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The AAPM/RSNA Physics Tutorial for Residents X-ray This article meets criteriafor hour the AMA x Award. To obtain credit, see on 961-966 After this taking reader the are produced their ics principles article test, the basic phys- relevant radiologic by which characteristic processes. and . radiation, This article ics of imaging and nuclear struc- ture. . Understand lung by Be x-ray phy . quality x rays. familiar with spectra for interact are produced are Bremsstrahlung with radiation. called x rays The the produce matter and unique two bremsstrahlung and a continuous x-ray familiar with equipment affect the (or both) atomic number of the anode material, tube potential, filtra- waveform. on x-ray typical production with mental physics sented within of this x rays. principles this first the articles the characteristic PHYSICS will review article the fundamental is to review mechanisms x-ray of x-ray and the physics. funda- the material The production, second specifically characteristics preobjecthe of an x-ray that affect the quantity user of x-ray-producing phys- various for understanding on basic processes, trum. The various equipment parameters an x-ray beam are discussed so that the the ramifications of his or her choices. U FUNDAMENTAL that of this the foundation remaining is to describe and of six first objective that form and article is the The spec- or quality (or both) devices can understand of PRINCIPLES radiogra- mammography various eters dcc- create and Be are mechanisms energetic can the voltage bremsstrahlung which basic which trons x rays electrons electromagnetic INTRODUCTION tive charac- bremsstrah- processes, the two . the and by and particles, and energy. teristic energetic into includ- fundamental atomic tion, to physics, electromagnetic force highly energy mechanisms is affected Understand when kinetic whereas characteristic x rays are produced at specific narrow bands of energies. Many technical parameters of the x-ray production equipment affect the magnitude and shape of the x-ray spectrum. The quantity of x rays produced varies proportionally to the tube potential squared, tube current, exposure time, and atomic number of the anode material and is inversely proportional to the distance squared. X-ray quantity is also affected by the voltage waveform (generator type) and tube filtration. The shape of the x-ray spectrum u’ill: . ing PhD spectrum, reading and rays convert questionnaire pp H. McCollough, I of Physician’s Recognition the Cynthia 1. 0 credit in Category the Productio& . Physical how To describe param- some quantity of an or Quantities and of which bitrary. are Thus, and measure the listed Units physical in Table by international worhd, 1. scientists The definition agreement, standards HVL layer, use various of physical have been physical quantities, quantities cannot developed that be arprecisely x- ray beam. Abbreviations: Index terms: RadloGraphics ‘From 55905. sion , amu Physics 1997; = atomic mass requested April = half.value SI = Syst#{232}me International 17:967-984 the Department of Diagnostic From the AAPM/RSNA Physics RSNA, unit, Radiography #{149} 3 and received Radiology, Tutorial April Mayo at the 2 1 ; accepted Clinic and 1996 RSNA April 24. Mayo Foundation, scientific assembly. Address reprint 200 First Received requests St. SW, Rochester. MN February 13. 1997: revito the author. 1997 967 Table 1 Physical Quantities and Quantity Units SI Units (mks)5 Engineering CGS Units Temperature #{176}K #{176}F centimeter gram second dyne erg watt dyne/centimeter2 #{176}C Charge coulomb coulomb coulomb Current Potential Resistance Magnetic Frequency ampere volt ampere volt ampere volt Distance Mass Force Energy Power Pressure 5mks t CGS foot slug second pound (hb) foot . pound foot . pound meter kilogram second newton joule watt pascal Time field . minute’ 2 ohm ohm ohm tesla hertz gauss hertz gauss hertz meter-kilogram-second. = = centimeter-gram-second. Table Rules 2 of Exponents Rule a” a a = = . defme the quantity quantity is measured. as distance, several a . . a . a . .. Example (multiply n times) 1/an = atm a (am) am atm ‘ and the units For many units in which quantities, of measure exist. a such the majority of countries, with the notable exception of the United States. The magnitude of many physical quantities can often be difficult to express without the aid of exponential notation, which offers a shorthand method of writing very large and very numbers. A base a raised to the exponent n signifies that a is to be multiplied by itself n times. Negative exponents indicate fractional values. When numbers with the same base small value U Imaging are multiplied, & Therapeutic the exponents Technology add. 106 10 . 10 . 10 10-6= 1/106 10 . 10 = 106 (10) = 1O . 10 . 10 . 10 = 1 ,000,000 (6 zeros) Table 3 Scientif ic Prefixes The International System of Units (Syst#{232}me International [SI] units) is the preferred unit system for scientific purposes and has been adopted by 968 Unitst How- Prefix Kilo Milhi Mega Micro Giga Nano ever, already ply. Exponential Abbreviation k m M 10 10 106 ?-i 106 G n 10 10 if an exponent has Several Notation is applied an exponent, examples the are to a number exponents provided that multi- in Table 2. For further convenience, prefixes can be applied as a shortcut to signify the order of magnitude. For example, it is more convenient to speak in terms of kilograms (7 kg) than grams (7 x 10 g). Several common prefixes are listed in Table 3. Volume 17 Number 4 Table 4 Fundamental Particles Particle Proton Neutron Electron Positron Alpha Symbol (beta (beta minus) plus) particle 5e = the charge of one t amu = 1/12 the mass Charge Mass (amu)t p n e e +1(e) 0 -1(e) + 1(e) 1.008 1.009 0.0005 0.0005 Ct +2(e) 4.003 electron = 1.6 x 10 of a carbon-12 at om C. 1 .6 x = 102 Energy (MeY) 938 940 0.511 0.5 1 1 3,727 kg. \=.wavelength 1. Figure Diagram illustrates the electric field and magnetic field cornponents of electromagnetic radiation. The electric field and magnetic fields vary sinusoidally at a 90#{176} angle to one another and perpendicularly to the direction of wave propagation. (Redrawn from Bushberg et ah, 1994, and reprinted with permission.) . Fundamental Particles In radiologic physics, several sidered fundamental, particles including the (eg, kilogram), it is more convenient to discuss mass in terms of the atomic mass unit (amu). An amu is defmed as one-tweLfth of the mass of a carbon-12 atom (amu = 1 .6 x 102 kg). Similarly, the charge of these particles is very small with respect to the SI unit coulomb (C), and thus the letter e is used to stand for the charge on one electron (e = 1 .6 x 10’ C). The are conproton, their neu- tron, electron, and positron. Although it is convenient to consider these particles fundamental, nuclear and high-energy physics have shown that they are damental actually objects for the purpose ics, we can tal. Protons blocks composed such of discussing consider nucleus. lively charged less Electrons quantities served are similar verted in mass; a system is positively charged and (ie, it has no charge). The are negatively and posirespectively, massive and phys- fundamen- are the building particles, considerably trons. particles They however, the proton the neutron is neutral electron and positron fun- Nevertheless, radiologic these and neutrons of the of smaller as quarks. than positrons and protons are tons of a helium and these two fundamental Because small July-August neutrons. compared 1997 atom and Several particles the mass with must be for elsewhere conserved. in the . Electromagnetic Electromagnetic neu- referred contains and energy are con- Interactions occur in which charged particles cease to exist, but the charge must be conserved and accounted to as beta minus or beta plus particles, depending on the charge. An alpha particle, which has two units of positive charge, is actually the nucleus mass, interaction. are and also of charge, nature. Mass and energy can be coninto one another, but the total energy of in two properties is visible pro- are given in Table particles is so standard units possesses Radiation an example the properties of which of a wave. It is a transverse wave because the electric and magnetic field components of light move transversely (perpendicular) to the direction of the wave propagation (Fig 1). This of of these light, radiation, 4. of mass McCollough U RadioGraphics U 969 Wavelength (nanometers) 1015 I Frequency 10’ 1012 I I -#{149}l-_ I I I I 10’ I I 1 10’ I I I 10-3 l_ I I I 10 I I 60 1012 lOS 1O’ I- (hertz) 4 10” 0 Ultra , Rao Television Radar 4 MRI 0 4 Infra red C Rad C Gamma C rays X-rays C C - he Visible Th_ 4 C Cosmic I Energy I 10-12 I I I I I I 10.