Introduction to x-ray film

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Introduction to x-ray film

INTRODUCTION
Photographic film can be exposed directly to X-rays but its sensitivity is very low and prohibitively large patient exposures would result if this appraoch was implemented on its own. Therefore, almost all conventional radiographic examinations require that the image be converted to light by an intensifying screen before being recorded by the film. We will consider pertinent features of both Intensifying Screens and X-ray film below.

FLUORESCENCE
We have seen previously that luminescence refers to the stimulated (by light, ionising radiation, chemical reactions etc.) emission of light by certain materials. If the light is emitted instantaneously, that is within 10 nanoseconds, the phenomenon is called fluorescence. If the emission is delayed somewhat, it is called phosphorescence. More particularly, in radiology, fluorescence is the term used to describe the ability of certain inorganic phosphors to emit light when excited by X-rays. Until the early 1970s the only phosphor of note was calcium tungstate (CaWO4), but since then a plethora of rare-earth phosphors with improved efficiency have appeared on the scene. No matter what type of phosphor material is used, the conversion of a relatively small number of X-ray photons of high energy to a large number of light photons of low energy is due predominantly to X-ray absorption via the photoelectric effect in the high Z components of the phosphor. The incident X-ray photons are absorbed either totally or partially in the phosphor layer. The absorbed energy is transferred to electrons which in turn deposit their energy by ionisation and excitation. The energy added to the atoms of the phosphor raises the atomic electrons to excited states. Most of this added energy is then dissipated as heat but a fraction (5% - 20%) is radiated as electromagnetic radiation in the visible or near visible wavelengths and it is this radiation which is utilised in the production of the latent image on the X-ray film.

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INTENSIFYING SCREENS
The use of intensifying screens has three major benefits: Reduction of patient dose Reduction of tube and generator loading and Reduction of patient motion artifacts. However, there is one disadvantage that is occasionally relevant to radiology which is that the image clarity is degraded in comparison with a directly exposed film. Figure 1 gives a schematic of a typical screen. The thin protective layer provides protection for the phosphor and can easily be cleaned. In some screens, the reflecting layer is not included. In a typical situation, two screens are used, one on either side of a double emulsion film To compensate for the absorption of some X-rays by the front screen, the back screen may be thicker than the front screen.

Figure 1: Cross-section of a typical intensifying screen. 1 micron = 1 mm.

The isotropic emission and scattering of light photons in the phosphor results in the lateral diffusion of the scintillation pulse before it escapes the screen. This results in a loss of resolution or sharpness and becomes increasingly important as the screen thickness is increased. This can be compensated for by using light absorbing dyes in the screen which will preferentially absorb the photons that travel the greatest distances.

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RARE EARTH SCREENS

We have already noted that the interaction of diagnostic X-rays with screens occurs primarily via the photoelectric effect. Therefore we can say that we need our phosphors to have Kedges appropriately matched to the X-ray photon energies. More explicitly, this means that we want a phosphor whose K-edge is between 25 and 50 keV. You may recall that the photoelectric effect interaction probability is a maximum at energies just above the K-edge. A look at Figure 2 establishes that Gd2O2S has a significant advantage over calcium tungstate for photon energies between 50 and 70 keV. The same is true of other rare-earth type screens such as BaSrSO4 to a slightly lesser extent. It is also useful to note that Gd-based phosphor screens are more favourably disposed to the detection of primary radiation than scatter radiation as a greater proportion of the primary spectrum is above the Kedge of Gd than of the scatter spectrum.

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Figure 2: Approximate Screen Absorption as a Function of Photon Energy for pairs of CaWO4, Gd2O2S and BaSrSO4 screens. The spectrum from an X-ray tube operated at 80 kVp with 12.5 cm of perspex as phantom is also illustrated.

Most inorganic phosphors (calcium tungstate is an exception) do not emit light efficiently unless doped with a small quantity of activator. For example, the activator in the rare-earth oxysulphides is terbium (Tb). The concentration of the activator not only affects the amount of light emitted but the spectral emission as well. This can be used to advantage to achieve better spectral matching between the phosphor and the film response. Certainly, the use of these activators is the reason for the substantially improved conversion efficiency of the rareearth screens compared with the old calcium tungstate screens.

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X-RAY FILM
The major recording medium used in radiology is X-ray film - although the situation is changing with the introduction of new technologies in recent years. The film can be exposed by the direct action of X-rays, but more commonly the X-ray energy is converted into light by intensifying screens and this light is used to expose the film, as described above. The basic structure of the film is outlined in Figure 3 below.

