ARTU RO GILARDONI

MARCO T. GILARDON I
ANDREA A. ORSINI
LUCA A. ORSINI

RADIOLOGY - ELECTROMEDICINE
PHYSICS - TECHNIOUE - APPLICATIONS

(432 pages, 542 illustrations, 89 tables)

G X
Ed. GILARDONI S.p.A. - MANDELLO LARIO (Como) -Italy
1987
 NO COPYRIGHT
In the spirit of worldwide technical cooperation.
Please mention the source in case 01 reprint.

1987 Printed by Casa Editrice Stefanon i - Lecco - (Italy)

To the people working for human health
alld welfare

The handbook is unfortunately pubblished posthumous

since on February 23, 1987, at the time of publication,
Arturo Gilardoni , the leading spirit and principal author
of the book deceased to the dismay of his famil y,
collaborators and countless admirers.
The joint-authors, in presenting the book, intend to
honour his memory offering to the reader his last work
which now identifies itself with his spiritual testament.

MARCO TACCANI GILARDONI

ANDREA ASCANI ORSINI
LUCA ASCANI ORSINI
 Authors

ARTURO Gll.ARDONI
A pioneer in X-ray Science and Technology, was born in 1905 in the quiet
village of Mandella Lario, on the shores of Lake of Como, now a prosperous
industrial town with some majo r industries includ ing the Gilardon i factory.
In 1929 he obtained his M.Sc . in Engineeri ng at the famous Milano
.. Politecn ico_ but before completing his studIes he became fond of Rad iology,
at the time of the first century celebrations of Alessand ro Volta's death.
He worked at .. Siemens" from 1930 to 1945 and in 1947 he founded the
Gilardon i Company.
He dedicated all his studies and activities to Radiology In various directions: 9
handbooks. more than 500 scientific and technical papers presented at the
most significant national and international conferences, orig inal patents, many
revolutionary equipment for medicine and industry.
He has been awarded various honours as the Honorary Degree in Physics at
Ferrara University in 1971, and in 1974 a special prize at the Brera Art and
Science Academy of Milano.
1977 marks A Gilardoni's Golden Wedding Anniversary with Radiology - fifty
years entirely devoted to X~ray. Over half a century of research, realizations,
struggles and victories which this scientist winds up, with the satisfaction of
having built one of the most important industries for Radiology in the whole
world.
A. Gilardoni has dedicated most of his life to form technicians, engineers, etc.
in radiologic science and technique. In all his publications th is d idactic aim is
pursued as a mission.

MARCO TACCANI GILARDONI

Grandson of Arturo G ilardoni, son 01 Cristina G ilardoni who is co-author in
the handbook .. Raggi X in Medicina_ 1973.
Marco is co-author In the English handbook ..Gilardoni Non Destructive Testing"
1981 .
Presently enrolled at the University of Milano, he is assistant to the Board of
Directors at Gilardoni and collaborated in the build up of this handbook.

ANDREA ASCANI ORSINI

Grandson of Arturo Gilardoni. son of Annapiera Gilardoni who is co-author in
the handbook Aaggi X in Medicina .. 1973.
Andrea is co-author in the English handbook .. Gilardoni Non Destructive
Testing.. 1981 .
He obtained his B.Sc. in Electrical Engineering at the University of Alberta,
Edmonton, Canada.
Assistant to the Board of Directors at Gilardoni, he actively collaborated to
this handbook.

LUCA ASCANI ORSINI

Grandson 01 Arturo Gilardoni, son 01 Annapiera Gilardoni.
Presently enrolled at the University 01 Alberta to get a B.Sc. in Electrical
Engineering. He has proved to possess a scientific-technical m ind with
organizing capacity.
He knows English well and collaborated in updating and translating the Italian
edition of the .. Gilardoni Non Destructive Testing .. handboo k. He also
collaborated to this handbook.

X-ray and Electromedicine have been and are a love and a tradition of
Gilardoni's family for three generations.

4 GIt..AROCNl AADIOLOGY _ ELECTll0t.4EDlClNE

The spark
which excited GUardonl's passion for Radiology

Alessandro Volta, inventor of the first electrical battery Now 80 years old, A. Gilardoni feels the need to tell
(Voltaic pile), lounder of Electrology, whose name was .. his Radiology to the youth of today j ust how he lived
given to the unit to measure tension (the Volt,,). was it, without regrets and with the hope that, if they wish,
born in Como in 1745 and died there in 1827. they may learn something from his experience.

A century later, the event was commemorated by the
erection of the Volta's Temple on the shore of Lake
Como, with the concourse of eleClrotechnic Associations
from all over the world . In this occasion a show of
electrolechnical equipment was held.
He has always repeated that ..TreatiseS?> are old the
moment they are born but they can serve as photographs
of the past, for details and perhaps as a starting point
for new conquests.

Arturo Gilardoni then twenty-two years old was an

engineering student, and he didn't loose the opportunity
to partecipate to such an important celebration held so
near to his birth place. Mandella LariO. on the shores of
the same Lake Como.

While visiting the show the future engineer was

particularl y attracted by a suggestive apparatus. It was a
200 kV equipment for X-therapy with mechanical rotating
rectifier.

The great circles of sparks and fire from the high

voltage of the great rotating wheels were producing a
fantastic effect.
Arturo Gllardoni at twenty-two when he <egot married
with his Radiology" at Volta's Temple in Como on the
recurrence of the 1st Century of Volta's Death (1927).
And this was the spark.

T he spar~ that illuminated Gilardoni's mind and gave

him the inspiration which is revealed to each one 01 us
once in a life time and decides our future destiny.

He decided there and then that he would dedicate

himself and his studies to Physics and radiologic
Technique. This he did with the audacity, perseverance
and self sacrifice that were already a part of his
character.

That spark for him was the light that indicated the path
he was to tread; he has now dedicated more than fifly
years to Rad iology and human service.

More than fi fty years of research, realizations, struggles,

defeats and victories which, thanks to Gilardoni, have
given Italy one of the wo rld ten most important
industries for Radiology, the only real Italian centre of
Radiologic research and production, and an Italian
tradition , in an activity schemed for the future. Arturo Gilardonl at eighty in his office (1985).

GllAAOONI RA,OIOlOGY ELECTROMEOICINE 5

 .'

Mandelic Larlo and famous Grigna Mountain.

The surroundings of Gllardonl', X-ray laboratories described by Leonardo da VincI.

Leonardo da Vinci visited and enjoyed this scenic country side; many 01 his famous paintings like ..The Virgin of the
Rocks, "The Last Suppe,.,. and others have the superb dolomitic mountain Grigna in the background.

Leonardo wrote:

..La Gr;gnia e piiJ alta mon/agn/a chabbi quest; paesl ada pelata. I maggio,; sass; SChoperti chessl truovno in quesll
paes; 50no Ie montagnie di Mandelic visino aile mon/agn/a dl Leche e di Gravidonia sequel/s di Valle di Ciavenna
malls magiore ecquella di Mandel/c ..,

Leonardo da Vinci: ~Coclice Atlantico (1483-1518).

"The Grigna is the highest mountain in th is district and is bare. The major mountains near Mandello are those 01
Leeco, Gravedona and Chiavenna but the most beautilul is the Grigna 01 Mandello~.

6 a..NIDONI RADIOlOGY ELECTROMEOICINE

 Mandello Lario - Gilardoni's factory, In the background the centre of the Lake Como

A famous book on the history of Radiology "The Trail of the Invisible Light- by Grigg, published by C. Thomas,
Springfield, Illinois. U SA read s: ~ Gilardon;'s factory is located in Mandello Laria on the shores of Lake Como -
prObably the most scenic location of any X-ray factory in the wor/d- .

Gilardonl has been the leading Italian company in developing the flolds of application of X-ray and Ultrasonic
equipment.

Gilardoni has always devoted major elforts to research (more than HXl persons, mainly graduated, are dedicated to the
research), hence gaining a world-wide reputation as one of the few self-sullicient and fully integrated companies
engaged in the development and manufacture of X-ray and ultrasonic appliances, ranging from X-ray tubes to
generators, accessories, etc.

On the basis of its experience, Gi lardoni has also given a fundamental contribution to scientific advancement in this
field by presenting its own papers to national and international Congresses

GllAROONI. RAOIOLOGY - El..ECTROMEOtCINE 7

PRESENTATION
uRadiology-Electromedicine, (Phisics, Technique, Ap-
plications) is the 3rd Handbook written in English
by the Gilardoni staff and has practical and divulga-
live purposes. It summarizes more than 50 years of
studies and experiences.
The 1st book : " X-Rays in Art,. was published in
1977 (232 pages, 262 illustrations).
The 2nd book: Gilardoni Non Destructive Testing
(Industrial Diagnosis) in 1981; (240 pages, 403 illus-
trations, 70 tables).
One of the Authors has already co-operated to the
writing of two other handbooks:
Roentgen and Curie Therapy" by F. Perussia and
F. Pugno-Vanoni (2 volumes, Garzanti Edition, Milan
1947).
.. Non Destructive Testing Handbook .. by McMaster
(2 volumes, The Ronald Press Edition, New York
1962) in collaboration with Coolidge for the Section
" Electronic Radiation Sources.
The parts of the Handbook dealing with Radiology
are more developed than Electromedicine ones be-
cause Radiology is more complex and over 90% of
total examinations are of radiological type.
Several parts of the Handbook, such as Physics of
radiations, radiological Electrotechnique, Dosimetry,
Protections, etc . are obviously common to the pre-
vious Gilardoni Handbooks and are reprinted In the
same way.
Other parts have been drawn from different works,
or derived from papers issued by Gilardoni Research
Laboratories, in addition to Gilardoni's communica-
tions published on leading magazines, on Notagil,
etc.
Some parts, as " Radiotherapy'" for example, have
perhaps a personal conception. derived also from
the results observed over a long period of practical
experiences.
Some others, such as Half century experience and
.. Industrial and Art Radiology may be considered
curious, not pertinent, criticable.
Equipment references are taken mainly from Gilar-
doni production, because handy.
We apologize for this and other peculiarities.
The writing is made in a simple synthetic form, be-
cause it Is our opinion that: simplicity is clarity'"
.. Radlology-Electromedicine is composed of about
432 pages, 549 illustrations, 89 tables: that is: almost
more illustrations than pages and perhaps more num
8 GllAR DONI . RAOIOLOGY
bers than words; numbers. figures, diagrams and
tables are facts. and words ... just words.
Diagrams are the quantification of phenomena and
tables the synthesis of knowledge: in fact. Mendele-
jeff's Table synthetizes the knowledge of the uni-
verse matter elements. and Digital techniques are
the apotheosis of numbers.
The treatise has a condensed-figurative character as
the previous Gilardoni book X-Rays In Art which
was reviewed by the American Journal of Roentge-
nology as ... well organized, clearly written and
nicely illustrated.
New detailed indexing system makes the reading
easy, giving the synthetic content of each classified
paragraph of the text in advance.
The Authors take for granted that the reader of a
scientific, technical book looks first at the index, il-
lustrations and related explanations before paying
further attention to the text; this is why a remarka-
ble space is reserved to illustrations and footnotes.
The treatise has been conceived with organic unity.
keeping as much as possible a logical link among
the various subjects.
It is provided with many numerical references to in-
terlink parts and arguments.
In order to have a synaptical view of the work, it
has been divided into parts, chapters, paragraphs
and sub-paragraphs according to decimal classifica-
tion .
The type of printing used allows a wide viewing of
text and illustrations for an easy reading , under-
standing and aSSimilation.
The Glossary has been composed and up-dated
with particular attention including new terminology
of: Digital, CT, NMA, ECT, etc.
Synoptic, detailed, subject Indexes and Glossary, all
four accuratiy developed, are the key for the good
use of the handbook.
The Authors apologize for mistakes and imperfec-
tions and will be thankful to anybody who will pOint
them out for correction in future editions.
Many thanks to Tomaso Ghislanzoni and his
daughter Monica and to Mirella Arrigoni for their
valuable collaboration and to all the staff of
Gilardoni Research Laboratories.
The other external collaborators are thanked in their
specific parts .
The Authors trust that the book may be useful and
may give a contribution to the progress of Radio-
logy and Electromedicine.
L E C TR O ~ EO I CI NE
SYNTHETIC-ORIENTATIVE STORY OF THE MOST IMPORTANT ACHIEVEMENTS IN RADIOLOGY

A synthetic-orientative story of the most important scientific-technical achievements in Radiology is traced by

A. Gilardoni, who had the chance to collaborate pioneeringly to the development of Radiology during the half
century of its famous progress that is from 1930 up to 1985.

mR 'EAR
IMPOflTANT EVENTS IMPORTANT EVENTS
(APPR.) (APPfI.)

1894 Men unconsciously produced X-Ray during scientific 1960 Image Intensifiers (II) replace direct fluoroscopy.
,nd experiments with Crookes lubes and Ruhmkorff high
before voltage coli 'n various Physics Laboratories. High Energy In Radiotherapy Cobalt bomb - Betatron.

1895 Fortuitous X-Ray discovery by Roentgen. 1965 Introduction of II-TV Spot lilm-Cine X techniques.
N Oli , Accessories and telecontrOI improvement.
81h
Scintigraphy.
1896 Immediately after this discovery, radiological experi-
ments with CrOOkes gas tubes are held in various 1970 Improvement in II-TV-Video Recording (VR) and tela-
Physics Laboratories. controlled e)(am lnation accessories.
Free film serial changers replace cassette fil m serial
screens, ,
Edison ood Pupln Introduce tungstate radiographic
pillar 01 Radiology. changers.
Automation 0 1 radiographic e)(posure.
1900 Focus 9" lobes development.
1975 Triumph of electroolcs, automation, telecontrol, II-TV-
1905 First primitive equipment with Focus tubes. VR; strong sophistication and costs increase.
Computed Tomography (CT).
1910 Ruhmkorff coil is replaced by High VOltage (HV) trans-
Medical Echography.
formers.

1913 Coolidge lube and Bucky grid diaphragm, both ba- 1980 Improvement in II-TV-VR, automation and control.
sis 01 Radiology, ".
invented. Gilardoni StatlOr"l8ry invisible lines grids replace Bucky
with moving grids (1978)
1915 Rotating selector for hall wave (HV) rec tifying with Digital Radiology (studies).
synChronous motor.
Important developments in Echography.
1920 Full wave HV rotating rectifier with synchronous mo- Emission Computed Tomography (ECT).
to, 10' HV generators.
1982 Digital Radlolology (applications) .
1925 OrthOscopes. manual serial changers. etc., allowing Nuclear Magnetic Resonance (NMR) (proposals) .
gastro-Intestlnal examinations.
Radiological computerization: Gi lardoni Roentgen-Gil .
1930 Bouwer introduces the rotating anode tube.
1983 Digital Radiology (improvements: processing, recurtling,
Increase 01 HV generators power.
filtration. etc.).
HV and RX protection with metallic tubeheads and
Tissue chBracteriza tion in Echography (studies) .
protected HV cables Introduced. Tomography.
'" Improvement in invisible grids application.
1935 Improvement In examination accessories. Special techniques In soft rays (Gnardoni Soft Gil).
Thermoelectronic glass valves replace mechanical ,e- TridimenSional techniques (studies).
ctifiers wi th synchronous motor.
-Gilardonl Total Body RadiographY'" WIth ooHomogmph-.
Contrast medium 10' internat port, examination.
New Image detectors: solid state photodiodeS.
1940 Improvement in examination accessories.
1984 Digilal Radiology (ennancement of the application mnge,
Tilling tables, etc. new detectors development).
Tissue Chamcterization in Echography (some practical
1945 Development 01 ..MonobfOOo units, mainly by Gilar- applications).
doni, with high output, minimum weight and dimen-
sions. Improvement in stall(lard radiological equipment com-
puterization.
.. Monobloc- technique allows also the development
01 .. Industrial Radiology". TridimenSional techniques (application, proposals).