#{149} I I 1 1 1 1 103 10S 1 1 I I I 10’ I I rays III 10’ 10’ (electron volts) Figure 2. Schematic of the electromagnetic large range of wavelengths and frequencies. MRJ = magnetic resonance imaging. (Redrawn from differs tion sound of the wave waves, in which travels parallel the to the oscillation needs no to conduct Sound waves their have conduction and or transport a physical will not it. medium travel for in a vac- uum. Generically, the velocity of a wave is wave times (i’) (f) equal to the frequency wavelength (A): of the its (1) v=fX. Frequency is defined as the number of times wave travels from its maximum to minimum and back to its maximum value within the second. The tance the propagation to-maximum quantity tities 970 U wavelength is defined solving ensure that match and from other 1 dis- physical an equation), the units cancel. of meters In this units tial to express the the frequency in hertz & Therapeutic per quan- it is essential of measure the Imaging as the wave travels along the direction of during one maximum-to-minimumcyche (Fig 1). When any physical is calculated (ie, example, wavelength to appropriately velocity second. has Thus, it is essen- in meters and (1/second). Technology I I Green A special wave- (a longitudinal wave). Ehectrocan travel in a vacuum; it must I OrWQeYeIIOW radiation spectrum. Electromagnetic Visible light occupies only a small from Bushberg et al, 1994, and form propagation magnetic radiation medium I Red is that property length. Because quency and Thus, a longer Violet radiation encompasses a portion of this entire spectrum. reprinted with permission.) of electromagnetic radiac is the speed of light in a vacto 3 x 10 m/sec. All electrotravels at this speed in a of its frequency or wave- its velocity used to represent uum and is equal magnetic radiation vacuum, regardless 1 Blue the is fixed. velocity wavelength are wavelength The letter is fixed, the inversely implies fre- related. a lower fre- wavelength units for visible light and x rays are the angstrom (A) and nanometer (nm), which equal 10#{176}m and 10 m, respectively. Electromagnetic radiation encompasses a wide spectrum of wavelengths and frequencies. In Figure 2, electromagnetic waves are described for a wide variety of wavelengths, frequencies, and energies. Long-wavelength (lowfrequency) waves carry radiant heat from its quency. Typical source. As the quency increases), wavelength decreases the waves radio, television, and region of the electromagnetic radar (and are used signals. fre- to carry It is in this spectrum that the waves used to induce and receive magnetic resonance imaging signals are found. The visible light region of the electromagnetic spectrum is narrow, with wavelengths on the order of 400-750 nm. As the wavelength decreases further, the energy of the wave increases to a point at which it can remove electrons from an atom, and the photons are known as ionizing Volume 17 Number 4 Table 5 Fundamental Forces Relative Force Description Strong Electromagnetic Short-range Attraction magnetic Weak Gravitational Interacts Attraction attraction or repulsion field rays originate gamma outside rays the originate between nucleons of charges and magnetic ray of the same They are their origin. X nucleus, inside the whereas responsible for beta Force the their miiar ally four fundamental forces in nature and relative strengths. Although the most faof these is gravitational force, it is actuweak compared with the other three forces. The strong force interacts at small distances on the order of 10 m and is responsible for holding nuclei together. The electromagnetic force is what causes charged particles to be attracted or repelled by one another, depending on the polarity of the charge. It also is responsible for the weak force is perhaps the four fundamental classified force. as a subset The weak action of magnets. The the least understood forces and is sometimes of the interaction of electromagnetic is involved an electric or in subpartiche transformations such as beta decay. To understand basic radiologic physics, it is important to be familiar with the basic properties of electricity and magnetism. Electrical charge can exist as a monopole; that is, a posilively charged object or a negatively charged object can exist independenthy. This is not the case for magnetic materials, which exist in the form of a dipole and must have both a north and a south pole. A north magnetic object or a south magnetic object cannot exist indepen- decay Electricity l0’ l00 and magnetism are interrelated that one opposite magnetic charges attract nucleus. The motion of an object depends on its properties and the environment in which it exists. The termforce is used to describe the property of the environment that acts on an object. Table 5 lists with and have the similar property (or like magnetic poles) repel tric . 1 dipoles 102 at a subparticle level, between masses radiation. An x ray and a gamma energy are, in fact, indistinguishable. named differently only to denote Strength each (or other. charge opposite Furthermore, creates protons, are deflected poles) a moving a magnetic ing magnetic field induces Moving charged particles, like charges another and field, and eleca mov- an electric current. such as electrons and by magnetic fields. How- ever, stationary charged particles, or uncharged particles, such as neutrons and photons, are not affected by magnetic fields. . Energy The energy within a system must be conserved: It can neither be created nor destroyed; it can only change ergy are known forms. of motion) stored and by an tion). A ball energy equal ject times its ergy of a ball is equal times common energy potential object energy forms of en- (the energy (the energy in a particular configura- rolling across the floor has a kinetic to one-half of the mass of the obvelocity squared. The potential enraised above the floor on a ladder to the the Two as kinetic mass of the gravitational ergy is not an of energy for the energy of the example the top of the tential energy floor. Energy placed on top absolute balh times its height constant. Potential number. It is an amount en- one state of an object relative the object at a reference state. of the ball on a ladder, the ball ladder has a given amount of relative to that of the ball on was stored in the ball when it of the ladder, because someone to In at pothe was dently. July-August 1997 McCollough U RadioGraphics U 971 had to fight higher the force position. (coulomb) of gravity Likewise, attraction object to lift it to its the electromagnetic of a negatively to a