Projection radiography

Projection radiography, also called conventional

radiography, represents a projection of the three-
Radiographic Imaging dimensional volume of the body onto a two-
dimensional image surface
Medical Imaging. Signals and Systems
Chapter 5 Projection radiography

Arnold Schilham
X-Ray Source
Detector/
Patient film

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Projection radiography Projection radiography

The projection radiograph represents the

transmission of the x-ray beam through the patient,
weighted by the integrated loss of beam energy
due to scattering and absorption in the body

The primary radiographic image is

a 2D display of these transmitted intensities.
Think of a projection radiograph as a shadow cast
by a semitransparent body illuminated by X-rays
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Projection radiography Projection radiography systems

Projection radiography (in short)

• A fairly uniform beam of x-rays falls on the patient and is (a) General projection radiography system
(party) absorbed by the tissues of the body
(b) Fluoroscopy and DSA system
• Emerging from the patient, the x-ray beam carries a
pattern of intensities depended on thickness and (c) Mammography system
composition of organs in the body
• Superimposed on the absorption pattern is scattered
radiation
• X-rays emerging from the patient are captured with a
detection device
• This detector converts the invisible x-ray image into a
visible image of light, which is then either:
– recorded as a negative image on film, to be viewed on a light
box; or
– displayed as a positive image on a video monitor

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Advantages projection radiography Projection radiography

The advantages of projection radiographic

systems are: Projection radiography is used to screen for:
– Short exposure time (0.1 second)
– Large area image – Pneumonia
– Low cost – Heart disease
– Low radiation exposure – Lung disease
– Good contrast – Bone fractures
– Good spatial resolution – Cancer
– Vascular disease
– …

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Instrumentation X-ray tube

Diagram of a conventional projection radiographic system

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Filtration and restriction Filtration

The bremsstrahlung photons that are generated

within the anode do not all enter the patient, and not It is undesirable for low-energy photons to enter
all photons that enter the patient end up leaving the the body, as these photons are almost entirely
patient
absorbed within the body (thus contributing to
patient radiation dose but not to the image)
Filtration is the process of absorbing low-energy
x-ray photons before they enter the patient

Restriction is the process of absorbing x-rays outside

a certain field of view

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 Filtration Filtration

Three important filtering processes Relative intensity of x-ray photons

A shift in the position of the spectrum
– The tungsten anode absorbs a large fraction of low- ‘to the right’ (i.e. to higher average
energy photons energies) can be observed as the
– The glass housing of the x-ray tube and the dielectric oil beam passes through successive
that surround it filter out more low-energy photons materials. => Beam hardening

These two processes are inherent filtering

– Metal placed in the x-ray beam, outside the tube, is

used for added filtering. The most common material is
aluminum

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Filtration Restriction

Radiation contributing to the image versus By design, the x-rays that exit through the tube
radiation contributing to patient dose window form a cone that is larger than the body
region to be imaged. The exiting beam needs to
be restricted; beam restriction

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Subject contrast Subject contrast

Body tissues attenuate x-rays in different amounts A structure in a patient is visible by:
depending on their linear attenuation coefficient – The resolution and sharpness of the image
and the x-ray energies – The contrast between it and adjacent tissues caused by
differences in the transmission of x-rays

This differential attenuation gives rise to contrast,

and therefore the ability to differentiate tissues, an
x-ray image 64 x 64 256 x 256

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 Contrast Contrast in x-ray imaging

Contrast is determined by:

– Thickness of structures
– Difference in linear attenuation coefficients (µx)

C ∝ ( µ1 − µ 2 ) ⋅ x Primary radiation

It − Ib
C= • Large contrast between bone and muscle
Ib 1 2 1 x
– Decreases with increasing kV (photoelectric absorption
in bone much larger at low energies)
I ( x ) = I 0 ⋅ e − µx • Little contrast between muscle and other soft tissue
1) Soft tissue • Large difference between air and tissue (owing to
2) Bone
difference in density)
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Contrast in x-ray imaging Contrast agents

The two most common contrast agents are iodine

(Z=53) and barium (Z=56).

