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Radiography

Radiography uses X-rays or electromagnetic radiation to generate internal images of the body, typically for medical examination. Or sizing shoes...

Sizing Shoes using X-rays

Radiographs - the very basics

Radiographs are images created using X-rays. X-rays are a form of electromagnetic radiation, with the same properties as visible light, but differing in wavelength:

Electromagnetic spectrum showing wavelength and photon energy of X-rays and gamma rays

Radiographs are Projections

Similar to your shadow generated by the sun, a radiograph is a 2D projection of a 3D volume.

Diagram of a Radiograph capture of a female patient

So, the way you are positioned between the X-ray tube and the detector affects how the radiograph will look. Just like the position of the sun affects your shadow.

Diagram illustrating change in radiograph depending on patient positioning (facing away or toward x-ray tube)

Generating X-rays

X-rays are generated using an X-ray tube. No external radioactive material is involved.

diagram of an x-ray tube

To generate X-rays, a small increase in the filament voltage results in a large increase in tube current, which accelerates high-speed electrons from the very high-temperature filament negative cathode within a vacuum, towards a positive tungsten target anode. This anode rotates to dissipate heat generated. X-rays are generated within the tungsten anode and an X-ray beam is directed towards the patient.

X-rays are generated by the interaction of electrons around the tungsten atoms that make up the anode.

Characteristic X-ray generation

Sometimes, these electrons crash into each other and cause an X-ray photon to be released in the process. This is known as Characteristic X-ray generation.

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When a high energy electron collides with an inner shell electron both are ejected from the tungsten atom leaving a 'hole' in the inner layer. This is filled by an outer shell electron with a loss of energy emitted as an X-ray photon.

Bremsstrahlung/Braking X-Ray Generation

Most of the time, the electrons emitted by the cathode simply wiz by the nucleus.

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When an electron passes near the nucleus it is slowed and its path is deflected. Energy lost is emitted as a bremsstrahlung X-ray photon. Bremsstrahlung = Braking Approximately 80% of the population of X-rays within the X-ray beam consists of X-rays generated in this way.

X-Ray Spectrum

Plot of an X-ray Energy spectrum

The above image shows the spectrum produced by X-ray tube. The continuous spectrum indicates the bremsstrahlung x-rays, while the peaks indicate the characteristic x-rays. Case courtesy of Raymond Chieng (Case rID: 176014)

Creating Images from X-rays

Similar to light images, the intensity values found in a radiograph (an image created from x-rays) represent the amount of X-rays that reach the X-ray detector (e.g. film, cassette, digitizer, etc). But in contrast to light images, the look-up table in a radiograph is typically inverted. That is, the brightest areas in the radiograph represent the regions that received the fewest amount of X-rays, while darkest areas represent areas that received the most X-rays.

Attenuation

Depending on their energy, X-rays passing through a body can either freely pass through, be absorbed, or be scattered. This interaction with the matter in a body is measured by the Attenuation Coefficient, which is a measure of how much the x-ray is weakened by the material it is passing through. Because different tissues in a body attenuate x-rays differently, a radiograph is in effect a grayscale map of x-ray attenuation.

This is also known as x-ray tissue densities, and there are 5 main densities

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Low density material such as air is represented as black on the final radiograph. Very dense material such as metal or contrast material is represented as white. Bodily tissues are varying degrees of grey, depending on density, and thickness. So, in a radiograph, bone and metal tends to be brighter than.

These tissue density standards are based on the historic properties of x-ray film, which used silver halide ions to detect x-rays. X-ray Film is naturally transparent, but exposure to X-ray energy makes film more opaque. When these films were placed on light table, the transparent areas (the areas where the x-rays were mostly blocked, like bone) appeared brighter.