positively charged charged object creates po- because of the physical constants ergy (joules) ond), where use in radiologic volts) equals they stroms). are of this allowed is the to come potential together. energy An stored example referred to as voltage is actually the electric potential between two points. For example, 9 V of electric potential exists between the positive and negative contacts of a 9-V battery. When trons are the contacts allowed to flow the positive contact. through an electric eV (electron is equal tial to the not lost, of energy charge forms. the the potential, and negative to energy converted of these poten- must be It cannot be to alternative alternative forms is mass. The relationship between energy and mass was discovered by Einstein and is expressed as energy equals mass times the velocity of light squared: E (2) mc2. = and Electromagnetic properties terms of wavelength composed and of discrete photons. late radiation, of waves and Thus, radiation. frequency, it is also The determined from to its wavelength which exhibits is characterized bundles referred energy pressed in Eq [1], velocity quency a photon frequency times wavelength). can be expressed or wavelength: called to as particu- of a single its frequency through the photon is (which is related relationship ex- of light equals = the term (the latter is valid kiloelectron volts expressions look only and different E is expressed amount but are U Imaging & Therapeutic Technology to two (x listed and character- gamma rays), 6. Fluence in Table area quanti- the the number and is expressed it is difficult is of phoin or flu- Flux, per unit in number Intensity, of photons area and is exjoules) per to measure the abso- of charge produced gamma the per radiation. amount unit mass Exposure of ionization of air meters in a specific volume, typically composed of air. When exposure meters are appropriately calibrated, exposure can be accurately measured with a relatively inexpensive device. The conventional unit for exposure is the roentgen (R), but the SI is the coulomb C/kg the per kilogram. units The is 1 R equals x and is not of exposure, gamma x gamma a less for by charged impossible rays familiar above to measure particles. 2-3 known the radiation energy and field; absorbed kerma MeV in energy. as kerma, amount describe It is exposure was of kinetic ergy released in matter per unit mass. nition of kerma allows it to be applied photon and charged particle radiation Exposure ex- measuring to measure unit, is valid Therefore, quantity produced x and however, radiation. a useful essentially developed equivalent rela2.58 of air. for also (C) between The definition the the 972 apply additional to express a given x and only in The several to describe Physically, of (4) when (ang- of energy lute number of photons per area or per unit time in an x-ray beam. The quantity exposure is more practical to measure and is defmed as the Thus, A in angstroms). by wavelength radiation crossing for 12.4/A for (kioelectron number per centimeter squared. ence rate, is the number of photons area per unit time and is expressed per centimeter squared per second. or fluence energy, is the number times the photon energy per unit pressed in energy units (typically centimeter squared. i0- or E= convenient Energy used are used tionship (3) are of which posure hf (3) is en(1/sec(6.63 x Units of ionizing ionization E is more divided physics, some unit fre- Thus, the energy in terms of either appropriate Equation expressions units measure in is actually of energy 12.4 istics from the (4) physics: These tons of to 1 .6 x 1019 system. Equation Radiologic ties 1 is a unit is equal a closed be electric J/sec). In radiologic the energy volt mentioned, it can One times . elec- because an electron within but from Thus, As previously conserved connected, An electron that moves potential of 1 V acquires volt) (voltage). energy, J (joule). are units. electromagnetic waves (photons) of any energy. Because approximately 1 5 eV of energy are required to remove an electron from an atom, those photons with energy greater than 15 eV are called ionizing radiation. in a bat- tery. Energy is released when the positive and negative contacts are connected. The quantity commonly of the and equals h times frequency h equals Planck’s constant tentiah energy. Energy must be put into the system to move the positive and negative charges apart from one another and is stored there until 10- application the The endefi- to both fields. energy of in contrast, dose describes by an object. That is, expo- Volume 17 Number 4 Table 6 Radlologic Units Quantity Description Fluence Flux (fluence Number Fluence rate) of photons per per unit time Conventional unit area 1/centimeter 1/(centimeter (meter Intensity fluence) Exposure (energy Number of photons times area Charge produced per unit gamma rays Kinetic energy released in Energy absorbed per unit (X) Kerma (K) Dose (D) $5 photon energy mass of air from matter mass per per unit [ 1/meter’J . second) second)] F1/ kiloelectron volt/centimeter[joule/meter2] roentgen [coulomb/kilogram]t x and unit . Unit5 rad rad mass [joule/kilogram [jouhe/kihogram or gray] or gray]t ‘SI units are given in brackets. t 1 roentgen = 2.58 x 10 coulomb/kilogram. $ 100 rad = 1 gray. The ergy S relationship within pute Photon energy (keV) and (the dose (the enen- dose: dose Figure 3. Graph shows the roentgen-to-rad conversion factor (ffactor) for bone, muscle, and water and photon energies between 10 and 1 ,000 keV. The appropriate f factor (rad/roentgen) is multiplied by exposure (roentgen) to yield dose (rad). (Redrawn from Bushberg et al, 1994, and reprinted with permission.) = unity. ergy keV, and kerma are used to describe the radia- of the x-ray beam, which reflects the en- ergy carried by the x-ray beam. Dose is defmed in terms of energy absorbed per unit mass. The traditional unit for dose is the rad (radiation absorbed dose), but the SI unit for energy per mass is the given the joule special per name kilogram and gray (Gy): has 1 Gy . However, for dependence. the radiation (dose) tion source; dose is used to describe the effect of the radiation on an object or person. All three quantities are proportional to the inten- exposure f factor. (5) For photons, the roentgen-to-rad conversion factor for muscle and water remains relatively constant from 100 to 1 ,000 keY and is near by bone, sity exposure field) ergy absorbed by an object) depends on the properties of the absorbing object (density and atomic number) as well as the energy of the radiation. Thus, for a given material and photon energy, a conversion factor is used to rehate cxposure to dose. This conversion factor between exposure (roentgen) and dose (rad), often referred to as theffactor (rad/roentgen), is plotted in Figure 3 for water, muscle, and bone for photon energies between 10 and 1,000 keV, where the following equation is used to com- P sure between a radiation thereby of the bone, there is a strong At energies less is more efficiently increasing same the amount en- than 100 absorbed biologic of incoming effect radia- tion (exposure). In Figure 3, the scale on both the horizontal and vertical axes of the plot is logarithmic. That is, equal distances along the axis represent a tenfold increase in magnitude (eg, equally spaced tick marks occur at the vahues of 1, 10, scales are pass a large 100, used and when 1,000). the Logarithmic values plotted encom- range. been = 100 rad. July-August 1997 McCollough U RadioGraphics U 973 . Atomic and Objects in the posed of millions ample, Nuclear The alh atoms shell and Bohr Figure charged an atom and atom. protons, and called atomic many