considerably higher dose rate than
two-pulse generator with same exposure data.
Low Skin Dose
The soft radiation produced with HF technology is bare minimum
as compared to two pulse generators, thus reducing radiation burden.
Shorter Exposure Time
The higher dose yield in combination with favorable depth dose
efficiency results in shorter exposure timings thus leading to
reduction in kinetic blurring (movement unsharpness) and
significant improvement in image quality. Also the rise time of the

waveform is also considerably reduced enabling the voltage
reaching the desired value in very short time.
Compactness
The conventional X-ray generator directly processes the power line
voltage and feeds the same to transformer with line frequency of
50 Hz. In HF generator the high voltage is fed with a considerably
high frequency up to 14 kHz. Voltage is proportional to product of
frequency, number of turns, cross-sectional area of the core. If the
frequency is increased the cross-sectional area can be decreased in
same proportion. This is given by formula as follows.
Voltage U = (4.14). (f). (A). (N)
Where f = frequency
A = Cross-sectional area
N = Number of turns
This drastically reduces transformer core size and windings
resulting in compact construction and lower weight. Thus this
technology has major advantage in saving space in stationary units
and easy mobility in mobile units.
Fig. 7.30: Block diagram of HF generator

X-ray Examination Units 125
X-ray
8 Examination Units
We have seen different type of radiology systems in Chapter 5.

X-ray examination unit is designed depending upon the
applications. Normally a radiology department, in more than 300
bed hospital, has installed, equipments are:
Mobile units: 60 mA/100 mA mobile units at least two numbers and
Stationary units: (i) 12 KW unit for accident cases
(ii) 24 KW hand operated unit or
Simple radiographic system for casualty
(iii) 50 KW motor operated system with Image
intensifier for GI studies
(iv) Dental X-ray unit for dentistry
(v) Mammography unit for breast cancer
detection
(vi) CT scanner
(vii) Bone densitometry unit
These radiographic systems must meet the safety standards
prevailing in the country. Safety can be classified in to three types.
Mechanical safety, Electrical safety and Radiation safety. Since
these equipments are extensively used in hospitals for diagnosis,
these three factors have utmost importance in designing and
manufacturing these equipments.
In order to obtain informative image, following steps should be
taken.
1. Easy positioning of the patient under examination. The tilting
of tube head, with respect to patient to get appropriate
radiograph of region of interest, should be easily achievable.
2. Source of radiation (X-ray tube), patient and image plane should
be stationary. The installation should be carried out with utmost
care so that there are no vibrations due to moving assemblies

which in turn generate artifacts.
3. The source to object distance should be as large as possible so
that parallel rays are obtained and the object to image plane
distance should be as less as possible so that magnification is
avoided. But in real practice this assumption has certain
limitations based on applications and constraints in design. This
can be clarified with few examples such as follows.
1. Mobile units are used in wards or operation theaters. The unit should
be able to move freely in the wards, lifts and should facilitate easy
positioning. For patient lying on bed to be radiographed with this
unit, the positioning of tube head both in over couch or under couch
position, the focus object distance variation is limited due to travel
of the tube head in both planes, up and down or towards the patient.
The size of tube head is a limitation in positioning the tube head
below the bed or below the table in operation theater. Hence the
smaller size tube heads are preferred as in case of HF multi-pulse
generators. Thus one has to make compromise on ideal focus object
distance.
2. Fluoroscopy with the under couch tube: Since the tube head is
mounted under the table, the available distance from tube head or
focal spot to the lower side of examination table is limited by the
height of hand operated or motor operated table which normally
is 80 cm from floor level, which means it is less than 80 cm, around
50 cm, because the tube housing should not touch ground. As
regards the location of image plane or film cassette in SFD, also
there are engineering constraints due to thickness of lead glass
assembly with fluorescent screen, grid and cassette thickness.
3. A stationary installation such as hand operated or motor operated
table with suitable generator requires certain specified prerequisites
such as area, height of room and proper leveled surface for
mounting heavy assemblies like table. In case the selected premises
by hospital does not meet the specified requirements, a compromise
in installation has to be worked out. These units are extensively
covered in Chapter Radiographic Systems. We now discuss features
and specifications of these equipments which form part of purchase
specifications.
1. Dental X-ray
Features and use: X-ray unit for intra oral radiography, organ
program preferred, single tank generator mounted on spring
counterpoised articulated arm, complete system wall mounted or
on mobile column base could be maneuvered around dental chair
with locking facility for mobile base, supplied with exposure release
switch and dental cone.
Specifications:
Single tank 1.2 KW X-ray generator with
Radiographic output: 70 kV @ 7 mA
Exposure time: 0.03 to 3.2 seconds
Stationary anode X-ray tube with focal spot of 0.8 m 0.8 mm
(IEC 336)
Rotation of tube head: 270 degrees in vertical and 360 degrees in
horizontal plane
Exposure release switch: Two step switch with coiled cable with
3 m length.
Total filtration : > 2 mm Al.
Source image distance (SID): 200 mm
Mains supply: 190 to 260 volts, 1 phase, 50 Hz, 0.9 ohms
Accessories:
Beam limiting device: 20 cm cone
Safety standards: BIS 13709 or equivalent
2. Orthopantograph
Features and use: Stationary X-ray unit for ortho radial tomography
of the whole jaw region incorporating single tank X-ray generator.
Motor operated movement of tube head as per geometry of the
jaw.
Specifications:
Single tank multi pulse 3 KW X-ray generator with
Radiographic output:
Radiographic kV : 60-90 kV
Radiographic mA : 9-16 mA
Exposure time: 5 to 25 seconds
Exposure release switch: Two step switch with coiled cable with
3 m length
Stationary anode X-ray tube with Focal spot of 0.5 m 0.5 mm

(IEC 336)
Total filtration : > 2.5 mm Al
Mains supply: 190 to 260 volts, 1 phase, 50 Hz, 0.8 ohms
Safety standards: BIS 13709 or equivalent
3. Portable Equipment
Features and use: It is an equipment intended to be moved from one
location to another while used or between period of use while being
carried by one or two persons. Portable X-ray is an equipment
which can be dismantled in various subassemblies and carried in
any transportable vehicle to the destination and assembled to take
radiograph. These are used when radiologist is visiting patient,
railway or road accidents, military base hospitals located in border
area. Under these conditions the dismantled unit can be transported
by rail or road or helicopter or parachute dropped and assembled
at site.
Specifications
mAs range: 0.12 to 150
Exposure time: 0.1 to 5 seconds
Stationary anode X-ray tube with focal spot of 1.8 1.8 mm
Rotation of tube head : 270 degrees in vertical and 360
degrees in horizontal plane
Exposure release switch : Two step switch with coiled cable
with 3 m length
Power supply : 190 to 260 volts, 1 phase, 50 Hz, 0.9
ohms mains or battery or DG set
Number of modules : Maximum 3 namely stand, control
console and X-ray tube head
Interconnections between modules preferably plug in type to save
time.
Total weight : not more than 25 kg.
Safety standards: BIS 7620 Part III or AERB safety code or
equivalent.
Single tank X-ray generator with radiographic output: 40 to 85 kV

@ 15 mA, (2 KW max.);
4. Mobile Equipment
Features and use: It is an equipment intended to be moved from one
location to another while supported by its own wheels without
dismantling. It should be able to reach the patient in ward, OT,
ICU, enter in standard lift and narrow passages. The parking of
tube head during transportation from one ward to another, should
facilitate easy mobility preferably at lower height, ensuring safety
when moving around corners, negotiating bends, and ramps. The
output of the generator should not affect due to mains voltage
fluctuations preferably incorporating high frequency multi-pulse
technique. The tube head should be compact, single tank to
maneuver for under coach position below patients bed or under
operation table.
Specifications
Single tank X-ray generator with
Radiographic output of 2.5 KW (preferably multi-pulse)
Kv range 40 to 100 kV incorporating Stationary anode X-ray tube
Tube current mA range from 15 to 60 mA
mAs range from 0.3 to 200 mAs
Exposure time from 20 ms to 5 seconds
Parameter display: Digital display of kV and mAs
Exposure release: Two step switch with coiled cable with 3 m length
Rotation of tube head: Along the axis 180 degrees/15 degrees
Collimator: Light beam type (Halogen lamp with automatic switch
off preferred)
FFD: 40 to 190 cm
Cassette box: To accommodate at least 8 cassettes.
Dimensions: 60 150 140 cm (W H L)
Weight: 130 kg
Mains supply: 195 to 265 volts, single phase, 50 Hz, @ mains
resistance 0.6 ohms.
equivalent.
4A. Basic Radiographic System (BRS)

Features and use: It fulfils basic radiographic requirement of chest,
abdomen, skeleton, skull and spine for rural hospitals. The patient
positioning is simple with fixed film focus distance (FFD). Patient

can be wheeled in exposure area with trolley and cassette holder
is parked below the trolley. In case of walking patients, the image
plane itself acts as small table top, where patient can place is hand
or leg for required radiographic exposure. For taking chest
radiographs the image plane can be swiveled out in 90 degrees so
that chest exposure can be taken. The single tank tube head
incorporating stationary anode X-ray tube and image plane are
mounted on carriage which can be moved up and down and can
be parked in desired position with mechanical locks.
Specifications:
Single tank X-ray generator with
Radiographic output of 2.5 KW (preferably multi-pulse)
kV range 40 to 100 kV incorporating stationary anode X-ray tube
Tube current mA range from 15 to 60 mA
mAs range from 0.3 to 200 mAs
Exposure time from 20 ms to 5 seconds
Parameter display : Digital display of kV and mAs
Exposure release : Two step switch with coiled cable with
3 m length
Collimator : Light beam type (Halogen lamp with
automatic switch off preferred)
Stand : Column stand with fully counterbalanced
swivel arm floor mounted
Travel with arm : Vertical 100 to 200 cm and horizontal 50 to
170 cm
Rotation of swivel arm at 120 degrees
Cassette tray to accommodate 5" 7" to 14" 17" cassettes
Stationary grid 6:1, 40 lines/cm
FFD: 1m
Trolley: Dimensions of table top: 194 55 cm ;
Height from floor : 65 cm
Mains supply: 205 to 265 volts, single phase, 50 Hz,
@ mains resistance 0.8 ohms.
Safety standards: BIS 7620 Part III or AERB safety code or equivalent.
4B. Simple Radiographic Equipment for Casualty

Features and use: These are used in casualty and emergency rooms
for Trauma cases to cater for emergency cases such as fractures of
skull, peripheries and spine. Bucky Table with floating table top
(both longitudinal and transverse movements) with electro-
magnetic brakes enables patient shifting and positioning easier.
Floor to ceiling column stand, incorporating twin focus rotating
anode X-ray tube on cross arm, powered by 10 to 24 KW two-pulse
generator and chest stand completes the radiographic system.
Bucky is a device for supporting and imparting motion to X-ray
grid.
Specifications
Bucky table with floating table top:
Table height 75 cm from floor; Table top dimensions 240 75 cm
Table top travel: Longitudinal +/ 55 cm
Transverse +/ 12 cm
Table top film distance 6.5 cm
Bucky travel longitudinal +/ 20 cm
Grid 10:1, 40 lines per cm
Cassette tray to accommodate 5" 7" to 14" 17" cassettes
Floor to ceiling Column stand: Fully counterbalanced
Focus floor distance:17cm (min), 180 cm (max)
Travel: Horizontal 290 cm, Transverse 83 cm,
Tube arm swivel 0 to 180 degrees,
Tube head swivel 0 to 205 degrees
Chest stand: Wall or floor mounted, Cassette tray height adjustable
with vertical movement approximately 2" with facility to lock
cassette compatible for 5" 7" to 14" 17" size.
Vertical bucky wall stand: Wall or floor mounted, cassette tray height
adjustable with vertical movement approximately 54 to 165 cm
with facility to lock cassette compatible for 5" 7" to 14" 17" size.
Additionally it incorporates Bucky with the grid, with self centering
plate marked for cassette and measuring position. It is used for
taking Radiographs for chest, spine with catapult bucky using
cassettes upto 14"17". Handgrips are provided for patient support.
HT cables: 1 pair of length 8 m each with sleevings and angles
X-ray tube: DRA-1, 125/20/40
X-Ray generator:
Specification Output power 10 KW HF Output power

(multi-pulse) 24 KW 2 pulse
Rating Maximum 160 mA 300 mA @ 100 kV
Radiographic kV 40 to 125 in 24 steps 36 to 125 in 25 steps
Radiographic mA 32 to 160 80, 100, 160, 200, 300 mA
Radiographic time 10 ms to 5 sec 10 ms to 5 seconds

Radiographic mAs 0.32 to 200 1 to 500 (F1), 1.6 to 240 (F2)
Technique Two point (kV and mAs) Two or three point
Exposure release Two step switch Two step switch
Examination units 3 3
Mains connection 415 V, 3 Phase, 415 V, 3 Phase,

50 Hz, 0.8 ohms 50 Hz, 0.8 ohms
Safety standards: BIS 7620 Part III or AERB safety code or equivalent
5. Hand Operated Equipment for Radiography/Fluoroscopy
Features and use: Diagnostic unit for health centers, general and
cottage hospitals. These units are used for conventional fluoroscopy
and radiography for standing, sitting, or recumbent patients for
over table, under table and teleradiography. It consists of hand
operated multi position radio transparent table with fluorescent
screen assembly and cassette parking facility (SFD), floor to ceiling
stand, chest stand. HT cables (in case of Rotating anode tube).
X-ray tube, and 24 KW generator.
Specifications:
Hand operated table: Multi position table with SFD.
Table parking at 90 (vertical), 75, 30, O (horizontal), and 12
(trendelenberg) degrees.
Table top height: 80 cm; Table top dimensions: Length 194 cm,
width 60 cm
Tube screen distance 90 cm
Spot Film Device grid 6/40 (FFD = 70 cm)
Light beam collimator
Catapult Bucky: Fully counterbalanced, electromagnetically

arrestable with moving grid Pb 8/40, FFD 115 cm.
Accessories: Immobilizing device, radiographic cone 12 cm
diameter, foot switch, multi section lead rubber ray guard, foot
rest, hand grips.
Floor to ceiling column stand: Fully counterbalanced
Tube arm swivel 0 to 180 degrees
Chest stand: Wall or floor mounted, cassette tray height adjustable
with 2" vertical movement and with facility to lock cassette,
compatible for 5" 7" to 14" 17" size.
X-ray generator: 24 KW two-pulse
Specification Output power 24 KW 2 pulse

Rating 300 mA @ 100 kV
Radiographic kV 36 to 125 in 25 steps
Radiographic mA 80, 100, 160, 200, 300 mA
Radiographic time 10 ms to 5 seconds
Radiographic mAs 1 to 500 (F1),1.6 to 240 (F2)
Technique Two or three point
Exposure release Two step switch from control console or
examination unit
Examination units 4
Fluoroscopic kV 40 to 90 kV
Fluoroscopic tube current 0 to 3 mA
Fluoroscopic time Set by time totalizer, maximum 5 minutes,
alarm
Fluoroscopy release From control console or SFD or foot switch
Anode braking Yes
Overload protection Yes
Mains connection 415 V, 3 Phase, 50 Hz, 0.6 ohms (30 KVA)

equivalent.
Vertical bucky wall stand: Wall or floor mounted, cassette tray height
adjustable with vertical movement approximately 54 to 165 cm
with facility to lock cassette compatible for 5" 7" to 14" 17" size.
Additionally it incorporates Bucky, with the grid with self centering
plate marked for cassette and measuring position. It is used for
taking Radiographs for chest, spine with catapult bucky using
cassettes upto 14" 17". Handgrips are provided for patient
support.
HT cables:1 pair of length 8 m each with sleevings and angles.
X-ray tube: DRA-1, 125/20/40
6. Motor Operated Equipment for Radiography and Fluoroscopy

Features and use: It is all purpose X-ray unit for versatile applications.
The under table tube unit and over table SFD ensures the complete
fluoroscopic and radiographic examinations with radiation safety.
For over table tube applications such as bucky radiography, tele-
radiography, Intravenus Paleography (IVP), examination of renal
pelvis) applications are possible. This unit along with Image
Intensifier Television System has become mandatory in medical
colleges. It enhances the applications such as GI studies. It
incorporates motor driven table which can be parked in any
position from vertical to trendelenberg position, semi automatic
or automatic SFD with lateral parking position for over couch
radiography, sliding chest guard (ray guard), floor to ceiling
column stand, two rotating anode X-ray tubes connected to 50 KW
generator with HT cables, chest stand.
Option: Image intensifier in place of fluorescent screen assembly.
Fluoroscopic image can be obtained on fluorescent screen or image
intensifier output screen. It has become mandatory to use image
intensifiers in developed countries, due to lesser radiation risks as
compared with conventional fluoroscopy with fluorescent screen.
For specifications of Image Intensifier refer to Image intensifier.
Specifications:
Motor operated table: Motor driven from +90 (Vertical) to 12 degrees
(trendelenberg) position with automatic stop in horizontal position
and extreme positions such as vertical and trendelenberg.
Table top height: 80 cm

Table top dimensions: Length 194 cm, width 60 cm
Catapult Bucky: Fully counterbalanced, electromagnetically
arrestable with moving grid Pb 10/40, FFD 115 cm
Spot film device: Semi automatic, cassette insertion from right,
manual cone/diaphragm. Plate travel, stationary grid Pb6/40 at
70 cm focus.
Motorized light beam collimator
SFD Movements: Longitudinal 60 cm, Transverse 25 cm,
Compression 30 cm
Accessories: Immobilizing device, radiographic cone 12 cm
diameter, foot switch, multisection lead rubber ray guard, foot rest,
hand grips.
Power supply: 415 V, 3 phase 50 Hz.
Floor to ceiling column stand: Fully counterbalanced
Tube arm swivel 0 to 180 degrees
X-ray tube: DRA-1, 125/20/40 for under couch and Bi 125/30/50
for over couch.
HT cables: 2 pairs of length 12 or 8 m each with sleevings and angles.
Chest stand: Wall or floor mounted, cassette tray height adjustable
with 2" vertical movement and with facility to lock cassette,
compatible for 5" 7" to 14" 17" size.
or
Vertical Bucky wall stand: Wall or floor mounted, cassette tray
height adjustable with vertical movement approximately 54 to
165 cm with facility to lock cassette compatible for 5" 7" to
14"17" size. Additionally it incorporates Bucky, with the grid
with self centering plate marked for cassette and measuring
position. It is used for taking Radiographs for chest, spine with
catapult bucky using cassettes up to 14" 17". Handgrips are
provided for patient support.
X-ray generator: 40 KW two-pulse

Specification Output power 40 KW 2 pulse
Rating 500 mA @ 100 kV
Radiographic kV 40 to 125 in steps
Radiographic mA 60, 100, 160, 200, 300, 500 mA
Radiographic time 10 ms to 5 seconds
Radiographic mAs 1 to 500 (F1), 1.6 to 240 (F2)
Technique Two or three point
Exposure release Two step switch from control console or
examination unit (SFD)
Examination units 4
Fluoroscopic kV 40 to 90 kV
Fluoroscopic tube current 0 to 3 mA
Fluoroscopic time Set by time totaliser, maximum 5 minutes,
alarm after elapse of set timing
Fluoroscopy release From control console or SFD or foot switch
Anode braking Yes
Overload protection Yes
Mains connection 415 V, 3 Phase, 50 Hz, 0.3 ohms (30 KVA)
Safety standards: BIS 7620 Part III or AERB safety code or equivalent
7. Image Intensifier Television Equipments
(A) For GI Studies
Features and use: GI track studies with R/F tables, and angiography
systems. With Automatic gain control, circular blanking, last image
hold, image reversal for both horizontally and vertically.
Specifications:
Nominal entrance field 230 mm,
Useful field 215 mm
1st zoom 170 mm
2nd zoom 130 mm
Output window diameter 25 mm
Weight of assembly 30 kg
Power supply 27 V DC/0.6 A
CCD camera: interline transfer
CCD sensor size: 752 582 pixels
Video output: 1 volt pp composite video
Video standard: 625 lines interlaced (CCIR) 50 Hz
(B) Mobile C-arm Image Intensifier

Features and use: Mobile C-Arm Image Intensifiers for Surgery in
Orthopedics, PCNL and URS procedures in urology, pacemaker
implantation.
Specifications:
Image intensifier:
Size 15/10 cm dual field, zoom facility
Resolution > 4.5 Line pair/mm
Enlargement < 1.6
Image storage >3
Grid on Image intensifier Pb 8/40
Two monitors 17" diagonal on trolley.
C-arm Movement:
Orbital rotation 115 degrees
Minimum distance of tube head from floor > 20 cm
Swivel +/12.5 degrees
Horizontal movement: 20 cm
Vertical movement motor assisted > 40 cm
Rotation of C-arm on horizontal axis: 180 degrees
Focus image intensifier distance >70 cm
X-ray generator: Single tank multi pulse at high frequency 3 KW,
temperature sensing
Fluoroscopy current: 0 to 6 mA
Radiography with 200 mAs
Anode voltage: 40 to 110 kV
Dual focus tube: Focal spot 0.6/1.8 mm
Grid on cassette: Al:17/70
Power requirement: 190 to 260 V, 50 Hz, 1 phase (15 Amps)
Safety standards: BIS 7620,13813,13814,13729 or equivalent
8. Body Section Radiography Equipment (Planigraphy)

Features and use: Motorized planigraphy attachment on Bucky table
with linear blurring and zonography for location of tumor in body.
Specifications:
Motor driven floor to ceiling column stand. (specs same as that in
motor operated table).
Layer adjustment 0 to 25 cm.
Planigraphy angle: 40, 25 degrees for planigraphy, and 8 degrees
for zonography.
9. Mammography Equipment
Features and use: It is used for detecting breast tumors by using soft
radiation. Unit constitute of mammography stand provided for
mammography in standing, sitting position with compression
device and biopsy attachment.
Specifications:
X-ray generator: Mono tank multi pulse high frequency 4 KW
Radiographic Ratings:
Radiographic kV 25 to 35 kV(steps of 1 kV)
mAs range : 2 to 560 mAs (mAs mode)
Dual focus X-ray tube: P40Mo, Rotating anode at 8400 rpm
Heat units: 1500,000.
Focal spot dimensions : 0.15/0.3 (IEC 336)
Magnification factor: 1.5 or 1.8
Stand with motorized height adjustment 650 to 1350 mm from floor
to object
Swivel angle: + 135 to 180 degrees
Motorized rotation of swivel arm, isocentric
Source image distance (SID): 65 cm
Film format: 18 24 or 24 30 cm
Reciprocating grid: Pb 4/27
Compression force 200N maximum
Accessories:
Compression Plate: 18 24 cm
Object Table: 24 30 cm
Spot compression plate
Axilla compression plate
Biopsy attachment with Shadow Cross
Biopsy compression plate

Magnification Table
Mammo cassette: 18 24 cm
The specifications mentioned above are for illustration purpose
only and may vary from equipment to equipment for different
manufacturers of respective radiological systems.
While purchasing the equipments from vendor, following points
should be considered:
1. Installation Prerequisites, their Actual Status and Procedure

This point is discussed in detail in chapter 5. There is always delay
between order placement from purchaser and actual installation
date, due to inadequate follow up on installation procedure both
from vendor as well as purchaser. The warranty normally starts
from date of installation. In many cases the equipment is lying
unattended due to completion work of prerequisites. Hence this
problem will not arise, if mutual agreement between vendor and
purchaser is arrived in the beginning.
One of the common complaints from purchaser is that, once
installation is begun, the work is periodic and not continuous.
Hence a contract, with mutually agreeable time plan, should be
made by both parties and strictly followed. Under this contract, if
penalty clause is incorporated, vendor will make all efforts to
complete the installation in specified period to avoid penalty and
will consider possible loss of revenue and adjust his price
accordingly.
2. Warranty
It means that vendor will repair the equipment for a specified time
at no cost to the purchaser. Normally the warranty period starts
from date of acceptance by end user. Since the vendor wants a
satisfied customer to add to his list for future sale of his equipments,
he may extend free service for period more than warranty. But if
customer is non cooperative he may not extend this period. One of
the major problem arises, when end user is not satisfied with the
performance of the equipment. This arises due to poor performance
of the equipment at site, may be due to inadequate installation

prerequisites, training of technicians operating the equipment or
end user not involved in purchase procedure and his requirements
were not considered during purchase process. It is advisable to
discuss the features and specifications with end user by
representative of vendor, before the deal is made. Hence both
purchaser and vendor should be clear about the expectations of
the equipment.
Vendor should also give up time warranty. Purchaser should
maintain log book regarding type of failures, time taken to rectify,
costs involved in repairs both material and labor. In case of
recurring failures detailed technical investigations should be carried
out by purchaser (this will be information for service contracts)
and if the problem points out towards the manufacturing defect of
equipment, the vendor should replace the unit. It is also important
to discuss response time taken by vendor to cater to the complaint
from purchaser. Vendor should also distinguish difference between
malfunctioning of equipment that make equipment totally
inoperable and faults due to usage of equipment. As regards latter,
it could be avoided by giving user training to the operating staff.
3. Delivery Period
Purchaser should plan out when the delivery should be made by
vendor, based on point 1. Delays in delivery will cause idle
manpower in the radiology department and unnecessary incurring
higher cost without revenue.
4. Methods of Payment
Normally vendor demands certain percentage of payment as
advance at the time of booking the order. Purchaser will make the
remaining payment after the completion of installation, inspection
and handing over the equipment to end user. Sometimes the
purchaser holds back some percentage of payment for performance
guarantee during warranty period and releases this payment after
warranty period is completed without any major breakdown. In
case major breakdown takes place the warranty period is extended.
5. Service Contract
Any biomedical equipment should have preventive maintenance
performed at periodic intervals to avoid trouble free working of
the unit. Well maintained unit lasts longer. In addition if the
equipment has been modified in factory after it was installed, these
changes should be incorporated in the equipment.
Since the staff in biomedical department is limited both in number
and skills, there is normal practice to enter into the service contracts
with the vendor on specific equipment, especially if it is high value
equipment when high cost spares which are normally not available
in market are involved. But first hand repairs in case of emergency
should be carried out by biomedical department to make the unit
working, so that the workload in department should not suffer. It
is therefore necessary for the biomedical engineer to know the
functioning of the unit. Sufficient training to biomedical staff should
be given by representative of vendor to cater to these emergency
problems. After their training, staff can inform the vendor the exact
fault, so that engineer from vendor can bring the required spare
parts, tools, test and measuring instruments to make the unit
working to the satisfaction of operating staff.
These maintenance contracts are applicable after warranty period.
There are two types of service contracts namely Annual
Maintenance Contract (AMC) involving labor only and
Comprehensive Maintenance Contract (CMC) involving labor and
parts. Purchaser is free to decide on which contract is to be finalized,
depending on the failures and their, costs involved during warranty
period. If the equipment is failure prone, with high value spares
one should consider CMC. The vendor has their policy regarding
the value of respective contracts. Biomedical engineer should opine
based on the nature of equipment, his assessment regarding the
type of contract to be finalized. As a general rule the AMC will cost
between 3 to 5% of the value of the equipment in first year of the
contract and it will be increased as per inflation rate for subsequent
years. The percentage for CMC may vary between 6 to 12%.
Minimum Service Requirements for Radiology Equipment:
In addition to routine maintenance items such as lubrication,
cleaning, wire rope for counterweights inspection, adjustments and
settings, following items should be checked periodically to ensure
trouble free performance of the equipment.
(a) Line voltage supply and mains resistance

(b) Calibration for mA, KV, and seconds
(c) Tube overload circuits
(d) Speed of rotation for X-ray tube and tube coast time for rotating
anode tubes
(e) Collimator alignments
(f) Performance of Catapult Bucky
(g) Tilting speed for motor operated table
(h) Radiation leakage
X-ray Image and Beam Limiting Devices 143
X-ray Image and

9 Beam Limiting Devices
In order to obtain clear, informative image following factors are

important.
(A) Source of X-ray radiation: size, power.
(B) Distance between source and image plane (SID).
(C) Projection of the object with respect to the incident primary
beam.
(D) Distance between object and image plane
(E) Efficiency of conversion of X-ray photons to better form of
energy such as light or electrons (intensifying screens).
(F) Size of crystals which converts X-ray photon energy into
another form.
(G) Source of radiation (focal spot), object (organ in patients body)
and imaging device should remain stationary in order to reduce
movement unsharpness.
However, it may not be possible to control movement in case of
moving organs such as heart, lungs, kidney. In these cases, since
the product mAs decides blackening of film, the exposure time is
reduced to minimum, provided tube current is within limits to
obtain desired mAs.
Example: Requirement 80 kV/20 mAs
Now 20 mAs can be achieved by 20 mA and 1 second or 500 mA
0.04 second exposure. In case of radiograph of heart latter is
preferred to obtain minimum dynamic blurring.
SOURCE OF X-RAY RADIATION