1950 Improvement
'0 examinati on accessories. 1985 Digital Radiology - Digital Radi ography: new computer
aided equipment.
1955 Selenium and Silicon, ..solid state~ rectiliers replace New high powerlull condenser generators: ~ Universal
th erm oelectronic glass valves. Condensor-Gil 150 kV, ~F~ replaces conventional ones.
Introduction 01 electronics, automation ood tele- New X-ray tubes with focus size continuously compu-
control. adjusted: Multifocus-Gil Tube~ .
'"
GllAROONI. RADIOLOGY - ELECTROMEOICINE 9
 SYNOPTIC INDEX: PARTS AND CHAPTERS
(Detailed index from page 12 to page 26)

""" "'- ''''

N
~.
N

"
N.
~
"""
4.6. Tomograhy
Subjecl ...,.
136 4
...
N.
.
N

4
N.
~

-
PART 1 4.7. Computed Tomography (CT) 158 15 13 2
INTRODUCTION 4.8. Digital ""d computerized Radio-
~, 166 5 5 -
1.1 . X-rays Generalities 29 3 2 4.9. Roentgen-Gil: Universal fu lly corn -
puterized equipment (Diagnostic
1.2.
1.3.
The ..Materia
Electricity
30
32
4
10
3
1
- Robol) 167 4 5 -
4.10. Digita l Angiography ;" clinical
practice 169 7 11 -
PART 2 4.11 . Digital image archiving 179 4 1
X-RAY PHYSICS AND TECHNIQUE

2.1 . Generalities 36 15 14 2 PART 5

2.2. X-ray Characteristics 41 6 4 2 ULTRASOUND IN MEDICAL DIAGNOSTICS
2.3. Physics 01 lhe X-ray image (Dia-
gnostics) 43 15 2 - 5,l. Introduction 181
2.4. Contrast media ,"d compensating 5.2. Ultrasound generation 181 10 3 1
filtration 45 9 6 - 5.3. Ultrasound Physics 183 8 4 2
2.5. Radiography 50 36 34 8 S.4. Ultrasonic probes 186 7 9
2.6. Radiographic technique 71 7 1 3 5.5. Ultrasound representation techn;que5 189 12 8 1
2.7. Fluoroscopy 75 32 36 1 56. Image quality 194 7 4
2.8.
2.9.
X-ray measurement (Dosimetry)
Physics and Biology of Aadlothera-
91 28 22 8 5.7. Electronic processing 01 the image 196 7 2 -
5.8. Tissue Characterization 199
ph, 104 35 19 7
5.9. Physical concepts 10' ultrasound
diagnostics 199 7 3 1
PART 3 5.10. Ultrasound diagnostics application
RADIOLOGICAL ELECTROTECHNIQUE fields 201 16 15 -
5.11 . Gilardoni 8-Mode Equipment So-
3.1. Generalities 115 4 4 1 nagil B 208 - 1 -
3.2. High voltage (HV) generators 10' 5.12. Collection of significant US images 208 - 1 -
X-ray p roduction 115 11 5 2 5.13. Equipment performance checking 208 2 4
3.3. COOlidge tubes. tube heads ood
HV cables 120 47 27 3
3.4. Con trol desks 132 12 4 PART 6
3.5. KV, mA e"d sec.: elec trical
timing fact ors of radiographi c
00'
,,- NUCLEAR MAGNETIC RESONANCE IMAGING
posure and their control 135 18 5 -
6.1. Introduction 212
3.6. Fundamental electrical data 10'
physicists, deSigners. manufacturers 6.2. Principles 01 NMR 212 6 6 1
and electroradiological technicians 139 13 1 3 6.3. '1Tl!.9.!ng wah NMR 214 2
3.7. Mos! important lest instruments and 6.4. NMR ;" tissue characterization 215 5 2
accessories "sed 10 evaluate p'o-
tection. equipment efficiency, ima-
6.5. Imaging techniques 216 2 3 -
ge quality, etc. 143 9 16 - 6.6.
6.7.
NMR system
Risks 10' lhe patients
218 7 3
3.B. The 10 fundamen tal pilla rs 01 21.
X-diagnoslics 147 11 - - 6.B. Future perspectives 220 - - -

PART 4
X- DIAGNOSTICS - EQUIPMENT - TECHNIQUES PART 7
APPLICATIONS NUCLEAR MEDICINE - ISOTOPE DIAGNOSTICS

4.1. High voUage (HV) generators 10' 7.1. Radioactivity 222 10 1 1

X-diagnostics 149 1 - 1 7.2. Principles of measurement of radio-
4.2. Low and medium power diagnos- activity 225 18 6 -
4.3.
,,'"equipment
Surgery, Orlhopedy,
149
Cardiology.
2 13 1 7.3 Instrument lor radioactivity measu-
rement ;" Nuclear Medicine 231 28 13 3
Emergency. etc. 152 - 5 - 7.4. Principal application fi elds 01 00-
4.4. Powerful diagnostics 152 2 clear medicine examinations ~i n
4.5. Examination auxiliaries (Orthosco- vivo,. 242 40 8 1
pes. Bucky Tables. Tilting Tables. 7.5. Radiation pro tection ;" a nuclear
Ceiling Tube Stands. Tomographs) 153 10 11 2 medicine department 249 6 - -

10 GllAROONl. RAOIOt.OGY - ELECTROMEOICINE

- SUbjecl

ANATOMY
PART 8
'- "
~,
,. ,
'. ~.
'"''' Subject

PART 13
INDUSTRIAL RADIOLOGY AND
'''' ~,
, , ,
fig
'"

NON DESTRUCTIVE TESTING (NOT)

8.1. Introduction 253 4 2
8.2. Organization 01 Ihe human body 254 9 1 - 13.1. Radiographic Testing (RT) 317 4 42 -
8.3. Arthrology 255 2 13.2. Ultrasound Testing (UT) 326 5 11 1
8.4. Osteology 256 20 21 13.3. Magnetic Testing (MT) 328 3 12 -
8.5. Digestive system 264 16 3 - 13.4. Penetrant Testing (PT) 332 3 5 -
8.6 Respiratory system 267 11 13.5. Comparison ood selection 01 NDT
8.7. Urogenital system 268 11 3 - processes 333 - - 2
8.B. Circulatory system 9 271 5 PART 14
8.9. Nervous system and organs of spe-.-
cial sense 274 14 2 ARTISTICAl RADIOLOGY
8.10. Endocrine system 276 10 - 14.1. Radiography 01 Pieces 01 Art 335 4 - -
8.11. Some anatomical drawings by 14.2. Paintings: the most important works
Leonardo da Vinci relative GTBR" of Art for radiological investigation 335 7 3 2
(Gilardoni Total Body Radiography) 277 - 6 - 14.3. Some radiographs of stamps. mum-
mies, paintings with relative inter-
PART 9 pretations 338 - 15 -
SOME SIGNIFICANT RADIOGRAPHS WITH
ILLUSTRATED PROJECTIONS AND PART 15
EXPOSURE DATA HALF CENTURY EXPERIENCE
Practical suggestions for researchers, designers,
9.1. Atlas 01 30 cases (figures with eng ineers, technicians and also for authors
relevant explanations) 282 30 -
15.1. Computer age, Human brain. th,
PART 10 be" computer 346 - - -
RADIOTHERAPY APPLICATIONS - TECHNIQUES 15.2. The five senses. pick-ups 10' h,-
EQUIPMENT moo brain computer 346 5 - -
15.3. Suggestion 10' Research, Design,
10.1. Generalitiesood references 294 - Production 346 - - -
10.2. Isodose curves applications 294 1 - 15.4. General Recommendations 347
10.3. Equipment 294 8 13 15.5. Success ood life satisfaction fac-
10.4. Deep tumour radiotherapy ;, a tors 347 - - -
miss bot untill oow necessary 298 2 - - 15.6. Practical suggestions for publications
(books, magazines, etc.) 348 1 - -
PART 11 15.7. Suggestions 10' Authors 348 8 - -
RADIOLOGICAL PROTECTION 15.8. Composing advice 348
11.1. Physical quantities and their measu- PART 16
rement units (Roentgen, Rad -Gray.
Rem-Sievert) 300 6 - 2 TABLES OUT OF TEXT
11 .2. Doae limits 10' individuals 300 4 16.1 Atlas of 18 tables of practical inte-
11 .3. Proteximetnc control Instruments 301 4 4 rest 350 - - 18
11.4. Proteximetric calculation 10' radio-
logic installation 302 3 - 3 PART 17
BIBLIOGRAPHY
11 .5. Recommendations 01 Ih. Interna-
tional Comm ission 00 Radiological
Protection (ICRP) 303 - - - 17.1. Handbooks ood papers 362 1
11.6. Protection against radiation used 17.2. Magazines 363 - - -
10' medical purposes 303 6 - - 17.3. Some Gilardoni scientific-techn ical
papers 364 - - -
11 .7. Therapeutic installation 306 6 - -
11.8. Protection 01 th, patient 308 8 17.4. Gilardoni Handbooks 368
11.9. Summary 01 different organ dose 17.5. Gilardoni Magazines 366 - - -
limits 10' ind ividuals 311 - - 1
PART 18
PART 12 GLOSSARY
PLANNING OF RADIOLOGICAL DEPARTMENTS 18.1. Preliminary 368 4 - -
AND EQUIPMENT SELECTION 18.2. Physical, Radiological ood Medical
12.1. Generalities 312 1 - - terms 370 - - -
12.2. X Diagnostics 313 6 2 2 PART 19
12.3. Radiotherapy 315 2 1 SUBJECT INDEX
12.4. General suggestions for the plan-
ning 01 X-ray departments 315 - - - 19.1 .1 Alphabetic classification 1419 1 1 1

GILAA DONI . RAD IOLOGY - ELECTADMEDICINE 11

 DETAILED INDEX
Parts, Chapters and Paragraphs

PAGE
PRELIMINARIES
Coolidge rotating anode tubes
Dedication ((;g. 312, 412, 512) ... . 36
Authors Coolidge and Gilardoni Collaboration 37
The spark which excited Gi lardoni's passion for Distance inverse square law (fig. 6/2) 37
radiology
Radiation intensity or output . 37
The surroundings of Gilardoni's X-ray Laboratories
Radiation quantity or dose 37
described by Leonardo da Vinci , , . . . .
Formation of the radiological image-
Gilardoni's factory from "The trail of invisible
enlargement (fig. 712) 3B
light.. by Grigg, Ed. C. Thomas - Springfield, Illinois
Geometrical unsharpness or penumbra
Presentation . ... .. .
(fig . 8/2) ..... 3B
Synthetic-orientative story of the most important
Measuring the tube focal spot size
achievements in Radiology
(fig. 9/2) . . . . . . . 3B
Synoptic index
X-ray exponential absorption law
Detailed index (tabs. 112. 2/2 . fig. 1012) 3B
Hall Value Layer (HVL) and Tenth
Value Layer (TVL) . .. . . 40
Part 1 2. 1.11. Photoelectric effect (absorption) and
INTRODUCTION Compton effect (scattering) (figs. 1112.
1212) . ... . .... . 40
2.1.12. X-ray ionization (fig. 13/2) 40
Chapter 1.1. - X-rays generalities
2.1.13 Primary and secondary scattered radia-
1.1.1. X-rays and their production (fig. 1/ 1) 29 tions ........... . 40
1.1.2. Kinds of electromagnetic waves 2.1.14. Negative effects of scattered radiations
((;g. ~1) ...... . 29 on image quality and ways to elimi-
nate them (fig. 14/2) ..... . 41
1.1.3. The discovery of x-ray - Historical notes 29

Chapter 1.2. - The umateria

Chapter 2.2. - X-ray characteristics
1.2.1. The structure of matter (fig. 3/1) 30
1.2.2. Nuclear rays (a, {J, y) (fig . 4/ 1) 30 2 .2 .1. X-ray lube emission spectrum. Conti-
1.2.2.1. Natural radioactive elements (fig . 511) 31 nuous spectrum and lines spectrum
(fig. 15/2, tab. 312) 41
1.2.2.2. Artificial radioactive elements 31
2.2.2 . Current (mA) influence on continuous
emission spectrum (fig. 16/2) 42
Chapter 1.3. - Ektctriclty 2.2.3. Voltage (kV) influence (fig. 17/ 2) 42
1.3.1. Surface electrification of bodies 32 2.2.4. Filter influence (fig. 18/2) 42
1.3.2. Conductors and insulators 32 2.2.5. Minimum wavelenglh In function of
1.3.3. Electricity generators (fig. 6/1) 32 tension (Amin) (tab. 3a/2) 42
1.3.4. Some types of electricity generators 33 2.2.6. Maximal intensity wavelength (-"max) 43
1.3.4.1. Chemical cells . 33
1.3.4.2. Photoelectric cells 33
1.3.4.3. Thermocouples 33 Chapter 2.3. - PhysJcs of X-ray Image (diagnos-
1.3.4.4. tics)
Piezoelectric generators 33
1.3.4.5. Electromagnetic generators 33 2.3.1. Unsharpness and definition 43
1.3.4.6. Bioelectricity (electrocardiography, ele-
2.3.2. Film unsharpness 43
ctroencephalography, electromiography) 33
2.3.3. Screen unsharpness and intensification
factors (figs. 1912. 20/ 2) 43
2.3.3.1. Practical simple evaluation of intensify-
Part 2 ing factor of radiographic screens 44
X-RAY PHYSICS AND TECHNIQUE 2.3.3.2. Control of screen quality and resolu-
tion with IOI-G IL or Lines Pair test
Chapter 2.1. - Generalities pattern 44
2.3.3.3. Control of bad screen-film adherence
2.1.1. Coolidge tube: X-ray generator with ..net.. method and suggestions to
(figs. 112. 2/2) . . . . . . 36 eliminate this frequent defect 44

12 GllAADONI. RADIOLOGY - ElE~EDlClNE

 PAGE PAGE

2.3.3.4 Balanced.. Gi lardon i HSU, Universal 2.5.5. Useful radiographic density range 52
Screens for Automation , Rare earth 2.5.6. Underdevelopment effec t (a common
screens 44 faul t) (fig. 28/2) 52
2.3.4. Geometrical unsharpness 44 2.5.7. Overdevelopment effect (fig. 29/2) 52
2.3.5. Kinetic unsharpness and exposure ti 2.5.8. Useful hints for good radiography and
me. 44 development efficiency control by the
2.3.6. Resultant o f the various unsharpness . "sample strip method .. (fig. 30/2) 52
Total unsharpness 44
2.5.9. Dosimetric control of fi lm, development
2.3.7. Absorption contrast (radiological can and automatic film processor efficiency 53
trast) 45 2.5.10 Films with blackening dose printed on
2.3.8. kV influence on contrast (fig. 2112 the packing box 53
page 46) 45
2.5.11. Effects of scattered radiations: fog in-
2.3.8.1 . Three types of Radiograph ies: standard crease and contrast decrease (fig. 31/ 2) 53
scale (standard rays 40-80 kV) , long
scale (hard rays, 80-100 kV and more), 2.5.11 .1. Antiscattered grids, grids factor and
short scale (soft rays, 1()..40 kV) 45 clean up (fig . 3212) 53
2.3.6.2. High kilovoltage technique reduces pa 2.5.11 .1.1 . Grid ratio ",.. and grid characterization
tient dose and increases information (1;9. 33/2) 54
power (long scale) 45 2.5.11 .1.2. Geometrical focusing 54
2.3.9. Contrast and definition (sharpness) the 2.5.11 .1.3. Practical focal range (tab. 3b/ 2) 54
basis of the information power 45 2.5.11.1 .4. Characteristics and appl ications of clas-
sic X-ray grids (tab. 4/2) 54
Chapler 2.4, Contrast media and compensating 2.5.11 .1.5. Grid density or number of lines/inch
""ration or cm (N) 54
2.5.11 .2. Bucky to cancel strips image 55
2.4.1 Use of contrast media (f ig . 22 / 2 2.5.11 .3. Stationary grids with invisi ble lines, a
page 47) 45 dream for Radiologists (tab. 5/ 2) 55
2.4.2. Compensating fi ltration to balance the 2.5.11 .4. Invisible stationary 150 lines grids have
density of different parts' absorption 45 greater information power than
2.4.3, Aluminium wedges to balance density 103 ones 56
of a.p. foot 47 2.5.11.4.1. Grids optimum and Alumin ium grid
2.4.4. ..Gilardon i Total Body Radiography filter equivalent referred to inter-
(GTBR).. with ..Homograph .. and rad io- space, cover material and clean up
log ical Checkup at a very low dose 46 (figs. 33a/2, 33b/2) 56
2.4.4.1 . Principle of <tGTBR- (figs. 23/2 and 2.5.11 .5. Scattered radiations in function of air
23aJ2 ) 46 gap between radiographic cassette and
2.4.4.2. "LeonardGil - spec ial equ ipm ent for patient (fig. 34/ 2) 56
"GTBR .. (fig. 23b/2) 46 2.5.11.5.1 Scattered radiations in lungs radiograph
2.4.4.3. Two orientative examples of .. GTBR and their elimination with suitable grids
are here reproduced (figs. 23c/2, (figs. 35/2 , 35a!2, tab. 6/2) 57
23d/ 2) 49 2.5.11 .6. Principle and advantages of Double
2.4.4.4. Some applications of <tGTBR.. 49 Grid Radiography " DGR system
2.4.4.5. Advantages of " GTBR .. on single stan (figs. 36/2, 37/2, 37a/2) 56
dard radiographs 49 2.5.11.7. Scattered radiations of different human
parts in different techniques (tab. 7/2) 56
Chapter 2.5. - Radiography 2.5.11 .8. Practical utilization of stationary invisi-
ble 150 lines grids 56
2.5.1. Densitometry (fig . 24/ 2) 50 2.5.11 .9. Tomography and Oblique projections
2.5.2, Blackening, densitometric or sensito- with DGR system 59
metric curve (fig . 25/2) 50 2.5.11 .10. Invisible grids allow the use of hard
2.5.2.1 Sensitivity or speed (a) 50 rays technique to reduce patient dose
and tube load 60
2.5.2.2. Photographic contrast (b) 50
2.5.11 .11. Grids Quality and their radiographic
2.5.2.3. Inherent fog (cl 50
control concerning uniformity and de-
2.5.2.4. Umit density (d) or saturation blacken- fects. Warranty 60
ing 50
2.5.11 .11 .1... Grids Acceptance Standard Radio-
2.5.2.5. Exposure latitude {el 50 graph.. : perfect uniformity with Density
2.5.3. Densogil, electronic densitometer 1 20% at 60kV 61
(1;9. 26/2) 51 2.5.11.12. Stationary invisible 150 lines/inch grids,
2.5.3.1 Pocket comparison densitometer the grids of the future 61
(fig . 2712) 51 2.5.11 .13. " Sucky Threegridsn with invisi ble, sta-
2.5.4. Practical di rect viewing evaluation of tionary, intherchangeable Gridgil 150,
density (finger method) . Radiographic ratio 6, 12 and 6 + 12 (cross grid)
blackening range 51 (fig. 38/2, tab. 7a/2) 61