ments of neutrons). Some state and naturally A hydrogen number and mass topes of deuterium tron) and trons), which Outside els the around the exist in one (energy levels). mains in orbit in a specific ther gained is known farther nor from so on. the assigned can The innermost (Fig inhabit a given the 1evorbit re- is nei- electron The 4). or- L shell M shell, is and to each of the K shell beof 1 , the L shell number of electrons cannot exceed the maximum value, which is equal to two times the quantum number squared. Thus, only two electrons can inhabit the K shelh, eight can inhabit the so on. ber L shell, A neutral of electrons the number cheus. Thus, for many arrangement more inhabit is one in orbit equals bers, 18 can atom the elements electron of electrons M shell, in which about of protons & Therapeutic more the chemically reactive properties. Neutral outermost orbital stable shell and and may atoms in cx- is completely known the the nucleus within of higher shells within and num- the as inert these in which Technology energy orbital is one or K, shell. an electron ergy-leveh in Figure electron diagram for a tungsten atom is shown 5. Energy must be added to move an from an inner shell to a more exterior shell or to remove Thus, an electron lower (more electron it completely bound in a more bound ermost shells are shell atom. very is at a than and Electrons wealdy atom. shell state exterior en- the inner energy to the electron from in an negative) tightly An are the innermost, an is more at the bound out- to the atom and are most easily removed. These are called the valence electrons. An electron that is not bound to an atom is said to be afree electron. A free electron is not under the influence of the nucleus and requires no energy to move it away filled. state electrons nucleus, is at the from an atom. Electrons nu- atomic are lowest num- This The leases can movement from atomic energy is required from an interior shell is a lower an outer to the between requires Energy electron interior move either energy. bound closer Imaging are influences charged charged tron U no.)2 Because the negatively attracted to the positively an 974 #{149} (quantum fulh are chemically electron is assigned shelh 98 of which specific as is the The 72 atoms filled magnetic neu- energy K shell so on. 50 characteristics hibit energy as the orbital shells, with a quantum number 2, and greatly shells electrons of these number 32 gases. shell, nucleus, A quantum the electron ing assigned that host. as the 18 an element. Elements in which neutral have unpaired electrons or incompletely isoneu- defmed As long 8 2 = (atomic one two shells enenergy has and The shells bit ra- radioactive. electrons. nucleus are neutrons and 34567 2 number number nuclear proton nucleus by dc- to a lower no proton both further which of 1) but (one (one are inhabited decay has 2 and neutrons (ti) is orbited by electrons at discrete energy levels. K through Q indicate the orbital dcctron shells. (Modified from Bushberg et al, 1994, and reprinted with permission.) is Most all isotopes number tritium (A) and in an elevated atom capacity of nude- isotopes, not Maximum i Figure 4. Diagram of the Bohr model of the atom, in which a central nucleus composed of protons (p) a nucleus atom. no. electron two number number but exist to Helium the same atomic number (different They Quantum an atomic within different have mass elements contains of the I! of proton. total mass are atoms that but a different state. The several dioactive: one properties have has neutrons) of according of 2 and so on. and the defines of the I a Z) element contains have within properties table number in of positively number many Nucleus an outer which Hydrogen 1 and (protons ergy atomic number. of and of protons each cxthat as diagrammed periodic an atomic states of neutrons, identifies number atom is composed the The its atomic ons a nucleus determines graphically has both number is called comFor 6 x 1023 copper of the and The nucleus the contains nucleus protons charge. actually of atoms. electrons, 4. The are millions model contain of orbiting no world 1 g of copper atoms. Structure everyday nucleus shell to remove shell. energy will shells. or re- state, naturally to fill the an dcc“fall” vacancy Volume a Because left 17 by Number 4 -2.5 keV -2.5 keV 67 keV -11 keV 64.5 keV Auger -11 keV Characteristic electron -69.5 Vacant K L teristic energy M 6, 7. (6) Diagram depicts emission of a characteristic x ray from a tungsten atom. Emission of characx rays occurs when an electron from an outer shell moves into an inner shell vacancy, and the excess is converted into electromagnetic radiation. (Redrawn from Bushberg ci al, 1994, and reprinted with (7) occurs is transferred to Diagram depicts when an electron another electron. electron. This with permission.) Zero C electron Valence the emission of an Auger electron from a tungsten atom. from an outer shell moves into an inner shell vacancy, The excess energy of the transition is decreased by the is known as an Auger a- electron. (Redrawn from ejected electron. the moves the atom. X rays is released. nucleus fled and by the shell x rays can and 0 C 0 ray are one form shell. be off moves energy in the a characteristic is called electron from in which fall the this into en- the x ray is identi- Thus, when to the ehec- K shell, K- emitted. an electron gives M shell re- is released electrons off x rays, the and an outer energy give from et ah, 1994, When destination move Emission of Auger and the excess energy binding energy of the shell, When trons When > 0, Bushberg to an inner ergy toward form the nucleus of x rays, x ray (Fig energy of the the 6). x This term is used because the resulting x ray is characteristic of the atom from which it originated. The energy of the x ray is equal to the difference between the binding energy of the destination shell and the binding energy of the origination shell. In the example in Figure 0 C 0 0 0 Figure 5. Electron shell energy diagram for a tungsten atom (atomic number, 74). By convention, the potential energy of a free electron (e) is defmed as 0. Electrons closer to the nucleus have a lower-energy state and thus negative potential energy compared with this reference value. Ehectrons closest to the nucleus have the most negalive binding energy. The binding energy of the K shell decreases (ie, becomes more negative) as the atomic number (Z) of an atom increases. X rays produced from the excess energy of an deetron transition are named according to the destination shell of the moving electron. For example, when an M shell electron moves to the K shell, the characteristic x ray emitted would be a part of the K series. (Modified from Bushberg dl al, 1994, and reprinted with permission.) July-August L 7. permission.) electrons emitted printed K M 6. Figures ‘p Vacant 1997 6, there is a vacancy in the K electron which has a binding electron from the M ing energy -2.5 keV, to fill the hole in the energy of -69. orbital shell, moves toward K shell. The ence is -2.5 (-69.5) = +67 keV. energy of this characteristic x ray the tungsten atom. When an electron from an outer - ward the nucleus excess energy electron (Fig Iron is ejected to fill an inner orbit, 5 keV. An with a bindthe nucleus energy differThe 67-keY is unique to shell vacancy, falls to- the can also be released to an orbital When this occurs and the elecfrom the atom, it is called an 7). McCollough U RadioGraphics U 975 Electrons Target atom dent electrons 2 Close inleraction: energy Moderate X.rays Figure 8. Diagram of a basic x-ray tube. from Bushberg et ah, 1994, and reprinted (Redrawn with per- 1 ftti nucleus: 3 