These agents have relatively high atom numbers,

and they have K-shell electrons whose binding
energies fall within the diagnostic x-ray energy
range (30 - 40 keV)
• Contrast due to different attenuations of materials
• Shortcoming: little contrast between various soft
tissues
• Contrast media (e.g. Barium, Iodine)
– K-edge (photoelectric absorption)

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Contrast agents Contrast agents

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 Effect of scattered radiation Primary and scatter image

• The primary radiation carries the information to

be imaged; the scattered radiation obscures it

• The amount of scattered radiation reaching a

point on the detector may be several times the
amount of primary radiation reaching the point

• The scattered radiation acts like a veil and thus

reduces contrast

primary p
rm
ia
y“image”
“m
ia
g
e
” p
rm
ia
y+
scte
primary + scatter r“m
ia
g
e
” “image”

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Scatter reduction and contrast improvement Scatter reduction: grid

Reduce scatter produced by

patient
– Reducing field size
• Reducing field of view, e.g.
using a diaphragm, reduces
the volume of scattering tissue
– Compression of the patient
• Also reduces volume of
scattering tissue grid
– Using lower kV
• Less forward scatter, and more
side scatter

primary + scatter “image” primary + scatter “image”

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Compton scattering Scatter reduction: air gap

Effect on image contrast

It − Ib • Air gap
without Compton scatter C=
Ib – Slightly decreases primary radiation
– Strongly decreases secondary radiation
C′ =
(I t + I s ) − (I b + I s )
with Compton scatter
(I b + I s ) – Requires higher kV and-or mA
– Results in a magnified, blurred image
C
C′ =
this leads to 1 + I s Ib

Therefore, scatter reduces the contrast

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 Film-screen detectors Screen-film cassette

X-ray imaging with film and intensifying screens: • An x-ray cassette is a flat, light-tight box with spring clips
and an internal pressure pad designed to keep its contents,
a film between a pair of screens, in close contact
– Film can be exposed directly
• highest resolution
• The front of the cassette is made of aluminum or carbon
• Inefficient; absorption of 2 to 6%
fiber in order to minimize the attenuation of the beam and
– Intensifying screen can be placed in front of the film so reduce the patient exposure required
• Increased contrast
• Reduced sharpness (due to blurring)
• The cassette back usually incorporates a thin lead sheet to
absorb the remnant radiation which would otherwise be
backscattered, irradiating the patient unnecessarily and re-
irradiating the screens, so degrading the image

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Intensifying screens Properties of screen-film assembly

The phosphor is the active part of an intensifying

screen; its purpose is to transform x-ray photons • Intensifying screens absorb X-rays and transfer
into light photons. The light photons then travel them into visible light.
into the film, forming an image • The film detects the light which is emitted by the
screens
• The cassette is light-tight
• After exposure, the film can be viewed as a semi-
transparent on a light screen

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X-ray absorption in intensifying screens Fluorescent screen

X-ray beam hits screen • Made of materials with high atomic number Z
• More efficient than film for stopping X-ray
photons
• Thickness determines amount of absorption
intensifying • Thickness also determines amount of blurring
screen

Blurred pattern

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 Two screens versus one Two screens versus one

d/2
d

blurred pattern using two

screens with thickness d/2
blurred pattern for
one screen with
thickness d
Increased sharpness

d/2
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Influence of absorption on film Influence of absorption on film

absorption
X-rays

film

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Fluoroscopy Image intensifier

In fluoroscopy an instantaneous (‘real time’)

image is produced by a phosphor screen which
converts the pattern of x-rays leaving the patient
into a pattern of light
In the image intensifier, electrical energy is used
to increase the brightness of the image, while
The brightness of the screen is too low to maintaining its proportionality with the x-ray beam
stimulate the cones in the eye. Image is seen intensity
only by the rods

With the introduction of the image intensifier, this

problem was overcome

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 Image intensifier Image intensifier