GILI<ROONI . FV.OIOLOGY EU:CTROMEOICINE 13

 PAGE PAGE

2.5.11. 14. Gilardon i Gridgil 200 GX. Stationary 2.6.2.2. Film handling 74
inylsible lines soft ray grid for Mam- 2.6.2.3. Darkroom processing 74
mography (200 lines/inch) (fig. 38aJ2) 62 2.6.3. Essent ial steps in film processi ng
2.5.12. Soft rays and hard rays (figs. from (tab. 11/2) 75
39/2 to 42/2 , tab. 8/2) 63 2.6.4. Unsatisfactory rad iographs, causes and
2.5.12.1...Soft-Gil System.. and .. Soft-Gil equip- corrective actions (tab. 1212) 75
ment,. for high information power ra-
diographs of bone and soft tissues Chapter 2.7. - FluorolCoPY
(muscle, tendons, etc.) with soft ray
technique and soft ray grids (figs. 42a/2, 2.7.1. The fluoroscopic image 75
42b/2) 63 2.7.2. Image intensifier (1.1.) with direct or
2.5.12.2. Exposure, skin and yolume dose, dose TV viewing (figs. from 48/ 2 to 50/2) 75
contrast and THVL with Soft ray, Stan- 2.7.3. Image Intensifier and television techni-
dard rays, Hard rays and Homogenized que 77
Total Body Radiog raphy (tab. 8aJ2) 66 2.7.3.1 Introduction to Image Intensification
2.5. 13. Information recovery of too high den- (figs. 5112, 5212) 77
sity overexposed radiographs 66 2.7.3.2. The Image Intensifier (figs. 53/2, 54/ 2) 78
2.5.13.1. In formati on recovery of overexposed 2.7.3.3. Conversion Factor (or Gain) 79
radiographs with the method of soft 2.7.3.4. Information Content (fig. 5512) 79
ray radiography of the film (figs. 43/2,
2.7.3.5. Viewing Sys tems (fi gs . from 56/2
44/ 2) 66 to 59/2) 79
2.5. 13.2. Information recovery of overexposed 2.7.3.6. Television (fig. 60/2) .
rad iographs with differential photogra-
80
phic reprint method 66 2.7.3.6.1. Television image formation (figs. 61/2,
6212) 81
2.5. 14. Exposu re and image quality factors
(I;g . 4512) 2.7.3.6.2. The T.V. Camera (figs. from 63/2 to
66 66/2) 81
2.5.15. DIN-Wire quality indicator for industrial
radiology 2.7.3.6.3. Th e synchronising pu lse generator
67 (I;g. 6712) 82
2.5.15. 1. IOI-GIL wire Image Ouality Indicator
2.7.3.6.4. The video amplifier B3
for medical radiology (fig. 46/2) 68
2.7.3.7. Automatic Gain Control (A.G.C.) circu-
2.5.15.2. Indicatiye Yalues of radiological resolu- its B3
tion power determined by IOI-GIL. Ra-
diography 0,5-1% Fluoroscopy 4-8%, TV 2.7.3.8. Automatic dose rate control B3
Fluoroscopy 2-4%, Digital Fluoroscopy 2.7.3.9 . Kinescopy 84
1-2% 68 2.7.3.10. Video tape recording (figs. from 68/2,
2.5.16. Resolution evaluation using Une Pairs to 70/2) 84
per mm method 68 2.7.3. 11 . Cinefluorography (fig. 71/2) 85
2.5.17. Modulation Transfer Function (MTF) for 2.7.3.12. Pulsed cinefluorography 66
contrast evaluation in function of spa- 2.7.3.13. Bi-plane cinefluorography 66
tial frequency (figs. from 46a/2 to 2.7.3.14. Cine film marking (fig. 72/2) 87
4Be/2) 68 2.7.3.15. Spot film fluorography 87
2.5.18. Image elements per mmsq and cmsq,
2.7.3.16. Fil ms fo r X-ray ci nefluorography
lines pairs per mm and cm, contrasV
definition evaluation with IOI-GI L, in-
(Ilg. 73/2) 87
formation power and applications of 2.7.3.17. Magnification techniques (fig. 7412) 87
principal diagnostic methods, including 2.7.4. Large field Image Intensifier (1.1.) with
CT, US, NMR, ECT, etc. (tab. 9/2) 71 Orthicon tube (figs. 75/2, 75a/2) 68
2.5.19. Practical rad iographic exposure data for 2.7.5. Panel Electron Tube for Fluoroscopy
different anatomical parts of human bo- (PET scope) . Principle and applications
dy (tab. 10/2) 71 (figs. 75b/2, 75cJ2) 66
2.5.20. Methods to reduce exposure patient 2.7.6. Photodiodes Image detectors: Principles
dose 71 and Applications (figs. 75d12, 75e12) 88
2.5.21. Radiographic unit = 100% exposure va- 2.7.6.1 . Flying spot solid state scanner
riation 71 (fig. 75f/ 2) 90
2.5.22. Explanation about KeV, KVcp, KVp, kV, 2.7.6.2. Solid State (CCO) Intensified linear
Standard ray and Normal ray 71 scanner (fig . 75g/2) 90
2.5.23. Aluminium and copper filters with ab- 2.7.7. Gonioscopy and dynamic examination
sorption equivalence to different human with angled fluoroscopy (fig . 76/2) 90
body parts for phantoms purposes. 2.7.7.1 . Spatial vision (tridimensional) through
Examples (tab. 10al2) 71 rotational fluoroscopy 91
2.7.8. Anti-terrorism equipment (f igs. from
Chapter 2.6. - Radlographfc technique 77/ 2 to 80/2) 91
2.6.1. Radiograph ic film 71 Chapter 2.8. - X-ray measurement (dosmetry)
2.6.2. Practical hints for good radiographs 74 2.8.1. X-ray dose and X-ray intenSity or out-
2.6.2.1 . Film storing (fig. 47/2) 74 put (A and R/ min) 91

14 GILAA DONI. RADiOlOGY ELECTROMEDtClNE

 PAGE PAGE

2.8.1.1. RAD (Radiation Absorbed Dose) and 2.9.1.3. Antiinflammatory and antipain therapy:
REM (Roentgen Equivalent Man) 91 arthrosis, rheumatism, etc. (IQO-.1SO kV) 104
2.8.1.2. Ionization viewing by means of a Wi I 2.9.1.4. Semi--deep therapy for treatments untitl
son chamber (fig. 81 /2) 91 5 cm depth (IQO-.200 kV) 104
2.8.2. Dosimeters Principle (fig. 82/2) 91 2.9.1.5. Deep therapy against deep tumours
2.8.2.1. Victoreen integrating dos imeter (400 kV, 50 MV) (fig. 96/2) 104
(Iig. 8312) 94 2.9. 1.6. Characteristics and applications o f
2.8.2.2. G ilardoni integ ra ting dosimeter fundamental rad iotherapy apparat us
(figs. 84/ 2, 85/2) 94 (tab. 2112) 104
2.8.2.3. Dogil: integrating dosimeter and inten 2.9.2. Ratio : tu mour dose / tissue dose
simeter (fig. 86/2) 94 (Diu/ DIS) , basis of Radiotherapy 104
2.8.2.4. Geiger counters (fig. 87/2, 88/2) 94 2.9.3. Balistic Efficiency (BE) and methods
to improve it 104
2.8.2.5. Scinti llation counters (fig. 89/ 2) 95
2.9.3.1. XTV Bomb now replaced by Cente-
2.8.2.6. Gilardoni Bol1le (figs. from 90/2 to
red Therapix (figs. from 97/2 to 110/2) 105
94/2. tabs. 13/2. 14/ 2) 96
2.9.3.2. Simulator (fig. 111/2) 105
2.8.2,6.1. Some evaluation possibilities of "Gilar
don i Bottle 98 2.9.4. Relative Biological Efficiency (ABE) 105
2.8.2.6.2. Manufacturing instructions and use of 2.9.5. Copper Half Value layer (CuHVl), se
the .. Bottie" 98 cond CuHV l , homogeneity degree
(tabs. 2212, 23/2) 108
2.8.3. Fundamental o rlentative data to be
remembered (tab. 15/ 2) 99 2.9.6. Tissue Half Value layer (THVl) 108
2.8.4. Radiation effects on human bOdy 2.9.7. Muscle / bone absorption ratio
(tab. 16/2) 100 (Iig . 11212) 108
2.8.5. Dosimeter output of X--diagnostic ge-- 2.9.8. Maximum ionization deplh (BuUdup) 108
nerator (tab. 17/ 2) 100 2.9.9. Dosimetric output of XTherapy equip""
2.8.5.1 . Efficiency measure of rad iograph ic ment wi th pulsating and constant po-
equipment and control of exposure fac tential voltage (tab. 24/2) 109
tors (kV. mA, sec.) with dosimetric me-- 2.9.10. Back scattered radiation (%) in func-
thod 100 tion of CuHVl and treatment field
2.8.6. Skin dose evaluation in Radiography (Wachsmann) (tab. 25/ 2) 109
and Fluoroscopy (fig. 95/ 2) 100 2.9.10.1 . Deep Dose in function of energy for
2.8.7. Dose volume evaluation (R . liter) in typical therapies: 500 kVc; Caban
Radiography. Fluoroscopy and Therapy 100 Bomb, Unear Accelerator 5 MV, Beta
2.8.7.1 Theoretical general relation: Dose Vo-
tron 35 MV (fig. 113/2) 109
lume (0 '1) 101 2.9.11. Techniques of Radiotherapy treatment
(from F. Wachsmann and G. Drexler) 109
2.8.7.2 Mayneord relation (for Dose Volume) 102
2.9.11 .1. Plesio or Contact therapy 109
2.8.7.3. Gilardoni's simple practical relation
(for Dose Volume) (fig . 95a/2) 102 2.9.11.2. Arthrosic, anti pain, antinflammatory the-
rapy. etc. 110
2.8.7.4. Gilardoni's simple mnemonical relation
(for Dose Volume) 102 2.9.11 .3. Tumor therapy 110
2.8.7,4.1. Diagnostics (Dose Volume) 102 2.9.11.4. Fundamental doses in Radiotherapy
(from F. Wachsmann and Dimotsis) . 110
2.8.7.4.2. Therapy (Dose Volume) 102
2.9.12. Dose volume evaluation in therapy
2.8.7.5. Comparison between Mayneord's and
Gilardoni's relations gives very similar
(R . liter) 110
figures 102 2,9.13. Geometrical Therapeutic Efficiency
(GTE) equivalent to Balistic Efficiency
2.8,7.6. Table with Dose Volume for typical 110
(BE)
Radiograph i es and commen t s
(tab. 1812) 102 2.9.14. Fundamental doses and Geometrical
T herapeutical Efficiency (GTE) for d if-
2.8.7.7. Table with Dose Volume for typical ferent therapy types (tab. 26/2) 110
Fluoroscopy and comments (tab. 19/ 2) . 102
2.9.15. Skin, tumor, Doses volume and GTE
2.8.7.8. Table with skin Dose and Dose Vo- In Plesio or Contact and deep therapy
lume for different types of examinations (tab. 27/2) I1t
(tab. 20!2) 102
2.9.16. Dose volume (ov) and Geometrical
Therapeutic Efficiency (GTE) with dif
Chapter 2.9. Physics and btology of radiothe ferent equipment: SOO kV. Cobalt Bomb.
<apy 5 MV Unear Accele rator. 35 MV Beta-
tron 111
2.9. 1. Xtherapy types 104 2.9.17, Other factors characterizing therapy
2.9.1.1. Superficial therapy. Dermotherapy efficiency 111
(5-50 kV) 104 2.9.17.1. Relative Biological Efficiency (RBE) of
2.9.1.2. Plesio therapy, or Contact Therapy of radiations 111
rapid dose decay for affections till 2.9.17.2. Muscle / bone absorption ratio
1 cm depth (3{}-80 kV) 104 (fig. 11212) 111