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Figure 3: Cross-section through a double emulsion film

The film base provides the structural strength for the film. However, the base must be flexible for ease of processing, essentially be transparent to light and be dimensionally stable over time. Early base materials were glass and cellulose nitrate, but more recently cellulose triacetate and polyester have been adopted. A thin layer of adhesive is then applied to the base and this binds the emulsion layer. Covering the emulsion is a thin supercoat that serves to protect the emulsion from mechanical damage. The two most important ingredients of a photographic emulsion are gelatin and silver halide. With most X-ray film the emulsion is coated on both sides of the film but its thickness varies with the nature and type of the film, but is usually no thicker than 10 mm. Photographic gelatin is made from bone and is ideal as a suspension medium in that it prevents clumping of grains. In addition, processing chemicals can penetrate gelatin rapidly without destroying its strength or permanence. Silver halide is the light sensitive material in the emulsion. In X-ray film, sensitivity is increased by having a mixture of between 1% and 10% silver iodide and 90 to 99% silver bromide. In photographic emulsion the silver halide is suspended in the gelatin as small crystals (called grains). Grain size might average one to 2.3 mm in diameter with up to a billion silver ions per grain and billions of grains per ml of emulsion. In its pure form the silver halide crystal has low photographic sensitivity. The emulsion is sensitised by heating it under controlled conditions with a reducing agent containing sulphur. This results in the production of silver sulphide at a site on the surface of the crystal referred to as a sensitivity

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speck. It is the sensitivity speck that traps electrons to begin formation of the latent image centres. Silver bromide is cream coloured and absorbs ultraviolet and blue light, but reflects green and red light. Historically, this was fine since the principle emission from calcium tungstate screens is blue light. Films for photography of image intensifier images and films for use with rare earth screens need to have their spectral sensitivity broadened to encompass the longer wavelengths associated with the emissions from these screens. This is accomplished by the addition of suitable dyes. Thus, we have green sensitive orthochromatic film and red sensitive panchromatic film.

FILM PROCESSING
Film processing is a multi-stage process involving development, fixing, washing and replenishment (Figure 4). In development, the exposed grains are preferentially reduced to black metallic silver. In fixing the remaining unexposed grains are dissolved so that they can be removed from the emulsion by washing. Replenishment ensures that chemical balance is maintained with usage of the processing solutions.

Figure 4: Schematic of an automatic film processor, showing the pathway followed by film as it is guided by roller mechanisms through the processing solutions.

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PHOTOGRAPHIC CHARACTERISTICS OF X-RAY FILM

When the X-ray beam passes through body tissues, variable fractions of the beam will be absorbed, depending on the composition and thickness of the tissues and the quality (kVp & filtration) of the beam. The magnitude of this variation in intensity is the mechanism by which the X-ray beam emanating from the patient produces diagnostic information. The information content of this X-ray image must be transformed into a visible image on the X-ray film with minimal information loss. In general radiography, the X-ray image is first converted to a light image using intensifying screens, which in turn produce a visible pattern of metallic black silver on the X-ray film. Ultimately, the degree of blackening is related to the intensity of the radiation reaching the intensifying screen. The amount of blackness on the film is called the optical density, D, which is defined in Figure 5. For example, if 100 light photons are incident on a film and only one is transmitted the film density would be log10(100) or 2. Useful densities in diagnostic radiology range from about 0.2 to about 2.5. High density means black films.

Figure 5: The definition of optical density, D.

If the relationship between the logarithm of the radiation exposure and the optical density is plotted we obtain a curve known as the Characteristic Curve. For film exposed with an intensifying screen, this curve is essentially sigmoidal in shape (Figure 6). It is characterised by: a toe or region of low gradient at low exposures,

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a region of relatively steep increase in density for minimal exposure increases, and a third relatively flat region called the shoulder at high exposures. The important part of the curve diagnostically is the approximately linear region between the toe and the shoulder where the density is proportional to the logarithm of the exposure.

Figure 6: The Characteristic Curve of X-ray film.

The information content resulting from the radiograph arises from differences in the film density, which we can define as radiographic contrast. Radiographic contrast depends on subject contrast and film contrast. For the moment you should recall that subject contrast depends on the differential attenuation of the X-ray flux as it passes through the patient and is affected by thickness, density and atomic number of the irradiated parts of the subject, the kVp, the presence of contrast medium and scattered radiation. For example, relatively few Xray photons pass through bone compared with soft tissue but care must be taken in selecting the correct kVp in order to produce an X-ray image of high information content for the screenfilm to record. That is, the kVp influences the magnitude of the subject contrast.

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Film contrast depends on four factors: the characteristic curve of the film, the film density, use of intensifying screens or direct exposure and the film processing. The slope of the straight line portion of the characteristic curve tells us how much change in film density will occur as exposure changes. The slope or gradient of the curve may be measured and the maximum gradient is called the film gamma, which tells us how well the film will amplify the subject contrast. X-ray film will fog slowly with time, the extent depending markedly on how well it is stored. This fogging, along with the optical density of the film base, will generate a low density in the toe section of the Characteristic Curve. The shoulder region of the curve indicates over exposure. Useful Link : Taken from http://www.life.rmit.edu.au/mrs/subject/mr100/fsrad.html#Introduction

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