Distant Interaction: energy Low ‘\ renergy mission.) V Figure 9. production. Auger electron. The movement of an electron from the M shell to the K shell nets a positive energy of 67 keV. This energy does not have leave the atom as a photon but can be transferred to another orbital electron to eject to the electron electron keY ergy shell Auger from the atom. Because this ejected was initially bound to the atom, the 67 of energy is decreased by the binding enof the electron. For an electron in the M (binding energy = -2.5 keY), the emitted electron has a kinetic energy of 64.5 keV. U TURNING ELECTRONS INTO X RAYS In 1895, Wilhelm Conrad Roentgen discovered x rays by using a device simiar to that shown Figure 8. An x-ray tube uses a heated filament, typically made of tungsten, to raise of atomic electrons high enough them from their atoms. Essentially, boils off ionic emission. the lively ode). from tracted x-ray electrons, tube. charged a process A power the as therm- is attached The filament (cathode) with respect to the Thus, the boiled-off electrons the negatively charged cathode to the positively charged to is negatarget (an- are repelled and at- anode. The free electrons are accelerated toward the anode because of the potential difference between the cathode and anode and thus acquire substantial kinetic energy (on the order of kiloelectron volts to megaelectron volts). When the energetic electrons strike the tungsten target, they hose their kinetic energy through three different mechanisms: excitation, ionization, and radiation. In excitation, the energy from the charged particle is used to move other electrons to higher energy states (more external orbital of characteristic loses Technology In ionization, the particle is sufficient from an atom. In the x rays, its energy a the through charged either ento case particle ionization or cx- citation; the characteristic x ray is produced by the subsequent emission of a photon as the electron vacancy is filled. In energy losses due to radiation, the energy from the charged partide 5 used to create a photon directly. The production of x rays by means of radiation is known as the bremsstrahlungprocess. Bremsstrahlung ing is a German radiation. mechanisms “ word Thus, that there by which are The majority the the energetic electrons the crc- charac- of the x rays produced is diagrammed in Figure electrons are slowed attracted to the As the “brak- unique and energized electrons show target are bremsstrahlung are means two ate x rays: the bremsstrahlung teristic processes. nucleus. & Therapeutic shells). ergy from the charged remove the electron they Imaging to an bremsstrahlung x ray that has the maximum energy (which is equal to the maximum electron energy as determined by the x-ray tube potential). Another incident electron (2) does not impact with the nucleus but travels relatively close to it and thus gives up a moderate amount of its energy to the bremsstrahlung x ray. For another incident electron (3), which travels distant to the nucleus, only a small amount of energy is given up as a bremsstrahlung x ray. (Redrawn from Bushberg dl al, 1994, and reprinted with permission.) charged U x-ray in- cident electrons are showed down by attraction the positively charged nucleus. In this example, incident electron (1) impacts directly with the nucleus and gives up all its energy. This produces cess 976 brernsstrahlung x-ray production, energy to release the cathode known source in Diagram illustrates In bremsstrahlung electrons 9. The negatively down positively slow when down or brake in x rays. This probecause charged down, Volume they give 17 Number 4 EeCtd Unfiltered bremaatrahlung Target spectrum spectrum Filtered bramsatrahiung (Inherent and added 0 electron atom fIltration) 5) 90 keV madmal photon energy Inddent energy electron wfth greeler than energy K-shell binding 4 40 50 Energy Figure 10. strahlung spectra. directly maximum electron ing the 60 70 80 90 ii (key) Graph of unfiltered and filtered brernsThe probability of an incoming impacting the nucleus and producenergy bremsstrahlung x ray is small compared with the probability of more distant interactions. Theoretically, the probability increases linearly with decreasing photon energy and produces a triangular spectrum. However, the preferential removal of lower-energy x rays by either inherent or added filtration of the x-ray tube removes the majority of low-energy x rays from the bremsstrahlung spectrum and produces a curved spectrum. (Modified from Bushberg et ah, 1994, and reprinted with permission.) off energy in the The energy form of bremsstrahlung of the bremsstrahlung x rays. x ray is deter- mined by the proximity of the electron to the nucleus. Incident electrons that directly impact the nucleus give up all their energy to the photon. Thus, the maximum bremsstrahlung x-ray energy is equal to the energy of the incoming electron and is determined by the tube potential. Electrons that do not impact the nucleus but that travel close to it retain some kinetic energy as they are deflected around the nucleus. They give off bremsstrahlung x rays with energy less than the maximum. The lowest energy bremsstrahlung incident lively x rays electron greater are passes distance. produced the when nucleus In this case, the at a relathe incident electron retains a considerable proportion of its initial energy. A graph of x-ray intensity (relative output) as a function of x-ray energy for the bremsstrahlung process would take the form of a triangle (Fig 10). The maximum bremsstrahlung energy is determined by x-ray intensity creases linearly produced at any with decreasing July-August 1997 the Characterlatic xray: From L’K electron transition x-ray tube potential. Figure 11. Diagram illustrates characteristic x-ray production. In characteristic x-ray production, the incident electron (1) has kinetic energy greater than the binding energy of a K shell electron (2). On impact of the incident electron with the K shell electron, a vacancy is created in the K orbit. An electron from the L shell (3) moves into the K shell to fill this vacancy. The excess energy from the L shell to K shell electron transition is emitted as a characteristic x ray (4). (Redrawn from Bushberg et al, 1994, and reprinted with permission.) the theoretic shape of an unfiltered bremsstrahlung spectrum. However, x rays produced within the target material must escape the target and the glass envelope enclosing the anode. Very low energy bremsstrahlung x rays are readily high Thus, absorbed by these probability the shape materials of not leaving the of the bremsstrahlung and have x-ray tube. a curve from the theoretic triangle because lowenergy x rays are removed due to either inherent or added filtration of the x-ray tube. The other mechanism by which energetic differs electrons produced by the cathode and accelerated toward the anode of an x-ray tube can produce x rays is known as the characteristic process (Fig 1 1). The incident electron must have energy greater than or equal to the binding energy of a given shell to remove an electron from that shell. Once a characteristic atomic the electron x ray electron fills ejected electron ence as a photon. and has is produced the emits been removed, when vacancy heft the energy another by the differ- The other energy inenergy. This is McColiough U RadioGraphics U 977 Molybdenum Characteristic radiation 0. target Bremsstrahlung 30 kVp (30 keV electrons) lines Bremsstrahlung spectrum continuous 0 10 Binding energies K--2OkeV L-.3 keV 5) 5) 10 20 30 40 50 . 