G ILAAOONI. RADiOlOGY - ElECTAOMEDICINE 15

 PAGE PAGE

2.9.17.3. Build ~up and skin erythema 111 3.3.2. Some Gilardoni X-ray tubes (tab. 4/3) 120
2.9. 18. ..Therapeutical Optimum .. (TO) is in 3.3.3, X-ray tubes manufacturing 120
the range of 400-600 kV (fig. 11 412) 112 3.3.3.1. Raw material selection 121
2.9.19. Gilardoni X-therapy Centered Thera~ 3.33.2. Pre-degasing of metallic parts
pix operating at " Therapeutical Opti~ (fig. 10/ 3) 121
mum. with incorporated Simulator to
increase .. Geomet rical Efficiency
3.3.3.3. Assembling in sterile cabins (fig. 11/3) 121
(fig. 115/ 2). 112 3.3.3.4. Glass processing. Tube sealing
(figs. 1213, 13/ 3) 121
3.3.3.5. Tube vacuum (fig . 14/3) 122
3.3.3.6. ..Getters" chemical vacuum refiners 122
Part 3 3.3.4. Additional information about Coolidge
tubes. Features, maximum tube load,
RADIOLOGICAL ELECTROTECHNIOUE tube lile, etc. 122
3.3.4.1. Maxi tube voltage 122
3.3.4.2. Maximum Electric Power in continuous
Chapter 3.1. - Generalities working (fluorosco py and therapy) 122
3.3.4.3. Radiographic power in kW referred to
3.1.1 . High voltage (HV.). the basis of X-ray
1 sec. load for stationary anode tube
generators 115 and to 0,1 sec . for rotat ing anode
3.1.2. High voltage production (tab. 1/ 3) 115 tubes. Power 01 the most used tubes
3.1.3. High voltage transformers (figs. from (tab. 513) 122
1/ 3 to 3/3) 115 3.3.4.4. Focal spot and radiographic load limit
3.1.4. Sofid state high voltage rectifiers: se- (max allowed load) , Diagram tube po-
lenium, silicon, etc. (fig . 4/3) 115 wer in function of load time (fig. 1513) 122
3.3.4.5. Relation between tube life and maxi-
mum tube load. Suggestions to im ~
Chapter 3.2. - High voltage tHY) generators for prove tube life. (fig . 16/3) 125
X-ray production
3.3.4.5.1. Effect of overload ing on the tubes 125
3.2.1. The main H.V. generators, electric cir- 3.3.4.6. Gilardoni condenser generator for
cuits, features and performances ext ra short radiog rap hies (less than
(tab. 2/3) 115 1 ms) using current of about 5000 mA
3.2.1.1. High frequency (H.F.l , high voltage (1;9. 17/3) 126
(H.V.) X-rays generators 3.3.4.7. Tube cathode screen (or grid effect,
3.2.2. Advantages of threephase, 12 pulse or intra effect) and its inlluence on
generators on Liebenow-Greinacher ma- focal spot, emission and out-put 126
nophase condenser generators for the- 3.3.4.7.1. Focal spot formation (fig . 1813) 126
rapy equipment 117 3.3.4.7.2. Striped focal spot in linear focus tu-
3.2.3. Advantages of self-contained equipment bes (cylindric liIament) (fig. 19/ 3) 126
without HV cables for therapy applica- 3.3.4.7.3. rnA emission curve and tube charac-
tions (figs. 5/3, 6/3) 117 teristic" (fig . 20/3) 126
3.2.4. Electric power (EP = kmAkV) and 3.3.4.7.4. Efficiency (output) of tubes fed with
radiograph ic power (RP = kmAklJ5) pulsating HV (self-rectifying and 4 re-
3.2.4.1. Ou tp ut of self-rectifying X-ray units ctiliers generator) (fig. 21 / 3) 127
and constant potential equipment 117 3.3.4.8. Radiographic load ratings of stationary
3.2.5. Electric mains resistance and its mea- anode X-ray tubes (fig . 2213) 127
sure 118 3.3.4.9. Radiograph ic load ratings of rotating
3.2.6. -Radiographic Optimum" (Iigs. 7/ 3, 8/3) 118 anode tubes (Iig. 23/3) 127
3.2.7. General radiological relation : 3.3.4.10. Heating characteristic of anode and
Yin) = kmAkVc n (fig . 9/3, tab. 3/3) 118 assembled tube head (figs. 24/ 3, 25/ 3) . 127
3.2.8. T he .. Radiographic Optimum. of a ge- 3.3.4.11 . Rotating anode tubes with tungsten-
nerator at 1/6 of short circuit current rhenium-molybdenum-graphite d isc
(mAlIC ) and 5/6 of max kilovoltage (1;9. 26/3) 128
without charge. Example 119 3.3.4.12. Metal-glass rotating anode tubes
3.2.9. Universal ..Condensor 150 kV, 5pF.. (Iig. 27/3) 128
.. Farad-G il. . New powerfull generators 3.3.4.12.1 Metal - ceramic rotating anode tube
advantageously replace conventional (fig. 278/3) 129
three-phase 6-12 pulses ones lor all
diagnostic pourposes: a revolution in 3.3.4.13. Rotating anode tubes with grid 129
X-ray diagnostic generators 119 3.3.4.14. Microfocus tubes and enlargement tech-
nique 129
3.3.4.15. Tubes for mammography and high
Chapter 3.3. - Coolidge tubes, tube heads and contrast radiography (tab. 4/3) 129
HY ca~et
3.3.4.16. Pulsed tubes for flash radiography
3.3.1. Generalities and references 120 (10-e sec.) (tab. 4/3) 129

t6 GllAADONI. RADIOLOG Y ELECTRQMEDICINE

 PAGE PAGE

3.3.4.17. Monostage 300 kV therapy tubes 3.5.2.3. kV control with resistor voltage divider
(tab. 4/3) 129 and cathode-ray oscilloscope 135
3.3.4.18. Multistages lubes with metallic dischar- 3.5.2.4 . Quick kV evaluation with a dosimeter
ge chamber for high potential (up to 3.5.3. mA control 138
600 kV and over) (tab. 4/3) 129 3.5.3.1. mA control in high voltage ci rcuit 136
3.3.4.19. Beryllium window tubes (tab. 4/3 ) 129 3.5.3.2. mA control in low voltage circuit 136
3.3.4.20. Grounded anode tube for endocavitary 3.5.3.3. mA check with milliampere-second me-
therapy (tab. 4/3) 129 ter (mAs) 137
3.3.4.2 1. Focal spot and tube load in conti- 3.5.3.4. mA control with cathode-ray oscillo-
nuous work (fluoroscopy, therapy) scope (fig. 4213) 137
(I;g. 28/3) 129
3.5.4. Exposure time control (sec.) 137
3.3.4.22. X-ray tube housing (fig. 29/3) 129
3.5.4.1. Time control with electronic pulse-
3.3.4.23. Therapy X-ray tube housing (fig . 30/3) . 130 counter 137
3.3.4.24. X-ray tube failures: remarks, defects 3.5.4.2. Time control with radiographic spin-
and causes (fig. 31/3) 130 ning-top method (figs. 4313, 44/3) 137
3.3.4.25. Tube life and suggestions to improve it 130 3.5.4.3. Time control using an oscilloscope on
3.3.4.25.1. Tube pre-heating after an off duty pe- the primary circuit 138
riod (fluoroscopy and therapy) (tab. 613) 130 Time control with oscilloscope on the
3.5.4.4.
3.3.4.25.2. Load and voltag e limits to prolong secondary low tension milliamperome-
tube life (fig. 3213) 130 tric circuit 139
3.3.4.26. High voltage cables (fig. 33/3) 130 3.5.4.5. Time control in high voltage. by means
3.3.4.26.1 . X-diagnostics high voltage cables 132 of voltage divider units and cathode
3.3.4.26.2. X-therapy high voltage cables (fig. 34/3 ) 132 ray oscilloscope 139
3.3.4.27. High voltage terminals (fig . 35/3) 132 3.5.4.6. Time control with dosimeter 139

Chapter 3.6. - Fundamental electrical data for phy-

Chapter 3.4. - Control desks sicists, deSigners, manufacturers and
electroradlologlcal technicians
3.4.1. Classic control desks 132
3.4.1.1. kV regulation 133 3.6.1. High voltage (HV) , basis of X-ray ge-
nerators 139
3.4.1.2. mA regulation and stabilization 133
3.6.1.1. Electric field intenSity (kV/cm ) for va-
3.4.1 .3. Exposure electronic timer 133 rious electrode shapes and distances
3.4.1.3.1. High voltage timer with triodes or te- (tab. 713) . 139
trades, inertia free switches for Cine-X Peak voltage (kVp) in function of spark
3.6.1.2.
and flash pulsed digital technique distance (tab. 8/3) 139
(I;g . 36/3) 133
3.6.1.3. Characteristics of the most important
3.4.1.3.2. Pulse-Gil, 500 kW power generator insulating materials (tab. 9/3) 139
(5000 mA at 100 kV) 133
3.6.2. Tracing of the electric field graph and
3.4.1.4. Tube overload safety device 133 stress evaluation by means of the elec-
3.4.1.4.1 . Previous overload protection 133 tric gradient (kVlcm or mm) (fig. 45/3) 139
3.4.1.4.2. Cumulative (real time) overload protec- 3.6.3. Insulating materials choice in function
tion, particularly useful with high ex- of the voltage gradient 139
posure rate (angiography) 133 The most used insulating materials 139
3.6.4.
3.4.2. Automatic and electronic control Mineral or synthetic oils 141
3.6.4.1.
desks (Gilardoni Multiloglx System)
(figs. 37/3, 38/3) 134 3.6.4.2. Kraft paper impregnated with vacuum
treated oil , one of the best insulating
3.4.3. Computed aided radiological control materials 141
unit (Logix) (fig. 39/3) 134
3.6.4.3. Transversal and longitudinal discharge
3.4.4. New .. Multifocus-Gil Tube.. computer in oil of impregnated kraft paper 141
operated: focal spot size automatically
selected in function of loads and iner- 3.6.4.4. Transversal and longitudinal discharge
tia free HV switch also for flash-pulses with plastics, resi ns, etc. 141
digital radiography. Cine X, etc. 135 3.6.4.5. Compressed gas; Sullur Hexafluoride
(SF,) 141
3.6.5. High voltage, a sophisticated techno-
Chapter 3.5. - kV, mA and sec.: electrical and togy 141
timing factors of radiographic exposure
and their control
Chapter 3.7. - Most important test Instruments
3.5.1. Generalities and references 135 and accessories used to evaluate pro-
kV and wave shape control 135 tection, equipment efficiency, image qu&-
3.5.2.
Ilty, etc.
3.5.2.1. kV control with primary Vmeter 135
3.5.2.2. kV control with a sphere spark gap 3.7.1. Safety equipment . Proteximetry
(fig . 40/3, tab. 8/3) 135 (fig. 4613) 143

OllAROONI. RAOIOLOGY ELECTROMOICINE 17

 PAG E PAGE

3.7.2. Xray test patterns for measuring Fo-- Chapter 4.4. - Powerful diagnostics
cal spot size, Resolution. Modulation
Transfer Function (MTF), etc. (fig. 47/3) 143 4.4.1. Volta-Gil + Farad-Gil + Coolidge-Gil
3.7.3. Solid state ' X ray output detector for + Roentgen-Gil today the best equ ip-
measuring X-ray generator parameters ment for X-Diagnostics (fig. 18a/4) 152
(figs. 48/3, 49/3) 143 4.4.2. Possible future orientation of H.V. gene-
3.7.4. Timing and mAs test kit for single- rators for X-Diagnostics: powerful con-
phase, three-phase, and CP equipment denser generators and middle frequen-
(fig. 50/3) 144 cy generators 152
3.7.5. Mammographic phantom Simulating con-
trast conditions normally found in mam- Chapter 4.5. - Examination auxiliaries (orthoscopes,
mography (fig. 51 /3) 144 bucky tables, tilting tables, ceiling tube
3.7.6. Tomographic phantom (fig. 52/3) 144 stands, tomographs, etc. (tab. 3/4)
3.7.7. X- ray anatom ical phantoms (fig . 53/3) 144 4.5.1 Orthoscope (fig. 19/4) 153
3.7.8. Gray-Mayo Clinic Patient Equivalent 4.5.2. Bucky Table (fig. 20/4) 153
Phantom (PEP) (figs. from 54/3 to 60/ 3) 144
4.5.3. Tilting Table (figs. 21/ 4, 2214) 153
3.7.9. Chronogil, radiOlogical wrisl watch
(1;9. 61/3) 147 4.5.4. All computerized, digitized, un iversal
equipment: Roentgen~Gil (fig. 23/ 4) 153
4.5.5. Ceiling tube stand (fig. 24/4) 153
Chapter 3.8. - The 10 fundamental pillars of 4.5.6. Bucky Stand (fig. 25/4) 154
X-diagnostics 4.5.7. Teleradiography (fi g. 26/4) 154
4.5.7.1. Chest Changer (fig . 26a/4) 154
3.B.1. Generalities 147
4.5.8. Different combinations of Condensor-
3.8.2. High voltage (HV) 147 Gil generators and exam ination acces-
3.B.3. Coolidge tube 147 sories 155
3.8.4. Radiographic intensifying screens 147 4.5.9. Treatment 01 the Kidney stones with
3.8.5. Fluorescent screens for Fluoroscopy 147 shock waves (Iigs. 26a/4 and 26b/4) 155
3.8.6. Contrast media 147 4,5,10. Mass Screening (military, schools, etc.) ,
3.B.7. Antiscattered grids 147 hospital general acceptance, periodical
radiological check up. etc. (tab. 3a/4) 156
3.8.8. Image intensifiers 147
3.B.9. Digital Fluoroscopy and recorded Ra-
diog raphy 147 Chapter 4.6. - Tomography
3.B.l0. Examination auxiliaries 147 4.6.1. Introduction (fig. 27/4) 156
3.8. 11. _The Radiolog ist.., the last mentioned 4.6.2. Linear Tomography: different methods
but, de facto", the first 147 (fig. 28/4) 157
4.6.3. Non linear Tomography 157
Part 4 4.6.4. Test procedures - Tomographic Phan-
tom (figs. 29/4, 30/ 4) 157
X- DIAGNOSTICS - EQUIPMENT
TECHNIQUES - APPLICATIONS
Chapter 4.7. Computed Tomography (CT)
4.7.1. Hystorical notes. Principles of CT 158
Chapter 4.1. - High Yoltage (HY) generators tor
X-diagnostics 4.7.2. Data acquisition in CT and 1.st gene-
ration CT-scanners (figs. 3114, 31a/4) 159
4.1.1 . Some Gilardoni HV generators and ac- 4.7.2.1 2.nd generation CT-scanners 159
cessories (tab. 1/4 and 1a14) 149 4.7.2.2. 3.rd generation CT-scanners (fig. 3214 ) 159
4.7.2.3. 4.th generation CT-scanners (fig . 33/4,
tab. 4/ 4) 160
Chapter 4.2. - Low and medium power diagno- 4.7.3. The detectors in the CT-scanners 161
stics equipment
4.7.4. CT-image reconstruct ion (figs. 34/ 4,
35/4) 161
4.2.1. X-Gil: easy portable monobloc for emer
gency and for dental and veterinary 4.7.5. CT-numbers (tab. 5/4) 162
radiology (figs. from 1/4 to 8/4 and 4.7.6. Grey - sca le, leve l and window
tab. 214) 149 (figs. 36/ 4, 37/ 4) 162
4.2.2. Med ium power monobloc for Practical 4.7.7. Image quality in CT (fig. 38/4) 163
Med icine (figs. from 9/4 to 13/4) 149 4.7 .8. Spatial resolution in CT - scanners
(figs. from 39/4 to 41/4) 163
4.7.9. Noise and contrast resolution in CT-
Chapter 4.3. - Surgery, orthopediCS, cardiology, scanners 164
emergency, etc. (figs. from 14/ 4 to 4.7.10. Mathematical filters in CT 165
18/4) 152

