1. X Rays
Medical Physics Notes

2. Ideal X-Ray Examination
a film that showed sufficient contrast between the features that the doctor wanted to examine
while putting the patient at minimal risk from the ionizing effect of the radiation.

3. The Beam An X-ray tube does not produce a monochromatic beam
It produces a spectrum of X-ray energies limited at the high energy end by the accelerating voltage applied.
With characteristic peaks relating to the material of the target

5. Attenuation (reduction of the beam strength)
Attenuation occurs as the X-rays pass through matter.
This attenuation is exponential.
Let Io = Intensity of the incident beam
I  = Intensity of emerging beam
x  = the thickness of the material the beam travels through
m  = linear attenuation coefficient

6. Syllabus Extract
Exponential attenuation Linear coefficient m, mass attenuation coefficient mm and half-value thickness x
Remember r is density!!
You did something similar with gamma ray absorption

7. Half Thickness I = Ioe-mx I/Io = e-mx natural log of (I/Io) = -mx
If the intensity halves
I = 0.5 Io
ln 0.5 = -mx ln 0.5 = -ln2
x = ln2/m

9. Half Thickness
This is similar to half life – the thickness of material that the rays must pass through in order for the intensity of the beam to be cut in half.
This varies with density of material – the denser the material the smaller the half thickness.

10. Where r is the density of the material
Half Thickness
Ensure you can calculate half thicknesses as well as find them off graphs.
In a similar way you can find out the thickness needed to reduce penetration to a tenth etc. ( just put I = 0.1 Io into the equation).    
Values for the mass attenuation coefficient mm can be changed into m by using the equation
mm = m / r
Where r is the density of the material

11. Attenuation mechanisms
The lower energy rays are more likely to be attenuated by the body than the high energy ones.
Attenuation occurs as the radiation passes through the body of the patient by two principal mechanisms:
photoelectric absorption and
Compton scattering.

12. Syllabus Extract
Differential tissue absorption of X-rays (excluding details of the absorption processes)
Note that you do NOT need details of the attenuation processes!
But you do need to know the names!

13. Attenuation
The lower energy rays are more likely to be attenuated by the body than the high energy ones. Attenuation occurs as the radiation passes through the body of the patient by two principal mechanisms: photoelectric absorption and Compton scattering.

14. Attenuation Processes _ Detail NOT required
Photoelectric absorption occurs when a photon of energy is absorbed by an orbital electron and this electron is then promoted to a higher energy level (more outer orbit) or leaves the influence of the nucleus completely (ionization).

15. Attenuation Processes – Detail NOT required
A.H. Compton discovered that if he bombarded graphite with monochromatic X-rays, the scattered X-rays had lower energies (longer wavelengths) than the undeflected ones: the greater the deflection the bigger the energy loss.

16. Attenuation Processes – Detail NOT required
The bombarding X-ray photon has a lot of energy - the force binding the electron to the atom is insignificant compared to the force exerted by the photon on impact.
When the photon 'bounces off' the electron, the electron recoils and thereby picks up some of the photon's energy. This is called Compton Scattering.

17. Attenuation Processes – need to know!
Photoelectric absorption is the dominant mechanism for low energy X-ray photons (used in soft tissue) whereas Compton Scattering becomes more significant for higher energy photons (bone).

18. Contrast in Breast Tissue
Low energy photon energies produce a better contrast between media of similar density (as in mammography) but overall absorption is greater.
This means that a higher anode current (resulting in a more intense beam) has to be used the lower the accelerating potential employed across the tube.

19. Contrast in Chest X-Ray
In a chest X-ray the densities of tissue to be investigated is diverse (bone/lung/heart) and ‘harder’ X-rays can be employed.
These still give the contrast required in the image but absorption is reduced by using high energy rays and filtering out the lower energy ones (soft X-rays) produced by the tube.

20. Contrast in Chest X-Ray
This can be done using an aluminium filter. Suitable energy for a chest X-ray would be keV depending upon the exact nature of the detail required to make the diagnosis.

21. Collective Dose
When calculating the collective dose to the population the average dose received per person is multiplied by the number of persons.

22. Average Dose
To calculate the average dose received because of X-ray examinations the number of each type of investigation would be found and then the typical dose given for each procedure would become the multiplying factor.

23. Hence one CT scan is equivalent in dose to about 800 knee X-rays!!
Typical Doses
X-ray examinations of
limbs, joints and teeth involve a typical effective dose of about 0.01 mSv whereas a
chest CT scan involves 8.0 mSv. and a
barium enema 7.2 mSv.
Hence one CT scan is equivalent in dose to about 800 knee X-rays!!

24. Typical Doses
This is why although many more low dose X-rays are carried out, they do not contribute very much to the population dose.
The much lower number of major scans make a significant contribution to population dose because they individually are equivalent to a vast number of low dose investigations.

25. Effective Dose
The effective dose of each procedure varies because dose depends on:
X-ray intensity,
energy and
application time.

26. Real Time Investigations
A real time investigation such as Barium meal involves the patient being bathed in X-rays as the doctor watches an image on a TV monitor.
The dose is minimized by pulse application and image freezing but necessarily involves a much bigger dose than a simple ‘snapshot’ method as used in a chest X-ray.

27. Real Time Investigations
The dose varies in its effect on tissue too as this is dependent upon the quantity of cell division taking place and summed absorption of layers of tissue.