Size of focal spot is extremely important for resolution of image.
Imagine a shadow on wall by light opaque material in the darkened
room with only one light. If the light source is small such as candle
light and is located away from the object which is very closer to
wall, then the shadow boundaries are sharp. In this example we
have assumed large source object distance resulting into parallel
rays from source, smaller source size and small object image plane
distance. Now instead of candle we take a normal tube light
(increasing source size), then we observe that shadow is blurred at
boundaries. If the distance between source and object is reduced
we get more blurring. The blurring is further increased if object
image plane distance is increased. This phenomena is called
Penumbra or Geometrical blurring. Thus in order to reduce penumbra
steps such as reduction in size of source to minimum possible,
increase in source object distance, reduction in object image plane
distance should be taken. But there are engineering limitations for
these steps.
I. Focal spot: We know that smaller the focal spot higher is the
resolution. But with smaller focal spot more heat is generated
per square area on anode which demands higher heat storage
capacity of anode.
II. Source image plane distance: It is not practical to achieve
very large SID due to limitations in size of examination room.
Larger SID means the power of generator should be high
(Inverse square Law). The large focus is used to reduce
movement unsharpness by increasing mA and reducing time
for the selected mAs. As large focus would increase geometric
blurring, the SID is increased to compensate geometric
blurring. Hence, normally for the chest stand radiograph, the
SID is 1.5 m and for over couch radiograph, it is around 1 m.
III. Object image plane distance: More this distance more is the
enlargement. Hence, minimum possible distance should be
kept. But it has limitations such as table top thickness,
requirement of grid, location of cassette in bucky tray, etc. In
order to overcome table top thickness now-a-days table tops
are manufactured with plastic with reinforced carbon which
are very thin as compared to wooden table tops manufactured
earlier and they have better radio transparency i.e. lesser
absorption coefficient.
We will now discuss how the X-ray image is obtained.
1. Fluoroscopy
There are three major applications of fluorescence property of
X-ray radiation namely conventional fluoroscopy with zinc
cadmium sulphide fluorescent screen, image intensifier technology
and intensifying screens. The intensifying screens find their
applications in direct radiography and will be dealt later.
Conventional Fluoroscopy
In order to obtain image of penetrated object (organ of the patient)
during examination, a fluorescent screen is placed in the path of
X-rays after the object and image thus obtained gives preliminary
diagnosis (refer Fig 5.1). When X-rays impinge on fluorescent
screen, light is given out by zinc cadmium sulphide crystals. The
degree of brightness is related to quantity of X-ray photons
(proportional to tube current) striking the fluorescent screen and
degree of penetration or quality of radiation which is related to
the accelerating potential between anode and cathode. If a object
is introduced between source of radiation and fluorescent screen,
the object absorbs certain amount of radiation depending on the
absorption coefficient of the object which in turn depends on
thickness, density and atomic number of the object. There will be
variation of absorption for adjacent areas in body under
examination, which brings proportionally the difference in
brightness of screen. Darker areas are seen as shadows cast by radi-
opaque substance having more density, thickness and atomic
number and brighter areas are obtained when X-ray beam is
encountered by radio transparent substance having lesser density,
thickness and atomic number. This leads to diagnosis by screening
of patient for lung fields or gastrointestinal track.
Since X-rays are harmful to human tissues, especially eye, viewing
of fluoroscopic image poses certain restrictions such as limited time
for diagnosis, filtration and complete darkness while viewing in
order to adapt eye to minute details of image. Hence, viewing is
done in complete darkness and viewer has to get himself adopted
to the darkness. Moreover due to harmful nature of radiation, a
lead glass is used for filtering extraradiation penetrating the screen,
and eyes of viewer are protected.
Unfortunately there is no recording of this event and the findings

cannot be reproduced later. For this purpose radiologist desires to
obtain a hard copy, which can be obtained by bringing cassette
loaded with film, parked in radiation free area in the radiation
field, the expose with desired parameters and develop the film for
future records. This device is called spot film device.
Drawbacks of Conventional Fluoroscopy

The size of zinc cadmium sulphide crystal is large. Hence one
cannot distinguish the change in brightness in adjacent areas which
in turn results in loss of resolution. The tube current required to
get the desired information in complete darkness is of the order of
3 mA to obtain informative visible image. It takes almost 30 minutes
to adapt human eye to complete darkness. If the radiologist does
not have so much time, dark adaptation spectacles are used which
is not very convenient to radiologist. Hence, the energy of radiation
is increased to get the desired brightness, subjecting themselves to
more radiation. Moreover there is lack of cooperation from patient
in darkness.
This technique is outdated and is replaced with indirect fluoroscopy
with Image Intensifier Television chain.
2. Image Intensifier
The basic working of this device will be dealt in separate chapter.
The input screen of image intensifier tube is coated with cesium
iodide crystals, which are smaller than that used in conventional
fluoroscopic screen. These crystals convert incident photons in to
light, obtaining high resolution image.
Resolution is resolving capacity of the image and is expressed in
line pairs per unit length, for example line pair/mm. Normally a
fixture is made with radiopaque substance like metal wires equi
spaced at the dimensions of diameter of wire. Resolution
measurement is carried out with this test pattern so that the radi-
opaque wires will cast a shadow on image plane and spacing
between the wires made of plastic radio transparent material will
allow the radiation to pass through. This test pattern is placed
directly between patient and image plane, near the image plane,
and its image is obtained. In case of image intensifier the pattern is
placed at the input screen and viewed at output screen.
The light photons fall on the photo cathode which converts light
image in to electrons. Electrons are accelerated towards the anode,
focused and aligned by electron lens system. The voltage applied
to the lens system vary from 80 to 12000 volts. The focusing of
electrons by electric lens system produce a fluorescent image on
the output screen which is several times brighter than that
produced on input screen. The image obtained is reversed.
Generally the input screen is 15 to 25 cm in diameter and output
screen is 15 to 25 mm in diameter. Thus the information available
on input screen of 25 cm diameter is concentrated on 25 mm
diameter of output screen. The area reduction factor is square of
the ratio of two diameters. In our example it will be 100. Hence,
the image on output screen is 100 times brighter than that at input
screen. This image is scanned by television camera and transmitted
to television monitor for suitable viewing.
Advantages
Much brighter image as compared to conventional fluoroscopy.
Multiple viewing of image simultaneously, facility used in
teaching hospitals.
No dark room adaptation because examination is conducted
in normal room light.
Complete cooperation from patients leading to reduction in time
of examination thus reducing radiation hazards.
Due to brighter image, substantial reduction in energy
requirement to tube, reducing radiation hazards.
Hence low dose required to get the better information.
Image can be recorded on VCR for documentation purpose.
Image can be enlarged by ZOOM technique.
This technique can be expanded to indirect radiography by
using radiographic cameras, serial film changers and cine
radiography exposures (Angiography technique).
3. Radiography
When photographic film is subjected to X-ray radiation, it becomes
black after processing. The amount of blackening depends on total
number of photons interacting with film which is proportional to
the product of tube current and exposure time provided the tube
voltage is constant. If the voltage (kV) is increased while mAs is
constant, the photographic emulsion will be more blackened
because penetrative power of beam is increased and more number
of photons will reach film. Thus blackening depends on tube
voltage. When an object is placed between tube and photographic
emulsion, it absorbs certain amount of radiation. The radiation thus
weakened by absorption, blacken the film to lesser extent with
respect to surroundings resulting in brighter area after processing
the film. Hence the bright area is called shadow while dark area are called
bright spots because more radiation has fallen on them. This is exactly
opposite to fluoroscopy. The correct image should have high degree
of contrast and sharpness in order to achieve good resolution,
contrast and sharpness influence each other for the human eye.
Contrast: There are two types of contrast namely subjective and
objective.
The subjective contrast is dependent on eye of the observer and
ability to distinguish contrast varies from person to person. The
objective contrast is actual difference of densities or difference
between black and white, suitably measured by instrument such
as photometer. There are number of measures which can be
implemented to obtain optimum contrast such as radiation quality
(kV), quantity (mAs), scattered radiation filtration, radiographic
materials and processing techniques. Hardness of radiation
depends on penetrating power (kV value). Soft to medium
radiation result in images which give more contrast and hard
radiation give more details. Hard X-rays along with high kV films
give advantages like larger source object distance, lower radiation
dose, shorter exposure time which in turn reduces dynamic
blurring, lower energy load (mA) on tube in high kV technique,
the components of higher atomic number absorb fewer X-rays than
at low (Conventional) tube voltages. Hence the absorption in soft
tissues is to lesser extent.
Example: In chest radiography at 120 kV, ribs are more transparent
and lungs can be seen better.
Radiation quantity: X-ray film has very little exposure latitude. It
must reproduce slight differences in intensity within the gray scale
leaving the object with maximum amount of contrast. Hence slight
deviations from contrast exposure value will give faulty results.

Therefore it is extremely important to use correct mAs value to
achieve optimum blackening on film at a given tube voltage.
Scattered radiation: This topic is dealt in production of X-rays under
Compton Effect. It has lower energy and hence lesser penetrating
power. This property is used in reducing scattered radiation or
noise. It reduces contrast and makes the film noisy. Hence it should
be removed or kept minimum as far as possible. Following
measures are adopted to reduce scattered radiation reaching the
film and making it foggy.
Limiting the radiation to desired area under diagnosis by using
radiographic cones, double slot diaphragms/light beam
collimator. We achieve two goals by using these beam limiting
devices namely
1. Only the desired area is radiated thus minimizing the
radiation hazards.
2. If other adjacent area is also exposed, then it will generate
more unwanted scattered radiation which is not desired.
BEAM LIMITING DEVICES

Radiographic Cone (Fig. 9.1)
They are made of metal preferably zinc or copper to absorb
scattered radiation. Their shape is tapered with smaller opening
towards tube and larger towards patient to enable radiation
reaching patient in circular field.
Fig. 9.1: Radiographic cone
Double Slot Diaphragm or Light Beam Collimator

It consists of two sets of lead flaps operating perpendicular to each
other. As they close the area between these flaps in the form of
rectangle reduces and finally when they overlap the area between
the flaps is zero thus permitting no radiation to pass through

(Fig. 9.2). In order to know how much area is going to be exposed
on patient, light beam principle is used. A lamp 12V/24 W is
illuminated and its light is reflected by mirror kept at 45 degrees
angle so that light source will be at the same position as that of the
focal spot, due to position and angulations of the mirror seen from
patients body. Thus light when passing through rectangular
aperture of lead flaps, which can be altered manually or with motor
operation, falls on patients body to indicate the area to be exposed.
Light is switched off once positioning the patient is decided. The
size of the field illuminated depends upon the openings of lead
flaps and source object distance. Larger the opening or SID, larger
will be the field size which match the size of cassette (5" 7" to
15" 17").
Fig. 9.2: Double slot collimator

Compression Device
There are two types of these devices namely compression cone
and compression band. Their purpose is to displace body fat in the
vicinity of the region of interest to be exposed so that the radi-
opaqueness or density of the organ under examination is
considerably reduced enabling the lesser dose to be given to the
patient and reducing scattered radiation. These devices are used
in abdominal examinations. It also ensures that object is stationary
during exposure to reduce motion artifacts.
Compression Cone
This device is made of lead cone with aperture of 85 115 mm
enclosed in ABS housing. Cone is pressed against abdomen to
displace body fat and fluids. During examination conducted with
spot film device.
Compression Band
This device is made of cloth band fixed to side rails of examination
table and the tension on the band can be altered as desired. As the
band is tightened over belly of the patient, it displaces the fat from
region of interest and reduces radiopaqueness which in turn
reduces scattered radiation.
Grids
We have covered path of the X-ray beam up to patient. Even after
using the beam limiting devices as mentioned above, it is observed
that the scattered radiation is not fully eliminated. The other source
of scattered radiation is patients body and table top which cannot
be avoided. In order to filter scattered radiation from these sources
a Scattered Radiation Grid is used. Grid prevents most of the
scatter produced in patients body and table top reaching image
plane (Film in case of radiography and screen in case of
fluoroscopy). The grid consists of vertically arranged radiopaque
thin strips, preferably made of tungsten or lead, separated by radio
transparent material such as plastic or aluminum. The strips of
lead absorb the scattered radiation as well as primary radiation.
The absorption depends on following factors.
1. Composition of radiopaque material (Atomic number)
2. Height of radiopaque strips
3. Distance between strips

The specifications of grid is defined by grid ratio as follows
Grid ratio = (Height of grid strips)/(distance between strips)
= H/D
4. Thickness of grid strips (d) (Fig. 9.3)
Hence, there are two important specifications of grid namely
(a)Ratio of the grid (higher the ratio more filtration to scattered
radiation and more cost)
(b)Number of lines per inch or cm (more the number of lines better
is filtration)
Example: Pb 8/40 grid has ratio = 8 and 40 lines per cm.
Fig. 9.3: Thickness of grid strips
There are two types of grids parallel and focused.

Parallel grid: In parallel grids the lead strips are parallel to each
other. These grids are useful only for large source object distance
(SOD) or small size of the film. Since X-ray beam is generated from
focal spot of small dimensions, the photons are not coming out
parallel to each other but in divergent beam at a plane of the film.
Hence only the center part of the beam will be parallel to the radi-
opaque strips of grid and will be allowed to pass unfiltered, while
as the photons at the extreme end of grid will strike at an angle
and will get filtered by the radiopaque strips of grid
(Fig. 9.4).
Focused grid: The disadvantage of parallel grid is overcome with
introduction of this grid. The grid strips made of lead are slanted
towards focal spot at a specified distance called focused distance
and hence the term focused grid. Tolerance of focal distance is called
focal range.
Fig. 9.4: Cut-off from parallel grid
As a general rule 12:1 and 16:1 linear parallel grids for distance of
1.5 m are used with tube voltage more than 100 kV for vertical
chest stand, while as 8:1 focused grid is used for over couch bucky
radiography for distance of 1.1 m.
Initially parallel grids were introduced, but soon they were taken
over by focused grids (Table 9.1). It is extremely important to use
the focused grids in such a way that the correct side of the grid
faces the X-ray tube. When using focused grid the direction of strips
is marked by a line on the side of the grid facing the tube with a
symbol of tube. If it is inserted in opposite direction, or not in the
center of the cone formed by primary beam, the primary rays will
Table 9.1: Tolerance of focus grid
Application Ratio Lines/inch SID (cm) Tolerance (cm)

Spot film device 6 40 70 64 to 79
General radiography 8 40 115 96 to 150
Chest stand 12 40 150 117 to 212
High kV 12 or 16 40 100 92 to 111
Mammography 4 27 60 60
Fig. 9.5: Cut-off from upside down placement
Fig. 9.6: Cut-off from lateral decentering

be filtered and cut-off will result (Figures 9.5 and 9.6). Hence, while
using focused grid direction, focal distance and centering is very
important.
If the grid is kept stationary it is called stationary grid. In this case
the radiopaque strips will cast shadow on the film because some
amount of primary radiation will get filtered by these strips. In
order to avoid these shadows, the grid is kept moving at a fixed
speed. There are two ways to move the grid.
(a) Oscillating with damped oscillations achieved by release of
magnetic lock against leaf spring. This results in damped
oscillations which may die out after 2 seconds. Hence, this
procedure is used in cheaper equipments.
(b) Catpult Bucky mechanism was introduced by two scientists
Potter and Bucky. In this case grid is kept moving by drive
mechanism with dc electric motor and cylindrical cam to
operate micro switches to initiate the X-ray exposure after the
grid has achieved required speed (Figs 9.7 and 9.8).
1. Scattered radiation grid

2. Power supply and motor assembly with cam
3. Step down transformer for power supply
4. Cassette
5. Cassette tray
Fig. 9.7: Catapult bucky assembly

Fig. 9.8: Travel characteristics of grid in bucky
Effect of Decentering
As the SID is increased we get more parallel rays resulting lesser
% loss. The amount of % loss increases if the distance from grid
center increased for a grid of same ratio and if the grid with higher
ratio is used for the same distance from center.
Other devices which contribute to Radiographic Image
(A) Cassette
They are made of aluminum for light weight and easy handling.
Four corners are connected with non metallic construction to give
protective cover. Soft push button locking arrangement with
stainless steel springs for cover is incorporated and suitable lead
protection is given on the rear side of the cassette to eliminate fog
effect on film. High grade foam material is pasted inside to give
the film a uniform contact with intensifying screen. They are also
provided with indicator indicating if they are loaded with film.
They are manufactured in several sizes to suit the film sizes. The
intensifying screens are pasted to inner walls on both sides upper
and lower of cassette and cassettes with intensifying screens should
not be exposed to direct light. These cassettes require periodical
checking with exposure of wire mesh as an object and have average
life span of 3 years. They should meet BIS 6991 standards.
(B) Intensifying Screens

They are used to reduce exposure of the patient to X-ray radiation.
Most of the blackening of X-ray film is achieved from interaction
of light emitted from intensifying screens when it is subjected to

X-ray radiation and small amount from direct X-ray photons. The
fluorescent material used is Calcium Tungstate. There are three
speeds namely detail, medium and high. They are composed of a
Polyester or paper base, reflective layer, phosphor layer and
protective coat (Fig. 9.9). The protective coat prevents damage to
phosphor from moisture (while cleaning the cassettes) and in case
if such screen is used in film changers, scratches from continuous
movement of film is avoided. The phosphor is made of small
crystals dispersed in solvent and binder. The crystal size is kept
uniform during manufacturing process. If they accumulate in one
area, it produces artifacts known as Screen Structure Mottle.
The resolution of image has direct bearing on the size of crystal
(Fig. 9.10). Reflective layer reflects light produced in phosphor
emulsion towards film, thus increasing efficiency of the screen.
There are several possibilities which determine efficiency of
intensifying screen namely
(a) X-ray photon passes through both screens and film without
interaction.
(b) Produce light photon on screen which may or may not
contribute to image.
(c) X-ray photon produces latent image on film.
(d) X-ray photon being absorbed by screen.
Hence the efficiency of screen vary between 2 to 5% in low, 5 to
10% in medium and 10 to 20% in high speed screens. As the
phosphor layer is increased in thickness, image is more intensive
hence resolution is decreased. Faster the screen, thicker is the
phosphor and power of resolution.
Rare earth screens: In these type of screens multifold (5 to 7) increase
in speed over conventional screens is achieved by new phosphor.
The light emitted by this new phosphor was different in character.
Conventional Calcium Tungstate emitting blue light had
Fig. 9.9: Construction of intensifying screen

wavelength at 420 nm while as from this new phosphor consisted

of sharp peaks emitting green light at wavelength of 545 nm. These
new screens are compound of various compositions of Gadolinium,
Yttrium, Lanthanum oxysulfide or oxybromide Barium Fluoro
chloride, etc. Gadolinium and Lanthanum oxysulfide emit green
light and rest emit blue light.
Advantages of rare earth screen over conventional screens:
Speed of system being high, radiation dose can be considerably
reduced and thus in turn the loading on generator could be
less. Hence the total population exposure is reduced.
Rare earth screens provide higher resolution than conventional
calcium unstated screens for same phosphor thickness.
Disadvantages:
Rare earth screens have non linear increase with respect to kV
changes as against flat linear increase in conventional screens.
Due to faster speeds, the technical latitude is small which means
there is little margin for error.
Unsharpness due to usage of intensifying screens: This arises
because the crystal of fluorescent material are larger than silver
bromide grains on film. The silver bromide emulsion of the film
reacts with this visible light. The actual exposure is achieved 95%
by light emitted from screen and 5% from primary radiation
towards blackening of film.
Effect of Intensifying screen depends on:
1. The type of fluorescent material, grain size, purity, color and
thickness of material.
Fig. 9.10: Speed/Resolution with respect to screen thickness

2. Matching between film and screen characteristics.

3. Quality (hardness) of useful radiationhigher kV more
intensifying effect
4. Density of film.
Depending on voltage applied to X-ray tube (50 to 125 kV) with
the use of universal intensifying screen reduce exposure time or
dose between 1/10 to 1/50 of those of non screen film. Hence,
now-a-days use of non screen films is reduced to practically nil.
Exceptional cases where the small fracture is to be detected, the
non screen film exposure is taken, for highest resolution films
should be exposed using cassettes without intensifying screens.
Some screens are manufactured and sold as combination screens
consisting of thin front screen for primary beam to encounter
minimum thickness and thicker rear screen marked appropriately.
Radiographic Materials
10 and Processing Technique
Radiographic materials constitute of cassettes, film, developer and

fixer. Developer and fixer are called chemicals. Since old chemicals
produce fog and poor contrast on film, these should be fresh.
Development time has great effect on film contrast. Poor film
development leads to poor image quality and contrast. There are
different types of X-ray films available in market namely, films
with intensifying screens, without intensifying screens. Structure
of X-ray film view is shown in Figure 10.1.
Fig. 10.1: Structure of X-ray film

Parameters such as shelf life, average gradient, film speed, base-
plus-fog density, film speed and reciprocity failure are very
important in selecting film.
Shelf life: As the film ages fog density increases. Sometimes within
three months, fog density increases to its unacceptable value of
0.22, thus resulting in film unusable. Film which accumulate
excessive density over a short period of time are having short shelf
life. Proper storage conditions should be maintained such as
temperature less than 27 degrees C with relative humidity 30 to
60%, stored in light tight, radiation free area. The lead equivalent
Radiographic Materials and Processing Technique 161
of partitions must conform to ICRP regulations, which specifies

the radiation dose permissible in room. Standard brick walls do
not give adequate protection. Hence unexposed film packages must
be stored in lead lined storage box.
Average gradient: It is defined as slope of film characteristic curve,
measured between densities of 0.25 to 2 and it denotes contrast or
latitude of film, which in turn determine its ability to record
different shades of gray. High contrast films are used for bone but
are undesirable for use in chest radiography, where wide latitude
films are used.
Base-plus-fog density: It is determined from the non exposed portion
of the radiographic film. The density represents inherent blackness
within the base of the film and minimal chemical fog produced by
processing the film. Limiting value is < 0.22.
Film speed: It relates the amount of radiant energy required to
produce net density of 1.0 on film characteristic curve. This
parameter will vary according to methods of film processing,
chemicals used and temperature. However, if these factors are
common for to different films, then one can determine the variation
in exposure factors to obtain optimum result. The measurement is
done by densitometry.
Reciprocity failure: We have discussed earlier the importance of
parameter mAs in blackening the film. If amount of radiation (tube
current) is increased, then exposure time can be reduced
proportionally. This is valid for exposure time variation between
10 ms to 2 seconds. Film emulsions cannot be manufactured so
that response to all variations of time and tube current factors will
produce equal densities. Hence for all exposures shorter than 10
milliseconds or longer than 2 seconds, the constant relationship
mAs may not produce identical film densities. Moreover if the film
is manufactured to be more sensitive for one end of exposure time,
it may not be equally sensitive on the other end of exposure time
scale. Since it is advisable to reduce exposure time to over come
dynamic blurring, films sensitive to lower end of exposure time
are preferred. If such films are used for longer exposures, increase
in tube current is required to compensate lack of response, which
means more heat units are produced in X-ray tube. As a general
rule, mostly film emulsion is formulated to have its maximum

speed at an exposure time of 100 milliseconds. Different types of
film must be matched to the radiograph to be taken such as
radiograph without intensifying screen, with intensifying screen,
dental radiograph, mammographs, image intensifier radiographs, etc.
X-ray beam which passes the patient is incident on film. If
X-ray photons are incident on film, the result is exposure by direct
X-ray photons (Radiograph without intensifying screen or Dental
X-ray). But if X-ray beam is converted to light photons, then the
sensitivity or response of film should match with fluorescent light
emitted by light photons, which in turn varies on conversion
efficiency of phosphorous material.
Example: Calcium tungstate gives blue light with wavelength of
420 nm and gadolinium and lanthanum emit green light at
545 nm.
PROCESSING OF X-RAY FILM

Hospital spends millions of rupees on good quality imaging
equipment by laying down appropriate specifications, features
desired, and later goes through purchase procedure, ensure the
proper installation and commissioning of the equipment. But often
very little attention is paid to film processing.
We have seen that radiographic film is to be used with specific
chemistry. We can change the film speed, contrast or fog which in
turn match the film characteristics with chemistry by altering brand
of chemicals. The safest practice is to follow recommendation by film
manufacturer on usage of chemistry.
The major problem which occur during processing is
underdevelopment of film due to contaminated chemicals arising
because lack of cleaning, inadequate replenishing rates and
inadequate temperature controls. X-ray film is extremely sensitive
to light.
Hence it is utmost important to store, handle, load and process the
film under complete darkness to achieve good contrast with
minimum fogging. Development of X-ray films can be performed
in two ways.
(a) Manually when load on department is less.