60 70 80 100 90 In the typical keY), ray tube the diagnostic x-ray is distributed shown in Figure 1 2. The maximum mined the the x-ray Bremsstrahlung nant role tube mize duced spectrum. and plays minimize of bremsstrahlung kVp). predomispectra. x-ray the the can shell the incoming electron ejects an electron from K shell of a molybdenum atom, the shell be filled with an electron from either the L or M shell. The energy difference between binding energies of the M shell (-0.5 keY) and K shell (-20 difference to is as monoenergetic as keY) between L shell (-3 keY) keY. Thus, and 17- and opti- rays radiation bremsstrahlung pro- This narrow band istic x rays is the target x rays. In the mate- which use a relakVp). The two x-ray spectra which 30-keY the positively a broad energy If, however, are from energy (-20 keY) of the is + characteristic from useful of the 17 x a molybdenum of energy discussion The energies target. the character- in mammography. distribution of ener- gies produced in the bremsstrahlung and characteristic processes, the spatial distribution of the x rays was not mentioned. For an extremely thin target in which the ejected electrons leave out further interactions, leave ure Technology K shell most keV. binding 19.5-keY produced the tube axis. 1 4, when cause the trons to undergo produced the produced (ie, However, target and at 90#{176}) to the as shown is thick x rays further photons the target material withthe majority of x rays perpendicular anode-cathode & Therapeutic is +19.5 the tubes is a typical rial for mammographic tubes, lively low tube potential (25-30 components of a mammographic are illustrated in Figure 1 3, in electrons are slowed down by charged nucleus and produce spectrum the it is important of characteristic the broad Molybdenum x rays is deter(90 x-ray x- (ksV) Figure 13. Diagrams illustrate bremsstrahhung and characteristic x-ray production with a molybdenum target, typically used in mammography. As in general radiography, the mammographic spectrum is composed of both a bremsstrahlung and a characteristic portion. However, in mammography, the characteristic x rays at 17 keV and 19.5 keY provide the majority of x rays for the imaging process. e = dcctron. (Modified from Bushberg ci al, 1994, and reprinted with permission.) as process, on top of spectrum. (90 keY) mammographic the amount axis of the potential radiographic However, in mammography, have an x-ray beam that Thus, energy majority radiation in most possible. the (50by the bremsstrahlung x-ray lines ride bremsstrahlung x-ray energy from range produced along are produced from and the characteristic the large, continuous The energy intensity . Radiation Energy Figure 12. General radiographic spectrum produced with a tube potential of 90 kVp. The continuous bremsstrahlung spectrum encompasses a broad range of energies, and the characteristic x rays reside in narrow energy bands. (Modified from Bushberg et al, 1994, and reprinted with permission.) 200 . 1L M (key) Energy Imaging 30 (keV) Characterasbc MO.5keV U 20 Energy 5) 978 Radiation and in Fig- enough ejected interactions, Volume to dccthe 17 spa- Number 4 a___#___Cable 500 kV sockets 20 MV stream Figure 14. Diagram depicts the spatial distribution of x rays produced within a thick target. At lower tube potentials (eg, 100 kV), the x rays are produced isotropicahly. As the tube potential increases, the x rays are produced in a more forward direction (ie, following stream). the direction of the incoming o_ tial distribution for a 100-kY tube potential is approximately isotropic (equally distributed in all directions). For both thin and thick targets, the distribution of emitted x rays becomes more and more forward (ie, in the direction of the incoming electrons) with increasing energy. The energetic in an x-ray electrons impinging tube their lose way of the three basic processes her: excitation, ionization, and amount of energy lost through radiation as a percentage on the energy by discussed earradiation. The bremsstrahlung of the Anode of a modern et al, 1994, x-ray tube. and reprinted (Rewith electron ciency target port Figure 15. Diagram drawn from Bushberg permission.) total energy lost of x-ray production with the bremsstrah- lung process increases dramatically ergy: At 4 McV, approximately 40% ergy is converted into x rays. The much ray next article greater tubes. detail However, in this series the the with en- of the describes enin workings of modern diagram of a modern x- positively ciency charged of x-ray anode. production Because is low the and effithe (including losses due to excitation and ionization collision) is a function of both the target atomic number and the electron energy. For electrons in the diagnostic energy range (approximately 50-200 keY) and a tungsten target, amount modern only are absorbed by the x-ray tube and casing. The output port of the x-ray tube has a reduced amount of attenuating material; it is from this portion of the tube that the usefuh beam is delivered. 1 % of the converted energy nostic to x rays. This into heating x rays in amounts imaging, to receive makes July-August of the goes produce heat point energy and x-ray energy. Tungsten, of 3,370#{176}Cand an excellent 1997 tube dissipate electron stream pate thick means that 99% of the the anode. Thus, to sufficient for diaganodes a substantial must be amount of heat deposited in the anode is high, x-ray tubes use rotating anodes to dissithe heat over a wider area. The relatively targets produce x rays isotropically (ic, in all directions). is able x- ray tube shown in Figure 1 5 provides a review of the principles discussed thus far. The energetic electrons arc produced by thermionic emission (ic, boiled oft) from the negatively charged cathode and accelerated toward the Thus, a large number of x rays of with its high melting high atomic number, target material. The effi- McCollough U RadioGraphics U 979 Fixed kVp Area cxmAs 150mM 0. 0 0 I 5) 5) 60 16. Figure Graph of the effect of varying tube po- tential (kVp) on the x-ray spectrum. At 60 kVp, the electron energy is insufficient to produce characteristic x rays in a tungsten target (K binding energy of -69.5 keY). (Modified from Bushberg et al, 1994, and reprinted with permission.) U THE X-RAY An x-ray sity is a graph output) ray and der an x-ray to describe the energy spectrum. beam. over Higher-quality a Quality is used beams to give are better tube a of the are more and quality (ie, for x-ray spectrum. These potential, tube current, tance, anode material, erator type. The anode electric and influences the ing x-ray potential cathode imaging applied and The shape) between tube quality quantity is also of the the dramatically of the result- of x rays, or or absence determined of characteristic by produces of 60 keV, which the tube of a tungsten keY). The of changes on trum in tube curve) rent potential is demonstrated quantity is directly the in Figure (area proportional and the exposure times time, seconds). Imaging & Therapeutic Technology atom effect x-ray spec- 16. under the spectral to the or their tube cur- product Changing the tube current or exposure time has no effect on the shape (or quality) of the x-ray spectrum. The effect of changes in the tube current and exposure time product on the x-ray spectrum is demonstrated in Figure 17. The x-ray quantity (area under the spectral curve) is directly proportional to the atomic number of the target material. The target material is fixed for most x-ray tubes and is typically an alloy consisting of 90% tungsten (Z = 74) and 10% rhenium (Z = 75). Some mammo- graphic tubes allow the user to select a molybdenum (Z = 42) or rhodium (Z = 45) anode. The choice of target material affects only the not the quality, of the bremsstrahhung of an x-ray spectrum. The target mate- rial, however, determines the position of the characteristic x rays and hence fluence x-ray quality. U A electron ento remove ergy an electron from the K shell (binding energy equals -69.5 quantity, portion 980 x potential. a maximum is insufficient beam (milliamperes higher- parameters include tube exposure time, disbeam filtration, and gen- of an x-ray quantity spectrum. and presence rays The x-ray of higherquality. potential, magnitude The monoen- quality beams produce a better image and impart a lower dose to the patient. Various fixed and operator-selectable parameters are involved in the production of x rays that affect the quantity area under the spectral curve, is proportional to the tube potential squared. The maximum photon energy is determined by the tube potential. 