18 GILAROONI. R.... DIOLOGY ELECTROMEDtClNE

 PAGE PAGE

4.7.1 1. Mathematical evaluation of CT-ima- 5.2.2. Ferroelectricity (fig. 3/5) 181

ges . . . . . . . 165 5.2.3. Piezoelectric materials (tab. 1/S) 182
4.7.12. Computed tomography: system's gene- 5.2.3.1. Nature 182
ral configuration (fig. 42/4) 165 182
5.2.3.2 Density
5.2.3.3. Maximum operating temperatu re (Curie
Chapter 4.8. - Digital and computerized radiology point) 182
5.2.3.4. Velocity 182
4.8.1. Digitization principle (fig. 43/4) 166 182
5.2.3.5. Acoustic impedance
4.8.2. Dig itization benefits . . . . 166 182
5.2.3.6. Frequency constant
4.8.3. How a digital imaging system for di- 183
5.2.3.7. Piezoelectric constants
gital temporal subtraction operates
(figs. from 44/4 to 47/4) 166
4.8.4. Dual-energy and hybrid subtraction, di- Chapter 5.3. - Ultrasound physics
gital filtering techniques 166
4.8.5. Fully computerized Radiology 167 S.3.1. Ultrasonic waves (fi g. 4/S) 183
5.3.2. Wave propagation velocity (tab. 2/5) 183
5.3.3. Beam geometry (figs. from 5/5 to 7/S) 183
Chapter 4.9. - Roentgen-Gil universal compute-
rized equipment (diagnostic robot) 5.3.4. Beam reflection (tab. 3/S) 185
5.3.5. Ultrasound energy attenuation 185
4.9.1. A computer controlled equipment S.3.S.1 Scattering 186
(fig. 48/4) 167
5.3.5.2. Absorption 166
4.9.2. Movements control operated by com-
puter of Roentgen-Gil (fig. 49/ 4) 168 5.3.5.3. Diffraction 186
4.9.3. Computer aided, radiographic parame-
ters choice on Roentgen-Gil (figs. from Chapter 5.4. - Ultrasonic probes
50/4 to 5214) 168
4.9.4. Images digitization and processing 169 5.4.1 . Ultrasonic probes (fig . 8/S) 186
S.4.2. Probes' characterization 186
Chapter 4.10. - Digital angiography in clinical prac- 5.4.2.1 . Electrical parameters (figs. 9/S, 10/S) 186
tice 5.4.2.2. Geometrical parameters evaluation
(fig. 11 / 5) 187
4.10.1. Introduction Immersion tank for probes characteri-
4.10.2. Materials and methods (figs. 54/4, 57/4, zation (fi9S. 121S. 12aJ5) 187
62/4) . . . . . Visualization of the ultrasonic beam
4.10.3. Clinical applications (figs. 13/5, 13a/S) . . 189
4.10.3.1. Neck vessels and intracranial circula- Gilardoni ultrasonic probes for medical
tion (figs. 53/4, 55/4, 56/4) inspections (fig. 14/S) 189
4.10.3.2. Mediastinal vessels
4.10.3.3. Abdominal aorta and branches Chapter 5.5. - Ultrasound representation techniques
(figs. 58/4, 59/4, 6OaJ4, 63/4)
4.10.3.4. Peripheral vessels and post-operative 5.5.1. A-mode display (fig . 15/5) 189
controls (figs. 6Ob/4, 61/4) 171 Static 8-mode display (fig. 16/5) 190
5.S.2.
S.S.3. Analogical Scan Conversion Tube (SCT) 190
Chapter 4.11 . - Digital Image Archiving S.S.3.1. Construction and operation of a SCT
(fig. 17/5) 191
4. 11 .1. Picture Archiving and Communication Digital Scan Converter (fig. 18/5) 191
S.5.4.
System (PACS) 179
5.5.4.1. Gray-scale 191
4. 11.2. Storage capacity required for a PACS
(tab. 6/4) . . . . 179 5.5.5 Real time display (fig. 19/5) 192
4.11.3. Digital Optical Recording (DOR) 179 5.5.5.1. Linear array and sector scan
(figs. 20/5, 21/5) 192
4.1 1.4. Laser disc juke-boxes 179
5.5.5.2. Dynamic focusing 193
55.6. Time motion display (TM mode)
(fig. 22/5) 193
Part 5
5.5.7. Computer echotomography 193
ULTRASOUND IN MEDICAL DIAGNOSTICS
5.5.8. Echotomographic equipment selection
(tab. 4/5) 193
Chapter 5.1 . - Introduction 181
Chapter 5.6. - Image quality
Chapter 5.2. - Ultrasound generation
5.6.1 . Probe performance checking (figs. 23/5,
5.2.1 . Piezoelectricy (figs. 1/5, 215) 181 24/5) 194

GllARDONI. RADIOLOGY aECTROMEDICI NE 19

 PAGE PAGE

5.6.2. Probe resolution capability (figs. 25/ 5, Chapter 5.12. - Collection of significant US ima-
26/5) 195 ges (fig. 48/ 5) 208
5.6.3. Probe selection 196
5.6.3.1. Freq uency selection 196 Chapter 5.13. Equipment performance checking
5.6.3.2. Diameter selection 196
5.6.3.3. Focusi ng selection 196 5.13.1 . Test objects (figs. from 49/ 5 to 52/5) 210
5.6.4. Time Gain Compensation 196 5.13.2. Salety aspects ...... . 210

Chapter 5.7. - Electronic processing of the image

Part 6
5.7.1. Pre-processing operations . . . . . 196
5.7.1.1 . Pre-zoom (fig. 27/ 5) . . . . 196 NUCLEAR MAGNETIC RESONANCE IMAGING
5.7.1.2. Selecting the Time Gain Compensation
Curve (fig. 2815) 197 Chapter 6.1. - Introduction 212
5.7. 1.3. Reset operation . . . . . . 197
5.7.2. Post processing operation . . . . . 197
Chapter 6.2. - Principles of NMR
5.7.2.1. Colour image: ch romatic code convers-
ion 197 6.2.1 Properties of atomic nuclei 212
5.7.3. Digital echotomography: research and 6.2.2. Nuclei in a magnetic field (figs. 1/6,
development ..... 197 2/6) ....... . 212
6.2.3. Larmor relationship 213
Chapter 5.8. - Tissue characterization 199 6.2.4. Magnetic resonance (figs. 3/6, 4/ 6) 213
6.2.5. The RF field (fig. 5/6) 213
Chapter 5.9. - Physical concepts lor ultrasound 6.2.6. Free precession (fig. 6/6) 21 4
diagnostics

5.9.1. Current Clinical Practice 199 Chapter 6.3. - Imaging with NMR (1Igs. 7/6, 8/6) 214
5.9.2. Specular rellectors 200
5.9.3. liquid collections . . . 200
Chapter 6,4, - NMR In tissue characterization
5.9.4. Back reinforcement effect (fig. 29/5) 200
5.9.5. Lateral cones of shade (fig. 30/5) 200 6.4.1. Relaxation process ..... 215
5.9.6. ..Rain" ellect (fig. 31 /5 ) . . 200 6.4.1.1. Tl : the spin - latt ice Relaxation Time
5.9.7. Comparison between liquid and solid (I;g. 9/ 6) .. . . . . . . . 215
formation (tab. 515) 200 6.4.1.2. T2: the spin - spin Relaxat ion Time
(fig 10/6) . . . . . . . . . . . 215
Chapter 5.10. - Ultrasound diagnostics application 6.4.1.3 True T2 measurement . . . .. 216
fields 6.4.2. Causes 01 Relaxation Time Differences
in various tissues . . . . . , . ' 216
5.10.1 . Abdominal scanning
5.10.1.1 . Liver (fig. 32/5)
5.10.1.2. Kidneys (fig. 3315)
5.10.1 .3. Urinary bladder, spleen and pancreas
(fig . 34/5) ..... .
5.10.1.4. Extraorganic abscesses (fig . 35/5)
5.10.2. Gynaecological and obstetric scanning
(I;g. 36/5)
5.10.2.1. Foetus (fig. 3715)
5.10.2.2. Placenta (fig. 38/5)
5.10.2.3. Gynaecological masses (figs. from 39/ 5
to 41 /5)
5.10.2.4. Evaluation of gestational age (fig. 42/5)
5. 10.3. Cardiological scanning (fig. 43/5)
5.10.3.1. Mitral valve (fig. 44/5)
5.10.3.2. Aortic valve and left atrium
5.10.3.3. Doppler effect (fig. 4515)
5.10.4. Neurology ..... .
5. 10.5. Thyroid scanning (fig. 46/5)

Chapter 5.11 . - Gllardonl B-mode eqUipment: So-

nagil B (fig. 47/5)

20 GILAROONI. RADIOLOGY ELECTfIO~EOICINE

 PAGE PAGE

Part 7 7.3.3.3. Scintillation cameras 235

NUCLEAR MEDICINE 7.3.3.3.1 . Operating principles (figs. 14n, 1Sfl) 235
ISOTOPE DIAGNOSTICS 7.3.3.3.2. Collimation (fig. 16/7) 236
7.3.3.3.3. Parameters characterising the response
of a gamma-camera 237
Chapter 7.1. - Radioactivity 7.3.3.3.3.1. Sensitivity (tab. 317) 237
7.3.3.3.3.2.Spatial resolution (tab. 4fi) 237
7.1.1. Radioactive dacays 222 7.3.3.3.3.3.Spatial linearity 238
7.1.1.1 . Alpha decay 222 7.3.3.3.3.4.Uniformily of response 238
7.1.1.2. Ir decay 222 7.3.3.3.3.5.Count-rate performance (fig. 1717) 238
7.1.1.3. If decay 222 7.3.3.4. Emission tomography 239
7.1 .1.4. Electron capture 223 7.3.3.4.1. Single photon longitud inal-section ima-
7.1.1 .5. Isomeric transitions 223 ging 239
7.1.2. Natural and artificial radioactivity . 223 7.3.3.4.2. Single photon transverse-section ima-
7.1.3. The law of radioactive decay (fig . 1fl) . 223 9in9 (fig. 18n) 239
7.1.4. Units of radioactivity 224 7.3.3.4.3. Positron emission tomography (figs. 19f1,
2017) 239
7.1.5. Principal radionu clides for medical use
(tab. 1fi) 224 7.3,3.5. Computer systems 240
7.3.3.5.1. Hardware 240
7,3,3.5.2. Acquisition formals 241
Chapter 7.2. - Principles of measurement of 7.3.3.5.3. Software 241
radioactivity

7.2. 1. Counting statistics and error predic-

tion 225 Chapter 7.4. - Examples of Nuclear Medicine dia-
gnostic applicalion. A short outline
7.2.2. Gas filled detectors 225
7.2.2. 1. Ionization chambers (fig. 217) 225
7.2.2.2. Proportional counters (fig. 3fl) 226 7.4.1 . Introduction 242
7.2.2.3. Geiger-Muller counters 226 7.4.2, Thyroid scanning and function 242
7.2.3 . Solid state detectors (Iig. 4fl) 226 7.4.2.1. Physiologic basis 242
7.2.3. 1. Crystal counters 227 7.4.2.2. Radioactive tracers 242
7.2.3 .2. Surfac&-junction detectors 227 7.4.2.3. ..In vivo- function studies 242
7.2.3 .3. Lithium drill detectors 227 7.4.2.3.1. R.I. uptake test 243
7.2.4. Scintillation detectors (fig . 5fl) 227 7.4.2.4. ..In vitro" function studies 243
7.2.4. 1. Photomultiplier tubes (Iig . 6fl) 228 7.4,2.5, Imaging (fig. 21fi) 243
7.2.4.2. Inorganic solid scintillators 228 7.4.3. Nuclear cardiology 243
7.2.4.3. Organic scintillators 229 7.4.3.1. Introduction 243
7.2.5. Electronic instrumentation 229 7.4.3.2. Non imaging radiocardlography (RCG) . 243
7.2.5.1. Pre-amplifiers and amplifiers 229 7.4.3.3. First Pass Nuclear Angiocardiography
7.2.5.2. Scalers and ratemeters 229 (FPNA) (fig . 2217) 244
7.2.5.3. Pulse-height analysis systems 229 7.4.3.3.1 . E.F. determination 244
7.2.6. Gamma-ray spectroscopy (fig. 7fl) 230 7.4.3.3.2. R.W.M. analysis 244
7,4.3.4. Equilibrium Gated Blood Pool Angio-
cardiography (EGBPA) 244
Chapter 7.3. - Instrumentation nuclear medicine 7.4.3.4 .1, LeM and right ventricles EF 244
7.4.3.4.2. TO left ventricle volume 244
7.3.1. Generalities 231 7.4.3.4.3. Parametric imaging (fig. 23fl) 244
7.3.2. Instruments for .. in vitro" measure- 7.4.3.5. Myocardium perfusion imaging 245
ments of biological samples 231 245
7.4.3.5.1. Radiopharmaceutical choice
7.3.2.1. Beta-counters 231 7.4.3.5,2. Technical procedure 245
7.3.2.2. Gamma-counters 232 7.4.3,5,3. Scintigraphic panero (fig. 24fl) 245
7.3.2.2.1. Well-counters (fig. 817) 232 7.4.3.6. Acute myocardial infart imaging 245
7.3.2.2.2. Counters for large sample volumes
7.4.4. Renal procedures 245
(fig. 917) 232
7.4.4.1 . Physiologic mechanism 245
7.3.3. Instruments for ~in vivo measure-
ments (fig. 10fl) 233 7.4.4.2. Non imaging procedure 245
7.3.3.1. Probes for in vivo.. tracer studies 7.4,4.3. Imaging procedures (figs. 25fl, 26fl) 246
(fig . 11n) 233 7.4.5. Bone imaging 246
7.3.3.2. Linear scanners (figs.1217, 13/7 and 7.4.5.1. Radio pharmaceuticals and Bone Phy-
tab. 217) 234 siology 246

GILAROONI, R.wtOt.OGY - ELECTROMEOICINE 21

 PAGE PAGE

7.4.5.2. Normal pattern 247 8.4.4. Upper extremity 257

7.4.5.3. Abnormal pattern (fig. 27fi) 247 8.4.5. Hand (fig. 5/8) 257
7.4.5.4. Benign diseases 247 8.4.6. Wrist (fig. 5/8) 257
7.4.5.5. Neoplastic diseases 247 8.4.7. Forearm (fig. 6/8) 257
7.4.6. Liver and hepatobiliary imag ing 247 8.4.8. Arm (fig. 7/8) 258
7.4.6.1. Introduction 247 8.4.9. Shoulder blade (fig. 8/8) 258
7.4.6.2. Static imaging 248 8.4.10. Collar bone 259
7.4.6.3. Liver scintiangiog raphy 248 8.4.11. Lower extremity 259
7.4.6.4. Blood pool imaging (fig. 28n) 248 8.4.12. Phalanges (figs. 9/8, 10/ 8) 259
7.4.6.5. Hepatobiliary imaging 248 8.4.13. Metatarsals 259
7.4.7. Patient dose in nuclear medicine pro- 8.4.14. Ankle (fig . 10/8) 259
cedures (tab. 5n) 248 8.4.15. Leg (figs. from 11/8 to 13/8) 260
8.4.16. Thigh (fig. 14/8) 260
Chapter 7.5. - Radiation protection In a nucle ar 8.4.17. Hip bone (figs. 15/8, 16/8) 261
medicine department 8.4.18. Skull (figs. from 17/8 to 21/8) 262
8.4.19. Vertebral colums (figs. 2218 , 23/8) 263
7.5 1. Storage of radionuclides in a nuclear
medicine departmenl 249 8.4.20. Ribs and sternum (fig. 24/8) 264
7.5.2. Exposure and contamination 250
7.5.3. Room and surface monitoring 250 Chapte r 8.5. - Digestive s yste m
1.5 4. Principles of monitoring of workers 250
7.5.5. Safe handling of radioisotopes 250 8.5.1. General (fig. 25/ 8) 264
1.5.6 The disposal of radioactive wastes 251 8.5.2. Mouth cavity 265
B.5.3. Salivary gland 265
8.5.4. Teeth (fig . 26/8) 265
Part 8 8.5.5. Tongue 266
B.5.6. Tonsils 266
ANATOMY
8.5.7. Pharynx 266
8.5.8. Esophagus 266
CNper 8.1. - Introduction 8.5.9. Siomach (fig. 27/8) 266
8.5.10. Small intestine 266
8.1.1 Scope 253
B.S.l1. Large intestine 266
8.1.2. Anatomical terms (fig. 1/8) 253
8.5.12. Rectum 267
8.1.3. Anatomical planes 253
B.S.13. Movements of alimentary tract 267
8.1 4 Anatomical postures (fig. 218) 253
8.5.14. Liver 267
8.5.15. Gall bladder 267
CMpter 8.2. - Organlzalion of the huma n body 8.5.16. Pancreas 267
82.1 General 254
82.2. The cell 254 Cha pter 8.6. - Reaplrlllory syste m
8.2..3. Functions of living cell 254
8.2.' Reproduction of the individual 254 8.6.1. General 267
8.2.5. Periods of human development 254 8.6.2. Nose 267
8.2.6- Concept of biological inheritance 254 8.6.3. Paranalsal sinuses 267
8.2.7 Body types 254 8.6.4. Larynx 268
82.8. Regions of body (fig . 3/8) 254 8.6.5. Tracheas 268
8.2.9 Fundamental tissues of the body . 255 8.6.6. Bronchi 268
8.6.7. Lungs 266
8.6.B. Mechanics of respiration 266
O\apter 8.3. - Arthrology 8.6.9. Lung capacity 268
8.3.1. General 255 8.6.10. Control of respiration 268
8.3.2. Types of joint movement 256 8.6.11 . Artificial respiration 268

Clapter 8.4. - Osteotogy Chapte r 8.7. Urogenital s ystem

8.41. General (fig. 4/ 8) 256 8.7.1 . General (fig. 28/8) 268

6.'2. Classification of bones 256 8.7.2. Kidney 269
8.4 3. Descriptive terms of bone structure 257 8.7.3. Ureter 269