(b) Roller processing machine if load is large.
The layout and requirements of the processing room is decided
based on these factors (Figs 10.2 and 10.3). Following measures
are taken in radiology department.
1. Adequate ventilation of the processing room is essential. Hence
exhaust fan or air conditioner should be provided so that fumes
from chemicals are not affecting eyes of radiographer.
2. Sufficient water supply round the clock is required in dark room
to wash the film.
3. Flooring of processing room should not reflect light and walls
should be painted black.
4. The location of processing room should be as close to radiology
examination room as possible with size of at least 10 sq m.
1. Developer Solution
2. Washing with water
3. Fixer solution
4. Water
Fig. 10.2: Arrangement of the chemical baths in sequence

5. Protection against radiation, external light should be ensured

so that film stock does not get foggy. The lead equivalent of
walls must conform to ICRP regulations which specifies
ambient dose < 40 mR per month. We know that standard walls
do not offer adequate protection. In case the stored films show
fogging, overall protection should be re-examined. In order to
expedite the movement of exposed cassettes from examination
room to processing room, lead lined cassette pass box is
incorporated between examination room and processing room,
provided these two rooms are located next to each other.
6. The processing room should be divided in two areas based on
activities to provide smooth flow of work.
(A) Dry Work Area

This area is utilized for loading and unloading of film in cassettes,
storage for cassettes and screens. While storing films care should
be taken that the boxes containing films are not stacked one over
Fig. 10.3: Ideal X-ray processing room layout

the other. These boxes should be placed vertically in upright

position in a row, so that boxes are not stored under pressure. This
area should be away from developing chemicals. Older stock of
films should be used on priority considering the manufacturing
and expiry date on the package.
(B) Wet Work Area

This area is used for developing, rinsing, fixing, washing the film
and mounting the film on hangers or clips to allow it to dry. Since
this area is used for liquid solutions of chemicals such as developer
and fixer, it should be away from dry area.
(C) Illumination Inside

Wall mounted lamps with recommended wattage and red filter as
recommended by film manufacturer should be provided. Lamps
should be at least 1.4 m away from the dry section where the films
are loaded and 1.2 m away from wet section so that film is not
exposed. Normally loading film in cassette is performed in darkness
to avoid accidental exposure to light due to leakage from filter.
Accessories: Timer, thermometer to read the temperature of
developer and fixer.
Automatic Film Processors

Normally if workload is more than 100 films per day, then
automatic film processor is recommended. We have seen the
requirement of clean environments during processing of films.
Automatic processor must also be cleaned on regular basis taking
care of transport racks, replenishing systems, tanks are properly
cleaned and proper working of pumps should be ensured. If one
part is cleaned, contamination from other part will affect the
performance. Since developer will oxidize in three weeks after
exposure to air, all old chemicals should be removed, processor
should be thoroughly cleaned and new chemicals to be added every
three weeks.
Inadequate replenishing rates: They cause variations in pressure
transmission through diaphragm and magnetic drive centrifugal
replenishing pumps. These pumps are greatly affected by head

pressure transmitted from the replenishing tanks. Under
replenishing may lead to under processing and therefore requires
increase in exposure factors, while as over replenishing is wasteful.
Temperature: It depends on temperature control functioning and
pressure of water inlet. Higher temperature increases activity of
developer and film is overdeveloped with dark gray film having
more mottle or grain than desired. Lower temperature results in
less density.
Poor screen contact: It results when intensifying screen has poor
contact with film. When light photons from intensifying screen
strike film at a greater angle and distance than that in case with
good contact, blurring of radiograph results affecting resolution.
Hence there should not be any air trapped in cassette. Hence
intensifying screens are tapered at edges to allow air to escape from
cassette.
Films are processed at 30 degrees C temperature. Film drying is
around 40 to 50 degrees C. Please note that automatic processors
require special films and chemicals. For details one should refer to
instructions given by manufacturer of processor.
Manual Dark Room Processing

The process contains developing, rinsing, fixing, final washing,
wetting, drying.
Developer: Normal photographic developers are not suited for
processing X-ray films. Radiographic developers produce good
contrast. Following procedure should be adopted.
Developer should be prepared as per instructions given on
package.
Exact capacity of tank should be known to determine the
requirement of quantity of developer. The capacity of tank is
in liters, ensuring that upper edge of largest size of the film can
be fully immersed in the tank. This level should be marked to
get assessment of addition of replenisher every day due to loss
of developer by removed films.
Tank must be thoroughly cleaned before preparing developer.
Normally these tanks are made of 316 grade stainless steel and
they should be cleaned with 5% nitric acid solution, scrubbed

and washed with fresh water to ensure no residue from
previous preparation of developer is left in tank.
Chemicals should be prepared outside processing room and
do not use metal containers or enamel buckets.
Add developer chemical to water and stir till it dissolve at a
room temperature. Do not use hot water. Follow instructions
given by manufacturer for developer preparation.
Replenisher should be prepared at the same time as developer
to match the performance. Regular replenishing maintains
strength of solution, enabling processing time to be constant
provided temperature is constant.
Record of dates should be maintained for preparation of
developer and replenisher.
Tank for developer and fixer should be clearly marked and their
respective stirring rods should never be interchanged.
Rinsing: Rinsing process is performed so that residue of developer
on the film after removal from developer tank is thoroughly washed
in water and it does not get mixed up in fixer. Running water is
required for this purpose. This process should be performed for at
least 30 seconds. In case running water is not available and
stationary water in tank is to be used, add 2% glacial acid to achieve
effective cleaning. Needless to state, such bath should also be
thoroughly cleaned frequently to avoid fog on film.
Fixer: Fixing bath combines chemically with unexposed silver grains
in the emulsion to produce soluble salt which then goes into
solution. Radiographic fixing salt is highly concentrated to
overcome thick emulsion layer of film.
Fixing time of screen film is twice that of developing time. For
non-screen film the fixing time is more than that of screen film due
to higher silver content and thicker emulsion. Fixing process
ensures that film developed and processed is a permanent record.
Hence fixing must be carried out more carefully by ensuring the
fixer solution is active and replenished by adding concentrated
fixer at least twice a week. Solution concentration can be checked
by litmus paper which turns from blue to red for fresh solution. In
tropical countries hardening fixing salt is added to fixing bath to
harden Gelatin. In case of automatic film processors it is done while
manufacturing. Care should be taken that the temperature of fixer

does not exceed temperature of developer and it should not exceed
50 degrees C during mixing. Now one can see the developed film
under dark room light.
A used fixer contains silver because 70% of silver bromide in film
goes in fixer. Hence used fixer is utilized for recovering silver and
is always sold at premium. Also spoiled or unrequited films should
be salvaged as it contains silver.
Final washing: This is required to remove residue from fixer. The
washing time is around 30 minutes for running water and one
hour for stationary water.
Wetting: Wetting agent ensures uniform and quick drying. Films
are treated in this bath for 2 minutes, after final washing.
Drying: Film should be dried in dust free room with proper air
circulation at room temperature to ensure that films are not melting.
This care should be taken for manually processed film. If film dryer
is used, ensure working of fan and filter is properly cleaned.
Steps taken in film processing:
1. Prepare the developer and fixer as per manufacturers
instructions.
2. Ensure continuous water flow (running water).
3. Check temperature.
4. Cleaning: The most important rule is cleanliness. Even a
smallest amount of fixing solution into developer will ruin the
developer. Hence take care that stirring rods are not exchanged.
5. Ensure that cassettes are of light proof quality. For testing
cassette expose the film loaded in cassette to sunlight for several
hours and then process.
6. Intensifying screens should be fixed to the cassette housing from
inside with adhesive tape on the reverse side. Do not use glue
which may have reaction with intensifying screen. Ensure
thinner intensifying screen is fixed to wall of cassette pointing
towards the tube. Cleaning of screen should be carried out with
soft hair brush. If they are soiled with developer or fixer, remove
stains immediately with soapy water using moisturized swab
and dab carefully with dry gauze or cotton.
Clean the hangers and film clips from time-to-time in hot soda
water.
BEFORE EXPOSURE
Select cassette as per requirement, size of the film, with or
without screen.
Select box of films which meets the requirement.
Close the door of dark room, switch off lamps, load the film in
cassette in dry area.
Once the film is taken out of the packet, close the packet carefully
so that it will not allow any light leakage for exposing other films
in packet. Normally films are individually packed in paper
wrapping inside film package.
EXPOSURE
The loaded cassette in dark room, transport it to radiology room
either through lead lined pass box or otherwise and place in cassette
tray provided in equipment. Use lead letters for patient ID and
date. Take care that thinner wall points towards tube. Select
radiographic exposure parameters on control console and position
the patient.
Expose: Remove lead letters after the exposure.
AFTER EXPOSURE
(a) Dry Section
Prepare film hanger, switch off light, and close the door. Open the
cassette, lift the film and close the cassette. Load the film on hanger
and take the film to wet section.
(b) Wet Section

Insert the film with hanger in developer tray and commence
processing by moving film up and down in the tank in such a way
that air bubbles are not formed.
Set developing time simultaneously on timer, otherwise
radiographer should have his own assessment of time in the
absence of timer.
Ensure that during development process, film is not taken out for
observation. If this is done film will be foggy and contrast is lost.
After the developing time is over, lift the film hanger from
developer tank and transfer it to rinsing bath. Wash the film in
running water for at least 30 seconds. In case if the running water
is not available, keep the film in water tray for 1 minute. Transfer
film hanger after rinsing to fixer bath. Time required for fixing is
normally double of developing time. Set this time on timer. Now
we can switch on the safe light after immersing the film in fixer.
After fixing time is over shift the film to final washing for 30
minutes.
Drying of film in film dryer or normal drying at room temperature.
After film is dried documentation should be completed before film
is sent to radiologist for his final opinion.
Requirement of
11
Good Radiograph
Based on the discussions on image quality and radiographic

processing, we now discuss these requirements briefly.
1. Film Quality, Size, Intensifying Screen

Non screen films are chosen for detail study such as minor fractures
in bone, dental radiography and mammography. Screen films are
used for reduction in exposure parameters, dynamic blurring, low
dose requirement and one can standardize use of one type of film
depending on screen chosen.
2. Beam Limiting Devices

Cone reduces scattered radiation because size of incident field is
reduced. Collimator collimates the beam so that only the desired
area is exposed. Compression device reduces the irradiated body
volume, which is responsible for scatter.
Scattered radiation grid along with catapult bucky improves image
contrast due to filtration of scattered radiation before it reaches
the film. The specifications of grid will have direct bearing on
exposure parameters.
3. Proper Immobilizing and Positioning the Patient

When positioning is not proper, the radiograph obtained is of no
use for diagnostic purpose, since it lacks desired information, even
if the correct exposure parameters are chosen. Repetition of
exposure means extra-radiation hazards. Normally the patient is
asked to remove clothing on the area to be exposed and asked to
hold the breath so that dynamic blurring is reduced. In case of
patients with bandages or splints, normal direction of beam is
obtained by turning the position of tube. The positions are fine

position: Position of arms, legs and head and Normal Position: Supine,
prone, erect, sitting, an-tero-pos-te-ri-or (a.p./pa), lateral.
4. Proper Location of Cassette

The object to be radiographed should be located such that the
radiographic information should be in center of film, which means
cassette should be located perpendicular to beam and in center of
beam.
Example: Radiograph of limbs should include adjacent joint section,
radiograph of spinal column include vertebra, joints on both
radiographs must be in the center of film.
Lead letters: L = Left hand; R = Right hand are placed on upper
edge of film. When patient is in prone position, letters are placed
facing downwards and in supine position upwards. Patient can be
kept stationary by means of sand bags, bandages with weight,
immobilizing device, pads, pillows, etc.
5. Beam Direction and Film Focus Distance

In some examinations the beam of X-rays is kept inclined to certain
degrees relative to normal position (vertically down the table) such
as cranially headwards, caudally footwards, one side transverse.
In order to get good image quality the film focus distance should
be as large as possible. But due to limitations of room size and
equipment design, focus film distance is 150 to 180 cm for chest
radiographs, 100 to 115 cm for general radiographs (over couch)
and 70 cm for under couch work with spot film device.
6. Selection of Exposure Parameters Depending on above

Factors and Mains Conditions
As discussed earlier, kV values depend on thickness of patient to
be exposed and mAs value is also determined. Generally the patient
weight and height is taken as 75 kg and 175 cm respectively.
Depending on variations in patient thickness, type of generator,
with or without plaster, the FFD, the parameter selection is varied
such as
(a) 20% increase in mAs value for thicker objects per cm.
Requirement of Good Radiograph 173
(b) 15% decrease in mAs value for thinner patient per cm.
(c) 1.5 cm thickness difference for lung radiographs instead of 1 cm.
(d) For wet plaster cast exposure 3 times normal and dry cast 2
times normal.
(e) For FFD apply inverse square law:
Distance factor = square of ratio of desired FFD over old FFD.
(f) Increase in kV for the same object:
(I) 60 to 70 kV range reduce mAs value to half
70 to 60 kV range increase mAs value twice
(II) Voltages below 60 kV, mAs factor must be divided or
multiplied by factor 3 for voltage change of 10 kV.
During this procedure, the tube current is kept constant but
tube voltage is increased from 60 kV to 90 kV (Fig. 11.1). Hence
energy of each electron is increased from 60 to 90 kV. Hence
Emax moves from 60 to 90 kV by shifting line V1 to V2 and
three more triangles of full energy have gained.
Area abc = (fbd) = (abc + aef + aec + ecd)
Fig.11.1: Alteration of tube voltage

Hence in this case with absorption edge Ef at 30 KeV an increase

in anode voltage from 60 to 90 kV increases the radiation output
four times.
(g) Alteration of tube current: In this case kV is kept constant and
tube current is doubled resulting in doubling number electrons.
Since kV is not altered the Emax for both curves is same.
Doubling the current means doubling the quanta at any point
of KeV scale and hence it will double the total energy.
Fig.11.2: Alteration of tube current
Area acd = 2 (bcd) Fig. 11.2.

Therefore I2 = I1 (mA2/mA1)
(h) Alteration of exposure: Doubling the exposure time, with other
parameters kept same, will mean that primary electrons are
doubled over a period of time. Hence the result will be same as
doubling the tube current. I2= I1 (t2/t1). Hence film density
with 100 mA @ 0.1 second will be same as that at 1000 mA @ 10
milliseconds.
The general rule is derived from the fact that there is exponential
decay of intensity as the radiation passes through media and change
in tube current is linearly proportional to density of exposure.
Hence based on these factors optimum exposure tables are devised
considering following:
1. Object and positioning
2. Object thickness
3. Film focus distance (FFD) in cm (Table 11.1)
4. Screen
5. Grid
6. Type of X-ray generator
These exposure tables are merely guide to obtain optimum results
which depend on power line quality, film processing and
chemicals.
Hence Point System is generated, representing the exposure data.
The points are logarithmic function of different factors so that
calculation of exposure value are simplified by addition or
subtraction. In most modern generators, kV or mAs values are in
logarithmic scale to compensate or overcome the exponential decay
in intensity.
Correction Values in Exposure Points
1. FFD:
Table 11.1: FFD values
Cm. 65 75 85 95 105 115 130 145 160 185

Point 5 4 3 2 1 0 +1 +2 +3 +4
2. Screen
Rare earth high speed= 7
Rare earth universal = 3
Rare earth detail or high speed standard = 0
Universal = + 2
High definition = + 3
3. Generator
DC/ Multi-pulse/12 Pulse= 0
6 Pulse = + 1
2 Pulse = + 3
4. Grid
Without grid = 6
8/40 grid = 2
10/40 grid = 1
12/40 grid = 0
5. Object thickness
Each cm more = +1
Each cm less = 1
Example: Kidney a.p. : Exposure parameters (66 kV/50 mAs)
= (12 + 16) points = 28 points
Now we increase kV to 70 kV = 13 points; Then mAs will be
15 points = 40 mAs
Hence new exposure parameters will be 70 kV/40 mAs.
Please note that in this example we have not altered other variables
such as FFD, generator, screen, grid, object thickness, etc. If these
are altered corresponding correction should be applied.
Now in this case if patient has 3 cm more thickness than average
patient then exposure points will be increased by 2 points on kV
and 1 point on mAs which means we can select 73 kV/63 mAs.
If the generator is six-pulse instead of two-pulse then we should
reduce two point that means either we can reduce mAs to 25 from
40 mAs or decrease kV further to 60 kV. Reduction in mAs is
preferred because the kidney has motion unsharpness. By
increasing kV one should also explore if the selected grid is capable
enough to filter scattered radiation. If not one should change the
grid with higher ratio and subsequently correct the exposure
parameters to achieve the same points (Table 11.2).
Table 11.2: Table for point system
Points kV mAs
0 40 1
1 41 1.25
2 42 1.6
3 44 2
4 46 2.5
5 48 3.2
6 50 4
7 52 5
8 55 6.3
9 57 8
10 60 10
11 63 12.5
12 66 16
13 70 20
14 73 25
15 77 32
16 81 40
17 85 50
18 90 63
19 96 80
20 102 100
21 109 125
22 117 160
23 125 200
24 133 250
25 141 320
26 150 400
Image Intensifiers
12 and Related Systems
Few years back, radiologist was seen wearing red goggles and
moving from one room to another in radiology department. Those
wearing red goggles were conducting fluoroscopic examinations
in the darkened room which was main work load of radiologist,
who used to perform fluoroscopy of lungs to diagnose tuberculosis
or bronchitis or GI track studies for intestinal disorder.
In 1940, Dr Manoel de Abreue a Brazilian radiologist, applied photo
fluoroscopy technique for mass examination of lungs. Photo
fluoroscopy is photography of image on fluorescent screen. This
procedure was first performed with normal lens camera and 35 mm
film, followed by usage of mirror camera made by M/s Odelca
with 70 or 100 mm films. Recently this procedure is taken over by
indirect radiography or image intensifier radiography.
In principle, this technique is similar to one devised by Dr. Abreue,
except the fluorescent screen is replaced by the output screen of
Image intensifier and normal camera is replaced the video camera.
The image intensifier has replaced the conventional fluorescent
screen in many developed countries, due to the relative advantages
and applications.
Working of Image Intensifier

X-ray photons of different intensities passing through patient are
made to fall on input screen of image intensifier, which converts
them into light photons by phosphorus material. These light
photons interact with photo cathode which emits electrons
proportional to number of incident X-ray photons. Electrons are
focused on output phosphor where light image of higher intensity
with image inversion is produced (Fig. 12.1).
The size of output screen is almost 15 to 25 mm and size of input
screen is 230 mm, which gives area reduction factor and hence,
Image Intensifiers and Related Systems 179
Fig. 12.1: Image Intensifier tube
image is intensified. Another important feature of this technique

is electrons can be focused, but X-ray photons cannot be focused.
Light Distributor
The image obtained on output screen as inverted image, can be
seen in various planes (directions) with the help of tandem optics
and mirror system, thus ensuring that image intensity is not
reduced. The light distributor is in two versions:
(a) Three channel for video camera, spot camera and cine camera or
(b) Two channel for any of the two of above mentioned in
point (a).
Video Camera
It converts the light image to electronic image, which scans the
input target of video camera and displays the electronic image on
television screen. Hence, the original X-ray beam undergoes
following changes.
Change Location/Device
X-ray to light Image intensifier input screen
Light to electrons Image intensifier input screen
Electrons to light Image intensifier output screen
Light to electrons Video camera
Electrons to visible image Television monitor
Hence, five conversions of energy take place during this process.

We loose certain amount of information depending on efficiency
of each stage, but due to advantages Fig. 12.2, this technique is
preferred. We now discuss these conversions in detail.
Function of Eye in Analysis of Image

Eye visualizes the scene. If light photons impinging on eye ball are
more than desired, very bright image, pupils of eye are narrowed.
If light image is seen with lesser intensity then pupils are opened.
In ophthalmology these are called cone and rod visions
respectively. Cone vision is color and daylight sensitive and
concentrates on the center of retina than on periphery. Low light
levels are perceived by rod vision which are located on the
periphery of the retina, hence not very informative. Since light
available from fluorescent screen is with very low intensity, it falls
under rod vision and therefore, there is necessity of dark room
adaptation because longer the time more sensitive Rods will be at
low light levels. The rods have tendency to distinguish between
white and black and little between different shades of gray (100 %
contrast).
While as Cones are more concentrated in the region with high light
activity, which in turn allows one to distinguish two different
shades of gray related to distance and intensity. Hence, image
Intensifier usage will increase the light output of fluorescent image
to the level where perception can occur with cone vision for better
visual information with increase in contrast.
The obvious disadvantages with conventional fluoroscopy with
screen of low light output and need of dark adaptation to eyes is
eliminated by use of image intensifier.
Apart from this other advantages are:
There is no longer requirement of working at close range and
since the distance can be kept between observer and television
screen, radiation hazards are low.
Multiple viewing is possible, which helps in obtaining second
opinion on observations and also is a requirement for teaching
medical institutions.
Electronic data of image can be recorded on magnetic media
for further consultations and records.
Fig. 12.2: Five conversions of X-ray television system
Patient cooperation during examination because it is conducted

in normal room light.
Lower dose rate since the examination time is reduced and light
output is high.
DESIGN (Fig. 12.3)

As discussed earlier, image intensifier converts X-ray photons to
bright visible light to be observed in broad day light without any
dark adaptation goggles. The device is a vacuum tube with cathode,
anode and focusing electrodes enclosed in an evacuated bell shaped
glass envelope. The circular input screen is located towards the
large part of glass envelope and output phosphor is located towards
smaller end. The focusing electrodes comprise of circular
electrostatic lenses and are placed between anode and cathode
within the glass envelope. The tube is in metal shield to protect
from stray magnetic fields. Normally dual field image intensifier
is used.
Photo Cathode or Input Screen

It is composed of fluorescent material, preferably cesium iodide,
vapor deposited on thin aluminum. Vapor deposition allows to
pack crystals at high density. Aluminum is used for its low
absorption coefficient to X-ray beam. These crystals act like fiber
Fig. 12.3: Diagram of image intensifier

optic bundles and eliminate flare due to lateral and oblique

transmission of light photons. Cesium iodide increases the
quantum efficiency (65% approximately) along with spatial
resolution. Earlier days zinc cadmium sulfide was used which had
quantum efficiency of 20%. It converts X-ray photons to bright
visible light. The photo cathode is deposited directly on input
phosphor which converts the light photons from input phosphor
into electrons. It is composed of alkali and antimony vapor
deposited directly onto phosphor. This vapor deposition eliminates
the need to have separate interface between photoactive and input
phosphor. Thus X-ray photon image is now converted to electron
image at photo cathode. These electrons can then be accelerated to
output screen with the help of focusing electrodes to get required
brightness level.
Electronic Lenses
The accelerating voltage is 25 kV for anode and 90 V, 360 V and
4 kV for focusing electrodes. The electron optics with these lenses
invert and reduce the image and acceleration of electrons by 25 kV
produces a fluorescent image on the output screen which is several
thousand times brighter than that produced at input screen.
Output Screen
The output screen is composed of zinc cadmium sulphide covered
with thin aluminum foil to prevent back scattering from output
screen from interfering with the photo cathode. The dimensions
are around 25 mm diameter of output screen.
Housing and Power Supply

The power supply voltages varying from 90 volts to 12 kV for
focusing electrodes and 25 to 30 kV for anode are located in the
housing of image Intensifier. The power supply, image intensifier
tube, metal shield require sturdy mechanical housing along with
lead shielding for avoiding radiation leakage. Therefore, over all
weight of image intensifier is around 30 kg. If we include tandem
optics, light distributor, video camera and cine camera it may go
up to 40 kg.
Basic Terms and Definitions

1. Gain or intensification factor: It is defined as ratio of brightness
of image at output screen over that of fluorescent screen.
Normally the ratio is of the order of 10,000 to 20,000 depending
on accelerating potential applied to electrons from photo
cathode.
Gain = Brightness of image at output screen/brightness of
fluorescent screen
2. Conversion factor Gx : It is ratio of luminescence at output screen
(Lux) over the input dose rate and it depends on following
factors.
(A) Type of radiation (quantity = mA, and quality = kV)
(B) Photocathode characteristics and efficiency
(C) Potential difference between anode and cathode voltage
(D) Luminescence of output screen
(E) Ratio of input screen to output screen diameter
Gx = (cd per square meter/mR per second)
3. Minification factor : This is defined as ratio of diameter of input
phosphor to that of output phosphor.
Example: If image intensifier has input screen of 9 diameter
and output screen has 1 diameter then minification ratio is 9.
Since the incoming rays are focused on small area, improvement
in contrast gradient and detail for better perception is achieved.
4. Area reduction factor: This is defined as ratio of input screen area
to output screen area. As in case of above example the area
reduction factor will be 81. In case of dual field image intensifier
the field size is 4.5. Then area reduction factor will be 20.25.
5. Resolution: It is resolving capacity of image intensifier. It is
expressed as line pairs per unit length (LP/mm). It is measured
with resolution phantom, made of opaque lines at equal
distance separated by the radio transparent material. Normally
opaque lines are made of lead or copper wires and transparent
material of plastic. Resolution phantom is placed at the input
screen of image intensifier and measurement of line pairs per
mm are carried out at the output screen. Normal range is
5-6LP/mm. Factors affecting resolutions are focal spot
dimension of X-ray tube, kV applied to X-ray tube, dose, source
image distance (SID), filtration offered to the X-ray beam.
6. Contrast ratio: It is ratio of the luminescence of the center of the

output screen when input phosphor is fully radiated to the
luminescence of output phosphor when a central area of 10%
of the input phosphor is shielded. The contrast is affected by
penetration of X-ray photons in the input screen, the back
scattering at output screen.
7. Lag: Lag is persistence of luminescence after termination of
radiation. Every phosphor material has rise and decay time.
Lag is important when the image is viewed by camera tube
especially in dynamic studies such as angiography.
8. Vignetting: Image at periphery is darker than that at center
because amount of radiation striking at the periphery is lesser
than that at center. Hence, lower number of light photons will
be produced at periphery, resulting fewer electrons produced
at periphery of photo cathode.
Multiple Field Image Intensifiers (Fig. 12.4)

The major advantage with multiple field (dual or triple field) over
single field Image intensifier is, increased quality of resolution and
contrast. The central portion of image intensifier input screen is
used with smaller portion and fall off in resolution in periphery is
eliminated. This is achieved by increasing the voltage of
electrostatic lens system (focusing lenses). Only a small portion of
input screen will be projected to output screen, resulting into
magnification of the image and increase in resolution and contrast.
Example: Dual field image intensifier 9/6; Triple field image
intensifier 9/6/4.5. During switching over to smaller field,
higher dose is given to the patient (20 R to 40 R). Failing which
the image at output screen will be noisy. As an example if one
wants to switch over from 9" to 6", it would require doubling of
dose rate. But HEW (Department of Health, Education and Welfare)
have specified regulations which require that the X-ray beam be
collimated and hence, the radiation coverage should be changed
automatically. Hence, integrated dose to the patient will be the
same Figure 12.4.
Processing of Image at Output Screen

There are various methods adapted to process the image obtained
at output screen namely:
Fig. 12.4: Basic dual field image intensifier
(a) Visualization
(b) Coupling systems
(c) TV camera
(d) TV monitor
(e) Automatic dose regulation
(f) Recording.
Visualization
There are two methods. Mirror optic and television viewing system.
Mirror optic system: This system is cheaper than television viewing
system due to its simple design. But since only one person can
view the image it has not become popular. The size of output screen
is around 25 mm. Image formed on output screen should be
converted large enough for viewing. This enlargement of the image
can be accomplished through a system constituting mirrors and
lenses as shown in Figure 12.5, without loss of brightness. The image
quality at the viewer depends upon quality of lenses and mirrors.
Misalignment can cause distorted image

Television viewing system with camera: This system has following
advantages.
(a) Multiple viewing
(b) Recording of image
(c) Improvement of contrast of X-ray image electronically.
The cost is more than mirror optic system (Fig. 12.5).

In this system the output screen is coupled to the television pick
up camera having target of 15 mm diameter. This interfacing is
achieved by two methods of coupling systems.
(a) Fiberoptic system (b) Tandem lens system
Fig. 12.5: Mirror optic viewing system
(a) Fiberoptic system (Fig. 12.6)

Fiberoptics have capability of light transmission with minimal loss
of intensity and flare. The coupling system is very thin fiber optic
disc sandwiched between the output screen of image intensifier
and target of TV camera tube. The fiberoptic components consist
of a bundle of fine, individually shielded, glass rods in large
quantity (several thousand per square mm). This system gives
uniform illumination of image thus eliminating vignetting effect
at periphery. Fiberoptic system is very short and light weight
allowing the unit as mobile unit. However, the possibility of usage
of light distributor or beam splitter is ruled out and hence it is only
for television applications and spot film device and cine camera
cannot be used. Resolution of the system is limited by the size of
Fig. 12.6: Fiberoptic system
individual fibers in the coupling system. This system finds its

applications in direct TV fluoroscopy and C-Arm Mobile Image
Intensifiers.
(b) Tandem lens system (Fig. 12.7)

This is used by using two sets of lenses called objective and camera
lens in tandem.
Objective Lens
It converts light emitted from output phosphor of image intensifier
tube into parallel beam so that light distributor or beam splitter
can be inserted in the parallel beam. In the absence of parallel beam,
since the beam is divergent beam, beam splitter will cast a shadow
on the pick up tube. The purpose of beam splitter is to reflect the
parallel light rays in the direction of recording systems such as
photo camera or cine camera without disturbing the main beam
Fig. 12.7: Tandem lens system

incident on target of television picture tube. When both photo and
cine camera are used the beam splitter is called three channel
distributor, (Fig. 12.8) whether beam splitter or mirror takes two
positions, one in the direction of photo camera and other in the
direction of cine camera. If only cine camera is used then we require
two channel light distributor. Hence, the job of beam splitter is to
split the beam in the direction of recording system without loosing
the information to the main path, towards video camera.
Camera Lens
It is tandem with objective lens, hence, the system is called tandem
lens system. It focuses the light on the target or input plate of
television picture tube. Since the light transmission is carried out
through tandem optics, the tandem optics should be handled with
utmost care especially when the lens system is kept cleaned for
dust.
As in other optical systems, amount of light transmitted from the
periphery of lens is not the same as that at center or axis of lens.
Fig. 12.8: Three channel light distributor
This loss of light can be as high as 10 to 30%. In order to overcome

this drawback either extra elements are added to the lens or the
television camera incorporates anti vignetting circuitry.
VIDEO CAMERA
Video camera converts the image projected on input screen into
video signal. As the technology advanced, new pick up devices
with better features were introduced in the market. These can be
classified in two types namely vacuum tube type and charged
coupled devices (CCD) type. Vacuum tube type cameras are recently
taken over by digital cameras in certain applications.
Vacuum Tube Type

These were first introduced in the market. They sub classify into
three types such as image orthicon, vidicon and plumbicon or
hivicon. Very soon the image orthicon tube was replaced by vidicon
which had smaller size and better efficiency. In vidicon the
photoconductive layer is most important part and its electrical
resistance varies with illumination. This property is known as photo
conductivity. While as in image orthicon, conversion of light into
electrical signal occurs in a layer which emits electrons when
illuminated. This property is known as photoemission.
In both these models charged storage principle is used which

means the incident light is accumulated in the form of electrical
charges, which are scanned in sequence. Plumbicon and hivicon
uses lead monoxide as a photoconductor. These tubes were
introduced after vidicon in the market and have two major
advantages over vidicon namely
(a) Lag is considerably less. Thus eliminating movement
unsharpness.
(b) The signal current is proportional to illumination. Hence
contrast is not diminished.
Plumbicon tube is slightly larger than vidicon and hence, cannot
be directly replaced with vidicon. But plumbicon tube, due to its
sensitivity, give quantum noise.
As a general practice if geometrical blurring is important then use
vidicon and if dynamic blurring is important use plumbicon.
Hence, for GI studies use vidicon and for angiography use
plumbicon.
Image Orthicon Tube (Fig. 12.9)

There is no lag, light sensitivity is almost equivalent to eye. But
due to high sensitivity the noisy image is produced. This tube
requires complex circuitry, high maintenance and is larger in
dimensions as compared to vidicon.
Light photons strike photo cathode giving electronic emission. These
electrons strike the glass target causing secondary electron emission, which
are then collected by metal target screen. A positive space charge is
developed on glass target corresponding to the image on photo cathode.
This image is scanned by electron beam which neutralizes the positive
Fig. 12.9: Image orthicon tube

charge. Excess electrons are then returned to the photo multiplier where
an electric charge is developed and amplified to become a composite video
signal output.
The orthicon tube is composed of an optical face plate on which
photo cathode is deposited. Each point on photo cathode emits
electrons proportional to the amount of light focused on to that
point from tandem lens system. Electrons emitted by photo cathode,
proportional to light photons, are collected on target which is
composed of thin piece of glass having low forward electrical
resistance and high lateral electrical resistance.
A very thin wire mesh is placed on anode side of target. Electrons
pass through this thin mesh. Electrons emitted by photo cathode
reach the target, and result in secondary electron emission and are
collected on wire mesh which develop positive charge on glass
target corresponding to light image on photo cathode. Higher the
light intensity, greater is the space charge on corresponding point
on glass target.
This image is scanned by an electron beam produced by electron
gun. This is decelerated to almost zero velocity before electron
scanning beam strikes the target, thus elimination production of
secondary electrons. When scanning beam hits a point on target,
electrons neutralize the positive space charge. After equilibrium,
the excessive electrons are deflected back as return beam towards
electron gun, strike the photo multiplier, which increase their
number. Current from photo multiplier is fed to amplifier and then
is converted to composite video signal.
Vidicon Tube (Fig. 12.10)

Major assemblies of vidicon tube are electron gun, grids, anode,
target and signal plate. The vidicon tube is surrounded by two
pairs of electromagnetic focusing coils and electrostatic deflection
coils to steer the electron beam on target for scanning.
The source of electrons is electron gun. The cathode is located at
opposite end of tube from the target. Cathode is indirectly heated
which is the source of electrons, creating space charge cloud. These
electrons form into a beam by control grid G1 kept at a potential of
0 to 50 V. The control grid initiate their acceleration towards the
target. The electron beam passes through another grid G2 kept at
Fig. 12.10: Vidicon/Plumbicon tube
a potential of 325 V and progresses into electrostatic field of anode.