60-kVp un- explic- distribution beams x rays. For a given area is not but energy all x- quality is used spectrum (ie, x-ray and have a greater percentage photons than beams of lower energy with The term of the of the High-quality ergetic for to the as is quantity, sense inten- of an x-ray summed is proportional the shape distribution). defmed, general x-ray energy radiography is provided in quantity is often used to the x-ray intensity energies itly x-ray An example spectrum for general Figure 12. The term describe of the at each set of conditions. given (key) Energy 17. Graph of the effect of varying tube current and exposure time (or their product, milliampere seconds [muls]) on the x-ray spectrum. The area under the curve, not the shape of the curve, is changed as the tube current or exposure time or both are increased. Figure SPECTRUM spectrum (relative 120 Volume (energy) does in- 17 Number 4 Average f-. J and Photon Energy Photon Quantity I mm HVI. Increases HVL Fixed kVp and mAs Decreases c_#{149} Jw\+ Jw\. M 0. nm m - - _5 iaarun- jnarsnfl c-. - Jw. Jw. 5) w. /- - 0 wssamr -- 20 Figure 18. Diagram ifiustrates the effects of beam hardening. Beam hardening is the process in which lower-energy x rays are selectively removed from the x-ray beam as the beam is passed through more and more attenuating materials. HVL = halfvalue layer. (Redrawn from Bushberg printed with permission.) et ah, 1994, and re- 30 kVp Unfiltered JMYbenum -- Spectrum larOet Graph creases and the of high- passes and shifts more because (softer) of increased and to higher energies. photons. As it more attenuating ma- (softer) x rays are abthan are the higher-energy x-ray spectrum is said exiting to have the percentage photons filtra- on the x-ray spectrum. As the the area under the curve de- the lower-energy more readily ened Mass Attenuation (key) low-energy through 100 80 effect spectrum sorbed x rays. Thus, the tenuating material E of the tion (increased HVL) filtration is increased, terial, 0 60 Energy 19. Figure tion 6 40 has been the at- been hard- of low-energy decreased. Beam increases the average energy of the beam, which causes an increase in the amount of material required to decrease the number of photons in the beam by a factor of two (defmed as the baljvalue layer [HYL]). Beam hardening produces a more monoenergetic x-ray beam, but it decreases the absolute number of photons in the beam. The effect of beam hardening, hardening I I 30 kVp Filtered Spectrum Molybdenum Target 0.03 mm Molybdenum Filter 25 Photon Figure x-ray 20. spectra energy 36 (key) Unfiltered and and graph of molybdenum coefficient as a function the effects of beam filtered of x-ray mammographic or filtration, attenuation energy crease demonstrate to higher filtration. Filtration is important in optimizing the mammographic x-ray clinically spectrum. The initial unfiltered spectrum from a molybdenum target contains both the narrow characteristic energy bands and the broad bremsstrahlung spectrum. Filtration with a molybdenum filter seleclively removes much of the broad bremsstrahlung spectrum and produces a spectrum with fewer photons occupying a narrower energy range. (Modified from Bushberg et al, 1994, and reprinted with permission.) through tially, July-August an attenuating an x-ray 1997 spectrum material contains (Fig 18). some the quantity x-ray while energies (Fig spectrum is to de- shifting the spectrum 19). The maximum en- ergy of the spectrum remains unchanged. Mammographic x-ray spectra provide an cxcellent example of the utility of beam filtration (Fig 20). The initial beam containing both the broad bremsstrahlung spectrum and the narrow characteristic x-ray spectrum passes through a thin (approximately ter that has 0.03-mm) a K shell binding keV. The graph in the center the attenuation coefficient sus energy absorption Beam hardening is the process in which x-ray spectrum changes shape after passing on the and indicates at a given molybdenum energy fil- of -20 of Figure 20 plots of molybdenum the energy. likelihood The verof x-ray attenuation an Ii- distribu- McCollough U RadioGraphics U 981 coefficient ing energy use increases sharply at the (“K edge”) of molybdenum. of a molybdenum creases and 30 the keY filter K shell bindThus, dramatically bremsstrahlung and produces de- x rays between a more monoenerge- 20 0. 0 5) tic spectrum containing the energies best suited 5) for mammography. A subsequent ray physics 5) article discusses properties in this series in detail of x-ray the generators. which the generators means that maximum means that tials are ode, and the (peak at some times at other the maximum value. from the This Energy 0 to poten- anode and cath- potential reaches type of waveform spectrum with a higher per- centage of lower-energy pared with generators nearer to the maximum erator should produce to the peak kilovoltage. (softer) x rays comthat produce voltages potential. Ideally, a gena constant voltage equal More typically, triplephase or high-frequency generators have an approximately 5% ripple and produce an x-ray spectrum with a greater proportion of high-energy x rays than that produced by a singlephase generator (Fig 2 1). Because x-ray increases with tube potential squared, generator type (voltage waveform) affects quantity as well as the quality of the x-ray trum. x rays emanating from a point source by the states that tional to the the inverse exposure distance square varies squared law, inversely a factor of four pling the distance posure by a factor The 982 U Imaging inverse square & Therapeutic (1/22) to 22.5 mR/h, law affects the x-ray Technology not affect in Table produce est the Distance of the on the x-ray x-ray spec- spectrum parameters dose, are the goal quality a diagnostic radiation of the summarized of radiography image at the different diagnostic is to low- tasks and scenarios require various equipment of this is the need avoid motion the sure different optimizations parameters. An cxto optimize anode madifferently for mammogra- fihm blur For during the screen-film density to the and and dark or too light). is chosen, some other must radiographic detection is related patient characteristics too cx- decreases squared. phy and general radiography. Another example is the desire to minimize exposure time to is tri- of photons quality 7. Because patient of the ample propor- spec- quantity equipment amination. and (key) of distance The influences various which reduces the to 10 mR/h. the inverse teriah and filtration -). This prim22, in which an cx- 100 trum. the dis- (1/d to the source of nine (1/32) the does are ciple is illustrated in Figure posure equal to 90 mR/h is measured at 2 feet from the source. Doubling the distance from the source to 4 feet reduces the exposure rate by in that by the the spec- uniformly distributed in all directions. Thus, amount of x rays measured depends on the tance from the point source. This relationship summarized trum quan- tity 60 40 Figure 21. Graph of the effects of generator type on the x-ray spectrum. Single-phase generators, which have 100% voltage ripple, produce a spectrum more heavily weighted with lower-energy photons than do triple-phase generators, which have an approximately 5% voltage ripple. (Modified from Bushberg et al, 1994, and reprinted with permission.) This how electric the times an x-ray varies 20 is ripple, kilovoltage). between and however, generators waveform. 