22 GllAAOONI. RAD iOlOGY - El.ECTAOMEDICINE

 PAGE PAGE

8.7.4. Urinary bladder 26' Part 9

8.7.5. Urethra 26. SOME RADIOGRAPHS WITH ILLUSTRATED
8.7.6. Genital organs (male) (fig. 28a/8) 26. PROJECTIONS AND EXPOSURE DATA
8.7.6.1. Genital organs (female) (fig. 28b/8) 26.
8.7.7. Function of excretory system 270 Chapter 9.1. - Alias of 30 cases (ligures with
8.7.8. Pathways of excretion 270 relevant e)(~analions) (figs. from 1/'
8.7.9. Micturition 270 to 30/ 9) 282
8.7.10. Defecation 271

Chapter 8.8. - Circulatory system Part 10

RADIOTHERAPY - APPLICATIONS -
8 .8.1. General (fig. 29/8) 271 TECHNIQUES - EQUIPMENT
8.8.2. Blood-composition and function 271
8.8.3. Heart (figs. 30/8, 31/8) 271
Chapter 10.1. - Generalities and references 294
8.8.4. Arteries (flg . 3218) 273
8.8.5. Veins (fig. 33/8) 273
8.8.6. Capillaries 273 Chapter 10.2. - Isodose curve applications
8.8.7. Circu lation of blood 273 (figs. 1/ 10, 2110) 294
8.8.8. Lymphatic system 273
8.8.9. Spleen 274 Chapler 10.3. - Equipment

10.3.1 . Fundamental equipment for Radiothe-

Chapter 8.9. - Nervous system and organs of rapy 294
special sense 10.3.2. Oermolherapy equipment (figs. 3/ 10,
4110) 294
8.9.1. General 274 10.3.3. Medium deep therapy equipment
8.9.2. Composition of nervous system 274 (fig. 5110) 296
8.9.3. Cerebrospinal fluid 274 10.3.4. Deep tumour therapy equipment
8.9.4. Cerebrum 274 (figs. 6/10, 7/10) 296
8.9.5. Cerebellum 274 10.3.5. Cobalt Bomb (figs. 8110, 9/ 10) 296
8.9.6. Medulla oblongata 274 10.3.6. Betatron (figs. 10/ 10. 11110) 297
8.9.7. Pons 274 10.3.7. Linear Accelerator (figs. 12110, 13/ 10) 297
8U. Spinal cord 274 10.3.8. Photonic (X and y) and electronic (,6)
tissue transmission curves up to 50 MV
8.9.9. Cranial nerves (fig . 34/8) 275 energy (figs. 14/10, 15/10) 298
8.9.10. Spinal nerves 275
8.9.1 1. Autonomic nervous system (fig. 35/8) 275
8.9.12. Special senses 276 Chapter 10.4. - Deep tumour radlotheraphy is a
8.9.1 3. Eye 276 miss but until now necessary
8.9.14. Ear 276 10.4.1. Choices of radiotherapic equipment. 29B
10.4.2. Specialist ability is an important factor
in a succesful therapy 29B
Chapter 8.10. - Endocrine system

8.10. 1. General 276

8.10.2. Thyroid gland 276
Part 11
8.10.3. Parathyroid gland 277
8.10.4. Adrenal gland 277 RADIOLOGICAL PROTECTION
8.10.5. Pituitary gland 277
8.10.6. Sex glands 277 Chapter 11.1. - Physical quantities and their
8.1 0.7. Pancreas 277 measurement units (roentgen, rad-gray,
8.10.8. Intestinal glands 277 rem-sievert)
8.10.9. Pineal gland 277 11 .1.1. Physical quantities 300
8.10.10. Thymus 277 11.1 .1.1 . Exposure (X) 300
11 .1.1.2. Absorbed dose (0) 300
11.1.1 .3. Kerma (K) 300
Chapter 8.11. - Some anatomical drawings by
Leonardo da Vinci relaling " GTBRn 11.1.1.4. Dose equivalent (DE) (tab. 1/ 11) 300
(Gllardonl Tolal Body Radiography) 11.1.2. Units (roentgen, rad-g ra y, rem-sievert)
(figs. from 36/ 8 to 41 / 8) 277 (tab. 2111) 300

GILAAOONI. RADIOLOGY ELECTAOMEOICINE 23

 PAGE PAGE

Chapter 11 .2. - Dose limits for Individuals 11.8.2.3. Rad iography 310
11.8.2.4. Dental radiography 311
11 .2.1. An nual dose limits 300 11.8.2.5. Radiotherapy 311
11.2.2. Weekly dose limits 300 11.8.3 Medical research 311
11.2.3. Daily and hourly dose lim its 300
11 .2.4. Natural radioactive background 300
Chapter 11.9. - Summary of different organs dose
limits for individuals (tab. 6/ 11) 311
Chapter 11.3, - Proximetric control Instruments

11 .3.1. Io nization chamber protex lmeters Part 12

(figs. 1/11 , 211 1) 301
11.3.2. Geiger counters 301 PLANNING OF RADIOLOGICAL DEPARTMENTS
AND EQUIPMENT SELECTION
11 .3.3. Film-badges (fi gs. 3/11 , 4/ 11 ) 301
11.3.4. Gilardon i Bottles 301
Chapter 12.1. - Generalities

Chapter 11.4. - Proteximetric calculation for ra- 12. 1.1. References 312
dlologiea/ Installation

11.4.1. SpecifiC references 302 Chapter 12.2. - X-diagnostics

11.4.2. Half Value Layer (HVL) of the prin- 12.2. 1. Percentage of different X-ray exami na-
cipal shielding materials for energy 20 tions, exams/year per 1000 in habitants,
kV-35 MV and shield ing calculation execution l ime and relating equipment
(Prac tical example) (tab. 3/11) 302 (tab. 1I I 2) , 313
11 .4.3. Shield ing requi rements for selected 12.2.2. Orientative guide-line for the selection
sou rces (tabs. 4/1 1, 5/11) .... 302 of X-diagnostics equipment and accesso-
ries (tab. V12) 313
12.2.3. Suggestions for the planning of X-dia-
Chapter 11 .5. - Recommendations of the Interna- gnostiCS Section 313
tional Commission on Radiological Pro-
tection (ICRP) 303 12.2.3.1. Private radiol og ists and small hospitals
(fig. 1/ 12) 313
12.2.3.2. Hospitals from 50 to 500 beds
Chapter 11 .6. - Protecti on against radiation used (fig. V 12) 315
for medical purposes 12.2.3.3. Hospitals over 500 beds 315
11 .6.1. X-ray diagnostic installations
11 .6.1.1. Fl uoroscopy . .
1 I .6. 1.2. Radiog raphy
1I .6.1.3. Photofluorog raphy
11 .6.1.4. Dental Radiography
11 .6.2. Diagnostic uses 01 radioactive
stances

Chapter 11.7. - Therapeutic Inslallations

11 .7.1. 8eam therapy 306 Part 13

11 .7.1.1. Conventional X-ray therapy 306 INDUSTRIAL RADIOLOGY AND
11 .7.1.2. Superficial X-ray therapy 307 NON DESTRUCTtVE TESTING (NOT)
11 .7.1.3. Megavolt.. X-ray and particle beam the-
rapy ....... . 307
11.7.1 .4. Sealed source beam therapy 307 Chapter 13.1. - Radiographic Testing (RT)
11.7.2. Non-collimated sealed source therapy 308 13.1.1. RT util ization examples in industry
(figs. from 1/ 13 to 5/ 13) 317
13.1.2. Gilardoni graph and ru les for radio-
Chapter 11 .8. - Protection of the patient graphic exposure based on film dose
(figs. 6/t3, 7/ 13) 318
11.8.1 . Introduction 308 13. 1.3. Equipment for X-ray and gamma ray
11.8.2. Recommendations with regard to ope- industrial radiography (figs. from 8/13
ra tional procedures 309 to 25/ 13) 320
11.8.2.1. X-ray d iagnosis 310 13.1.4. Examples of Rad iog raph ic Testing
11.8.2.2. Fluoroscopy . . . 310 (figs. from 26/13 to 4V13) 323

24 GllAAOONI. RAOIOlOGY - ELECTAOI.! EOIC INE

 PAGE PAGE

Chapter 13.2. - Ultrasound Testing (UT) 14.2.7. ART -GI L, extra-thin beryllium window
tube, energy 5 to 80 kV, 5 rnA - Fun-
13,2.1. Physics of Ultrasound (US) 32 damental equipment for Art Radiology
13.2.2. UT utilization examples in industry (figs. 2114, 3/14) . . . . . 337
(figs. from 43/13 to 46/13) 32
13.2.3. Equ ipment for Ultrasound Testing
(figs. from 47/13 to 51/1 3) 327 Chapter 14.3. - Some radiographs of stamps,
13.2.4. Ultrasonic Aule (fig. 52113) 328 mummies, paintings with retative inter-
13.2.5. Ultrasonic Probes (fig. 53/13, tab. 1/13) 328 pretations (figs. from 4114 to 16/14) 338

Chapter 13.3. - Magnetic Testing (MT)

13.3.1 . Principle (figs. from 54/ 13 to 57/13) . 328 Part 15

13.3.2. Magnetic particles test equipment HALF CENTURY EXPERIENCE
(figs. from 58/ 13 to 61 / 13) 330
13.3.3. Examples of Magnetic Testing utiliza* Practical suggestions for researchers, designers,
tion and inspection (figs. from 62/13 engineers, technicians and also for authors
to 65/13) 331
Chapter 15.1. - Computer age, human brain, the
Chapter 13.4. - Penetrant Testing (PT) best computer 346
13.4.1 . Princi ple (figs. 66/13, 67/13) 332
13.4.2. Pene tran t Testing Equipment Chapter 15.2. - The five senses, pick*ups for hu*
(figs. 68/13, 69/ 13) .... . . 333 man brain computer
13.4.3. Examples of applications (Iig. 70/ 13) 333
15.2.1. Sight 346
15.2.2. Touch 346
Chapter 13.5. - Comparison and se~tlon of NOT
processes (labs. 2113, 3/13) 333 15.2.3. Hearing 346
15.2.4. Smell 346
15.2.5. Taste 346
Part 14
ARTISTICAL RADIOLOGY
Chapter 15.3. - Suggestions for research , design,
production 346
Chapter 14.1. - Radiography 01 pieces of art

14.1.1 . Foreword . . . . . . 335 Chapter 15.4. - General recommendations 347

14.1.2. Films used in art radiography 335
~ 4.1 .3, BlaCkening film dose, the basis of ra-
diographic exposure in art radiology 335 Chapter 15.5. * Success and lIIe satisfaclion tac-
14.1.4. Art pieces of inlerest for radiography to .. 347
and relating investigation energy (kV) 335

Chapter 15.6. - Practical suggestions for publlca-

Chapter 14.2. * Paintings: the most Important tlons (books, magazines, etc.)
works of art for radiological Investlga*
tlon 15.6.1. Introduction 348
14.2.1. Painting components 335
14.2.2. X*ray absorption of painting compo-
nenlS (labs. 1/14, 2114) . 335 Chapter 15.7. - Suggestions tor authors
14.2.3. Equ ipment characteristics required lor 15.7.1. Inspiration 348
paintings radiography ... .. . 337
15.7.2. Creativity 348
14.2.4. M-GiI, electronic instrument for optimal
contrast choice and correct exposure 15.7.3. Documentation 348
(fig . 1/ 14) . . .. 337 15.7.4. Start of work 348
14,2.5. Quick correct exposure evaluation with 15.7.5. Drafts 348
M-GiI: no more faulty radiographs 337 15.7.6. Figures 348
14.2.6. Gilardoni's exposure system. Constant 15.7.7. Tables 348
factors: film blackening dose, mA and 15.7,8. Conclusion 348
distance. Variable factors: kilovoltage in
relation to contrast choice and expo-
sure time in order to reach the pre-sel
blackening dose . . . . . . 337 Chapter 15.S. - Composing suggestions 348

GIL.A.RDONI. RAOIOLOOV - ELECTAOMEOICINE 25

 PAGE PAGE

Part 16 Part 17
TABLES OUT OF TEXT BIBLIOGRAPHY

.....
Chapter 16.1. - Atlas of 18 tables of practical in- Chapter 17.1. - Handbooks and papers

17.1.1. Index of the most important publica-

16.1.1. Fundamenta l physica l constan ts tions of International Commission on
(tab. 1(16) 350 Aadiological Protection (IC AP) 362
16.1.2. Trigonometric data (tab. 2/16) 351
16.1.3. Periodic table 01 the elements Chapter 17.2. - Magazines 363
(tab. 3/16) .. .. 351
16. 1.4. Commonly available radionuciides lis-
ted alphabetically (tab. 4/16) . 352 Chapter 17.3. - Some Gllardonl sclentiflo techni-
16.1.5. Alpha emitters by increasing energy cal papers 364
('ab. 5/16) ..... 353
16.1 .6. Prefix and multi pliers for Metric Sys- Chapter 17.4. - Gllardonl handbooks 366
lem and SI (lab. 6/16) 354
16.1.7. Faclors for conversion to SI units
(tab. 7116) 354 Chapter 17.S. - Gllardonl magazines 366
16.1.8. Conversion from inches to mm
(tab. 8/16) 354
16.1.9. Fundamental and derived units 01 MKS Part 18
System (tab. 9/ 16) ...... . 354
GLOSSARY
16.1.10. Temperature, energy, power conversion
graphs (tab. 10/16) ...... . 355
16.1.11 . Maximum, effective, medium values of Chapter 18.1. - Preliminary
a sinusoidal quantity (tab. 11/ 16) 355
16.1.12. Peak voltage (kVp) in relation with 18.1.1. Abbreviations 368
spark-gap distance (tab. 12/16) 355 18.1.2. Prefixes 368
16.1.13. Electric field intensity (kV/cm) for var- 18.1.3. Suffixes 369
ious electrode shapes and distances
(tab. 13/16) ....... . 356
16.1.14. Electrical features of insulating mate- Chapter 18.2. - Physk:al, radiological and medical
rials (tab. 14/16) . . . . . . . . 357 terms 370
16.1.15. Velocity of sound (tab. 15/16) 356
16.1.16. Properties of metals as conductors
~blM. m Part 19
16.1.17. The rma l propert ies of pure metals SUBJECT INDEX
(tab. 17/ 16) . . . . . . . . . . 359
16.1.18. Melting, boiling points, and atomic wei-
ghts of the elements (tab. 18116 ) 360 Chapter 19.1. - Alphabetical classltJcation 418

26 GllAIIDONI. fIAOlOlOGY - ElECTFIOMEOICINE

 PART 1

INTRODUCTION
 PART 1 When high energy electrons accelerated by HV, strike
the anode they convert part of their kinetic energy into
INTRODUCTION electromagnetic waves, that is into X-rays.
Accelerated electrons, (also called cathode rays or beta
rays) are different from X-rays just as steel balls are dif-
Chapter 1.1. - X-RAYS GENERALITIES ferent from the sound produced by the impact with the
bronze plate.
Electrons are negatively charged particles travelling in
1.1.1. X-rays and their production straight lines Irom cathode to anode just as steel balls
in a gravity field. X-rays are electromagnetic microwaves
Steel balls fall ing from a tower onto a bronze plate spreading in all directions, just like the sound produced
produce, on impact, soundwaves spreading in all direc- by the bronze plate.
tions. A similar effect, as shown in fig. 111 , occurs X-rays show, among others, the property 01 crossing ob-
when in a vacuum tube electrons are launched at high jects which are opaque to normal visible light.
velocity, by means 01 high voltage (HV) lorce, onto a
This property is the basis of Radiology, the science that
metal target. The waves produced are electromagnetic
investigates opaque substances.
waves called .. X-rays" (see par. 1.1 .2. and fig. 211).
Electrons correspond to the steel balls; high voltage
(HVJ. the accelerating electric force, corresponds to the
1.1.2. Kinds of electromagnetic waves
gravity force.
X-rays are electromagnetic osci llations similar to those
used in radio. TV, etc. but with much higher frequen -
cies. Visible light is also a kind of electromagnetic wave.
Fig. 2/1 shows the spectrum of the main electromagnet-
ic waves.
1
Frequency, the number of electric oscillations per se-
cond, is indicated in Hertz (Hz).
A A X-ray frequencies lie in the range of billions of Hz.
The propagation speed of electromagnetic waves is

+r
\
I ... .. .- U
\
300,000 km per second; the same as the speed of light.
The wavelength of X-rays, that is the distance between
two adjacent oscillation peaks, is measured in millionths
of a millimeter.
The relation between wavelength (A in meters) and fre-

~
quency (Hz) is:
~ 3 300,000,000 (m . sec- 1)
" (m) =
Hz (sec- ')

Fig. I I I (par. 1. 1. 1.) - Principle of an Xray generator.