Anode has a positive potential of 550 V with respect to cathode
and has a whole in the center to allow the electron beam to pass.
The grid G4 kept at 650 V with respect to cathode. Hence, the
electron beam acquires high velocity.
The wire mesh and signal plate form a uniform decelerating field
adjacent to target. Signal plate has a lesser potential than wire mesh.
Hence, electrons flow from signal plate to wire mesh. Electrons
are decelerated by the time they reach the Target.
This also straightens the path of electrons as shown in dotted line
in the figure, so that they strike target in perpendicular direction.
The electron beam scans the dot picture. Hence, it must be focused
to a point where dots appear. This is achieved by two pairs of
electromagnetic coils for focusing. These coils extend to full length
of tube, create magnetic field that forces electron beam into narrow
bundle.
The electron beam is steered by varying electrostatic fields
produced by 2 pair of deflecting coils. The focused electron beam
is moved up and down by alternating current in coils and scanning
of target is achieved. The other pair of coils move beam in horizontal
direction (side by side). Hence, all four coils move electron beam
over the target area in repetitive scanning motion. Scanning starts
in upper left hand corner and ends up in lower right hand corner.
This scanning produce a trace called Raster. The scanning speed is
33 milliseconds for standard 525 lines TV system.
Image from the object, i.e. light photons is focused on target with
the help of optical lens system. Target consists of three layers.
(a) Glass faceplate for maintaining vacuum.
(b) Signal plate made up of transparent film of graphite located
on inner surface of faceplate. A positive bias of 80 V is given to
signal plate. It is known as signal plate because it transmits video
signal.
(c) Vidicon target is a thin film of photoconductive material.
Antimony tri sulfite is used for vidicon and lead monoxide is used
for Plumbicon. It is applied to electrically conductive base layer
of zinc oxide signal plate. When light quanta impinge on the
semiconductor layer, it alters resistance according to
illumination due to internal photoelectric effect. The change in
resistance of photoconductive layers is due to free electrons
being generated in the layer, by light quanta absorbed and this
alters conductivity. The transparent metallic signal plate and
free surface of the semiconductor layer represent a capacitance
whose dielectric is formed by semiconductor layer. The
equivalent circuit of a single storage element is represented by
parallel connection of capacitor Cs and photoresistor Rs. The
value of Rs is determined by the illumination E present at that
point. When a signal plate voltage Ua is applied, each storage
capacitor Cs charges. When a photoelectric storage layer is
illuminated, the resistor Rs of each storage element changes in
accordance with magnitude of illumination E (Fig. 12.11).
The storage capacitor Cs then discharges to varying degrees via
Rs during the time between scanning of electron beam.
Since every storage element capacitor is periodically scanned by
electron beam, the current pulse produced is proportional to the
capacitor discharge provided that free surface of the target is held
by electron beam close to cathode potential. The current pulse
produce negative voltage pulses also known as video signal at
external resistor Ra.
Fig. 12.11: Equivalent circuit of picture elements of target in camera tube
The amount of current required to accomplish equilibrium is

measured at the collector ring, via coaxial cable as composite video
signal which is proportional to the recharge current of an individual
point on the photo conductive layer.
Initial scan only neutralizes the charge on photoconductive layer
by certain percentage 60 to 70% in Vidicon and 90 to 95% in
plumbicon. Hence, new image is added during scan time of 33
milliseconds during new scan to the remaining image resulting in
Lag or Persistance. This is dependent on percentage of maximum
recharge of photoconductive layer by electron beam.
During fluoroscopy, lag presents previous event for a short time
when the area of interest (Region of Interest) is changed as in case
of GI studies from stomach to duodenum. Since the movement of
radiopaque substance is not very fast, this lag is acceptable in GI
studies. But in cardiovascular studies this lag causes problems.
If sensitivity is increased, the beam current is increased which
affects resolution. Higher signal level is obtained when target
voltage is increased. But this increases dark current, which is the
signal voltage generated when target is not illuminated.
Plumbicon tube uses lead monoxide as photo cathode target
material. Signal current generated by plumbicon is proportional
to level of illumination resulting into no significant contrast
reduction of tube and no dark current generated. There is less lag

with plumbicon resulting into lesser movement unsharpness and
higher resolution. Plumbicon tubes are higher dimensions and
hence are not interchangeable with vidicon tube (Table 12.1).
Table 12.1: Comparison of picture tubes
Feature Orthicon Vidicon/Plumbicon

Size Large; Small; L=15 cm, D = 3 cm
Sensitivity High, large noise Low, less noise
lag Not noticeable Noticeable
resolution Poor due to noise Good, use plumbicon
for Motion unsharpness
Loss of contrast Large 20 to 30 %
cost Average Vidicon: Average
Plumbicon: High
CCD CAMERA
It is a device that measures light and coverts this information into
picture signal. The incident light photons are focused on to a sensor
with the help of lens system. The sensor converts the incident light
into an electric charge. This analog information is converted into
digital form by A/D converter and saved in proper file format.
The standard sensor technology for this type of device is Charged
Coupled Device (CCD). The CCD is a collection of tiny light
sensitive diodes which convert incident light photons into electrons.
Each photo diode or photo site is sensitive to light. Brighter the
light, greater is the charge that accumulates at the site. The number
of photo sites on a CCD (pixels) determine its maximum resolution.
Next step is to measure charge of each cell in image. The charge is
actually transported across the chip and read in one corner of the
array. The analog to digital converter (ADC) converts each pixel value
into digital value. The photo site measures total intensity of light
striking its surface. It cannot distinguish different colors of light
from one another. (monochromatic). It is easy to process this
information, than the complicated circuitry adapted in
photographic cameras for different colors. In order to get colored
image, special filters are used (endoscopy application) to separate
light into three colors, red, green and blue. All colors in the visible
spectrum can be created by combining these colors. The higher
quality of CCD camera use three CCD chips each with different
filter. The beam splitter sends the same light information to all the
three sensors, so that each sensor gets identical information of
image. After overlaying red, blue, green images one can get full
color picture. This type of camera has advantage that it can record
each of the three colors at each pixel location.
Output, storage and compression
When the image leaves CCD sensor through ADC and

microprocessor, it is ready to be viewed by liquid crystal display
(LCD). Alternatively this digital signal can be transmitted to
television monitor.
Storage of image can be performed in digital format into computer
(or print out same with printer). There are several ways to store
images in the camera and then transfer them to computer by coaxial
cable with serial, parallel, USB and or SCSI port. They also provide
removable storage device like floppy discs, CD, or memory readers.
ZOOM
These images can be zoomed by optical or digital techniques. An
optical zoom magnifies the image by changing focal length of the
lens. It has advantage that it can focus the magnified image on
entire surface of CCD.
Digital zoom uses a small portion of photo sites on the CCD and
then uses interpolation technique to add details. This can be
achieved by blowing the image by computer software. A
technology developed recently is used in CR systems to enhance
the region of interest. These cameras record light values in digital
form, create images one can manipulate with computers, send the
images over phone lines or post them on Website. A webcam is
essentially a digital camera that takes pictures regularly and
transmits them directly to computer. One can program the
computer, to upload these images to a webpage as they are
transmitted. Depending upon frequency of the pictures Web
viewers will see the series of digital pictures as a moving object.
This technique is nowadays utilized in transmitting medical images
from one location to other to obtain second opinion and
teleconferencing.
The single chip camera may cost around Rs. 1 lakh, while as the 3
chip camera may cost around Rs. 5 lakh. Since we are using solid
state device the power requirement is very low as compared to

vacuum tube type.
Specifications: Image sensor : inch.; Pixels: 752 (H) 582 (V);
Automatic gain control; S/N ratio = >52 dB; Weight of camera
head = 70 gm; Classification: CF; Compliance standards: UL, CE,
IEC-601-2, CSA.
CAMERA CONTROL UNIT (Fig. 12.12)

The power supply and all controls that regulate the camera are
located in camera control unit. This assembly amplifies the video
signal, after pre-amplification in camera, regulates the focusing
and deflection coils and synchronizes the video signal between
the camera and monitor. The video signal produced in the camera
is fed to the control unit via coaxial cable. All the required voltages
and currents are fed from control unit to camera.
In the control unit synchronizing pulses are generated which
ensures synchronization of camera and monitor. The control
amplifier amplifies the low noise input circuit. Since the camera
tube represent high input impedance source, control amplifier has
high input impedance. Since the signal plate of camera tube is
scanned in the ratio 1:1, the round input image is fully within square
scanning raster. In order to avoid edge disturbances from those
part of signal plate outside the round image field, circular blanking
of the image field is carried out.
Automatic Gain Control

The picture signal supplied by camera (BAS or composite video
signal) is fed to the video amplifier in control unit. The circuit of
AGC picks up the control voltage actual value from the picture
signal in dominant time, compares with reference value and
produces the control voltage from the difference of these two
values.
Dark Current Compensation

Due to thermal agitation of charged carriers, current is generated
in non-illuminated condition of the photoconductive layer. This
current is known as dark current. Hence, the signal plate voltage
must be altered to prevent this dark current being exceeded.
Fig. 12.12: Block diagram of camera control unit
In Television Fluoroscopy the picture signal is also used as sample

value for Automatic Dose Rate Control (ADR) and hence this may
result in setting faulty dose rate. Therefore, dark current is sampled
during fluoroscopy intervals and compensation voltage is derived
from it. Compensation of dark current consists that a rise in
undesirable signal DC voltage caused by increased dark current is
countered by subsequent shift in operating point to low signal
potentials. When the camera tube is cut off during the horizontal
fly back time, a fixed dark current equivalent voltage is inserted
into blanking interval. This also ensures there is definite signal
level present during blanking interval.
Television Sync Generator

The requirement of exact positioning of the field line scanning raster
is rigid coupling of the horizontal and vertical sync pulses. These
pulses are generated by video pulse generator which produces all
pulses required for television system using clock generator and
counters.
For video mixing and superimposition, the BAS signals of the
individual camera and video recorder must be in synchronization
with one another. Exact synchronization is possible with voltage
controlled oscillator, controlled with saw tooth voltage. It regulates
the input clock frequency for the pulse generator, so that phase
relationship between the interval and external S signal always
remains the same.
MONITOR
The purpose of television monitor is to display radiographic image
in visual picture format with the help of synchronized signals
generated by television camera connected to monitor with coaxial
cable. The radiologist views more intensively than viewer in
broadcast TV. He also goes nearer to the television screen. Hence,
these monitors are installed on trolley or ceiling suspension. In the
large set up more than one monitor is used, one in the examination
room and other in specialist room or teaching hall. They are
connected in parallel. These monitors are furnished with automatic
brightness control to suit the ambient light.
Television monitors for this application are different as compared
to commercially available ones. They are with 17" diagonal Cathode
Ray Tube (CRT), having display screen in 4:3 (Horizontal : Vertical)

ratio. These monitors do not have channel selector and audio stage
and they are black and white type.
In television, the image is formed by scanning, resulting in linear
time based signal from television camera to the monitor. Image
dot is placed in relation to where it was picked up at the camera
image. In television, each individual point is transmitted
consequently one after other. Depending upon the line frequency
and bandwidth the number of points per image will be determined.
Construction and Design (Fig. 12.13)

Television monitor is an evacuated glass envelope in horn shape
having electron gun, deflection coils and anode. Electron gun serves
as source of electrons. At the aperture of electron gun, control grid
is fitted to limit number of electrons leaving the gun and is
controlled by composite video signal BAS. The BAS signal with
amplitude of 1 Vpp is fed to the 75 ohms coaxial socket of TV
monitor. Focusing coils located at the neck of tube form electron
beam leaving the gun into sharp scanning beam. Deflection coils
are located outside the tube. Synchronization pulse of video signal
synchronizes the electron beam deflection coils, thus they duplicate
the exact scanning raster of television pick up tube. A second anode,
at approximately 15 kV, is located inside the tube at the mouth
Fig. 12.13: Monochrome television monitor tube

and is provided with graphite coating and output phosphor. The

output phosphor gives maximum light with minimum lateral
scattering. It is faced with thin layer of aluminum which acts as a
reflector of light. The brightness of television monitor is increased
by anode voltage or gain of the system and contrast is increased
by increasing video input signal. Proper way to adjust these controls
is to adjust the contrast until background noise is just visible and
then turn down the brightness level until the dark part of the picture
becomes black.
The electron scanning beam hits the phosphor from left to right
and top to bottom as in case with television picture tube. This
scanning pattern is known as raster. As raster reaches lower portion
of the screen, electron beam is deflected back to the top of screen.
During this period, no signal is introduced resulting in no
illumination of the monitor. This is called blanking and the
movement of electron beam from bottom to top is called vertical
retrace while as movement of electron beam from the end of raster
line to the start of another line is called horizontal retrace
(Fig. 12.14).
This may cause flicker. In order to overcome flicker, a single picture
consisting of two half pictures is produced in 40 milli-seconds
synchronized by 50 Hz input, thus overcoming motion
discontinuity and flicker by presenting 50 half pictures per second.
Fig. 12.14: Typical scanning raster

The first half picture is composed of a raster scan starting from

upper left hand corner of screen ending at lower right hand corner
and second half picture is produced by having the next raster scan
placed between the lines of previous scan. Each half picture is called
television field. Combination of two television fields produce
complete picture and is called television frame. Process of placing
one raster line between two others is called interlacing and such
system is known as 2:1 interlace system. Number of such raster
lines per television frame is called line rate.
Example: 625 or 1249 lines per frame.
Vertical Resolution: In 625 line system, 625 lines are available per
television frame. Lines used for retracing are say 45 lines (7%)
makes 580 lines available for frame. Since interlace system is 2:1,
each television field is 290 lines. It should be noted that vertical
resolution increases with line rate and larger the size of monitor
less detail is prevailed because these lines are evenly spaced in the
size.
Horizontal Resolution: Bandwidth is the number of times event
can be cycled per unit time or number of times the scanning electron
beam can be turned off and on per second to produce image in its
true value from black to white. Bandwidth is related to horizontal
detail and hence, very important in X-ray TV systems. Mostly the
bandwidth is 5 MHz.
Hence, available line pairs for each raster line for 625 lines and 5
MHz bandwidth
= Bandwidth/(frames per second line per frame).
= 5000000/(25 625)
= 320
The aspect ratio of monitor is 4:3 and monitor size is specified by
its diagonal, the size of monitor should be selected in such a way
that the dimensions will be 5/3 of II input screen dimensions. In
that case the image size on the monitor will be same as that on
image intensifier input screen.
Example: The size of input screen of image intensifier is 9"
Hence, the monitor size should be 5/3 of 9" = 15"
Automatic Dose Rate Control (Fig. 12.15)

The absorption offered by object or anatomical structure is not
uniform. Let us take example of GI studies. The barium meal (radi-
opaque substance, patient is made to swallow), traces path starting
from mouth, esophagus, stomach, duodenal cap, intestines, colon.
At each stage, due to different density, absorption is different.
Hence, one has to alter parameters of X-ray energy given to X-ray
tube frequently to compensate variation in density, so that same
brightness level is maintained at output phosphor of image
intensifier. Hence, there is requirement of automatic dose rate
control, which automatically changes the dose rate as per
requirements. This can be achieved either by kV automatic or mA
automatic or pulse width variation (Time).
kV automatic: Voltage across X-ray tube is varied, based on
feedback received from comparator, keeping the tube current
constant. It offers wide dynamic range and maintains good contrast
throughout anatomical thickness provided adequate tube currents
and exposure times are maintained. This method of variation of
high tension primary voltage is simple and inexpensive.
mA automatic: In this system the tube voltage is kept constant and
tube current is varied as per inputs from comparator circuit.
Fig. 12.15: Block diagram for automatic dose regulator

This system is simple to operate and has low cost. But it has major
disadvantage of poor reaction time due to heating or cooling of
filament of tube. For patient with smaller structure, X-ray image is
noisy due to small mA requirement at high kV across tube. Hence,
this technique is not used for cineangiography due to its low
response time.
Pulse width automatic system: This system controls the exposure
time and is used in pulsed fluoroscopy using video disc or electronic
video storage system. In this system both kV and mA are kept
constant and are pre-selected prior to viewing or recording and
pulse width is varied as per requirement of comparator circuit.
This system offers minimum exposure time for fixed ideal kV and
high constant mA resulting in reduction in motion unsharpness.
This technique is widely used in applications with cine and photo
camera especially with secondary switching. This system is costly,
complex and more service breakdowns are noticed if not
maintained properly.
Combined System
It primarily controls mA till maximum permissible mA is reached
and then kV is automatically increased to maintain desired
brightness of image. This is called milli amperage automatic
system with kilo voltage override.
Figure 12.16, indicates that screen brightness with image intensifier
TV link is multifold as compared to that with conventional
fluoroscopy with fluorescent screen for the same dose rate.
Example: For dose rate at 100 micro roentgens per second the
brightness achieved with image intensifier TV chain is 10 cd per
sq m while as at the same dose rate it, is 0.007 cd per sq m with
conventional fluorescent screen.
The Figure 12.17, indicate that resolution is three fold for image
intensifier vidicon tube as against conventional fluoroscopy. In
order to get same resolution with conventional fluoroscopy with
fluorescent screen one has to give very large amount of radiation
dose.
RECORDING
While performing fluoroscopy with image intensifier, one
visualizes the event, but if permanent records are required to be
Fig. 12.16: Luminous density of X-ray fluorescent screens with image

intensifier and TV monitor screen as a function of dose rate
Fig. 12.17: Resolving power of image intensifier TV system (Vidicon)

together with resolving power of conventional fluoroscopy
handed over to patient as means of documentation, recording

devices such as spot film device or photo spot camera or cine camera
or video cassette recorder are used.
Spot Film Device (SFD)

The spot film device incorporates the fluorescent screen or image
intensifier. We have seen relative advantages such as less amount
of radiation and better resolution with image intensifier TV chain.
Recording cassette is loaded with unexposed film and parked in
the radiation proof area. This device forms an image plane and
interposed between patient and observer. It carries its name spot
film device from its function of exposing film during fluoroscopic
examination at that spot when the radiologist requires permanent
record of findings on X-ray film. During this procedure, the cassette
from parked position is brought to radiation area and exposed to
desired parameters to get good radiograph. The cassette transport
from its parked position to exposure area could be manual or motor
operated (automatic). The automatic has additional feature of
selection of program with cassette subdivision of 1:1, 2:1, 4:1. Pause
time is required for series exposures between each exposure or
frame, to enable to shift the cassette to the desired position and
collimating X-ray beam accordingly.
During fluoroscopy, the transparency of patient is determined and
X-ray tube is energized with desired kV at tube current of
approximately 3 mA. This operation is conducted with dual foci
tube on small focus to get minimum geometric blurring. During
radiography, the tube current is of the order of 300 mA. Hence,
filament is boosted to desired temperature which requires almost
1 second to reach stable temperature, to get desired constant
radiographic current also during this delay time of 1 second, anode
acquires desired speed. Hence, the recording is made after 1 second.
Moreover if the radiographic exposure requirements does not
satisfy the small focus ratings, large focus is selected, thus shifting
the focal track in case of Biangulix tube, which may give different
image than that in fluoroscopy.
However, the advantage of direct film radiography is that recording is
limited only by resolving power and loading capacity of X-ray tube,
geometry, film and intensifying screen characteristics. The resolution
achieved with this technique is around 4 line pairs per mm. But
the disadvantages are as follows:
(I) Due to time delay of 1 second, event recorded on film is an
event that occurred after last event during fluoroscopy
1 second earlier.
(II) Bringing of cassette in radiographic area at high speed will
introduce vibrations in SFD and affect the image resolution,
if these vibrations are not reduced either by appropriate
cushioning effect or larger time delay.
(III) Cost: Since the SFD is considered conventional technology
with cassette movement, the relative cost is much lesser
against spot film camera. But due to constant wear and tear
of moving parts, SFD requires frequent maintenance and is
failure prone. Hence, strict preventive maintenance schedules
have to be observed from date of installation failing which
the end user has to pay heavy repair charges. There is a need
of replacement of cassettes and intensifying screens due to
their continuous use and subsequent damages due to
mishandling. They have average life span of two years after
which the intensifying screens fade and give lesser light
output. The replacement cost of intensifying screen is very
high. Moreover the running cost of films used in SFD is very
high, as compared to those in photo camera. Hence, if we
calculate the costs for a period of seven years, it will be seen
that the photo cameras are much economical as compared to
SFD. With the introduction of Automatic Dose Control, one
can expose the patient to much lesser degree as compared
with exposures from SFD. However, due to initial cost of
investment being low and the workload also low, SFD is
acceptable in smaller hospitals such as district hospitals and
teaching institutions. Another reason for its acceptance is the
technology is simple and hence appreciated by end user.
Photo Spot Cameras

Since the introduction of image intensifier with parallel beam,
optical coupling between image intensifier and video camera using
tandem optics and light distributor, the use of photo spot camera
and cine camera has become very common. Due to the introduction
of light distributor, only 10 to 20% of light is passed on to the video

camera and rest of the light is reflected towards photo camera or
cine camera depending upon position of reflector used in light
distributor or beam splitter. This light is used to expose film loaded
in respective camera (Fig. 12.8).
Beam splitter takes position automatically after recording mode is
selected as spot filming with photo camera or cine camera. At the
same time, radiation output is increased to expose respective film
for desired level of blackening. An iris diaphragm is simultaneously
placed in front of television camera to control desired light input
for television camera. Normally radiation dose required for photo
camera is around 100 R per frame and for Cine camera is 20 R
per frame.
Photo camera uses either cut film or roll film with format of 70,
100 or 105 mm. Since these cameras record light available from
output phosphor of image intensifier, the resolution is function of
resolving capability of image intensifier and optical system used.
Since recording is obtained from output phosphor screen of Image
intensifier, simultaneous viewing is possible. But single photo shot
event cannot be observed due to shorter exposure time of 50 milli-
seconds or less. Since the exposure time is shorter the dynamic
blurring is small as compared to exposure with SFD. These cameras
are cassette less, the frame speed can be increased up to 12 frames
per second without loosing the event during dynamic studies of
GI track. The radiation exposure is considerably reduced due to
introduction of automatic dose control. This also eliminates chances
of repeat exposures as in case of SFD.
The overall weight of spot film camera is around 7 kg in addition
to the weight of image intensifier and light distributor. When this
system replaces the conventional fluoroscopic screen with lead
glass protection, there is overall increase in weight of 25 kg.
Additional ceiling suspended counterpoise is required to cater for
this increase in weight so that the tower of spot film device or
exploratory frame does not sag or get damaged.
Cine Camera
Cine camera records light from output screen of image intensifier
through beam splitter (Fig. 12.8). The radiation is triggered with
shutter open phase of cine camera. Radiation exposure is increased

from fluoroscopy to cine mode to achieve desired blackening on
film loaded in cine camera depending on film rate during filming
the event. Beam splitter allows simultaneous viewing and recording
without loosing event.
Cine camera is phase locked, providing synchronization of
television and cine systems. Since camera shutters open almost
40% of time of film cycle, they are controlled by motor which
operates at line frequency (50 Hz) power supply and synchronized
to the 25 frames per second video. Hence cine film rates are 12.5, 25,
50, 75, 100, 125 and so on using 16 mm or 35 mm film. During
early days the cine film was exposed from continuous X-ray
radiation irrespective of whether the shutter is open or closed
subjecting the patient to very high radiation dose and gathering or
collecting information was possible during shutter open phase only.
Now-a-days modern systems utilize pulse X-ray beam
synchronized with shutter open phase produced by secondary
switching X-ray generators.
Radiation obtained is not as good as direct radiography, due to
use of image intensifier and optical system. But radiation exposure
per frame is much lesser than direct radiography and information
received with good image quality is improved, due to
characteristics of human eye during projection of cine film at high
film rates. For recording with cine camera following events should
take place.
(a) Beam splitter should be in place for cine mode recording.
(b) Increase in radiation level to 20 R per frame by boosting of
filament and picking up speed of anode for rotation.
(c) Change in focal spot if required for cine loading (Reduction in
dynamic blurring)
(d) Cine camera to pick up desired speed. Time required is of the
order of 1 second.
Due to advantages such as higher resolution and more information
can be recorded, a 35 mm film is preferred over 16 mm.
For cine mode, we also require automatic cine film processor and
film projector. Strict quality control is required using film
processing. For details one has to follow instruction given by the
manufacturer of cine films and processing unit. As regards film
processing similar care should be taken as described in Chapter 10.
Video Recording
This is achieved by video tape recorder.
It is also known as magnetic picture recording and is a counterpart of
audio tape recording. Video signals are stored in magnetic tape
along its length. The tape consists of plastic base material coated
with magnetic oxide. It is fed past recording head, video signals
are stored in magnetized oxide particles. Playback is possible
without any development or processing.
The common problems associated with this device are:
1. Accumulation of oxide coat on magnetic head from video tape
2. Slippage of drive belt.
Advantages: Video signal is easily available for viewing. Simulta-
neous video and cine recordings are possible. With the help of video
recording one can immediately assess the usefulness of recorded
event. The output of television camera is ideally suited for this
device. During recording, the boosting of required radiation over
normal frequency, providing better quality video tape recording
without noise.
Earlier Developments:
(A) In 1898 Paulsen developed Telegraph-phone for recording
telegraphic messages and later speech on thin steel wire as
magnetic media.
(B) In 1930 M/s AEG developed Magneto phone using iron
oxide powder as storage material applied to base consisting
paper or plastic.
(C) In 1953 M/s RCA developed video tape recorder at a speed of
6 m/sec longitudinal recording with fixed recording/
reproducing head. It was not found suitable due to its high
speed.
(D) In 1956 Ampex introduced a model, which recorded signals

transversely at speed of 38 cm/sec. It had 4 recording and 4
reproducing heads positioned at 90 degrees around rotating
disc. It offered good picture quality and tape speed similar to
audio tape recorder. It was also suitable for color picture
recording on television.
(E) In 1959 Toshiba introduced a recorder with tape speed of

19 cm/sec and oblique recording on a helically guided tape
by means of single recording head.
Description of Ampex System

Video input received by FM modulator which modulates at carrier
frequency of 50 MHz. A picture of 64 microseconds duration is
recorded on track length of 2.4 mm at a speed of 38 cm/sec. Tracks
are 0.25 mm wide, 0.131 mm apart. Complete 625 line picture is
recorded on 15.2 mm length of 50.8 mm wide tape. At a speed of
250 revolutions per second, tape travels at a speed of 4 0.381
250 = 381 cm/sec.
Reproduction and recording was performed by same head, which
converts magnetic recording into frequency modulated signal
voltages. These after conversion to 50MHz and demodulated to
produce video signal at video output. The four recording heads
are consecutively connected to demodulator, in order to obviate
the overlaps between the individual heads during recording. For
reproduction the head and tape must be synchronized with
accuracy of 0.1 microsecond. Hence, tape speed must be controlled
by means of control frequency corresponding to the actual
recording head speed and recorded on tape along with picture.
The speed of rotation of heads is controlled by frame synchronizing
impulse of the video signal. The reproduction of color video signals
calls for higher accuracy of 100 times more than monochrome.
Audio signal is recorded on 1 mm wide track at the edge of the tape.
CONSTRUCTION AND DESIGN OF VCR