100% voltage value applied produces have x- operation Briefly, one distinguishing feature of x-ray the amount of ripple in the voltage Single-phase on basic to the the be radiation patient expo- transmission optimized If a short variable cx- systems, (ic, exposure may not time need to be changed to increase the photon fluence and to achieve appropriate film darkening. Either the tube current or the tube potential could be increased or the distance between the patient and the detector could be decreased. The operator must understand the ramifications of each of these scenarios to make the best choice. Volume 17 Number 4 Table 7 Summary of Influenc es on X-ray Variable Quantity Anode Tube material potential Tube current Time Distance Filtration (Z) (kVp) Quality Affects position (energy) of characteristic x rays Determines presence or absence of characteristic x rays; determines maximum x-ray energy None None None Increased percentage of high-energy x rays with increased filtration (higher HVL) a Z a kVp2 (mA) a mA a time cx 1/distance2 Decreases with increasing filtration (higher HVL) (HVL) Waveform Inverse Spectrum Increases with decreasing voltage ripple (flatter waveform) square Increased decreased percentage filtration of high-energy x rays (flatter waveform) law: (1/distance)2 Exposure 3’ Figure 22. Diagram illustrates the inverse square law. The inverse square law dictates that the exposure (L) is inversely proportional to the distance (D) squared. In this cxample, doubling the distance from the source from 2 to 4 feet reduces the exposure by a factor of four (from 90 mR/h to 22.5 mR/h). (Modi- Source E-9O mRlhr (5)5 fled from reprinted 10 mRlhr Bushberg et al, 1994, with permission.) It is often desirable to provide information regarding the x-ray spectrum. This can be done with regard to either the quantity or quality of the spectrum. X-ray quantity, or intensity, is A particularly useful descriptor spectrum is the effective energy The effective energy is determined surement of the most material required easily measured and described in terms of exposure. It is easier to measure charge duced in an ion chamber than to count proindividual photons. To describe quality, citing a single value is convenient but incomplete. A graph of the actual x-ray spectrum is the only complete representation of the energy distribution of the x-ray beam. However, if target material, filtration, and waveform are similar for the x-ray tube spectra being compared, the tube potential can be used as a reasonable indicator of the energy characteristics of the x-ray beam. Typically, the average tron volts) is equal the tube potential. July-August with 1997 x-ray to one-third energy (in by a factor of two. HVL, which If one of an x-ray of the beam. from a mea- is the to decrease amount the photon knows and the HVL, of flucnce an ef- fective attenuation coefficient of the entire beam can be estimated. Although the photons at each energy all have a different attenuation coefficient for a given material, the effective attenuation co- efficient reflects the global behavior of the beam and ignores the individual energies. After one determines the effective attenuation coefficient, the energy corresponding to the effective attenuation coefficient is used as the effective energy kihoehec- to one-half of McCollough U RadioGraphics U 983 of the ray entire beam beam. The is a helpful tenuation of the effective tool beam for energy of an x- predicting for a given the at- object. article ciples reviewed inherent physics fundamental physics discussion of radiologic to the and described as the loss across an electric the of energy production from potential sult of electrons influence Characteristic down positively x rays from an atom, atomic shell. Outer fall into vacancies. The electron tion yields excess energy that can be released from the atom in the form of characteristic x rays. An x-ray versus spectrum the x-ray is a plot energy and of x-ray potential squared, tube a broad, current, expo- sure time, and anode material and inversely proportional to the distance (from the source) squared. The x-ray quantity decreases with increasing filtration (a higher HVL) and increases with decreasing voltage ripple (a flatter voltage waveform). The distribution of photon energies within an x-ray spectrum anode material, potential, waveform. Increasing creases the maximum and determines characteristic 984 U Imaging & the Therapeutic filtration, by the and tube voltage the tube potential inx-ray energy produced presence x rays. This article meets Award. To obtain is affected The or absence atomic number the criteriafor 1.0 credit credit, see the questionnaire Technology it determines the broad bremsthe posi- articles addressing the basic physics of imaging with x rays provide the user of radiographic equipment with a deeper understanding of the tools used in clinical radiology. intensity includes continuous bremsstrahlung spectrum and marrow, discrete energy bands (lines) produced by characteristic x rays. The quantity of photons produced by an x-ray beam is proportional to the tube affect but subsequent are in an the not transi- ehectrons a vacancy does spectrum, atom of the nucleus. when leaving electrons to fill the created characterisis the rc- because charged occur ejected mechanisms: and the radiation slowing of the accelerated by two the bremsstrahlung process tic process. Bremsstrahlung prim- of x rays electrons material strahlumg tion of the narrow energy band of characteristic x rays. Finally, an increased percentage of highenergy x rays occurs with increased beam filtration or decreased voltage ripple. These basic principles of x-ray production form the foundation for the effective use of radiographic equipment in clinical practice. Understanding the effects of equipment parameter choices allows the user to optimize the radiographic examination in terms of both image quality and patient dose and to reduce the need for repeat exposures. In addition, knowledge of the principles that govern equipment operation can be of substantial benefit when medical equipment is purchased. This article and the U SUMMARY This anode of of the hour Acknowledgment: sistance of Candra manuscript. The author appreciates K. Jones in the preparation U SUGGESTED Several excellent the topics which listed asof the READINGS texts presented are the are available in this that article, some address of below. Bushberg JT, Seibert JA, Leidholdt EM Jr, Boone JM. The essential physics of medical imaging. Baltimore, Md: Williams & Wilkins, 1994. Curry TS III, Dowdey JE, Murry RC Jr. Christensen’s physics of diagnostic radiology. 4th ed. Philadelphia, Pa: Lea & Febiger, 1990. Hendee WR, Ritenour ER. Medical imaging physics. 3rd ed. St Louis, Mo: Mosby-Year Book, 1992. Huda W, Sloan RM. Review of radiologic physics. Baltimore, Md: Wihhiams & Wilkins, 1995. Johns HE, Cunningham JR. The physics of radiology. 4th ed. Springfield, Ill: Thomas, 1983. Sprawls P Jr. Physical principles of medical imaging. 2nd ed. Gaithersburg, Mo: Aspen, 1993. in Category onpp 961-966 1 ofthe AMA Physician’s Recognition Volume 17 Number 4