1.1.3, The discovery of X-rays - Historical notes
1) High Vo ltage (HV) generator, 2) vacuum lube, 3) elec-
trons generator (ca thod e). 4) metal target (anode).
Th, marked points be tween electrodes represent Ih. X-rays were discovered by chance on November 8, 189S
electrons th at. accelerated by Ih, electric force (HV), by w.e. Roentgen.
bombard the anode thus prOducing X-rays. He was investigating the effects produced by electrical
Electrons oed X-rays IwO dllferent things: electrons
." '"
elementary negative particles, X rays are electroma-
gnetic microwaves.
discharges through rarefied gases in a Crookes-Hittorl
tube, wrapped up in black paper, when he noticed that
some barium platinum cyanide, placed just by change

Fig. 2/1 (par. 1.1.2.) - Electroma

gnelic waves spec/rum.
'H....., .."..,

.,! ! ~~ l~
.... COO>' TH ...,..

Wavelength, frequency. quanlum

~ ~
energy and pr&Cllcal use.
The viSible light spectrum is only
! a small part of electromagnetic
Q ,...._, i f1) waves.
1 Angstrom
gi;i ~~i ~.",",-
u

<0> (A) :. 10" mm.

... . . .. ,'"
.'

,. ........ , ~
"",,,,,
,I G..........

. .."""",,. ,.......... ,.....

._", _., '000,,",
".OU'~C' 'M,
."",NT"" .... 00
' ''H,
~. 0.'....
>00000010",
......, ...
.... .. H,
.....
.,0"".. ",

GILAROONI. RADiOlOGY ElECTl'lOMEOICINE 29

near the tube, emitted fluorescent light. Not understand-
ing this phenomenon, Roentgen thought it was caused
by unknown radiations which he called "X-rays.
Even before 1895, experiments on Crookes tubes dis-
charges, fed with Ruhmkorlf coils, were being carried
out in all physical laboratories. Therefore X-rays had al-
ready been unawarely produced by man before Roent-
gen's discovery. If X-rays had not been discovered by
Roentgen in 1895, somebody else would certainly have
discovered them shortly alterwards.
In fact, immediately after Roentgen's discovery was an-
nounced, many physical laboratories were able to make
radiographies and fluoroscopies.
Chapter 1.2. - THE uMATERIAn
1.2.1. The structure of matter
All substances occurring in nature consist of a limited
number (about one hundred) of simple elements, differ-
ent from one another.
Some are gaseous, at room temperature and pressure,
such as Hydrogen (H) and Oxygen (0) . Some are solid
metals, such as Silver (Ag), Copper (Cu), Iron (Fe) .
Others are non-metals, such as Sulphur (S) and Carbon
Ie).
When combined, these elements form chemical com-
pounds.
Water is composed of Hydrogen (H) and Oxygen (0),
hence its formula is H.aO; hydrochloric acid (HCI) Is
made up of Hydrogen (H) and Chlorine (CI) .
Bodies are aggregates of "molecules, that is particles
which behave In a chemically defined way.
Molecules, as for example in a solid, are not in close
contact with one another, but are separated by a dis-
tance comparable to their average dimension .
They vibrate around their equilibrium poSition, by the
so-called thermal agitation_.
Modern physiCS established that an atom basically con-
sists of three kinds of "elementary" particles, the proper-
ties of which mostly involve electrical or nuclear phe-
nomena.
These particles are elementary granules- of charge and
mass; they are named according to their electrical be-
haviour.
.. Electrons" are negatively charged. "Protons.. are poSi-
tively charged . .. Neutrons" are electrically neutral.
The interaction among charged particles Is governed by
the following rules ( Coulomb interaction) : homologous-
Iy charged particles repel, whereas opposite charged
ones attract each other. All actions caused by a posi-
tively charged particle are equal and oPPosite to those
produced by a negative particle in the same conditions.
It follows that any collection where both species of par-
ticles are present in the same amount. does not show
any of the peculiarities of its components, i.e. it is
electrically neutral".
This is the case for atoms in unperturbed state: protons
and electrons in equal number yield a zero total charge.
Particles in each atom are not in close contact with
one another. Protons and neutrons form the nucleus,
hence they are called nucleons-.
30
Electrons, because they are located in shells around the
nucleus, are said to "rotate" around it, although any
analogy with macroscopical systems is prevented by
quantum mechanics which will be dealt with further on.
Mass is concentrated in the nucleus, as the mass of an
electron is 1856 times smaller than that ot a proton.
Neutrons are almost as heavy.. as protons.
The factor that allows the previously defined sim ple
elements.. to be told apart is the number of protons in
their atoms, called ..atomic numbe". or ..z".
According to lig. 3/1 Z of Hydrogen (H), Helium (He),
and Sodium (Na) are 1, 2, and 11 , respectively.
A10MIC "' \I(;lEUS .... ,T!<
U .11(110"" ANO,t NE UTRON.
Fig. 3/1 (plJf. 1.2.1.) Models of Hydrogen (H). Helium (He)
and Sodium (Na) aloms.
The simplest is H, consisting of 1 proton and 1 electron,
having atomic number Z "" 1 and atomiC mass A - I .
The next element ie He. a noble gas, the nucleus of which
consisls of 2 protons and 2 neutrons. Around It 2 electrons
rotate.
The aloms 01 other elements are built In a similar way.
Protons and neutrons form the nucleus. Electrons, which
balance th e nucleus electric charge, afe distributed In
shells around the nucleus.
For example, Na (Z "" II ; A "" 23) has 11 protons and
12 neutrons; 11 electrons occupy 2 concentric shells. on
the outer of which only 1 electron is located. This par-
ticular electron Is responsible tor Ihe chemical reactivity
ot Sodium.
..Atomic mass- or ..A.., is the sum of proton and neu-
tron masses in a nucleus. Assuming the mass of a
proton as a unit, A equals the number of nucleons of
an element.
Neutron number is not a constant for a nucleus: atoms
with the same Z (hence of the same element) which
differentiate because of neutron content, are called iso-
topes, from Greek, because they occupy the same posi-
tion in the periodic table of the elements.
Isotopes are separable with expensive means because of
slightly different chem ical and physical properties.
Artificial isotopes may also be produced, the most inter-
esting being the unstable ones (radioisotopes) which
emit nuclear radiation .
1.2.2. Nuclear rays (a, P. y)
Radioactive substances produce the same effects as em-
issions from gas discharges or X-ray tubes, e.g. lumi-
nescence, heat emission, gas ionization, photog raph ic
film sensitization.
A radioactive decay can be identified according to the
emission involved.
GILAROONI. AADIOI..OGY ELECTRO~EOIC I NE
If, as in fig. 4/1, some Aadium (Aa) compound is put
on the bottom of a lead cylinder (P) and the latter is
placed between electrically charged plates (E, E'), these
are the resulting effects:
a) one kind of radiation is deflected a liHle towards the
negative plate E. These are alpha (a) rays, consisting of
positively charged particles, having A = 4 and Z = 2,
I_e. they are He nuclei emiHed by Aa atoms at very
high speed (14000 to 20000 km/sec).
They behave as ..anode rays,. obtained in low pressure
gas discharge tubes.
b) another kind of emission Is more effectively deflected
towards E'. These are beta (13) rays, consisting of fast
electrons which can approach the speed of. light. They
are therefore cathode rays.
c) the th ird kind of radiation propagates undeflected by
the plates: it consists of gamma (y) rays which behave
as electromagnetic waves with very small wavelengths
e. very high frequencies (from 1()20 to 1()23 Hz) .
With respect to X-rays, y rays turn out to be more
-penetrant (see par. 1.1.1 . and 1.1.2. page 29).
\ ,0<
,, Y
,,
,,
,,
\
E'
E
~
\, / I
,,
,
I
p
Frg. 4/1 (par. 1.2.2.) - Alpha, bela and gamma rays from Ra
or other radioactive substances.
o rays are formed by positively charged particles, having
short penetrati on In matter. They are atopped by a sheet of
paper.
~ mys are last electrons, wllh higher ponatrallon than a rays.
They are stopped by 2 + 3 mm thick AI foil .
y mys are electromagnetic waves, like X-rays (see part. 1.1.1 .
and 1.1.2. page 29). They can paS! through 100 ... 200 mm
of Fe or 800 mm of air.
Radium decay also produces a strongly radioactive gas,
Radon (An) , the emission of which halves in about 4
days. An rapidly transforms into other elements, releas-
ng a particles.
f all the 0 particles emitted by Ra and its by-products
are neutralized to yeld He gas, 1 g of Aa produces
about 156 mm 3 of He per year.
1.2.2.1. Natural radioactive elements
Radioactive decay in general involves the trasformation
01 one element into others, together with particle or y
ray emission.
An example occurring in nature is the Uranium (U) ser-
es, where the starting nuclide is U (238/92) (here the
upper su bscript denotes A, the lower Z). Along its de-
cay Ra(226/88) and An (222!86) are produced, among
0Ihers. The series ends up with a stable element, Pb (206182).
GLNIDONI. RADIOLOGY - ELECTAOt.lEDICINE
The discovery of some of these elements belongs to
history.
Becquerel in 1896 discovered that some U salts emitted
radiations spontaneously.
M. and P. Curie, from other evidence, supposed these
properties to be due to small amounts of a yet un-
known substance contained in U ores. By their patient
research work , from one ton of pitchblende they ex-
tracted 0.12 g of a bromide of the element they named
Radium.
Other elements were discovered later, such as Thorium
(Th), Polonium (Po), Actinium (Ac) .
Cosmic rays, that is, high energy particles coming from
outer-space, are another natural source of ionizing radi-
ation.
The earth is shielded against this radiation bombard-
ment by the atmosphere, where very interesting reac-
tions among elemen tary particles occu r, which are in-
tensively studied by physics laboratories.
Fig . 5/1 shows cosmic rays intensity as a function of al-
titude.
'00
"-
>
t::: eo
z
~z "" -
Q -- -
a~ '"
20
-_ .. --
0
'"
H EIGH T IN Km
'00
Fig. 5/1 (par. 1.2.2. I.} - Cosmic rays intensity as a function
of altitude.
Intensity Is amost constant aboYtl 50 km (cosmic vacuum).
Primary cosmic rays Interact with air molecules as they
penetrate Into the atmosphere and cause secondary radia-
tion.
Intensity thus reaches a ma)Clmum at 20 km.
At sea level It Is about 4% of the maximum.
During a fl lghl on a Jet plane al 10 km above sea level a
Geiger counter Similar 10 that described in fig . 87/2 page 94
clearly detects this Intensity difference.
1.2.2.2, Artificial radioacltve elements
In 1919 Rutherford bombarded nitrogen with a rays em-
itted from Po 21 4 and observed the production of oxy-
gen and free protons. He had thus succeeded in trans
forming a nucleus of an element into that of another
one. Th is was man's first intervention in nuclear pro--
cosses.
In 1934 M.and P. Cu rie discovered that Magnesium (Mg),
even after a Irradiation, emits fJ particles at a rate de-
creasing exponentially and halving every 2 min 30 sec
(half life of the fJ emitter), i.e. Mg becomes a radioactive
nuclide.
This transmutation resembles the one produced by Ru-
therford : the resulting nuclide is however unstable or
radioactive.
a irradiation yields a relatively small fraction of radioac-
tive nuclides,
31
Nowadays a more effective method is used, i.e. bom-
bardment with neutrons produced in nuclear reactors.
In this way, from stable iron (Fe) and chlorine (CI), ra-
dioisotopes of Manganese (Mn) and Phosphor (P) can
be produced, respectively.
In 1934 E. Ferm i. at the Physics Department, University
of Rome, obtained slow neutrons by using -thermaliz-
ing .. shields of water, graphite or paraffin-wax.
These slow or "thermal" neutrons have average kinetic
energy identical to that of molecules of matter at a' giv-
en temperature, hence slow velocity: they are particular-
ly effective in producing radioisotopes of known elements
and also new elements, such as: Neptunium (Np 93),
Plutonium (Pu 94), Curium (Cm 96) Fermium (Fm 100).
Radioisotopes are used in gammagraphy, a section of
radiography, they are also used for example in Cobalt
bombs for cancer therapy: Co (60/27) is produced by
activating Co(59127) in a nuclear reactor.
Chapter 1.3. - ELECTRICITY
1.3.1. Surface electrification of bodies
Molecules at or near the surface of a body are involved
in mechanical actions, such as impact and friction.
Friction can alter the electron contents of outer shells
of those molecules.
This change can be observed In practice only if the dis-
turbance does not propagate too fast from the surface
to the bulk, for example, if removed electrons are not
going to be replaced by others released Irom molecules
in the bulk.
The body is said to be positively charged: this is the
case of glass when rubbed with a wool cloth, which, on
the other hand, retains electrons, becoming negatively
charged.
Electron removal (or ionization) involves supplying an
amount of energy to overcome the attraction forces
which bind it to the molecu le. It is important to note
that ionization is merely separation of charges, not crea-
tion. Charge conservation is actually one of the basic
principles of physics.
1.3.2. Conductors and Insulators
The above described bodies. which allow friction electri-
fication phenomena to be observed are called insulators
because electrons are ordinarily not allowed to move
across them.
This is the case for glass, ceramics, most plastics and
hydrocarbons.
In other substances such as metals and their alloys, or
amorphous carbon, the electrons of outer shells are
loosely bound to the nucleus and are relatively free to
move with very little energy expense from outside.
These bodies are called conductors, because an external
constant force acting on free electrons can make them
drift in a determined direction, thus causing an electric
current...
The application of the same force to an insulator causes
a different phenomenon, called dielectric polarization,.:
molecules tend to change their shape and align them-
selves along the direction of force until an equilibrium
configuration is attained.
32
It should be apparent that no permanent current can
flow in this case, unless the external force is so intense
as to ionize the molecules thus producing free electrons
("dielectric breakdown,.). In nature substances can be
classified according to their ability to supply conduction
electrons (<<conductivity) under a given force.
There is a smooth transition from conductors to semi-
conductors (e.g. Silicon, Germanium) to Insulators.
Neither perfect insulators nor perfect conductors exist,
at least at room temperature.
Near absolute zero, conductors tend to behave more
ideally, while for some metals and alloys a peculiar
phenomenon, -superconductivity". sets on.
In liquidS, besides electrons, also ions of both signs are
charge carriers. Ion currents are called "convective" cur-
rents, because they are associated with mass transfer.
Conductive liquids are water salt solutions, acid or basic
solutions where molecules are spontaneously dissociat-
ed. Oils are generally insulators.
1,3,3. Electricity generators
It has been explained that electrical phenomena stem
from a change of the natural state of molecules, by
overcoming the opposing electrical forces.
A device capable of doing this, that is, of displacing
electrons in a determined direction, is called a genera-
tor-.
To create a current, the generator must establish a "po-
tential difference" between its "poles, that is In the
generator itself there must be a point towards which
electrons are pushed (negative pole. -) and a point
which is depleted of electrons (positive pole, +).
This must happen at the expense of a force called
electromotive force - e.m.f.", the nature of which will
be examined later.
An observer from outside the generator says that there
is a potential energy difference between electrons al the
+ and - poles.
Potential energy difference divided by electron charge is
called "potential difference .. or si mply voltage, measured
In Volt (V) after the Italian scientist Alessandro Voila
(see fig. 6/1).
It should be easily understood that if the poles of a
generator are connected together by a conductor, elec-
Fig. 6/1 (par. 1.3.3) - Alessandro Volta presenting his famous
pile fo Napoleon Bonaparte (from a picture by G. Bertini)
GILARDONI. RAOIOI.OGY ElECTfIOME OICI NE
trans will flow from the minus to the plus pole, moving
across the conductors and colliding with its atoms, thus
transforming their potential energy into molecular kinetic
energy or heat. This is the Joule effect.
1.3.4. Some types of electricity generators
The nature of the force which creates a potential differ-
ence enables some classification.
1.3.4.1. Chemical cells
They convert chemical energy, coming from two differ-
ent metals dipped into a dilute acid, into electric energy.
The first pile was built by Alessandro Volta in 1795
tfig. 6/1) .
The voltage produced by one element is in the order of
one Vall.
Baneries are widely used in wireless sets, such as radi-
os, measuring instruments etc.
1.3.4.2. Photoelectric cells
light impinging on Silicon or Selen ium films excites
some electrons. The device has a particular structure in
order to convey excited electrons and exploit their energy.
The voltage produced by a single element is some tenths
of a Volt.
Also photocathodes. thin alkal1 antimonide or gallium
arsenide films might be considered among photoelectric
cells, although the electrons they release are usually
accelerated by an external generator.
Photocathodes are contained in radiologic image ampli-
lers.
1.3.4.3. Thermocouples
A voltage difference of some thousandths of a Volt (mil-
livolt: mV) appears at the ends of a bar made of two
metals or alloys, if the junction Is heated.
Typical use: temperature measurement, because voltage
IS linearly dependent on it.
GIlAADONI. RAOIOLOGI' aeCTflOMEOICI Ne
1.3.4.4. Piezoelectric generators
Let us consider a quartz plate, cut from a crystal along
particular directions; a voltage will develop between the
opposite faces of the plate when mechanically strained.
A piezoelectric microphone converts sound waves (air
pressure variations) into an electric signal.
Piezoelectricity is a reversible phenomenon: voltage app-
lied to the plate produces mechan ical deformation. This
is the basis for ultrasound generation in NOl)destructive
Testing and in biomedical Echography.
Besides quartz. other materials show piezoelectricity, al-
though they may differ in the law connecting voltage
vs. strain and viceversa.
1.3.4.5. Electromagnetic generators
They are also called electrical machines .. because they
convert mechanical into electrical energy.
The operating principle is electromagnetic induction, that
is, the production of potential difference inside a con-
ductor when it crosses a magnetic field.
A copper wire coil rotating in a magnetic field might be
an example of these generators. which are the most
important and most widely used .
Power. voltage, and current delivered can be chosen at
the designer's will.
VOltages as a function of time can be constant or chan-
ge sign (alternate) periodically.
These properties are the basis for industrial plant opera
tion.
1.3.4.6. Bioelectricity (electrocardiography, electroence-
phalography, electromlography)
Muscular work produces potential differences of some
millivolts.
These voltage differences can be detected and present-
ed on the screen of a G.R.T.: this instrument is known
as electromiograph .
An electrocardiograph (EGG) records the voltage pro-
duced by heart muscle.
Brain work also produces electrical signals, of a millj
onth of a Volt uN), wh ich must be amplified before re-
cording by an electroencephalogram (EEG).
33
 PART 2