Since the recording and reproducing (playback) may last for more
than one hour, the tape length should be very large. In order to
achieve same performance in shorter length, the tape heads are
designed to move along with tape; two or four tape heads ride on
rotating drum. This drum is tilted at an angle in relation with the
tape so that the drum moves along the tape diagonally. Each tape
head records or plays one diagonal band on every pass. The helical
scanning system allows the VCR to fit in more information on
length of tape and tape can move at reasonable speed past recording
heads.
Basic requirements of VCR are as follows:
VCR has to wrap up video tape against the rotating head, when
it plays or records.
VCR needs to read and encode linear audio and control tracks
on the same tape.
VCR should move the tape at right speed and it should detect
the end of the tape.
While recording VCR should move the tape past erase head to
get rid of previously recorded data.
Tape Movement
When tape is inserted in VCR, pin releases and opens plastic guard
located at bottom of cassette so that tape is exposed. VCR also inserts
pin into cassette to unlock the spools. Two movable arms pull the
tape out of cassette to fit it around rotating drum as well as other
heads and rollers that tape must pass. The pinch roller and inertia
roller press the tape into audio head, the control head and erase
head. The tape is also spooled between small light and light sensor.
Since the beginning and end part of tape are clear without any
magnetic material, VCR senses from light reflected from shining
surface of the tape and stops tape movement.
The control track indicates to VCR, the recording of mode such as
Standard Play (SP), Long Play (LP) or Extended Play (EP) and gets
tape head to line up with diagonal tracks correctly. It also ensures
the speed of the tape. Due to its continuous usage there is a
possibility that tape is stretched. In that case VCR may have to
increase its speed for correct video playing. The movement of
recording head and magnetic tape requires exact adjustment for
maintaining synchronization during replay. The resolution of
player depends on quality of magnetic tape and gap in recording
head. For higher bandwidth of video signal, smaller should be the
gap in recording/play head and smaller should be crystals in
magnetic tape. Precautions should be taken while cleaning the head

in order that damage is avoided. If the gap is widened, there will
be loss of video signal during replay.
DVD PLAYERS
DVD is a short form of Digital Video Discs. They include following:
(a) Up to 133 minutes of high resolution video in letter-box or PAN-
SCAN format with 720 dots resolution; Video compression ratio
of 40:1 using Moving Picture Experts Group (MPEG)
compression.
(b) Soundtrack using 5:1 channel Dolby Digital Sound.
DVD can store 7 times more data than CD because pits and tracks
are much smaller in size. DVD format does not waste space on
error correction.
Multi-Layer Storage
DVD can have maximum 4 layers, two on each side. The laser beam
can focus on desired layer through the earlier layer. However, the
capacity of disc does not increase with number of layers because
then the pits are little longer on both layers than in single layer.
This enable to suppress interference.
Normally DVD is 1.2 mm thick. In order to focus separately on the
first or second layer, the first layer uses semitransparent gold
coating and the second layer uses opaque aluminum mirror. The
laser beam can focus on gold layer or it can pass through gold
layer and focus on aluminum layer. Each layer is injection molded
plastic impressed with billions of tiny bumps. Layer of gold or
aluminum is sprayed on to the bumps to create the reflective
coating. After all these layers are made, they are coated with
lacquer, squeezed together and the disc is cured under infrared
light. Labeling is done on non-readable area. Each layer has spiral
track. Track circles from inside to outside of disc. The elongated
bumps are 320 nm wide, 400 nm long, 120 nm high; separation of
track is 740 nm.
Recording on DVD is done with 24 frames per second speed. MPEG
encoder creates the compressed file, analyses each frame and
encodes. Each frame can be encoded in three ways as follows:
(a) Intraframe: It contains complete data for that frame. Encoding

provides least compression.
(b) Predicted frame: Frame contains only the data that relates to how
the picture has changed from previous frame.
(c) Bidirectional frame: DVD player needs information from
surrounding intraframe and predicted frames. Using this data
from closest surrounding frames, using interpolation technique,
player can calculate the position and color of each pixel. Encoder
decides which type of frame to use depending up on type of
scene to be converted.
Example 1: Newscast: Lot more predicted frames could be used
because most scene is unaltered from frame to frame.
Example 2: Dynamic studies: Changes take place rapidly from frame
to frame. Hence, more intraframes have to be encoded. This
requires larger size as compared to newscast.
Construction of DVD Player

Its job is to find and read the data stored in bumps of DVD. The
drive consists of 3 major components namely, drive motor Laser
and lens system and tracking mechanism.
(I) Drive motor assembly: It spins the disc, controlled to rotate
between 200 and 500 rpm depending upon which track is
read.
(II) Laser and lens system: It focuses on the bumps and read them
with light at 640 nm.
(III) Tracking mechanism: It moves the laser assembly so that laser
beam can follow spiral track. Tracking system moves laser in
micron resolution. The DVD players can focus either on
semitransparent reflective material or in case of double layer
disc, through the layer on to reflective material behind the
inner layer. The laser beam passes through poly carbonate
layer, bounces of the reflective layer, hits opto-electronic
device which detects changes in light. Such as changes in
reflectivity of flat areas of disc and bumps. The electronic
circuitry interpret these changes in reflectivity to read the
information in bits. The most sensitive part is Tracking system
which enables laser beam centered on the track. It moves
Laser beam continuously outwards from center of disc and
bumps move past the laser at increasing speed. As the laser

move outwards, the spindle motor slows down so that data
is read at constant rate.
Upgradation of System
Due to economic considerations the end user may buy a simple
R/F equipment with SFD. Later the end user would prefer to
upgrade the system to image intensifier television system. This is
also known as retrofitting. Manufacturers offer retrofit package,
to incorporate this change. In case if only the image intensifier needs
to be changed to the recent model, depending on the technology
involved the circuitry need to be changed along with mechanical
modifications.
Angiography Techniques and Systems 217
Angiography
13 Techniques and Systems
Angiography is visualization of blood vessels by injecting positive

contrast medium into bloodstream. The word Angio is a Greek
word means blood flow and graphy is to plot the flow. Hence
angiography is a measure of blood flow. Since blood is radio
transparent, it offers minimum absorption to X-ray radiation (like
pure water offering minimum absorption to light). In order to
visualize the flow of blood, contrast medium is added as impurity
so that blood becomes radiopaque (like color added to pure water
to determine flow of water in glass tube). Thus angiography is
representation of blood vessels by injection of contrast medium,
while observing flow of blood by capturing the blood circulation
of contrast medium on film.
It is, therefore, necessary to take series of exposures depending on
organ under study and flow rate of contrast medium. For this
purpose there are rapid film changers such as AOT (Angiography
table) or PUCK cut film changers. They can expose at the rate of 2
to 6 exposures per second with 10 12 or 14 14 cut films. In
addition to direct radiography procedures, indirect radiography
procedures using photo camera can be adapted, using photo
camera taking up to 6 exposures per second with 70 mm roll film
or 100 mm cut films. For higher image frequencies cine camera is
used. There are two types of cine cameras manufactured by M/S
Aritechno both using 35 mm film namely, 90/35 R using 90 frames
per second and 150/35R using 150 frames per second. The
requirement of radiation dose per frame of these indirect
procedures, as compared to direct radiography, is very small and
image quality using latest Image Intensifier and optical system is
far superior. Since we require total dose for all frames (complete
procedure) larger than direct radiography, such systems are

matched with high power X-ray generators using 6 or 12 pulse or
DC waveforms. These systems are classified into following areas:
Peripheral angiography: Visualization of arteries and veins of
limbs.
Cerebral angiography: Visualization of arteries and veins of brain.
Cardioangiography: Cardioangiography is performed in CATH
LAB, a laboratory where heart catheterization is performed by
inserting catheter in blood vessel in the arm or leg of patient
under local anesthesia and visualization of heart cavities, and
blood vessels near the heart.
Renal angiography: Visualization of arteries and veins of kidney.
Brachial angiography: Visualization of arteries into brachial
artery.
Cholangiography: Visualization of bile ducts after intravenous
injection of a positive contrast medium excreted through liver,
or following evacuation of the gallbladder filled with contrast
medium.
Contrast medium is a substance having higher (positive contrast)
atomic number than surrounding body tissue. It is used to
distinguish difference in absorption and hence organs which are
radio transparent can be clearly seen on film after exposing to
X-ray radiation. Barium sulfate based substance is used for
visualizing the GI track and iodine base for blood vessels.
According to classifications or requirements as explained above, the
examination unit must also be suitable for that application. A system
designed for one application may not be suitable for other and hence we
require dedicated systems for such applications.
For example: For peripheral angiography we require, floating table
with motorized movement of the table top (up to 4 steps), film
changer upto 3 exposures per second and high power X-ray
generator 50 KW with rotating anode-type X-ray tube, mounted
on ceiling suspended stand so that full utilization of floor space is
achieved (Table 13.1).
Table 13.1: Film rate
Anatomical area Object motion Recording method

Head of the neck 5-30 mm/sec Cut film changer 2-3 FPS
Thorax/Coronary 50 mm/sec Cut film changer or photo
spot 2-3 FPS
Thorax/Valves 200-500 mm/sec Cine radiography up to 100 FPS
Extremities 1 mm/sec Cut film changer programmable
table top up to 4 steps
(Peripheral angiography table
PAG4) up to 1 FPS
Hence, the object motion produced by individual organ determine the

examination procedure and recording event.
Due to this special application, such set up will be unsuitable for
cardioangiography. There are two major problems encountered
during angiography procedures.
1. Magnification
In order to minimize magnification, image plane should be as close
to the object as possible. But as we had seen scattered radiation
plays important role in image quality and in order to filter out the
scattered radiation the use of grid is mandatory. This increases the
object film distance leading to certain amount of magnification.
However, one can locate the cut film changer or image intensifier
as close to the object as possible permitted by engineering
mechanical design of system. In case of peripheral angiography the
cut film changer is kept below the table at a minimum distance
from lower end of table top and in case of cerebral angiography, the
cut film changer is kept close to skull area with X-ray tube as over
couch. While as in cardioangiography the image intensifier is almost
touching the chest of patient in over couch position and X-ray tube
is under couch. The image intensifier is moved in circular motion
forming an arc and away from patient with linear movement in
order to get different projections such as LAO (left anterior oblique),
RAO (right anterior oblique), the focus table top distance is
approximately 70 cm. Table top is manufactured with very thin 2

mm thick carbon reinforced plastic material which is in the form
of tray so that patient cannot fall down and it offers minimum
attenuation to X-ray beam. The table can be lowered or moved up
depending on requirements of end user. In order to have more
working space, the table is ceiling suspended. The image Intensifier
and X-ray tube are mounted diametrically opposite to each other
on C arm and the patient table is positioned at isocenter of C arm.
The C arm can be moved in arc of circle (radially), transversely
and up/down to obtain most convenient position so that
magnification is minimum.
2. Motion Caused by Vascular Pulsations

There are three types of motions which should be considered while
imaging patients blood flow namely, (a) Respiratory (b) Peristaltic
(c) Vascular. Respiratory is of little concern because patient can
hold the breathing and exposure time is very short. Peristaltic
motion is slower than vascular motion and if we take care of vascular
motion automatically peristaltic motion will be taken care off.
The equipments used for recording these events within the
specified anatomical areas should have different capabilities such
as geometry, filming rates, etc. and hence are with different
mechanical designs. But one should understand that object motion
parameter is not exposure time. For example, in peripheral
angiography the object motion is 1 mm/sec, if we set exposure
time as 1 second then we will loose the event because contrast
medium will not be seen by the time exposure is over. It is, therefore,
important that exposure time should be considerably reduced to
capture the event of contrast medium flow in the region of interest.
Acceptable exposure times are 100 to 200 milliseconds for cranial
area, 20 milliseconds for pulmonary artery, 3 to 6 milliseconds for
coronary artery, 1 to 2 milliseconds for valve studies and 50 to
80 milliseconds for abdomen. Needless to say, if greater details are
desired, shorter exposure times are required (Table 13.2).
Table 13.2: Exposure times required for various degrees of motion
Organ Motion Exposure time to limit Optimal

motion to 1 mm
Head and neck 1-5 mm/s 1000 ms 50 to 100 ms
Heart 100 mm/s 10 ms 3 to 7 ms
Lungs 100 mm/s 10 ms 20 ms
Heart valves 500 mm/s 2 ms 1 to 2 ms
Abdomen 50 mm/s 20 ms 50 to 80 ms
Extremities 1 mm/s 1000 ms 50 ms
Exposure Requirements
We notice that the requirement of exposure will vary depending
on the recording system used, object motion, type of intensifying
screen used with cut film changer, type of lens (focal length) used
in optical system of tandem optics, and image intensifier mode
(9, 6, 4.5 or Zoom). In case of cine camera we refer to exposure
per frame. It is observed that less radiation exposure and shorter
exposure times are required for exposures made with image
intensifier system. Although the resolution is inferior with image
intensifier system as compared to film changers, the loss of
resolution is compensated by advantage of shorter exposure time
to overcome dynamic blurring.
For example: Cut film changer at 6 exposures per second, radiation
dose requirement is 800 R for calcium tungstate screen, 400 R
for rare earth relative speed 2 screen and 200 R for rare earth
relative speed 4 screen.
9 6 4.5 image intensifier
Photo spot camera f = 11 f = 8 lens opening
For 9 100 R 50 R
For 6 220 R 120 R
For 4.5 500 R 250 R
35 mm cine camera with f = 4 lens opening
For 9 13 R
For 6 30 R
For 4.5 50 R
X-ray Generator Requirements

Depending upon source (focus) object distance and anatomical
object structure, the power of X-ray tube and focal spot dimensions
are determined. We have discussed importance of object motion

and exposure times to get detailed angiograms. The X-ray generator
should be capable to deliver required power to get desired film
density. It should also match these requirements with X-ray tube
ratings, especially for smaller focal spot to overcome geometrical
unsharpness and magnification. In case of larger focal spot higher
power output can be obtained. Hence depending upon the organ
under examination, select the focal spot of tube.
For example: The abdominal procedures with photo camera large
focal spot and higher KW ratings is desired to cover thicker
anatomy.
Equipment Requirements
The equipment should be so designed that it facilitates the operator
to fully control the procedure with easy access to all control
parameters and adjustments, so that operator can concentrate
towards patient. This is extremely important because angiography
procedure is performed with incision given to patient. We have
discussed the angiography applications for peripheral, cerebral and
cardioangiography and how they differ. If an equipment is
designed for all these applications, it will be so complicated and
turn out to be very big and costly. Moreover due to sensitive nature
of the procedure for cardioangiography, this equipment requires
special installation in CATH LAB, which can be treated as an
operation theater. Hence, there are two types of equipment designs
available commercially in the market namely, for universal
angiography (Fig. 13.1) and cardioangiography.
Universal Angiography Equipment

This installation incorporates basic conventional standard
components for universal angiography to carry out routine
angiographic examinations. The X-ray generator requirements are
40 to 125 kV for radiography, 40 to 110 kV for fluoroscopy, 100 KW,
1000 mA, 12 pulse or DC generator (Fig. 13.1).
PAG4 (Fig. 13.2)

As an extension to the same universal angiography, a specialized
equipment for peripheral angiography was introduced having
concept of table top movement in four steps and is known as PAG4.
Fig. 13.1: Universal angiography equipment
(Peripheral angiography with 4 positions) with automatic kV

reduction for compensation of thickness. Hence, the feedback from
table position is given to the X-ray generator, to reduce kV to cater
for reduction in thickness of patients leg. This can be programmed.
In this system both X-ray tube and recording equipment (film

changer) are held stationary and only the X-ray table top, on which
the patient is lying, is made to move at a regular speed (shift able
table top), so that the flow of radiopaque contrast medium in
patients leg can be recorded on film changer (Fig. 13.2).
Fig. 13.2: Combined angiography of abdomen and both legs with puck
film change and telescopic table with additional facility of automatic
shifting of table top
Cardioangiography (Fig. 13.3)

This equipment is designed to operate on C arm principle. X-ray
tube is mounted on one side of the C arm and on the other side of
C arm, the image intensifier is mounted diametrically opposite to
tube. The X-ray tube is normally in under couch position so that
1. C-Arm, 2. X-ray tube, 3. Image intensifier, 4. Light distributor with video camera,
5. Cine camera, 6. Floor to ceiling column stand incorporating C-Arm, 7. Collimator,
8. Patient table, 9. Carbon reinforced plastic table top with linear movement.
Fig. 13.3: Single plane cardioangiography set up

the scattered radiation from floor is minimal. The image intensifier

can be moved away or nearer to the patient in linear direction, so
as to accommodate different size of patients. The C arm is moved
radially as well as up and down, so that this rotational benefit of
this configuration together with craniocaudal positioning of X-ray
tube and image intensifier can be utilized to perform most of
angiography examination.
The X-ray generator requirements are as follows:
40 to 125 kV for radiography, 40 to 110 kV for fluoroscopy,
70 KW, 700 to 800 mA, DC generator with fine focal spot, rapid
X-ray tube (Table 13.3).
Table 13.3: Selection of X-ray generator with anatomical area
Anatomical KW Focal Recording System

Area power Spot Size
Head and neck 100 1.2 Screen film changer
Thorax 150 1.8 Screen film changer
Thorax 100 1.2 Screen film changer
Thorax 30-70 0.6 Cine camera
Thorax 14-20 0.3 Photo camera
Abdomen 150 1.8 Screen film changer or
photo camera
photo camera
photo camera
Extremities 100 1.2 Screen film changer
Extremities 30 0.6 Screen film changer
Serial Film Changer

Serial film changer is a device which transports film from stored
area to exposure area and after exposure is over, it is transported
to another area where the exposed films are stored. Both these
stored areas for unexposed and exposed films are kept radiation
proof and only the exposure area is radiotransparent
(Figs 13.1 and 13.2).
Film cycle denotes the time taken for the film to be picked up from
unexposed film cassette, brought to the exposed area, pressing of
the pressure plates, actual exposure, releasing of pressure from
pressure plates, and finally transportation of the film to the exposed

cassette. Both unexposed and exposed cassettes have capacity to
store several films available in desired format. The speed at which
the film is transported is determined by exposure rate (number of
exposures per second or FPS). The higher the exposure rate, faster
is film transport speed and hence the exposure time is lower.
When this technique was initially introduced, the cassettes were
loaded manually, which resulted in radiation hazards to the
operator. Later this technique was modified with motorized
transport mechanism. Cassette type of devices have slower
exposure rate due to weight of cassette and increasing speed
beyond 4 FPS required special design for dampening the vibrations.
This system was also very costly.
Cassette less type film changers, as shown in Figs 13.1 and 13.2,
transfer film either in roll film or cut film. Due to reduced weight
of film, film transport is faster without vibrations resulting in
achievement of faster rate.
The exposure area is specially designed so that when unexposed
film reaches exposure area from storage area of unexposed films,
the pressure plates close down. These pressure plates are glued
with intensifying screens to achieve reduction in exposure time.
The intensifying screen facing the X-ray tube is having lesser
thickness as compared to the intensifying screen glued to pressure
plate which is away from X-ray tube. These intensifying screens
are with antistatic coating to remove electric charge caused by
friction and for easier entry of film and passage of air during
compression movement of pressure plate, intensifying screens are
curved at the edges. If air is captured, when pressure plates are
closed, air will get ionized causing inferior quality radiograph.
If the humidity is high, cut films unless loaded directly from original
package, curl. Such curled films can cause havoc in cut film changer.
Hence cut films should not be stored in film changer, if films are
not required to be exposed immediately. Jamming of such curled
films result in film salad due to very fast movement of transport
mechanism. When pressure plates close, the micro switch is
activated and through the contacts of micro switch the X-ray
generator is triggered for desired exposure. At the end of exposure
time, the pressure plates are opened up allowing the film to be
transported to receiving cassette in unexposed storage area.
Comparison of Roll Film and Cut Film

Roll film transport systems do not require the complicated
mechanism for film transport. Cut films must be loaded in dark
room while as roll film can be loaded in daylight since they are
supplied in cartridges. These roll films are numbered to enable
serial viewing of the event without sorting and arranging of films
in proper sequence as in case with cut films.
In case of cut films, they can be filed separately as per examination
or patients data which is not possible in case of roll films. Also in
order to achieve this feature, film has to be cut in dark room.
Processing of exposed film is much easy with cut films as compared
to roll films. For roll films automatic processors are required.
Moreover when angiography procedure requires less number of
films, it is desired to use cut films than roll films.
Commercially available cut film changers are AOT (Angiography
Table) and PUCK. When these film changers are used for peripheral
angiography, with floor space at premium, advantage of large film
changer AOT was waived in favor of smaller film changer PUCK.
The major applications are cerebral, peripheral angiography,
aortography for film changers.
Exposure Time and Film Cycle

The minimum radiographic exposure time in angiography is
dependant on X-ray generator capacity, loading capacity of X-ray
tube. The operating time of cassette less film changer is very small,
it allows larger exposure times. The total film cycle is decided by
the desired exposure rate. The total cycle time is the time available
for the film to be transported, intensifying screens open and close,
film stationary time in exposure area when film is parked during
the actual exposure.
For example: For exposure rate 5 frames per second the film cycle
time will be 200 milliseconds. Film transport time is the time during
which the screens are opened, film is brought in the exposure area
and at the same time already exposed film from previous exposure
is removed from exposure area, and screens are compressed.
Generally this time is 60% of total film cycle. In our example it will
be 120 milliseconds, leaving remaining 40% (80 milliseconds) for
film stationary time. Hence, time available for exposure depends
on how long the film is kept stationary and exposure rate.
Film stationary time: During this period, one must take into
consideration the inherent time delays of film changer to X-ray
generator interface and phase in time required for X-ray generator
depending on type of timer used in X-ray generator.
Definitions
Zero time: Interval between electrical command from the film
changer to start of exposure by triggering timer.
Phase in time: Time required for actual start of radiation from time
of triggering of exposure, also known as interrogation time. Both
zero time for film changer and phase-in time for X-ray generator
are fixed, once we choose the device. Hence, the actual maximum
time available for exposure can be determined for particular film
rate. In the example of 5 FPS each film cycle time is 200 ms. The
film stationary time is 40% or 80 ms and if zero time and phase-in
time is around 30 ms, the exposure time will be 50 ms.
Referring to angiographic ratings of X-ray tube focal spot used,
one can determine whether this exposure time is sufficient or not.
If required the exposure rate should be changed. This is called
maximum permissible exposure time (Fig. 13.4).
Angiographic Injectors
Since we are imaging vital organs such as heart or brain, it is very
important that we take all safety precautions while giving contrast
Fig. 13.4: Film cycle

media injection to the patient. Easier and reliable methods of

injecting should be adapted.
Injectors devised earlier were volume controlled. They delivered a
pre-selected amount of contrast medium at a pre-selected pressure.
The time of injection was dependant of viscosity of contrast
medium, length and inside diameter of catheter and pressure.
Sometimes the injection pressure required for proper bolus was
beyond the limits of injector. Due to these problems, insufficient
opacification was noticed and many times the procedure had to be
repeated, resulting in discomfort and unnecessary radiation
exposure to patient and additional contrast medium injection.
New injectors have improvised with more safety features, desired
controls for setting parameters, programming the parameters,
uniform delivery of contrast medium and user friendly controls
on panel. There are two methods for controlling basic three
parameters namely, volume, pressure and time. The first method
is known as Pressure controlled injection and second type is called
flow rate injection.
Pressure Controlled Injection

In this method both pressure applied to syringe and delivered
volume of contrast medium are involved with duration of injection.
Duration of injection can be known if catheter parameters such as
diameter and length as well as viscosity of contrast medium are
known. But these injectors pose problem that they are not able to
deliver contrast medium of desired volume to achieve proper bolus
of contrast media within specified time.
Flow Rate Injection

It gives contrast delivery rate per unit time irrespective of viscosity,
catheter length and inside diameter. Actual flow rate is monitored
and pressure is kept constant.
Design Aspects
Each injector basically consists of following components:
1. Electromechanical motor driven screw.
2. Controls for parameter settings.
3. Safety device.
4. Mobile stand.
1. Electromechanical motor driven screw: It is the main part of the
injector which transforms electrical energy into mechanical energy
by pushing or pulling the plunger of an injection syringe to achieve
injection of contrast media into patients blood stream.
2. Controls for parameter settings: Operators control panel is designed
to operate switches for start, stop, forward, reverse, fill, etc. as well
as motor speed selection to determine pressure, volume per second
and rate rise.
3. Safety devices: It includes following:
(a) Automatic circuitry to detect the rate of injection by sensing
speed of motor and comparing pressure and volume per second
set by operator. It terminates the injection and malfunctioning is
indicated on panel.
(b) Electrical safety: Syringe are electrically isolated to protect
against electrical shock hazards. Since the patient is undergoing
angiography, electrical devices such as ECG leads are connected
to patients body and are sometimes inserted near the heart or in
the heart. This may cause fibrillation. The leakage currents should
not exceed 10 mA for electrically sensitive patients. A grounding
connection in wall receptacle are found to be at different potential
with respect to other which cannot be accepted in cardiac applic-
ations where patient is subjected to angiographic examination. A
grounding system that allows all equipments in examination room
to the same potential is called equipotential ground. This is
recommended as an additional ground network. The power
distribution system in special angiography room should have
separate grounding lead that is separate from conventional
grounding. This special ground lead is connected to structural
grounding. Neutral lead which is current carrying conductor
should not be used as grounding conductor. Neutral lead should
not be grounded in room and should not be connected to
equipment. As per electricity rules separate non-current carrying
conductor should always be used to connect equipment to ground.
It should have higher cross section than main current carrying
conductors.
4. Mobile stand: This provides features like raising or lowering height

of injectors. The injector is mounted on stand with electrically
conductive wheels.
Other important Features

In case the contrast medium requires different temperatures than
that of patient, then syringe heater is required. Injection trigger
control provided on panel of equipment is dead man type. Injection
will be given to the patient as long as inject button is pressed and
held. By removing the pressure on injection button, injection can
be stopped. This feature is essential in case of malfunctioning of
equipment or motion of patient during injection.
ECG Triggering Facility

Following options are available:
(a) Synchronizes injection to the R wave with preset decay of 0.8
seconds.
(b) Synchronizes injection of single or repetitive injections to the R
wave and can terminate at R wave only.
(c) Same feature as (a) or (b) and injection profile programmer with
programmed preview facility with this preview, flow pattern
is displayed to facilitate the operator to correct the procedure
and corrections can be made before the injection is delivered to
the patient.
Tomography 233
14 Tomography
In routine diagnostic radiology, when an exposure of an object

inside the patients body is taken, the image is formed with
overlapping of several organs, which encounter the primary
X-ray beam. Hence, the image formed on image plane is super-
imposition of shadows formed by overlapping organs. In case if
we have X-ray beam striking patients body at an angle, we get
distorted image of the organ on the image plane, but overlapping
images are avoided. This phenomena is utilized in planigraphy
technique. Equipments using this technique was introduced in
market to get proper location of tumor in patients body.
Tomography is a special X-ray technique that blurs out the shadows
of superimposed structures to show more clearly the principal
structures being examined (Fig. 14.1).
Fig. 14.1: Illustration of X-ray image by normal and oblique projection

Since it is very difficult to diagnose from superimposed image due

to summation of shadows, using oblique projections technique with
object kept stationary and source as well as image plane (film) is
moved linearly in each individual plane at the same speed in
opposite directions as shown in Figure 14.2. The X-ray tube focal
spot has two extreme positions F1 and F2, while as film cassette has
correspondingly two extreme positions I1 and I2. In order to achieve
this effect, the tube and image plane (cassette containing film) are
coupled by double ended arm called planigraphy arm, which pivots
about an axis intersecting the XY planigraphy plane. The height of
planigraphy plane, which passes through the pivot is adjustable.
Since both cassette and X-ray tube move in parallel plane this
technique is known as Planigraphy (Fig. 14.2).
The body section radiograph of the area in the object closer to pivot
point (fulcrum) are still sharp and for other points away from
fulcrum we get blurred image. The amount of sharpness depends
on planigraphy angle. Planigraphy angle is an angle made by the
travel of focal spot with respect to central ray. The greater the angle,
the larger is blurring of object at a given distance from planigraphy
plane or fulcrum and smaller the section thickness. The normal
settings of this angle are between 8 to 40 degrees. The layer
thickness is determined experimentally. Points located above the
pivot point will be blurred as compared to pivot point (Fig. 14.3).
Fig. 14.2: Planigraphy principle

Tomography 235
Fig. 14.3: Planigraphy angle
This unit incorporates X-ray tube assembly fixed on column stand

along with planigraphy rod so that both X-ray tube and cassette
tray in bucky are synchronously moved in horizontal plane parallel
to each other but in opposite direction. This movement is achieved
by motor fitted at the base of floor to ceiling column stand. The
planigraphy angles can be adjusted between 8 to 40 degrees
(Fig. 14.4 and Table 14.1).
Fig. 14.4: Variation in section thickness with tomography angle

The layer height adjustment of 0 to 25 cm is achieved either

manually or by motor. The planigraphy attachment is normally
fitted on Bucky Table (refer Fig. 5.9).
Thus the planigraphy system has following major components:
(a) X-ray tube
(b) X-ray film loaded in cassette parked in cassette tray
(c) Rigid connecting rod that rotates about fixed fulcrum
(d) Floor to ceiling column stand assembled on floor and ceiling rails.
The important factors during imaging process are amplitude of
tube travel, distance from focal plane (maximum focus plane
decided by fulcrum position), object film distance and orientation
of tube travel.
Table 14.1: Comparison of tomography with different angles
Specifications Wide angle Narrow angle