Section through image

intensifier
&
Processes occurring in
image intensifier

1. Glass envelope
2. Phosphor screen
3. Photocathode
4. Electrodes for
focusing (electron
lens)
5. Aluminum film
6. Phosphor screen

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Gain Flat panel detector

The image is intensified, minified, and inverted. Advantages flat panel digital x-ray detector
– The detector is smaller and more robust
– Digital image can be made available
For each x-ray photon absorbed by the input
in multiple locations simultaneously
phosphor about 400 light photons are emitted,
– Digital images can be transmitted over
producing some 4000 photoelectrons, which then
long distances in real-time
cause the output phosphor to emit nearly
– Digital images are simpler and easier
400,000 light photons.
to archive
– Digital images make computer-aided
The overall gain in brightness is typically 5000- diagnosis possible
10,000

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Flat panel detectors Flat panel detector

A number of detector technologies have been Indirect digital X-ray imaging

developed, but the most widely used detectors
are called ‘indirect’ detectors – An X-ray tube sends a beam of X-ray photons through a
target
– X-ray photons not absorbed by the target, strike a layer
These detectors are based on amorphous-silicon of scintillating material that converts them into visible
TFT/photodioded arrays coupled to X-ray light photons
scintillators – These photons then strike an array of photodiodes which
convert them into electrons, that can activate the pixels
in a layer of amorphous silicon
– The activated pixels generate electronic data that a
computer can convert into a high quality image of the
target
– This image is displayed on a computer monitor

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 Flat panel detector Use of fluoroscopy

Fluoroscopy is mainly used for guidance of

interventions (e.g. orthopedic or vascular)

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Image formation Geometric effects

The x-ray tube emits x-rays that, after filtration

and restriction, are incident upon the patient. X-ray images are created from a diverging beam
These x-rays are attenuated as they pass of x-rays; this divergence produces a number of
through the body, and measured by a detector undesirable effects that arise from geometric
considerations

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Geometric effects – Inverse square law Geometric effects - Obliquity

The inverse square law states that the net flux The obliquity effect is caused by the detector surface not
of photons decreases as 1/r2, where r is the being orthogonal to the direction of x-ray propagation
distance from the x-ray origin
Obliquity decreases the beam intensity away from the
detector origin
Without compensation
this effect could be
falsely interpreted as
object attenuation

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 Geometric effects – Anode heel effect Geometric effects - Magnification

• X-ray A has to pass through a much greater thickness of • Image I of a structure S

anode material before escaping from the x-ray tube produced by a diverging x-ray
• X-ray B only has to pass through only a small amount of mean is larger than the
tungsten structure itself
• As the angle of the anode is increased, the anode heal Focal spot, f • Magnification is reduces by
effect increases using a longer film-focus
• In clinical practice, the distance, or by decreasing
anode heel effect may object-film distance
• Therefore film is usually placed
not be so apparent and
F close to the structures of
only occurs at large Structure, S interest
focus film distances h • Magnification M = F/(F-h)
• Compensate the effect
by filtration B Image, I B

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Geometric effects - Magnification Quantum efficiency

Important consequences of depth-dependent

magnification
Quantum efficiency (QE) is the probability that a
– Two objects within the body of the same size may single photon incident upon the detector will be
appear to have different sizes on the radiograph detected; it is a basic property of any x-ray
– Anatomical features studied over time can only be detector
compared in size if the same radiographic conditions
and patient positioning is used
– The boundaries of a single object can be blurred
because the ‘front’ of the object is closer to the
radiograph than its ‘back’

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Current applications of x-rays Digital subtraction angiography

Object:
• Plain radiography Produce images of contrast-filled vessels in
• Mammography isolation from other tissues, with the minimum of
• DSA = Digital Subtraction Angiography contrast medium
• CT = Computer Tomography
• CTA = CT Angiography How:
• 3DRX(A) = 3D Rotational X-ray (Angiography) Images of the same region are taken in rapid
succession, before and after injection of a
contrast medium, while avoiding any movement
of the patient or equipment

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Digital subtraction angiography Digital subtraction angiography

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Mammography Rotational X-ray system

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Computed tomography

Questions?

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