Tomography arc >10 degrees < 10 degrees
Section thickness Less More
Unsharpness of focal plane Considerable Very little
Blurring of object outside focal plane Maximum Minimum
For tissues with high contrast (bone) Best Low contrast
(Lung)
Exposure time Longer Smaller
The movement of tube and image plane can also be in circular or

elliptical or spiral type instead of in linear plane. Then it is called
multidirectional blurring. This has advantages in examination of
objects with high image contrast.
ZONOGRAPHY
In this case the planigraphy angle is very small around 5 degrees.
The sharpness of image obtained is from specific zone. It contributes
to the planigraphic sharpness of thicker objects (kidney). The spatial
relationship of the region of interest to the surrounding body tissues
is maintained, as though these tissues will form unsharp
radiographic image. Modified version of planigraphy is
tomography. Planigraphy examination is restricted to one plane
while tomography is at various angular projections due to
movement of X-ray tube and image plane in arc.
Tomography 237
Disadvantages of Planigraphy System

1. Higher radiation dose.
2. Complicated mechanical movements supported by electrical
motors.
3. Friction offered during movement of tube head and cassette.
4. Vibrations causing artifacts and lesser tube life.
5. Frequent demand of preventive maintenance.
6. Requirement high power X-ray generator and large exposure
timing.
Due to these disadvantages this technique was discontinued and new
technique of computer tomography was introduced which will be
discussed in detail now.
COMPUTER TOMOGRAPHY
In conventional radiography, the part of body under examination
is exposed to primary radiation and absorption image is recorded
on film or seen on screen. However due to superimposition of
several organs of different absorption coefficient, the image is not
very informative for the region of interest. In order to overcome
this disadvantage, tomography units were developed as discussed
earlier. But these units were very difficult to operate and maintain.
In the year 1967, Godfrey Haunsfield of EMI Ltd. introduced first
clinically useful Computer Tomography Unit. It was used for
diagnosing brain tumor and was known as Head Scanner. The first
CT scanner was commercially introduced in market in 1973.
The name computer tomography implies that it analyses the
tomographic image of patients body with the help of computer.
The image is obtained by exposing smallest cross-sectional area of
patient called Slice, by collimating the beam which scans the body
linearly from various directions. The image is developed from
multiple measurements of X-ray absorption coefficients and is
computed. These images or slices are in transverse or oblique plane
to the long axis of body and hence this technique is called
computerized axial tomography or CAT.
Principle of CT Scanner
The simplest CT scanner constitute of X-ray tube and detector
assembly, which are mechanically coupled and aligned with each
other. The X-ray tube along with detector assembly form a scanning
system, which moves around the patient in circular motion. After
completion of each rotation or scan, the system moves linearly with
a fixed predetermined distance. At each scan, the detector system
records the different measurements based on different absorption
values, which are converted to electrical signals by electronic
circuitry and fed to computer. After calculations a tomogram of
that slice or scan is displayed on monitor screen and also is recorded
on magnetic media or film. The image computed from this unit is
usually formed from very small rectangular image elements in the
form of matrix such as 256 256 or 512 512 etc. Higher the number
better is the resolution. CT units can differentiate between
attenuation values of various tissues of body. Hence, contrast media
is not commonly used.
Initially the CT unit was developed for head and neck region and
was called as head scanner. This was used for cerebral hemorrhage
or accidental injuries in head and neck region. Due to its
applications, the focal spot of X-ray tube was very small. Later the
whole body CT Scanners were introduced for the scanning of
complete body.
Thus CT Scanning is a noninvasive radiographic technique, that
involves the reconstruction of a tomographic plane of body (slice),
from a large number of collected X-ray absorption measurements
taken during a scan around body.
Major Components of CT Scanner Unit

CT system consists of following components:
(a) X-ray generator and tube
(b) Scanning gantry which includes the X-ray tube, detector system
and data acquisition electronics
(c) Patient table (couch)
(d) Computer and viewing console (Fig. 14.6).
X-ray Generator
The high frequency, multi-pulse, high voltage X-ray generator in
single tank construction (reder Fig. 7.11) to eliminate high tension
cables supplies electrical power to X-ray tube, which usually is
high speed rotating anode type and is capable of withstanding the
high heat load generated during rapid multiple slice acquisition.
Tomography 239
Scanning Gantry
The gantry houses the X-ray tube, detectors, collimators and
rotational circuitry. In some scanners it also houses compact X-ray
generator. X-ray tube used is high power, rapid rotating anode at
high speed tube with small focal spot dimensions to overcome
geometric blurring. The anode of tube is made of rhenium,
tungsten, molybdenum and carbon material (RTMC Anode). There
are various types of detectors used namely.
Sodium iodide crystals with photo multipliers
Calcium fluoride crystals with photo multipliers
Xenon gas detectors
Solid state detectors
Xenon gas detectors are commonly used. They produce current
(output signal) when incoming radiation ionizes xenon atoms. This
signal is proportional to intensity of radiation. Detector array is
used to indicate the number of detectors. It is associated with
scanning motion and geometry of scanner. In case of pencil beam
coupled with single detector, X-ray tube and detector are
mechanically coupled and move together as a unit.
Solid state detectors contain cesium iodide or calcium tungstate
crystals that produce light when subjected to ionizing radiation.
Silicon photodiodes convert this light into an electrical signal.
Collimators located near X-ray tube and detector end are aligned
so that the scattered radiation is minimized and X-ray beam is
properly defined for scanning.
In the modern CT scanners, the X-ray beam is collimated to form
shape called Fan Beam and set of detectors forming an arc of circle,
are placed in the pathway of X-ray beam. They both are
mechanically coupled and rotate together as a unit. In some units
only the tube rotates in 360 degrees while as the detectors are fixed
along the arc and are stationary. Gantry assembly can be tilted for
oblique view.
Patient Table (Couch)

The table is specially designed and automated for both vertical
and horizontal movements in both longitudinal and transverse
planes due to precise placement of anatomical part in primary beam
for scanning. Electromagnetic brakes are used for arresting
movements of table. All movements are motor operated and are

jerk free. The table top is made of high density carbon reinforced
material offering uniform low absorption to X-ray beam and
adequate mechanical strength to cater for patient load up to 200 kg
and is in the shape of tray, furnished with attachments to
immobilize the patient during scanning. The table design
incorporates sliding mechanism for easier patient entry and
positioning inside gantry.
Computer Console
The computer console controls the operation of the complete CT
system, processes the image, reconstructs and stores the images.
The capability of computer supplied with the equipment
determines the specifications of equipment. More mathematical
calculations are calculated with larger matrix rapidly by larger
computer and having larger storage facility. The image
reconstruction is performed by taking large number of
measurements made by exposing the object with finely collimated
X-ray beam and measuring intensity of the beam after it emerges
through the patient. One can measure the intensity of beam
emerging from the object by projecting the collimated beam
through the object under examination at different angles. The
reconstruction of object will be more accurate, if number of
measurements are large. In order to reconstruct the image the
amount of energy absorbed per unit volume must be calculated.
The quality of reconstructed image depends on following factors:
X- ray source
Efficiency of detectors
Number and speed of measurements
Methods of reconstruction (algorithm)
X-ray generator characteristic
Geometry of measuring system.
The image can be viewed on monitor. Modern systems flicker free,
14 inch 1249 line monitor for displaying images. During a CT scan
the table moves the patient into gantry, X-ray tube along with the
detectors rotate around the patient. As the X-rays pass through
the patient to the detectors, the computer acquires and processes
the data to form an image. The computer also controls the X-rays,
gantry movements and image display and storage.
Tomography 241
Generations of CT scanners
Over the years, CT technology has advanced from first generation
(Fig. 14.5 A) introduced in early 1970 to fourth generation
(Fig. 14.5 D) developed in late 1980. Today only third (Fig. 14.5 C)
and fourth generation CT systems are used. With this advancement
in the movements of X-ray tube/detector system, the slice scan
time in first generation of few minutes in head scan unit in first
generation has come down to less than a second for the whole
body in third and fourth generation scanners.
First Generation
Fig. 14.5A: First generation (translate rotate with single detector)

Patient is stationary. During first scan the detector is stationary
and X-ray tube moves linearly. For next scan, the tube and detector
move in arc of circle and after detector is parked, linear scan is
performed as in first scan. Multiple scan angles over circle are
achieved.
Second Generation
In this case following procedure is followed:
(a) Patient is stationary.
(b) During first scan the tube moves linearly.
(c) For next scan tube moves in arc.
Fig. 14.5B: Second generation (Translate rotate with multiple detectors)
Third Generation
Fig. 14.5C: Third generation (rotate-rotate, detector array)
In this case following procedure is followed.

Patient is stationary and both X-ray tube and detector array move
in arc.
Tomography 243
Fourth Generation
Fig. 14.5D: Fourth generation (Rotate-fixed, stationary ring of detectors)
In this case following procedure is followed:

Patient is stationary.
Detector array is stationary ring.
X-ray tube moves in arc of circle between the scans, but during
scan is stationary.
Difference between Conventional and Slip ring CT Scanner

In conventional CT scanners, the high tension cables connected to
tube move with tube and detector assembly as gantry rotates
around patient. This limits the tube detector assembly rotation to
only 360 degrees and has to reverse the direction of rotation after
that to avoid entangling of the cables.
In slip ring CT scanners use grooved copper bands or rings with
series of electrically conductive brushes instead of cables and hence
continuous one way rotation is possible and do not require direction
reversal. This continuous one way rotation of the gantry allows
rapid continuous scanning and eliminates sudden starts and stops
and cable wrap up problems. The scan time and the inter scan
delays are greatly reduced due to this.
Slip Ring Spiral CT Scanner

In spiral CT, the scanning is continuously performed as the patient
couch moves at a constant speed, unlike conventional CT scanner,
where the scanning follows the patient couch movement for next
slice.
Spiral CT is used to scan a large volume of anatomy in short time.
Spiral CT generates large volume of data which enables more
precise and detailed 3D reconstructed images. It also permits
generation of vascular images.
Multi-directional Computer Tomography (MDCT)

Extensive evolution has taken place in the last two decades since
primitive CT scanners were developed due to the advent of new
generation electronics, computers, detectors and contrast agents.
Development of high frequency generators with higher power
ratings, specially designed tubes and higher heat storage capacity
of CT tubes have permitted in the development of sub-second
scanners. Slip ring electrical energy transfer allowed for continuous
gantry rotation and multidetector arrays were developed to have
large area of coverage with a single gantry rotation. Newer CT
scanners with reduced gantry rotation times, faster acquisition
times have resulted in decreased breath-hold times with reduced
motion artifacts and high quality diagnostic images. The initial
drawback in the development of MDCT was the primitive crystal
technology and radiographic tube design. The principle reasons
for this were the difficulty in production of sufficient photons and
the reduced crystal scintillation which could not reduce afterglow
so as to produce adequate speed. New generation MDCT systems
have crystal detectors which have favorable afterglow properties
so as to allow acquisition of hundreds of slices at great speeds.
Acquisition of large datasets and new post-processing techniques
are extremely common in most CT techniques. Improvements in
software have allowed in processing and 3D display of large
datasets in CT angiography, colonoscopy and bronchoscopy. Real
time display is possible with techniques such as MIP, VR and
SSD.
Tomography 245
Applications of CT Scanner
(a) Conventional CT scanner: Diagnosis of spine, head injuries, brain
scan, intracranial tumors, blood clot in brain, cerebral ventricles,
soft tissue lesions, gastrointestinal lesions, abdominal and pelvic
malignancies, 3D reconstruction of bones etc.
(b) Spiral CT scanner: In addition to above normal scanning
techniques, special applications which can be performed by spiral
CT scanner are:
Spiral CT technique is more effective in breath hold studies
like thorax or abdomen where scanning large volume in short
time is important
Effective contrast flow studies
CT angiography
CT vascular endoscopy.
(c) MDCT Scanner: MDCT advances have especially been
pronounced in CT angiographic applications in evaluation of the
vascular system. Large scale availability, excellent spatial and
temporal resolution and comparatively low costs have established
and cemented the role of CT in angiographic studies. CT
angiography requires the use of 3D reconstruction techniques for
extracting volumetric information and display of information
produced from acquisition of large datasets. MDCT is commonly
indicated in evaluation of hepatobiliary pathology with the main
objective being the capability of newer scanners to obtain
multiphase datasets, i.e. timed arterial and portal venous phases
accurately. The study indication dictates whether dual or triple
phase scanning is required. Multiphase study is commonly
required in evaluation of cirrhotic livers for detection of focal
hepatic lesions as well as evaluation of the arterial, portal and
hepatic venous anatomy. CT volumetry is routinely performed in
cirrhotic patients posted for liver transplants as well as donor liver
evaluation. Helical CT scanners have produced high quality non-
contrast and contrast images of the retroperitoneum
which historically have always been an extremely difficult
anatomical region to evaluate. Pancreas, kidneys and the urinary
collecting system are easily identifiable, evaluated with excellent
representation of pathological processes involving these organs on

MDCT. MDCT has become the imaging modality of choice in
evaluating acute pancreatitis and CT severity indices on MDCT
have high specificity, sensitivity and correlation with clinical
parameters such as Ranson Imrie scores and APACHE scores.
MDCT colonoscopy is useful for the detection of lesions 1 cm or
more in recently published literature and may become a useful
technique or adjunct in screening of patients for colonic pathologies.
The reproducibility of such techniques however still needs to be
critically evaluated to facilitate large scale use of such techniques.
MDCT of small bowel loops is an extremely accurate and robust
technique in evaluation of bowel pathology in combination with
bowel distension. Distension techniques such as CT enteroclysis
are currently in vogue in combination with intravenous contrast
enhancement to evaluate luminal and wall pathologies of the small
bowel.
However, collective radiation doses have progressively increased
with random usage of CT scanner for various diagnostic and
therapeutic procedures. On MDCT scanners, image quality is
directly proportional to the radiation dosage. Increased radiation
administered to the patient is the cost one pays for improvement
in image quality. The ALARA (as low as reasonably possible)
principle is now more than ever required to be kept in mind in CT
parameter selection. Radiation dose reduction methods and
automatic exposure controlled beam nodulation processes are being
provided by commercial CT vendors. Image quality is primarily
dependent on image sharpness, image contrast and noise. CT
parameters directly related to image noise include slice thickness,
mA and pitch. Image noise is indirectly proportional to the square
root of the dose and a noise reduction of 50% requires a 4-fold
increase in radiation dosage. Hence current generation radiologists,
physicists and CT technologists need to evaluate and obtain
adequate and optimal radiation dosages and criteria to be
implemented in different CT techniques and on different patients.
In the era of MDCT this is essential and may be required so as to
set an even balance between image quality and patient protection
from high doses of radiation.
Tomography 247
Evaluation of CT Scanner System

Following important parameters should be considered:
Minimum scan time
Scan cycle time
Reconstruction time and matrix
Spatial or low contrast and high contrast resolution
Type and number of detectors
KW (kV/mA) ratings
Gantry aperture and tilt
Multi-tasking functions of the computer
Maximum number of continuous rotations in spiral CT
Automated patient management
Future upgradability
Software packages like 3D construction, bone mineral
densitometry, dental software, CT angiography, endoscopy, etc.
Accessories of CT Scanner
1. Automatic voltage regulator
2. Automatic film processor
3. Laser camera.
Fig. 14.6: Block diagram of CT scanner

DEVELOPMENT OF IMAGE
It should be noted that there is requirement of finite number of
X-ray photons to reach image plane to get informative image.
Patient will be subjected to higher dose if the resolution desired is
high. As we had seen earlier, the density of anatomical structure
under examination will determine absorption of X-ray radiation.
This absorption can be determined by measurement of intensity
of radiation emerging out of patients anatomical structure.
Matrix is defined in mathematics as an array of numbers arranged
in rows and columns. Each number of matrix is called element of
matrix. Size of matrix depends on the demand of resolution or
contrast. There are two terms which are mentioned quite often
namely,
(a) VOXEL which is volume element, and
(b) PIXEL which is picture element
Pixel is representation of anatomical voxels in reconstructed image.
Each pixel is identified as to its exact location of matrix. The most
commonly used matrix are 256 256 or 512 512 or 1024 1024.
In order to increase resolution of image, finer matrix with more
number of pixels should be developed with finer X-ray beam. Since
for better resolution, we require higher dose to get better signal to
noise ratio, there should be choice of matrix given to end user to
select type of matrix required, depending on anatomical part under
examination.
The measured signals occurring are coded in a suitable form and
transferred into computer. Since the digital computer can directly
process discrete values, the radiation profile is split in each case
into few measured values. Hence, for each picture several
projections are required.
Control unit coordinates the functioning of the equipment,
X-ray generator and measured value acquisition electronics.
Computer calculates from measured data, distribution of
absorption values corresponding to examined object slice. Strongly
absorbing region of the object is assigned high value and weakly
absorbing one low value. Each absorption value describes the
average absorbing capability of a block-shaped element of the object
slice, to which value is assigned. The object slice can be imagined
as composition of many blocks. The array of numbers obtained,
Tomography 249
designated as matrix, initially present only in the memory of

computer, represent image of the object, but as yet completely
evades visual realization. The calculated absorption values can be
printed out in an arrangement corresponding to the object slice,
resulting in image in the form of matrix of numbers. This technique
leads to extremely-tedious analysis due to large number of values.
The numeric image, thus, obtained is converted into black and
white TV image with each matrix element as a discrete image point
and with the individual absorption value being assigned
corresponding gray step.
The image generated by computer should be converted to visual
image. There are different constituents in body such as bone, fat,
air, water, soft tissues, etc. Each one offers different attenuation
coefficient to the X-ray beam. The soft tissue may have variation of
5% from water and may cause problems. In order to get more useful
display of this information, correction factor is used which is also
called CT Number which converts the effective absorption
coefficient of voxel into CT number given by equation.
CT = K ( Tissue Water)/ Water, where K is magnification
constant.
Relative deviation from absolute absorption coefficient of water
is indicated (Fig. 14.7).
Fig. 14.7: Absorption value scale of CT scanner

For visual display, CT number is converted to video signal which

is fed to the grid of cathode ray tube. The CT number depend upon
the type of voltage applied to the X-ray tube. If the X-ray beam is
generated with higher anode voltage (high kV technique), there
will be less absorption in soft tissues resulting in lower CT number.
When the image reproduction uses TV chain, it is possible to select
a window (restricted range) from total extent of the absorption
value scale for image reproduction. This windowed image can be
spread over the complete intensity of the monitor. This results in
considerable increase in contrast which is necessary to utilize
information content of computer program. Hence, only 30 gray
steps can be distinguished on monitor while as about 2000
absorption values can be represented.
Each image point can assume 2000 different absorption value steps
in the digital image. If the whole absorption value range is
reproduced in B/W TV picture, as shown in left scale in
Figure 14.8, the absorption resolution capability of the equivalent
Fig. 14.8: Window (spreading of image) of the absorption value scale

with image reproduction
Tomography 251
cannot be used, because eye is not capable of distinguishing

appropriate number of gray steps. For reproduction of small
absorption differences, a partial range of interest is selected and
displayed on the whole B/W range of the monitor. The absorption
values lying outside the selected range limits are reproduced black
or white respectively and are displayed on the monitor along with
actual image. The high absorption value discrimination capability
of the equipment permits display of soft tissue without use of
contrast medium.
Image Reconstruction
We now go back to the properties of X-rays. They are attenuated
while passing through the matter. The amount of absorption
depends upon density of the medium through which they pass.
Higher the atomic number of medium greater is the absorption of
X-rays. It is given by following formula:
I = (Io) e x
where, I is the intensity of the radiation at a distance x when
incident beam is passed through the medium having absorption
coefficient as and Io is the incident intensity. As explained in this
equation, there will be exponential decay of X-ray energy as the
beam passes through the medium. In order to determine the
distribution of absorption coefficients in one slice, the slice is radiated
from different directions as shown in Fig. 14.9. For simplification
we assume that slice is subdivided in 4 fields with each field having
constant absorption coefficient . (1, 2, 3, 4). The measured value
of intensity I gives sum of 1+ 2 (Fig. 14.9 A).
If more measurements are carried out as shown in Fig. 14.9 B, the
four unknown absorption coefficients 1, 2, 3, 4 can be
calculated from sums as follows:
It is assumed that 1 = 6, 2 = 2, 3 = 2 and 4 = 2. Then
for I1, 1 + 2 = 8; For I2, 3 + 4 = 4; For I3, 2 + 4 = 4; For I4, 1
+ 3 = 8; For I5, 1+ 4 = 8.
Each measured value obtained with CT scanner supplies a linear
equation with unknown values of absorption coefficient of the
object under examination. The number of equations are quite large.
Hence, there are various methods adopted for displaying values
of attenuation coefficients for each pixel.
Fig. 14.9: Calculating technique
I = Ioe (Ab. coeff. 1 t + Ab. coeff. 2 t)

I
logn
I Therefore (Ab. coeff. 1 + Ab. coeff. 2) = I0
t
where t = thickness of each block
Fig. 14.9A: Sum of two absorption coefficients
Fig. 14.9B: Algebraic determination of four unknown absorption

coefficients with vertical, horizontal and diagonal measurements
Tomography 253
They are as follows:

(a) Iterative method
(b) Back projection method
(c) Analytical method
We will now discuss relative merits of each method.
(a) Iterative Method

In reconstruction technique, the term iterative means successive
approximations with starting arbitrarily with value chosen for each
pixel. After measuring values from measured projections,
corrections are applied to this arbitrary value to get closer to the
measured value, then again corrections are applied and so on, till
measured data is closer to the value assumed. In this method, an
approximate linear absorption coefficient value is assigned to each
pixel. As progressively projections are made with measurements
and density value corrected until the value assigned is very close
measured value. The disadvantage of this method is that it is more time
consuming depending upon speed of computer to solve these equations.
The iteration process can be carried out when all measurements are present.
(b) Back Projection Method

The detected signal is divided equally among all pixels transversed
by X-ray beam. When a value has been assigned to each pixel after
all projections have been made, an approximate original image is
produced. The specific value assigned to each pixel may be higher
or lower than actual value, but the ratio of densities will be accurate,
thus allowing true reconstruction of image. For a given point in
the image, the assigned density is sum of all rays projected through
that specific point.
(c) Analytical Method

The disadvantage of previously discussed methods is avoided by
this method. In this method image construction is performed in
parallel with data acquisition. This technique is widely used in
modern CT scanners. It is also known as convolution technique. It
is modified technique from basic classical planigraphy. During
tomography the blurring of the object takes place which can be
compensated by filtering or modifying signal that is back projected.
In this way spurious images that produce blurring of the object

cancel out. The filtered back projection method has an advantage
that image is available immediately after the completion of scan
because each projection can be processed as it is measured.
The technique in Fig. 14.10, results in smearing of details over the
whole image. The properties of the image carrier effect signal
reversal with low intensity producing brighter image. The
overlaying of individual projections produce greater light intensity
at the position corresponding to the detail with higher radiation
absorption, but at the same time results in extensive blurring of
the detail.
In convolution technique, Fig. 14.11, two additional steps are
undertaken. The intensity values are logarithmic and result in
proportional to the respective absorption values.and before
overlaying the individual projections to produce the image, the signal
is convoluted with correction function and thus deformed in
accurately defined manner.
Negative component in the signal are more significant after
convolution. With correct choice of correction function they are
Fig. 14.10: Image construction from uncorrected intensity profiles

Tomography 255
Fig. 14.11: Image construction from uncorrected intensity profile

(Convolution Technique)
big enough so that with overlaying of the contributions of the

individual projections for resulting image positive and negative
values compensate outside the area of interest and excessive
smearing is compensated. Advantages of CT over classical
tomography are as follows:
1. For image construction only information from the slice of
interest is processed and thus overlaying of slice image by the
blurred image of the slice surrounding is avoided and
2. The computer tomogram is free from extensive unsharpness in
the object detail of slice.
The convolution technique is also called of frequency analysis. In
this method reconstruction is performed with fourier transform
space, where different coordinates refer to different frequencies.
Transferring each projection into its frequency components and
arranging them in frequency space, reconstruction is achieved.
The frequency space description become more filled with more

projections. When process is complete, frequency space description
of object is transferred back into real space. In this method the
blurring correction require simple multiplication.
The appearance of extensive blurring in layer can be interpreted
as the appearance of false structures of low spatial frequency. It
must accentuate the high spatial frequencies and suppress low
spatial frequencies.
Radiation Protection 257
15 Radiation Protection
Radiation is defined as emission of any rays, wave motion or

particles (alpha, beta or neutrons) from source. The radiation can
be classified in two types namely, nonionizing and ionizing
radiation. Nonionizing radiations are ultraviolet, visible light,
infrared and radio waves. Ionizing radiation are alpha, beta,
gamma and X-rays. These could be from natural sources like
celestial or from radioactive materials or manmade such as
gamma or X-rays. Since they are harmful to human tissues they
pose radiation hazards. It is defined as that radiation which
makes the gas conductor of electricity by splitting gas molecules
into positive and negative ions. Radiation hazard is defined as
potential danger to health resulting from exposure to ionizing
radiation or consumption of radioactive materials. The man-made
radiation exposure can be classified in three categories namely
Occupation exposure for radiation worker; Medical exposure for
patient (it can be external in case of X-ray examination or internal
in case of nuclear medicine studies); Nonoccupational exposures
for relatives of patient who are in the vicinity of radiation.
Radiation sickness is illness caused by exposure to ionizing
radiation with initial symptoms of vomiting and diarrhea,
followed in some cases Leukemia or blood cancer. When ionizing
radiation passes through matter, there is interaction between
X-ray quanta and the matter. In case of human being tissues of
body absorb them and it results in biological effects which are
listed in Table 15.1.
Table 15.1: Radiation exposures and their effect on mankind
Exposure (Whole Body) Roentgen Effect

0-25 No detectable clinical effect
25-50 Blood cell destruction
(Possible blood changes)
50-100 Blood cell changes, injury, radiation sickness.
100-200 Nausea, diarrhea, shortening of life
expectancy, radiation sickness
250 to gonads Temporary sterility
300 localized Loss of hair, reddening of skin
400 Nausea and vomiting in 1 to 2 hours, death
in 50% of exposed human population in
30 days
600 Death in 100% cases
1000 Death in 2 weeks
3000 Death in 2 days
Special unit of exposure is roentgen applies to measurements in

air of X-rays and gamma rays energies upto 3 MeV only and is
defined as the quantity of X or gamma radiation which will
generate 1 esu of charge per cc at NTP when passing through air
and is directly proportional to intensity of incident radiation.
There are two types of working areas namely, high radiation and
low radiation.
High radiation area is where dose limit = 0.3 times annual dose
limit likely to be exceeded and is called controlled area. Low
radiation is where dose limit is 0.3 times annual dose limit not
likely to be exceeded and is also called restricted area.
Therefore, only persons with relevant technical knowledge of
radiation protection should be allowed to work with ionizing
radiations. Recommendations and guidelines are issued by
following international institutions in this regard:
1. International Atomic Energy Agency (IAEA).
2. International Commission on Radiation Protection (ICRP).
3. International Commission on Radiation Units and
Measurements (ICRUM).
These recommendations are mandatory and has become law in
many countries. In India the governing body is Department of
Radiation Protection (DRP) of Bhabha Atomic Research Center
(BARC), Atomic Energy Commission. The Bureau of Indian

Standards have laid down specifications for radiation safety as BIS
7620 Part III.
ICRP recommendation No. 26 states, Radiation protection is
concerned with the protection of individuals, their progeny and
mankind as a whole, while still allowing necessary activities from
which radiation exposure might result. Most decisions about
human activities are based on an implicit form of balancing costs
and benefits, leading to the conclusion that the conduct of a chosen
practice is worthwhile.
ICRP recommends the following system dose limitation:
1. No practice shall be adopted unless its introduction produces
positive net benefit.
2. All exposures shall be kept as low as reasonably achievable,
(ALARA) economic and social factors being taken into account.
3. The dose equivalent of individuals shall not exceed the limits
recommended for appropriate circumstances by commission.
Protection Procedures
Radiation hazards on mankind are classified in two ways namely,
somatic and genetic effects. Somatic effects affect life span of the
individual subject to radiation. This results in cancer of skin,
reduction in blood count, loss of fertility, loss of eye sight,
shortening of life span. It is related to injuries of cells in blood and
bone marrow. Genetic effect affects life of future generation. This
related to injuries to gonads, offsprings are abnormal.
If a controlled X-ray beam is directed towards body, the amount of
quanta which will interact with atoms of body mass will result in
biological effects. Each interaction will transfer energy to several
atoms with absorption of quantum energy into the atoms of
material of larger density resulting in heating effect. The energy
absorbed can be expressed in joules per kg, which has led to the
concept of radiation dose.
Measurement of Dose
Unit of dose = Roentgen Absorbed Dose = RAD
1 RAD = 0.01 joules per kg
Where rem is roentgen equivalent of man. Hence, compliance with

radiation protection measures is utmost importance on patients
undergoing X-ray examination.
Severity of Radiation Injury: It depends on following factors:
1. Energy, total dose of radiation is received
2. Part of the body which has been radiated
3. Age of person exposed. It is given by formula:
Age dose = 0.5 (n-18)
It is expected that the person is working in radiation area after age
of 18. Age of person is n and annual dose is 0.5 rem maximum.
4. Sensitivity of organ involved
5. Radiation source is internal or external.
Measurement of Dose
As discussed earlier in interaction with matter, this process is
accompanied with liberation of electrons and this type of radiation
is called ionizing radiation. Since it is difficult to measure the
degree of absorbed energy in human tissue, the easiest way to get
a quantitative assessment of radiation is the measurement of
ionization in air and it is called ion dose given by formula:
Ion dose J = c/kg = coulombs per kilogram.
Refer Fig. 15.1. The ionization chamber current Ic is constant if
tube voltage and current is kept constant. But the dose increases
since it is measured as total number of electrons produced during
the exposure time. Hence, for dose measuring circuit, integrator is
used.
The ion dose unit in use is roentgen (R).
Definition as per according to ICRU
1 roentgen = 0.000258 Coulomb per kg
Ion Dose Rate: It describes how many ions are produced in one kg
per unit time.
J = C / (kg sec)
= mR/second
Refer Fig. 15.2. The chamber current Ic is proportional to the total
amount of produced electrons in a unit of time. Therefore, we
incorporate proportional amplifier, dose rate will be proportional
to chamber current.
Fig. 15.1: Measurement circuit for dose
Fig. 15.2: Circuit for dose rate measurement

Energy Dose D or Absorbed Dose: Radiation dose means the

amount of energy absorbed. The absorbed dose D was introduced
by ICRU in 1953 and is defined as amount of energy imparted to
matter by ionizing particles per unit mass of irradiated material at
region of interest.
D = Joules/Kg = 1 gray
ICRU suggested substituting joules/kg by a unit gray.
Hence, any ionizing radiation which transfers energy of one Joule to one
kilogram of matter is called one gray. This unit is universal and
considers higher absorption power of materials with higher atomic
number and is independent of quality of radiation.
Since 1 RAD= 0.01 Joule/kg, 1 gray= 100 RAD.
The energy dose in human tissue cannot be measured directly. A
tiny ionization chamber should be placed in area of interest to
measure ion dose (C/kg). Then one can calculate the energy dose
(J/kg) with ion dose.
Hence, energy dose = F X iondose
Energy Dose Rate D'

This specifies number of transfers of energy in one kilogram of
matter per unit time.
D = Joules / (kg seconds) = mrem/second
Dose Equivalent H
The biological effects of various ionizing radiation depend upon:
(a) Type and quality of radiation.
(b) Irradiation conditions.
Hence, equal energy absorption of different type of ionizing
radiations will produce different biological effects. The dose
equivalent is product of energy dose D and coefficient q. Therefore,
dose equivalent H = q D
where value of q is unity for X-ray, gamma rays and beta radiation
where, value of q is 10 for fast neutrons, protons and alpha radiation
where, value of q is 20 for heavy nucleus.
Local Dose
It is the absorbed dose for soft tissue measured at a specific area.
Local Dose Rate

It is the absorbed dose for soft tissue measured at a specific area
per unit time or exposure rate.
Maximum Permissible Dose Levels

The manufacturer of radiological equipment must design and
install the equipment in such a way that unnecessary exposures
must be avoided. In order to reduce risks of radiation ICRP has
defined maximum permissible dose for two categories of
individuals.
(a) Adults exposed in course of their work.
(b) Members of public.
This has been indicated in Table 15.2.
Table 15.2: Dose limits for individuals
Organ Maximum permissible Maximum permissible

dose for adults exposed dose for adults exposed
in one year in one year
For radiation workers For general public
Whole body, gonads, 5 rem 5 rem
red bone marrow
Eye lens 30 rem 3 rem
Skin, bone, thyroid, 50 rem 5 rem
hands, forearms,
feet, ankles
Embryo during first NA 1.5 rem
two months
Other single organs 15 rem 1.5 rem
Hence, it is mandatory that person working with ionizing radiation

must have complete knowledge in their own interest and patient.
It is the responsibility of concerned persons to keep the harmful
radiation to minimum. Based on technology used and technical
expertise following precautions should be taken:
(A)Distance: Keep distance from source (inverse square law).
(B) Shielding: Block unnecessary radiation.
(C) Time: Keep exposure time to minimum, so that interaction with
human tissues is minimum.
where, F can be found experimentally (Table 15.3).

Table 15.3: Value of F
Energy of Total Filtration F F F F
Radiation in mm Air Water Muscle Bone
(KeV)
50 1.4 Al 0.87 0.88 0.93 4.2
100 0.2 Cu 0.87 0.89 0.92 3.6
150 0.5 Cu 0.87 0.92 0.94 2.3
200 1 Cu 0.87 0.94 0.95 1.6
300 3 Cu 0.87 0.96 0.95 1.2
400 3 Cu 0.87 0.96 0.96 1.1
(D) Collimation of X-ray beam.

(E) Avoid direct beam.
(F) Use protective clothing.
(G) Monitor the radiation absorption.
(H) Use image intensifier close to object under examination.
Hence, attention must be paid to radiation safety of patient, users
of equipment and protection of persons working in the areas
surrounding the X-ray department. AERB has issued guidelines
for installation of various radiological equipments with
recommended layout drawings. They should be strictly followed
during planning and installation of these equipments.
We are aware that overall penetration power of X-ray beam is
decided by the anode to cathode voltage and is referred as quality
of radiation. The penetration of X-ray beam is the quanta of
radiation which comes out of the medium. This would be the
radiation after absorption and scatter.
Refer Fig. 15.3. The relative intensity is calculated by measuring
the ionizing current with and without filter. Relative intensity is
given by formula:
Measurement B = Ib
Relative intensity =
Measurement A =Ia
When relative intensity is reduced to half (50%) it is known as half
value layer.
There are two curves plotted in Fig. 15.4. I1 at 150 kV and I2 at 50
kV tube potentials. The kV scale can be roughly subdivided as:
Fig. 15.3: Relative intensity
Fig. 15.4: Half value layer
Up to 20 kV quality very soft

20 to 60 kV as soft
60 to 100 kV as medium hard, and
Above 100 kV as hard.
One can define half value layers for different kV potentials and
media.
Table 15.4 indicates that as we lower the energy (KeV), then the
wavelength increases resulting in decrease of value of half value
layer in that medium. We also note that at 125 KeV, the thickness is
0.28 mm of lead will reduce half value. Hence, lead is preferred as
better shielding material or filtration of X-ray beam.
Table 15.4: Half value layer
KeV Air Water Al Cu Pb

(m) (mm) (mm) (mm) (mm)
25000 0.0005 330 400 117 22 9.5
1250 0.01 95 110 47 15 10.4
250 0.05 48 55 23 6.2 1.1
125 0.1 38 44 17 2.6 0.28
41 0.3 22 26 4.5 0.17 0.05
The absorption of X-ray beam depend upon the thickness of the

substance in the direction of beam, density of absorbing material,
atomic number of absorbing material, the quality of X-rays.
Composition of beam and quality of radiation: In the discussions
of X-ray generator, we have noticed result of different waveforms
across X-ray tube. In case of single or two pulse waveforms, the
voltage rises from zero volts to the peak value, remains at peak for
very small time and falls down to zero. If we increase number of
pulses in each cycle, the waveform becomes more towards DC by
reducing the ripple, thus ensuring that voltage is more at peak
value as compared to two pulse generators. Hence, two pulse
generators will give more softer radiation than six or twelve pulse
generators. This spectral composition is of very high importance.
Soft radiation is absorbed by body tissues and does not contribute
to image, thus making it hazardous to health. Therefore they should
be filtered so that unnecessary exposure of patient with softer
radiation is avoided. The glass wall of X-ray tube, oil column and
ray port offers inherent filtration but that is not sufficient.
Additional filters are therefore incorporated at the ray port of the
X-ray tube head. As a radiation safety measure, the tube is fitted
with additional filters using aluminum. IEC 407, edition 72 (1974)
prescribes following filters. Hence, additional filter with protective
cone is furnished of desired value. During installation of the unit,
service engineer should ensure that this filter is provided in tube

head (Table 15.5 and Fig. 15.5).
Table 15.5: Filtration as per IEC 407
Working Minimum value of total filtration in

voltage (kV) equivalent filtration offered by
aluminum
Less than 70 1.5 mm
Between 70 and 110 2 mm
More than 110 2.5 mm
Fig. 15.5: Filtration process
PROTECTION AGAINST X-RAY RADIATION

We must protect radiation worker from:
Direct radiation
Scattered radiation from patient, table and other sources
Radiation leakage from X-ray tube; without their movements
restricted by protective clothing.
IEC 407 describes design requirements to be followed by

manufacturers to protect both patient and radiation worker from
unwanted exposure to X-ray radiation. Examination units
manufactured as per IEC 407 have protective zones which ensure
that radiation worker will not be exposed to excessive radiation
leakage in protected zone. Radiation workers must be careful, not
to subject themselves to scattered radiation, radiation leakage from
tube shield, etc. The amount of scattered radiation is different for
over couch and under couch installations. The direction of scattered
radiation diverges from primary beam by 45 degrees and most of
this radiation is filtered by protection devices in table design for
under couch units. The only limitation being the distance of focal
spot from table top (source object distance). While as the scattered
radiation from incident beam in case of over couch tube diverges
at 45 degrees and is more alarming (Fig. 15.6).
Fig. 15.6: Overcouch radiography

We now analyze the different sub-assemblies in over couch X-ray set up

and safety aspects incorporated in design.
1. X-ray Tube: There are two executions namely single tank (see
Fig. 7.11) and X-ray tube shield. In both the units the X-ray tube
insert is immersed in oil which serves two purposes namely,
insulation and coolant. Apart from these the oil column offers filtration
to primary X-ray beam. The tube insert is enhoused in shield
assembly, which is made out of aluminum casting housing and
lead lined from inside, so that the radiation leakage from other
directions except ray port is avoided or is within specified limits
by IEC 407 or ICRP. At the ray port a special cone made of lead is
furnished to filter out soft radiation coming out from tube shield.
Additional aluminum filter is kept at the ray port over the lead
cone to achieve desired amount of filtration as per IEC 407 (Table
15.5). The tube head is provided, a flange on which collimator or
double slot diaphragm is provided, to collimate the beam to the
required area of patients body to be exposed. The collimator
consists of two pairs of lead flaps which could be opened or closed
as per requirement and light source with mirror to illuminate the
body part to be exposed. This ensures the required area is exposed
to the radiation by operator. The mirror offers attenuation to X-ray
beam and filtration to primary beam of X-ray.
2. Beam Limiting Devices: Primary beam collimators as discussed
above and radiographic cones confine the useful beam so that softer
radiation is not coming out of the tube assembly in the direction
different from desired primary beam. Each manufacturer has
special designs to suit their tube head and hence they should be
used with the tube head for which they have designed by the
manufacturer. These have already been dealt in detail in
Chapter 9 X-ray Image.
3. Compression Band: During over couch radiography the usage
of compression band ensures that the patient remains stationary
and undesired body fluids are displaced from the main exposure
area, so that the body thickness in abdomen area is reduced,
enabling reduction in exposure parameters which eventually
reduce radiation hazards.
4. Table Top: This offers certain absorption to the primary beam
depending upon the material used and its thickness. Generally
plywood with sun mica top is used with overall thickness of 6 mm.
This ensures that there is no sagging with heavy patients weight.

The uniform opacity should be ensured over entire length and
breadth of table top. The table top is major source of scattered
radiation. Costlier units incorporate carbon reinforced plastic
material for the table top which offers smaller thickness (lesser
absorption and scattering) and uniform opacity to primary beam.
5. Intensifying Screens: They are used in film cassettes. If newly
introduced rare earth type are used, the exposure parameters need
to be reduced 3 to 4 times. Thus, reduction in radiation hazards is
achieved.
These were the radiation protection measures for over couch tube.
Now we take the case of under couch tube. Since we are using
under couch tube the film focus distance is 70 cm as against 1 m
for over couch tube. The X-ray radiation is directed upwards and
is scattered by spot film device and roof of room. Hence, the amount
of scattered radiation is much less as compared to over couch tube
exposures.
6. Spot Film Device: The spot film device is close to the radiologist
and hence more protective measures should be incorporated in
designing of SFD. The plate, on which the lead glass and fluorescent
screen assembly is mounted, is lead lined from all sides except the
area of observation which is about 35 35 cm (Fig. 15.7). The
complete assembly can be moved in three directions namely, up/
down, transverse, and compression, with facility of hand grips
located in this area, so that radiologist will be protected from
radiation. Since the radiologist stands close to the patient who is
lying on horizontal table or standing on foot rest. Due to proximity
of radiologist with patient following radiation protection measures
are incorporated in design:
Fig. 15.7: Spot film device plate

They are:
(a) Protection plate
(b) X-ray ray guard
(c) Metal plate
(d) Double slot collimator for under couch tube.
(a) Protection plate at SFD: This is manufactured from lead sheet
sandwiched between the two layers of plywood so that X-ray
radiation will not leak to the X-ray cassette which is loaded with
unexposed film in parking area. This plate is located at rear side of
the SFD, towards table top, with a slot of 35 35 cm (Fig. 15.8).
(b) X-ray ray guard: X-ray ray guard is manufactured with lead
rubber, having a lead equivalent of 0.5 mm Pb with multiple
overlapping flaps. It is heavy but flexible so that desird position of
patient is adjusted by radiographer during examination. The
physical position of ray guard can be changed with the position of
table (horizontal or vertical); for details refer to Fig. 15.9.
(c) Metal plate: Metal plate at the base of table is made up of thick
mild steel which serves two purposes namely radiation protection
from scattered radiation from floor and radiation leakage from
under couch tube. Additionally it gives mechanical strength to the
table assembly and improvement in esthetics. This is also called
ornamental cover.
Fig. 15.8: Protection plate for SFD

Fig. 15.9: Ray guard in different positions of table
(d) Double slot collimator for under couch tube: Under couch X-ray
tube is furnished with lead cone, additional filters and double slot
collimator to collimate the X-ray beam.
7. X-ray Generator: It is now clearly understood that, the lesser
amount of soft radiation generated, it is preferred. This has direct
relationship with the waveform of voltage applied across X-ray
tube. Smaller the ripple less is softer radiation. Hence, the choice
of high power X-ray generator with low ripple will reduce exposure
time. Reduction in exposure time will reduce the interaction time
between X-ray radiation and human tissue which will reduce the
radiation hazards. Modern generators work with electronic
switching using solid state circuits. The automatic dose rate control
(ADR) is easily compatible with these generators due to its
electronic switching timers. X-ray systems with ADR facility will
give the required dose to patient and reduce radiation hazards.
These modern X-ray generators are provided with fluoroscopic
timer. This has now become mandatory as per AERB. Since
fluoroscopy is an examination, which has no control on duration
of time, as in case of radiography procedure, there is a possibility
that radiologist will continue fluoroscopy and subject himself as
well as patient for radiation hazards. The incorporation of
fluoroscopic timer will sound an alarm after 5 minutes of
fluoroscopy examination.
8. Other Methods of Radiation Protection: Medical exposures of

patient are subjected to dose limitation. Hence, following procedure
should be followed:
(I) Avoid unnecessary exposures.
(II) Justification of necessary exposures in terms of benefits that
would not otherwise have been received.
(III) Limitation of dose administered to minimum amount
consistent with medical benefit of individual patient as per
ICRP.
When radiographic examination does not give sufficient information, then
only carry out fluoroscopy examination with image storage unit for re-
examining the results during fluoroscopic examination.
Referring to dose limits as indicated in Table 15.2, gonads and fetus
must be specially protected and should never be irradiated. Hence,
in women of child bearing age, X-ray examinations of pelvic region
should be carried out only if conception is unlikely to have occurred.
X-ray examination should be avoided during pregnancy, unless it
is extremely important and urgent to carry out the same. Then it
should be conducted with utmost care. For chest radiographs of
standing patients proper radiation protection should be used in
order to protect patient from gonad exposure. Beam should be
collimated to the desired area only and working closer to gonads
should be shielded so that secondary radiation is reduced to
minimum. In case of exposures to hand, wrist and fingers position
the patient away from abdomen area so that exposure to gonads is
avoided.
9. Radiographic Lead Apron: It is made of lead rubber with lead
equivalent of 0.5 mm Pb at 80 kV. Although it is heavy and bulky,
in order to protect themselves, occupants in radiation zone must
wear apron. The apron is normally up to knee length and can
protect the wearer from direct radiation from floor during
fluoroscopy examination when table is vertical.
10. Lead Rubber Gloves: They are used by radiologist to operate
controls on SFD such as collimation control, exposure release
buttons, electromagnetic brakes, table tilting switches etc. during
fluoroscopy examination so that hands do not get undesired
radiation.
11. Dark Room Adaptation Goggles: Their usage will reduce the
fluoroscopic examination time.
12. Cones: Radiographic cones used should be long enough to filter
the soft radiation. They are generally made of zinc or brass. In case
of dental radiography, the radiographic cone should be used with
lead diaphragm, such that diameter of X-ray field on the skin does
not exceed 6 cm. This will protect eyes of the patient. If eyes are
unnecessary exposed to radiation, cataract may develop.
13. Focus Film Distance (FFD): The FFD should not be too small
as the dose increases inversely to the square of distance. Therefore,
radiation to patient is considerably higher than at conventional
distance of 70 cm for under couch tube, since we have limitation of
distance due to geometry and design considerations of X-ray table.
In horizontal position table height should not exceed 80 cm to
ensure easy patient entry and in under couch tube should not touch
flooring. But in case of over couch, the normal FFD should be 1.1
to 1.2 m. This is limited by room height and design of floor to ceiling
column stand. In case of radiographic exposure with chest stand,
this distance should be at least 1.5 m, limiting factor will be room
dimensions.
14. Protective Screens (Mobile Protective Barrier): They are
manufactured in two designs namely, fixed and mobile. Fixed ones
are used for placement of X-ray generator console behind the
screen, so that during exposure radiation worker stands behind
this protective screen away from the radiation zone. They are
manufactured with lead lining, so that radiation leakage behind
the screen is avoided. Since radiation worker wants to observe the
patient during examination, a lead glass window is provided in
the center of the screen (Fig. 15.10). These screens come in two
executions (a) two fold, (b) three fold. Depending upon the room
plan the type could be selected.
The mobile protective screens are provided for radiologist to use
during fluoroscopy examinations. During this examination
radiologist sits on elevated chair to view lead glass fluorescent
screen assembly and is very close to patient, hence, in radiation
zone. For radiation protection from scattered radiation from floor,
a mobile protection screen is used which can be removed and kept
Fig. 15.10: Three fold protection screen with lead glass window
next to wall away from examination area, once the fluoroscopy

examination is over so that moving space is available in room. This
screen is manufactured with lead lining so that radiation leakage
behind the screen is avoided.
GENERAL RULES
1. Only persons required for radiographic examinations should
be present in X-ray examination room.
2. Radiation worker should stand behind protective screen during
radiography exposure.
3. Proximity of patient: Medical staff should take extra-precautions
while attending to infants because they may be required to hold
the patient in radiation zone. They should wear all protective
clothing as described above. Alternatively infant cradle which
can be attached to the table only when required could be used.
Choice of Films and Processing Material

It is imperative to select correct radiographic technique such as:
Usage of cassettes of same type with intensifying screens
Use of high speed screens (screens from different manufacturers
are not same in speed. Hence, screens from the same
manufacturer with same batch should be used.)
Use consistent quality of good developer with replenishment

as and when desired and keeping the temperature of developer
in tanks constant refer Chapter 10.
Proper patient positioning
Use of high sensitivity films of consistent quality.
These above mentioned steps may be costly on face value, but in
long run they are most important for good image quality at
minimum dose.
Duty of Radiologist
1. Radiologist must weigh the necessity of diagnostic X-ray
examination against risks due to radiation.
2. Information should be obtained from patient about previous
radiation examinations, type of exposures and details about part
of body exposed before starting the examination. The answers
given by patient should be recorded on case paper for future
reference.
3. Pregnant women should not be exposed to X-ray examination
of pelvis.
4. Attempts to reduce radiation burden should be made.
Dose Monitoring
As guidelines set by ICRP, in India the controlling authority is
Atomic Energy Commission, Directorate of Radiation Protection
(DRP), Bhabha Atomic Research Center. They have set down
mandatory standards for manufacturer of X-ray equipment and
end user (Radiation Worker).
Every manufacturer must get AERB approval of design and
development of product for radiation safety standards, before
launching the product in market. Team of testing engineers from
AERB inspect the equipment at vendors premises and after
conducting radiation measurements suggest amendments to
improve the radiation leakage if required. After implementation
of same, the clearance for manufacture with complete description
of system is issued by controlling authority. The controlling
authority can carry out surprise inspection during manufacturing
process and if discrepancy is found the certification is withdrawn.
Every purchasing authority should insist that vendor should
furnish the AERB certificate. AERB also issues the recommended
installation plans for X-ray and therapy installations. These plans

should be strictly followed by both vendor and purchaser.
Every radiation worker should be covered with film badge service.
Film badge should be issued to every radiation worker above 18
years of age by his employer. Radiation worker should be well-
trained regarding hazards of radiation. AERB conducts radiation
protection course. Film badge issued should be worn by radiation
worker on chest when working with ionizing radiations. Every
month the badge should be sent to DRP for measurement and fresh
badge should be issued to radiation worker. The holder for film
badge is made of plastic material incorporating different filters of
various thickness of different materials. They are associated with
different types of ionizing radiations. There is clear window at the
back of holder to determine if the worker has really worn the badge
during actual work. This is determined by amount of back scatter
from rib cage. Films used are dental films supplied in envelope so
that they cannot be exposed with normal light. The film is loaded
in holder below the filters. These badges worn by radiation worker
for one month and then sent to AERB, are processed in their lab
under film dosimeter and also assessment of hardness of radiation.
In case radiation worker has overexposed beyond acceptable limit,
compulsory rest from radiation work will have to be given. The
readings are added to previous readings so that accumulated dose
can be calculated. The institution will get the readings of radiation
worker in stipulated time. This procedure has an advantage of
permanent record of radiation worker for his lifetime service
period. Another method of monitoring is TLD (Thermoluminescent
Dosimeters) which can be reused after obtaining the reading by
heating the badge. Their sensitivity is high and cost is less.
Duties of Radiation Protection Officer in Institute

He is responsible for the measurement of personnel doses,
measuring dose outputs and maintaining permanent record of
readings obtained from DRP. He is responsible for organizing
medical check up of radiation worker if excess dose is received.
Installation Requirements
In order to ensure adequate radiation protection, compliance to
building and installation plan of radiographic system
recommended by AERB is essential. This protection is not only for
radiation worker, but also for persons visiting radiology

department. The radiation protection plan distinguishes between
controlled area and other areas such as office, typist pool, passage,
garden, etc. The area outside but adjacent to radiology department
requires supervision and monitoring of radiation dose. The severity
can be determined based on occupation factor. While planning
radiation protection of building, operating data of the equipments
in usage should be considered such as:
Workload, degree of utilization of X-ray equipment.
Direction of primary beam, scattered radiation assessment to
plan occupational areas.
Occupancy factor of personnel in different areas to be protected
with time factor.
Protection curtains for mobile or dental X-ray equipments
should be used or other radiation protection techniques should
be adapted, if they are operated in radiology department.
Bone Densitometry 279
16 Bone Densitometry
It has been noticed that, with receding of age the bone mineral
density is reduced, resulting into the possibility of fractures of
wrists, elbow, spine or femur. Bone Mineral Density (BMD) has
become the complete bone assessment tool ever devised. This
diagnostic tool is used to determine osteoperis or osteoporosis
developed in aging patient. Generally, as age of the patient is
around 50 in male subjects and in female subjects after menopause,
the BMD starts decaying. The amount of decay depends upon the
age.
As the age increases the BMD reduces at a faster rate (Figs 16.1
and 16.2).
The green area indicates that BMD is within tolerable limits. Yellow
area indicates osteoperis means reduction in BMD but still
acceptable limits (on border) and red indicates osteoporosis, which
means that BMD level is alarmingly low and patient is susceptible
to fracture of bone.
The most susceptible bones during fall are elbow, femur and spine.
In case of elbow fracture the tendency of patient is to take support
Fig. 16.1: BMD of sample patient

of hand during fall. The patient can be treated with plaster cast or
sling in local area. Patient can perform other tasks with certain
limitations. But if the fracture is in vertebral column (L1-L4) region
or at femur neck the patient has to lie down in bed till corrective
measures like orthopedic surgery are performed. This means that
patient will be immobile for some time till the fracture heals.
If the patient BMD is known in advance, the patient is administered
required quantity of calcium and other drugs to prevent further
decay, thus avoiding the possibility of fractures. The three curves
A, B, C, indicate the decay of BMD over the age in different patients.
The statistical data is arrived with screening of different patients.
When a whole body scan is taken with BMD equipment, the BMD
is calculated for different parts of body as indicated above in
Fig. 16.1. Hence, patients with low bone density, and vertebral
fracture are at high risk.
It is well-established that existence of a previous vertebral fracture
increases the risk of subsequent fracture. Irrespective of patients
BMD, previous fracture increases risk significantly. Additionally,
it is well-established that risk for future fractures is increased for
patient with low BMD.
Risks Involved with Patient Having Earlier Fracture

It is noticed that patient with low BMD and vertebral fracture has
25 fold higher risk for subsequent vertebral fractures compared to
patient with high BMD and no vertebral fracture. While as a patient
Fig. 16.2: Prevalence of vertebral fractures vs age

with medium BMD and an existing one vertebral fracture has twice
the risk for subsequent fractures compared to a patient with low
BMD and no fracture. (Fig. 16.3).
Fig. 16.3: Risk vs. BMD
Methods of Calculating BMD

There are two methods used for BMD calculations namely,
(a) Ultrasound Method
(b) Radiology Method (Fig. 16.4)
(a) Ultrasound Method

This method is used as mass screening tool. Since femur and heel
are both weight bearing and metabolically active, this method is
used for determining BMD of heel. The correlation between heel
and hip is around 85%, hence it may give 15% wrong results. An
ultrasound beam at 0.5 MHz is passed through patients heel.
Attenuation and speed is measured. Stiffness index is calculated.
Due to lack of penetration, this method has limitations for sites
like spine and femur. Radiology method has taken over from this
method for detection of BMD for whole body.
Fig. 16.4: Bone densitometer unit
(b) Radiology Method

This equipment utilizes X-ray radiation for diagnosing BMD. There
are two types of equipments available in the market.
1. Using pencil beam and photo multiplier type detectors.
2. Using narrow pencil beam with Cadmium Zinc Telluride (CZT)
detectors.
This method gives higher speed. If fan beam angle is increased
from 12 degrees, higher magnification is obtained. Cadmium Zinc
Telluride (CZT) detector can discriminate between high and low
energy X-ray photons. Hence, one can achieve low lag at high
speeds while as the pencil beam type of equipment offers higher
lag and low speed.
Dual Energy X-ray Absorption

Dual energy X-ray Absorption (DEXA) technique is widely used
nowadays. The site contains both bone and flesh.
Initially patient is subjected to a low energy at 38 kV obtaining
total absorption.
Z1= X1 + Y1
where, Z1 is total absorption at 38 kV, X1 is absorption in bone
and Y1 is absorption in flesh.
Then patient is subjected to higher energy at 76 kV.

Z2 = X2 + Y1
where Z2 is total absorption at 76 kV, X2 is absorption in bone.
Hence, Z2 Z1 = X2 + Y1 X1 Y1 = X2 X1
Assuming that flesh will absorb the same amount of X-ray radiation
Thus, absorption in bone at a particular site is calculated and this
gives BMD.
Specifications of DEXA Equipment

X-ray tube:
Stationary anode, maximum kVp = 95 kV
Focal spot 0.5 0.5 mm
X-ray tube voltage : 38/76 kV @ approx. 3 mA
Focal spot receptor distance : 67 cm.
Patient table attenuation : less than 0.7 mm Al equivalent
Maximum scan area : 40 cm 22 cm.
Scan area for femur : 21 cm 18 cm
Scan area for elbow : 41 cm 20 cm
Scan area for whole body : 195 cm 60 cm
Minimum irradiation time : 2 seconds
Patient dose: AP spine, femur = 3 mrem; Total body = 0.02 mrem.
Power supply: 240 volts, 50 Hz, 1 Phase, 250 watts.
Standards: IEC - 601 2 75.1
Configuration
K edge filter
Rare earth filter for elimination of continuous calibration
Constant potential X-ray Generator
Simultaneous dual focus beam
Patient positioning table
Under couch X-ray tube head utilizing stationary anode tube
and Over couch detector system both coupled together for
continuous movement in longitudinal direction at a low speed
to scan the patient from head to toe, thus completing whole
body scan.
Laser Beam for patient positioning with output power of less
than 1 MW,
Wavelength = 635 nm
Beam aperture = 4 1 mm
Aspect ratio = 4:1
Divergence 28 degrees
Current drain = 105 mA
Input voltage = 4-6 volts DC
Safety = Class II
Computer
Laser printer.
Digital Radiography 285
17 Digital Radiography
We had seen in chapters 9, 10 and 11 development of X-ray films

and final image obtained in the form of radiograph. This technique
is used for last 100 years and with the introduction of image
Intensifying screens for last 60 years. The high quality image thus
obtained is standard image because their dose efficiency and
functional utility. Conventional film-screen intensifying screens
are composed of a fluorescent material which absorbs the incident
X-ray energy and converts it to light during exposure. A substantial
fraction of light never reaches the film and gets scattered resulting
in loss of sharpness. The light creates latent image on film which is
visible after processing the film in developer, fixed in fixer, rinsed
and dried to obtain for archival record or can be viewed on X-ray
light box as a visible image. Most of the conventional units, almost
70%, still use the conventional method of film development
techniques even today.
Digital imaging (DR) or computed radiography (CR) with CT,
ultrasound, MRI and nuclear medicine gained acceptance in 1980.
The digital imaging offer high luminance, high resolution display
monitors combined with high performance computer workstations.
Efficient storage with less space requirement and retrieving the
large amount of data generated by projection radiography with
electronic image archives are most cost effective. High speed
electronic networks with adequate bandwidth to transmit image
is added advantage with this technology. This CR technology has
an additional advantage that it is compatible with existing X-ray
equipment for film-screen imaging. In recent years a new
technology has emerged with large area flat panel, solid state
detectors with thin film transistors (TFT) as readout mechanism.
Thus with the help of advances in digital display, archiving and
communications, quality and productivity of radiology department

has been improved multifold. Hence, the introduction of this
technology promises very rapid access to images and provide better
image quality than conventional film-screen technique. This has a
special bearing on high workload in Radiology department. The
ideal DR system would have high spatial and contrast resolution,
dose efficiency. The weight of detector, being solid state, would be
very much lower than conventional film cassette, thus it is easier
to handle. Moreover this technique interfaces well with Hospital
Information System (HIS) and conveniently output images to
printers, archives and workstations.
Contribution to ideal digital radiography could be classified in three
areas namely:
Image quality: Images better than those with film-screen
technology
High spatial and contrast resolution
Dose efficiency
Other: Minimal change from existing cassette systems,
14" 17" scanning area, solid state robust design
Workflow : Immediate image access with HIS
(Hospital Information System),
PACS (Picture Archiving and Communication
System) and
DICOM (Digital Communication) connectivity
Intelligent operator console.
DETECTORS
There are many types of detectors marketed by different companies
and they are similar in size, appearance and applications but have
differences in the image capturing technology incorporated, which
in turn decide the image quality. There are three distinguishing
technologies incorporated namely, CCD Camera Technology (uses
gadolinium oxy-sulfide as X-ray scintillator with lens optics and
CCD Camera), Flat PanelIndirect (uses cesium iodide as X-ray
scintillator with a-Si: H photodiode and Thin Film Transistors (TFT)
screen), Flat panelDirect uses a-Se as X-ray Photoconductor,
Storage Capacitor and a-S: H Thin Film Transistors (TFT) screen.
We will now discuss their relative advantages and disadvantages.
CCD Camera Technology

We are aware that CCD cameras are used in video and digital
photography. They use optics to minimize the image. Since they
are small in size of the order of 2 to 3 square cm, optical means to
reduce size of image from image intensifier is to be adapted by
using lenses and fiber optic tapers. Thus the smaller size of image
is not so good. Another important factor is number of light photons
reaching CCD is very much less as compared to that on scintillator.
Hence, signal to noise ratio is poor and image noise is increased
which in turn degrade the image quality. Moreover lenses and fiber
optic tapers introduce geometrical distortions, light scatter,
resulting in poor resolution. Thermal noise within CCD also
degrade image quality. Hence, this technology was treated as
transition phase and flat-panel technology has taken over now.
Flat-panel Technology
This technology have two types of detectors namely direct
conversion type and or indirect conversion type.
Direct-conversion Flat-panel Digital Detectors

They use X-ray photo conductor material, amorphous selenium to
directly convert X-ray quanta into electric charge. This is simple,
efficient method because it does not require additional process.
It offers narrow response profile as shown in Fig. 17.1.
Fig. 17.1: Direct radiographic system

It characterizes the direct capture resulting in electronic charges,

thereby maintaining the signal to noise ratio.
Indirect Flat-Panel Digital Detectors

They use a light scintillator similar to that used in film screen
systems. They require a two step process for X-ray detection
namely, a fluorescent material (gadolinium oxy-sulfide or cesium
iodide) to capture and convert X-rays in to light, which has
drawback of loss of energy and scatter thus degrading the image
sharpness, and conversion to electronic image by an array of thin
film photo diodes. (Fig. 17.2).
The electrical signal thus obtained is read out by an array of thin
film transistors. The quality of image depends on keeping high
signal to noise ratio, hence preserving the signal profile at the
detector stage is important feature. Since indirect conversion
systems rely on light, due to scatter, amplitude is reduced.
In both direct and indirect conversion detectors, electric charge
pattern is temporarily stored by detector during exposure. After
the exposure, the stored charge is fed to amplifier and A/D
converter which produces raw digital image giving direct read
out. This is then used to produce images suitable for display and
diagnosis. Hence fully automatic image processing technique gives
high quality images, even if exposure is under or over.
Fig. 17.2: Indirect digital radiographic system

Repeat exposures can be avoided with the incorporation of

automatic exposure control. The stored data can be erased after
the desired image is obtained and processed with the help of eraser
system and same digital cassette can be reused again.
THIN FILM TRANSISTOR (TFT) ARRAYS

TFT based flat panel systems are manufactured so that the charge
collection and readout electronics assembly are adjacent to the layer
where X-rays interact. Thus, compact design is possible with
immediate access to digital images. These arrays are used in active
electronic switching elements. They are deposited on glass substrate
in multiple layers constituting readout electronics at lower level,and
charge collector arrays at higher level. X-ray sensitive elements
and light sensitive elements or both are deposited to form the top
layer of this electronic structure depending on type of detector
system desired. The entire assembly is then encapsulated in a
protective enclosure with external connection to computer. More
the number of layers, more complex is the array, and this results in
lower yield and reliability. Direct conversion detectors have few
layers and simpler design.
Design of Flat Panel Direct Conversion System

This type of detector is constructed by adding an X-ray photo
conductor layer adjacent to the amorphous silicon thin film
transistor and charge storage capacitor. Amorphous selenium acts
as a photo conductor material having good detection property and
high spatial resolution. Electric field is applied before the exposure
across amorphous selenium layer through bias electrode on upper
surface of selenium. Electric charges are drawn along electric field
and storage capacitor gets charged, when X-rays are absorbed. This
charge is amplified and converted to digital value for that area
(Pixel) by electronic circuitry.
The detector elements are separated by electric field shaping within
selenium layer. Hence entire selenium surface is available for
energy conversion. Since selenium is used in amorphous form, large
areas to suit this application can be manufactured by vapor
deposition, resulting in cost effective solution.
Design of Flat Panel Indirect Conversion System

This type of detector is constructed by first adding amorphous
silicon photodiode, biasing electrodes and scintillator as top layer
of detector. This is equivalent to single X-ray photoconductor layer
used in direct system described above. When X-rays impinge on
scintillator, light proportional to incident energy is emitted in all
directions. This emitted light is either absorbed in scintillator or
scattered before reaching photodiode. Only those light photons
which reaches photodiode are converted to electric charge,
resulting loss of information. Electric charge is amplified and
converted to digital value for that area (Pixel) by electronic circuitry.
(Fig. 17.3) Scintillators used here are conventional intensifying
screens, causing scattering of light and spread to number of adjacent
pixels reducing spatial resolution. In case cesium iodide crystals
are used in place of intensifying screen, which are hygroscopic
and rapidly degrade, they are properly sealed. This structure
behaves similar to fiber optic channels for photodiode layer. Light
spreading is reduced in this case as compared to intensifying screen
type but not completely eliminated. It also allows thicker layers of
scintillators to be used that have light spread comparable to
conventional intensifying screens. Hence this design provide
increased X-ray energy absorption as compared to earlier type
(intensifying screens).
Fig. 17.3: Direct detector principle

Evaluation and Selection of DR System

Analysis of the system includes detector and image processing
techniques used. DR system must provide connectivity to DICOM,
HIS and PACKS. Following parameters are important:
(a) Detector Size

It is important that the detector should be sufficiently large enough
for anatomy to be exposed, but compact enough for desired
applications. Ideal size should be rectangular 14" 17" for over
couch work. In case of smaller size, there is possibility to loose
information. Moreover rectangular format corresponds to monitors
and workstations. In case square format is used, image data is
minified to meet the requirements of output devices.
(b) Detector Element and Matrix Size

Detector element is smallest resolvable area in the digital imaging
device. The matrix size of detector is the number of detector elements
in two orthogonal directions. The maximum spatial resolution of
image is determined by detector element size and their spacing.
Image in pixels defined by matrix size. Each pixel carries unique
information in case of direct detector which has no source of pre
sampling resolution loss. In case of indirect detectors the pixel
values are correlated, because each one is not carrying unique
image information, resulting in wasted storage space and network
bandwidth. Hence, if number of detectors are only compared, it
will give wrong assessment because spatial resolution will be
limited due to image blurring resulting from scattering in detectors.
Special applications such as mammography require smaller
detector element size. Detectors with smaller elements and large
pixel matrices require increased data volume per image, larger
network, increased archiving, and need for image reduction when
image is displayed on video monitors. These detectors do not suit
general radiography applications.
(c) Image Spatial Resolution

It depends on physical detector characteristics. It is determined by
pixel spacing in detector. The frequency that characterizes this
limiting resolution is called Nyquist frequency. Nyquist frequency

is the highest spatial frequency that can be represented in a digital
image and is determined by the pixel size. Every image can be
described in terms of the amount of energy in each of its spatial
frequency components. The modulation transfer function (MTF)
describes the fraction of each frequency component that will be
preserved in captured image. Modulation transfer function is a
measure of the ability of an imaging system to preserve signal
contrast as a function of spatial frequency. It describes the fraction
of each component that can be preserved in captured image.
Nyquist frequency and MTF allow visualization of finer details,
thus giving better image. For finer structures we require higher
resolution in applications such as small bone details or lung tissue.
Image blur prior to sampling increases effective size of the pixels
as compared to physical size. In case of direct detectors using
amorphous selenium, physical and effective sizes of pixel are
identical resulting in high spatial resolution. While, as in case of
indirect detectors, the effective pixel size can be larger than physical
size, thus this system offers low spatial resolution. The line spread
function describes the image blur that can occur for a narrow
X-ray beam incident on detector. The line spread function for
indirect detector is wider, due to the substantial contributions to
the signal recorded by neighboring pixels. This can also be
understood in terms of equivalent aperture, which is a measure of
effective size of an imaging element. The effective pixel size of
indirect pixel is actually double its physical size. While, as in Direct
conversion system effective pixel size and actual physical size are
same. Hence, X-rays only contribute to the signal recorded by the
pixel on which they are incident, resulting in independent pixel
data and there is no wasted network bandwidth or archive storage.
(d) Image Quality

Recent experiments have shown that anatomical noise can be
limiting factor in detection of clinically relevant findings and in
some cases it may have more bearing than signal to noise
characteristics of detector. The objective physical measurements
such as modulation transfer function (MTF) and detective quantum
efficiency (DQE) are widely accepted overall measure of detector
image quality performance. DQE is the efficiency with which a
detector captures information present in X-ray exposure. The

information depends on the X-ray quanta incident on imaging
detector which is related to patient dose. DQE depends on detection
efficiency of detector for incident radiation quanta, internal noise,
exposure parameters such as kVp and mR and spatial frequency.
The maximum DQE for film screen system are ranging from 15 to
25% as against 45% in case of direct conversion system. Hence direct
conversion DR system is far superior than film-screen or CCD based
DR systems. Hence quality of X-ray image depends on factors such
as signal profile captured by detector, direct or indirect conversion.
Advantages of DR System
To The Hospital
1. Negligible repeat examinations, increased room use and
reduced cost.
2. Higher productivity resulting in large number of patients in day.
3. Improved patient care.
4. Eliminates the need of conventional film processing, thus
reduced load on purchase department for frequent ordering of
dark room chemicals.
To The Radiologist
1. Rapid, good quality images, easy transmission, display, archive
and retrieve.
2. Capture and convert X-ray image into digital format within
seconds of exposure enabling technician to preview each image
prior to completion of examination procedure.
3. Enhance work flow through distribution of diagnostic images.
Digital image can be transmitted electronically via reading on
monitor or printing or storage.
4. Adjustment of electronic image at workstation (as well as
hardcopy), by radiologist for optimum information of the
desired anatomy.
5. Images can be communicated to other location for second opinion.
6. Image data on workstations, printer or in archives is identical
and does not get affected due to multiple viewing or storage
modalities.
Index 295
Index
A Basic circuits 80
Basic dual field image intensifier
Absorbed dose 262 186
Absorption 6, 18 Basic heating 100
Absorption value scale of CT Basic radiographic system 36, 129
scanner 249 Battery powered unit 34
Age dose 260 Beam direction 172
Air conditioning 53 Beam limiting device 149, 171, 269
Ampex system 212 Biangulix filaments 68
Analog to digital converter 196 Blanking 202
Analytical method 253 Blocking circuit 110
Angiographic injectors 229 Body section radiography equip-
Angiography 217 ment 138
Angiography systems 44 Body section radiography unit 42
Anode 58, 76 Bone densitometer unit 282
Applications of CT scanner 245 Bone densitometry 279
Area reduction factor 184 Boosting 67
Armstrong units 5 Brachial angiography 218
Attenuation 6 Brems strahlung 4, 11, 12
Auto transformer 102 Bright spots 148
Automatic circuitry 231 Bucky table with floating table top
Automatic dose rate control 204 131
Automatic exposure control 116
Automatic film processor 165 C
Automatic gain control 198
Automatic programming tech- Camera control unit 198, 199
nique 122 Camera lens 189
Average gradient 161 Capacitor discharge unit 33
Cardioangiography 218, 225
Cassettes 26, 156
B
Catapult bucky 133
Back projection method 253 Catapult bucky assembly 155
Backfire 81, 99 Catapult bucky mechanism 155
Base-plus-fog density 161 Cathode 58
CCD camera 196, 286 Contrast ratio 185

CCD camera technology 287 Controlled area 258
Cerebral angiography 218 Conventional CT scanner 245
Characteristic radiation 13, 14 Conventional fluoroscopy 145,
Characteristics of X-ray tube 72 146
Charged coupled device 196 Conventional X-ray generator 122
Charged storage principle 191 Conversion factor 184
Chattering of relay 113 Conversions of X-ray television
Chemical composition of muscle, system 181
fat, bone 20 Core and frequency 92
Chest stand 131, 133, 135 CT number 249
Choice of films and processing CT scanner unit 238
material 275 Cut film 228
Cholangiography 218
Cine camera 209 D
Cine fluorography 115
Circuit for dose rate measurement Damage to the X-ray tube 76
261 Dark current compensation 198
Civil work 51 Dark room adaptation goggles
Classic scatter 16 274
Clearances 51 Deep therapy 9
Collision with orbiting electrons Dental X-ray 28, 127
12 Design of filament 66
Combined system 205 Detector element 291
Compactness 124 Detector size 291
Composite video signal 192 Detectors 286
Composition of beam 266 Determination of maximum load
Compression band 151, 269 73
Compression cone 151 Developer 166
Compression device 151 Development of image 248
Compton effect 16, 17, 149 DEXA Equipment 283
Compton scattering 16 Diagnostic X-ray equipment 21
Computed radiography 285 Digital imaging 285
Computer console 240 Digital radiography 285
Computer tomography 237 Digital zoom 197
Computerized axial tomography Direct radiographic system 287
237 Direct-conversion flat-panel digital
Cone vision 180 detectors 287
Cones 274 Distance 263
Connections of windings 94 Dose equivalent 262
Constant potential generator 83, Dose monitoring 276
84, 115 Double slot collimator 150, 272
Construction and design of VCR Double slot diaphragm 149
212 Dry work area 164
Index 297
Drying 168, 169 Filament cup 59

Dual energy X-ray absorption 282 Filament curve 103
Duties of radiation protection Filament emission curve 99
officer 277 Filament heating 102
Duty of radiologist 276 Filament transformer 67, 94
DVD players 214, 215 Film cycle 226, 228, 229
Dynamic blurring 67 Film focus distance 172
Film quality 171
E Film rate 219
Film salad 227
Earthing 49 Film speed 161
ECG triggering 232 Film stationary time 229
Effect of decentering 156 Filtration 74
Effect of field lines on electron Filtration process 267
focusing 60 Fixer 167
Effect of focusing cup 68 Flat panel 286
Effect of space charge 70 Flat panel direct conversion system
Effects near the nucleus 11 289
Effects near the orbiting electron 11 Flat panel indirect conversion
Electric power 46 system 290
Electrical safety 231 Flat-panel technology 287
Electromagnetic coils 193 Floor to ceiling column stand 131,
Electromagnetic contactors 113 133, 135
Electromechanical motor driven Flow rate injection 230
screw 231 Fluoroscopic heating 100
Electron gun 192 Fluoroscopy 126, 145
Electronic lenses 183 Fluoroscopy technique 22
Electron-volt 11 Focal spot 54, 59, 144
Electrostatic fields 193 Focal spot area 62
Energy dose 262 Focal spot size 65
Energy dose rate 262 Focus film distance 274
Energy quantum 11 Focused grid 152
Equipotential ground 231 Focusing cup 58
Exposure parameters 172 Function of eye 180
F G
Falling load technique 106, 111 Generations of CT scanners 241
Fan beam 239 Genetic effect 259
Fiberoptic system 187, 188 Geometrical blurring 67, 144
Filament 77 Glass envelope 70
Filament characteristics 70 Glass faceplate 194
Filament circuit 101, 103 Grid controlled tube 115
Filament control by triac 108 Grids 151
H Indirect flat-panel digital detectors

288
Half value layer 264-266 Infrastructural requirements 46
Hand operated radiographic/ Input screen 182
fluoroscopy unit 38, 39, 132 Installation prerequisites 139
Hand operated table 132 Installation requirements 277
Heat units 8 Intensification factor 184
Heel effect 56, 57 Intensifying screens 26, 156, 157,
HF generator 124 171, 270
High dose yield 123 Interaction at the anode 10
High frequency generators 123 Interaction with nucleus 14
High frequency multi-pulse Interlace system 203
generator 84 Interlacing 203
High tension transformer 86 Interrogation time 116
High tension transformer Inverse square law 5, 6, 263
assembly 97 Inverse voltage suppressor circuit
High tension voltages 98 81
High voltage rectification 95 Ion dose 260
Historical development in Ionization chamber 116
radiology 3 Ionizing radiation 257, 260
Horizontal resolution 203 Iontomat circuit 118
Horizontal retrace 202 Iontomat controls 117
Housing and power supply 183 Isowatt technique 105
Housing or shield 77 Iterative method 253
HSE chamber 118
HT Cable terminal 98 K
HT cables 135
Kinetic energy 4, 17
HT cables and plugs 97
L
I
Lag 185, 195
Image formation 19 Lead apron 26
Image intensifier 146, 178, 182 Lead letter 172
Image intensifier television Lead monoxide 194
equipments 136 Lead protection screen 26
Image intensifier television units Lead rubber gloves 273
43 Light beam collimator 149
Image intensifier tube 179 Light distributor 179
Image orthicon tube 191 Line focus principle 55
Image quality 292 Line rate 203
Image reconstruction 251 Local dose 262
Image spatial resolution 291 Local dose rate 263
Indirect digital radiographic Low skin dose 123
system 288 Luminescence materials 7
Index 299
M N
Magnetic voltage stabilizer 104 Nonionizing radiations 257
Magnification 219 Normal values for tungsten 14
Mains compensation 48, 119
Mains compensation circuit 120 O
Mains resistance 48, 90
Mammography equipment 138 Object image plane distance 144
Mammography units 45 Objective lens 188
Manual dark room processing 166 On load voltage 88
mA-Ri correction 89 Optical focal spot 55
Market requirements 27 Optical zoom 197
Maximum permissible dose levels Orthicon tube 192
263 Orthopantograph 29, 127
Maximum permissible exposure Output screen 183
time 229 Overcouch radiography 268
MDCT scanner 245 Overload protection 109
Measurement of dose 260
Metal plate 271 P
Methods of calculating BMD 281
Minification factor 184 PAG4 222
Mirror optic system 186 Pantix filaments 68
Mobile C-arm image intensifier Parallel grid 152
137 Patient table 239
Mobile equipment 129 Penetration 15
Mobile protective barrier 274 Penumbra 144
Mobile stand 232 Peripheral angiography 218
Mobile units 126 Persistence 195
Mobile X-ray 31 Phase in time 229
Modern X-ray generators 121 Photo cathode 182
Modular designs 123 Photo spot cameras 208
Monitor 200
Photoconductivity 190
Monochrome television monitor
Photoelectric effect 17
tube 201
Photoemission 190
Motor operated equipment for
radiography and fluoroscopy Photographic film 7
40, 134 Pinhole camera 66
Motor operated table 134 Planigraphy 42, 138, 233, 234
Multidirectional blurring 236 Planigraphy angle 234, 235
Multi-directional computer tomo- Planigraphy arm 234
graphy 244 Planigraphy principle 234
Multi-layer storage 214 Plumbicon 194
Multiple field image intensifiers Portable equipment 128
185 Portable X-ray 31
Multiplier 119 Portable/mobile X-ray 30
Power ratings of X-ray generator Radiography technique 23

47 Radiological system for use in
Power supply 32 mobile van 46
Preheating 67 Radiopaque substance 145
Pressure controlled injection 230 Rapid tubes 64
Primary switching 112 Raster 194
Principle of CT scanner 237 Reciprocity failure 117, 161
Processing of image at output Recording 205
screen 185 Reduction in anode angle 56
Processing of X-ray film 162 Register technique 105
Properties of X-rays 4 Relative intensity 264, 265
Protection against X-ray radiation Remote controlled R/F tables 41
267 Renal angiography 218
Protection of X-ray tube 109 Resolution 6, 146, 184
Protection plate 271 Resolution camera 66
Protection procedures 259 Restricted area 258
Protective earthing 49 Retrofitting 216
Protective screens 274 Rinsing process 167
Pulse width automatic system 205 Ripple 47
Ripple factor 86
Q Rod vision 180
Roentgen effect 258
Quality of radiation 266 Roll film 228
Quality of X-rays 8 Rotating anode circuit 120, 121
Quantity of radiation or intensity Rotating anode X-ray tube 62, 75
18 RT anode 63
Quantity of X-rays 7 RTM anode 63
R S
Radiation dose 259 Safe light 26
Radiation hazard 257 Scanning gantry 239
Radiation injury 260 Scattered radiation 5, 15, 149
Radiation protection 8, 257, 259, Scattered radiation grid 151
273 Screen structure mottle 157
Radiation quantity 148 Secondary switching 83, 114
Radiation sickness 8, 257 Selection of DR system 291
Radio transparent substance 145 Selenium rectifiers 95
Radiographic cone 149 Semiconductor radiation receiver
Radiographic image 7 118
Radiographic lead apron 273 Serial film changer 226
Radiographic materials and Serialography 116
processing technique 160 Service contract 141
Radiography 7, 147 Shield 71
Index 301
Shielding 263 Thin film transistor (TFT) arrays

Shorter exposure time 123 289
Signal plate 193 Three channel distributor 189
Silicon controlled rectifiers 113 Three channel light distributor 190
Simple radiographic equipment Threshold of emission 67, 101
for casualty 130 Thyratrons 113
Simple radiographic system 35 Timer 111
Single tank generator 95 Tolerance of focus grid 153
Single-pulse generator 80 Tomography 233, 236
Six-pulse generator 82 Tube current measurement 107,
Slip ring CT scanner 243 108
Slip ring spiral CT scanner 244 Tube insert 70
Somatic effects 259 Twelve-pulse generator 83
Source image plane distance 144 Two-tube connection 96, 97
Source of X-ray radiation 143 Two-pulse generator 81
Source of X-rays 19 Typical scanning raster 202
Space charge 99
Space charge resistor 105 U
Space requirement 51
Universal angiography equipment
Speed of rotating anode 64
222, 223
Spiral CT scanner 245
Spot film device 38, 207, 270
V
Standby heating 100
Stationary anode X-ray tube 58, 61 Vacuum tube 190
Stationary grid 155 Vascular pulsations 220
Stationary installation 126 Vertebral fractures 280
Stator windings 71 Vertical bucky wall stand 131, 134,
Structure of X-ray film 160 135
System earthing 49 Vertical resolution 203
Vertical retrace 202
T Video camera 179, 190
Video recording 211
Table top 269 Vidicon tube 192
Tandem lens system 188, 189 Vignetting 185
Tape movement 213 Visualization 186
Target angle 56, 65 Voltage stabilizer 104
Target diameter 64
Target disc 63 W
Television field 203
Television frame 203 Warranty 139
Television sync generator 200 Washing 168
Television viewing system with Water connection 53
camera 186 Waveforms of X-ray generators 85
Webcam 197 X-ray generator requirements

Wet work area 165 221
Wetting 168, 169 X-ray ray guard 271
Windings 92 X-ray tube 10, 25, 54, 135, 269
Wiring and wiring terminals 50 X-ray tube current 99
X-ray viewing box 25
X Z
X-ray chest stand 27 Zero crossing 114
X-ray examination unit 25, 125 Zero time 229
X-ray generator 22, 24, 79, 132, 133, Zonography 236
136, 238, 272 Zoom 197

Diagnostic Radiology and Imaging For Technicians

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Diagnostic Radiology and Imaging For Technicians

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Diagnostic Radiology

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

Diagnostic Radiology and Imaging for Technicians

First Edition: 2008

The rapid advances in the field of radiology

we definitely lack a definitive and concise book which encompasses

Dr. Mukund S. Joshi

When I began my teaching career, I painstakingly compiled the

I owe a great debt of gratitude to M/s Siemens Limited, where I

Biomedical engineering has grown by leaps and bounds over past

densitometry and digital radiography and other allied

The historical developments in radiology are listed below:

Nature and Properties

When the fast moving electrons are suddenly stopped by matter

1. X-rays pass through the matter

2. X-rays propagate linearly from source of X-rays

3. They produce secondary radiation in all matter through

Fig. 2.1: Inverse square law

of X-ray image and deteriorates the quality of image. Hence the

4. X-rays cause metallic salts to emit light

Table 2.1: Applications of luminescence materials

Luminescence Material Application

Cesium Iodide Image Intensifier fluoroscopy

The applications of these are discussed in detail in chapter How

5. X-rays blacken photographic films

The Quality of X-rays depends upon its penetrating power which

6. X-rays cause gases to become electrically conductive

7. X-ray photons are not deflected or accelerated by magnetic

8. X-rays produce biological effects and are harmful to human

In the field of Therapy, the ability of X-ray Radiation to destroy

INTERACTION AT THE ANODE

prime importance. Although matter seems to be empty space, the

1. Effects near the orbiting electron

2. Effects near the nucleus

Fig. 3.1: Brems Strahlung

Example: If the anode voltage is 100 kV and electron speed is

Fig. 3.2: The continuous spectrum of X-rays

3. Collision with orbiting electrons

shell. The primary electron has to overcome the binding energies

Fig. 3.3: Characteristic radiation

A similar jump from M to K shell will produce K quantum of higher

4. Interaction with nucleus

We have used terminologies like transmission, reflection and

1. Classic Scatter (Fig. 4.1)

Fig. 4.1: Classic scatter

2. Compton Effect (Fig. 4.2)

Fig. 4.2: Compton effect

3. Photoelectric Effect (Fig. 4.3)

Fig. 4.3: Photoelectric effect

organ is soft tissue we require energies between 25 to 40 kV). If

Image Formation (Fig. 4.4)

Fig. 4.4: Image formation

Table 4.1: Chemical composition of muscle, fat, bone: wt.%

Component Atomic Number Muscle Bone Fat

The above mentioned table gives information regarding the

DIAGNOSTIC X-RAY EQUIPMENT

(A) X-ray Generator

Fig. 5.1: Fluoroscopy technique

transparent substance in body. The tube current selection is between

Fig. 5.2: Radiography technique

indirect radiography. In case of direct radiography image is obtained

filament and anode-cathode voltage as well as exposure time with

sheet sandwiched between phenol bonded laminated sheet with