X-RAY PHYSICS AND TECHNIQUE

 PART 2 The cathode (negative electrode) has two functions: the
X-RAY PHYSICS AND TECHNIQUE first one is to produce electrons (incandescent filament),
the second one to focus the electron beam onto a
small, almost a point anode area. A small focus produ-
ces sharp radiological images (see. par. 2.1 .7. page 38).
Chapter 2.1 . - GENERALITIES The filament, wound up in a spiral, emits electrons when
reaching temperatures of about 26OO'C, corresponding
to the temperature and luminosity produced by the fila-
2.1.1. Coolidge tube: X-ray generator ment of car headlights.
Electron emission increases with filament temperature;
Fig. 1/1 page 29 shows the operating principle of an X- this makes possible to regulate the electron beam inten-
ray generator using a vacuum tube. sity by operating on the auxiliary electric c ircuit that
supplies the fi lament.
Figs. 1/2 and 212 show the X-ray production principle
and a traditional Coolidge tube. The anode (positive electrode) is the target bombarded
by the highly accelerated electrons coming from the ca-
thode. Unfortunately only a minimum amount (1%) of
the electrons kinetic energy is turned into X radiation,
'Ocu$I"O' _ the remaining 99% is converted into heat on the tungsten
focal spot.
'''"OO'~ , \ r"~ Tungsten melts at 34000c so that it can withstand high
thermic loads of the focal area of a few sq.mm .
- -j_::::------- ' I I 0 The heat of the focal area sp reads inside the tungsten
plate and than to the copper radiator externally cooled
by air or oil systems.
/
, .. CANN I CU, ." ... U, _
\ The focus as seen from the central beam axis is called
focal spot or optical focus ~; it has a square size of
0.3 mm per side in small power microfocus tubes, 1-2
mm in middle power tubes and 4-5 mm in high power
Fig. ' /2 (par. 2.1.1.) - Coolidge tube principle lor X-ray pro- tubes.
duction.

Tho incandescent filament 10 lh, cathodic '"P emits

el ectrons that. accelerated
"
between the electrodes, bombard Ihe anode 10 ,
lho strong electric field
limited
area (local spot) producing X-rays .
2.1.2. Coolidge rotating anode tubes
The fixed anode tubes have a li mited load capacity,
which is nol sufficient for many applications.
Therefore, rotating anode tubes, having a greater load
capacity, have been developed.
Figs. 3/2, 4/2, 5/2 show the principle, a practical realiza-
tion and a section of the rotating anode tube.
The X-ray tubes, both with fixed or rotating anode, can
be bifocal, that is with two indipendent catode filaments,
as shown in fig. 4/2.
Small focus gives a beUer definition of the images, but
allows smaller loads; large focus vice versa.

J
, 3

2

"
~
~
I
1--- - 11" -11'''' ' ~1.D1 "'. -----1

Fig. 3/2 (par. 2.1.2.) - Principle of rotating anode lube.

Fig. 2/2 (par. 2.1.1.) - Left. Traditional Coolidge tube.
1} Cathode; 2) incandescent spiral filament emitting elec-
trons: 3) copper anode with tungsten target; 4) radiator to
absorb and to dissipate the heat produced by the electronic
bombardment.
Right. Tube section with 2(J> anode inclination.
l}, 2) . 3), 4). as above; 5) electron beam; 6) real focus size:
7) optical focus of focal spot.
Real focus size with anode inclination of 20', as shown in
the figure, is about 3 times the focal spot.
l} Anode; 2) electrons; 3} orbits of focus.
The four arrows on the left of the figure represent the elec-
tron beam. At the edge of the disc, the line focus is repres-
ented schematically and under the effective focus (optic
focus).
At right of the figure the surface bombarded by the electrons
during one disc reyolution is shown. the optic focus size is
unvaried.
The diameter of the tungsten disc shown in the figure is
70 mm.
The r.p.m . can be 3000. 9000 and in certain cases l8.0CX>.

36 GILAROONI. RAO IOlOGY - ELECTROMEOICINE

 on industrial diagnostics .. Non Destructive Testing Hand-
book.. , 2 volumes, by Mac Master - The Ronald Press
- New York, 1962.

2.1.3. Distance inverse square law

Radiation intensity decreases according 10 square law

with increased focal distance.
Fig. 612 illustrates the distance inverse square law.

Fig. 6/2 (par. 2. 1.3. ) - Graphic /1-

lustralion 01 distance Inverse SQuare
,
law.

At distance x on pl ane Cl ra-

diation covers 4 small squares
,
with Intensity 1.

L."
At distance 2 on plane C2 the
same radiation spreads to 16
small sq u ares with i ntens ity
4/16 :: 1/4.
With the same energy beam, at
double distance Intensity beco-
"
mes (112)' '" 1/ 4; at three times
the distance (1 / 3) 2 = t/9 etc .
Fig. 4/2 (par, 2.1,2.; - Bifocal rorating anode tube. Obviously the law is valid as
far as source d imensions are
1) The rotor is forced to rotate by the rotating magnetic field smaU compared to object-focus
generated by the motor stator (which Is not visible in the distance (X In figure) .
figure) placed ou tside the anode glass tube.
2) The tungsten rotating disc is bombarded by the electrons
emitted by one or the other of the two liIamenlS 3). in-
serted in the focusing ca thode cups 4). In X-ray tubes the focal spot size Is In the order of
one mm. and the distance Inverse square law is valid
lor distances from locus exceeding 50 mm.

2.1.4. Radiation Intensity or output

Radiation intensity expressed in Roentgen/second R/sec

is given by:

= K-..:m:.:Ac:...'.,.ko.V:.."_
D'
that Is: intensity (I) is directly proportional to tube cur
rent (mA) and with exponent n 10 tube high voltage
(kV) and inversely proportional to Ihe square of the dis
tance D as previoulsy explained .
The exponent n varies from 2 to 7 depending on vol-
tage and filtration ranges.
Fig. 5/2 (par. 2,1.2.; - Section of. rolating anode tube.
Radiation intensity (R/sec) determines Ihe fluoroscopic
1) Glass-metal sealing; 2) ball bearings; 31rotor, 4) rotor
luminosity.
temli nal wilh molybden stem; 5) tungslan rotaling disc;
6) cathode with filaments; 7) glass envetope.
For metallic rotating anode tubes see par. 3.3.4.12. page 128.
2.1.5. Radiation quantity or dose
In rotating anode tu bes the most used optical foci are: It is expressed in Roentgen (R) and it is proportional to
large focus 2x2 mm .. small focus 1x1 mm. and microfo- radiation intenSity (see preceding par.) and 10 irradiation
cus Q,3xQ,3 mm. time (sec. or min.).
The diameter of rotating tungsten disc varies from 50 to That is:
100 mm. up to 120 mm., depending on the tube power.
The length 01 rotating anode tubes is about 250 mm.;
they operate from 50 to 100-150 kV with cu rrent reach- Dose = I . sec = K - ,m::.:::Ac.'- ::
SOC
:-:-_
' "kV.:."_
D'
Ing also 1000 and more mA for short time loads.
Further information on X ray measurement is given in
Chapter 2.8. page 91 .
2.1.2.1. Coolidge and Gllardoni collaboration The dose determines the radiographic exposure.
Blackening , with films and screens used in medical ra-
Cool idge and Gilardoni collaborated for the section diography, is proportional to about the 5th power 01
Electronic Radiation Source.. of the international treatise the kV.

Glu.ROONI. RAOIOLOGY - ELECTROMEOtCINE 37

The kV, besides having a strong influence on radiation
intensity, determines the characteno of the radiological
Fig. 812 (par. 2.1.7.) . Ge0-
image: low kV (soft rays) produce high contrast, marked metrical unsharpness dater-
black and white tones, with visualization of few steps of mined by an ex/anded sour-
the object (short scale); high kV (hard rays) produce
low contrast, grey tones, with visualization of many steps
".
of the object. ~ ____
s = source or local spot.
The other factors: mA, sec, distance, have no influence o = opaque Object. A =
on the ..character of the radiological image but only on object contour. C :: Ima- D o
the exposure. ge plane. D = focus-film
distance, d == object-111m
d istance. E = enlarge-
ment. Ug "" unsharpness. d
2.1.6. Formation of the rad~ogJcal Image - Enlargement
E= ~
Fig. 7/2 shows the formation of the radiological image. D- d
Enlargement, thai is, the dimensional image/object ratio ",, ~_d_S
Is given by: D-d

focus-film distance If the object is a 20 em diameter sph&re, the object-fUm

Enlargement = distance is 20 cm (d). the locus-lilm distance Is 100 cm (0)
focus-obJect distance and the local spot size Is 1 mm (S). the geometrical
unsharpness is:

Ug = 20 . 1 = 0.25 mm
100 20

Fig. 712 (par. 2.1.6.) - Formation 01 II the objects Is thin and lIat and can be placed close
the radiological Image. to the film, the geometrical unsharpness Is practically
zero,
S == source or tube locus.
o =- object.
C == Wm plane or Image plane.
11 S Is a point source and the ob-
ject Is opaque. the Image is sharp. Fig. 9/2 (par. 2. 1.8.) - Mltasuremenl
Enlargement Is proportional to the
raUo: focus lilm distance/locus ob-
Of tube local spot with the ~pln
hole_ systam.
: .
ject distance. i
Exam~: referring to the radiograph
of a 20 cm diameter sphere with
equatorial diameter placed at 80 em
1) Focal sPOt. 2) lead or tungsten
diaphragm with a hole of abOut
'.I,
trom tne locus and with focus-film 0.1 mm. 3) image of focat spot.
distance 01 100 cm tne enlargement If the diaphragm is placed ex-
Is: E == 100180 IE 1.25 that is 25,*. actly hall way between focus and
fil m, as shown In the figure. Ima-
The enlarged radiolog ical Image 01 the sphere becomes ge shape and dimensions are
20 . 1.25 '" 25 cm. equal to those 01 focus.
Geometrical considerations In-
dicate that focal spot dimensions
are increased by twice the pl-
hole diameter.
2.1.7. Geometrical unlharpnet.S or penumbra That is: with a 0.1 mm diameter
hote, the focus image is enlar-
If the source Is wide. not a point, the above figure ged by 0.2 mm: with a 0.2 mm
changes as in fig. 8/2 that is, the image edges become diameter hole. the focus Image
I. eoterged by 0.4 mm.
unsharp.
This unsharpness is called geometrical unsharpness and
is direclly proportional to focus width and to object-film
distance and inversely proportional to objecHocus dis-
tance, mathematically expressed' as:

Geometrical locus width x object-film distance

~

unsharpness object-locus distance

2-1.8. Measuring the tube foe.! spot size

: "

Fig. 9/2 illustrates the "pinhole camera system to de-
termine the form and size of focal spot.
~ "
I
'~ " ' . ' ..
Fig. 1012 (par. 2.1.9.) - Graphic iIIus/retion of exponential
2-1.9. X-ray exponent... absorption law absexptiOn law with monochromatic radiations.

Radiation intensity. when crossing matter, decreases with
exponential law.
The absorption values depend on: type of radiation,
characteristics and thickness of the crossed material.
Materials of equal thickness have the same absorption per-
centage. Reported thickness correspond to Hall Value Layers
(HVL), which helve the intensity 01 the incident beam (see
par. 2.1 .10. page 40).

38 OILAADONI. RAOIOLOGY ELCTIlOMEOICINE

Fig. 10/2 illustrates the ~tion law.
where: I. intensity at depth x (thickness)
I, intensity at depth zero (superficial intensity)
e ~ natural logarithm base (e = 2.718)
p ~ absorption coefficient of the material.
The absorption coefficient not only depends upon the
TAB LE 1/2 (par. 2.1.9.) - Absorption coefficient for
different materials having relative density (p) in func-
tion of kV, keV and wave length.
nature of the material but also varies accord ing t o ra-
diation energy changes.
Table 1/2 gives the absorption coefficients for different
mater ials in function of kV, keY and wave length; table
212 gives the values of e- X " for d iffe rent "x thick-
nesses to faci litate the calculation.
TABL E 2/2 (par. 2 .1.9.)- Values of ..e -~ for dif-
ferent x values.
The table helps the calculation of expressions, fre-
quent in radiation physics, where the exponential
e - ~ .. form appears.

,- . ,-. ,-. ,-.

0.00 1.0000 0.19 0.8270 0.80 0.4493 3.00 0.0498

0.01 0.9901 0.20 0.8187 0.85 0.4274 3 :~0 0.0408

0.02 0.9802 0.22 0.8025 0.90 0.4066 3.40 0.0334

0.03 0.9704 0.24 0.7868 0.95 0.3867 3.60 0.0273

0.0. 0.9608 0.26 0.7711 1.00 0.3679 3.80 0.0224

0.05 0.9512 Q28 0.7558 1. 10 0.3329 4.00 0.0183

0.06 0.9418 0.30 0.7408 1.20 0.3012 4.SO 0.0111

0.07 0.9324 0.32 0.7262 1.30 0.2725 ' .00 0.0067

0.08 0.9231 0.34 0.7118 1.40 0.2488 ' .SO 0.0041

0.09 0.9139 0.36 0.6977 1.SO 0.2231 ' .00 0.0025

0.10 0.9048 0.38 0.6839 1.60 0.2019 '.SO 0.0015

0.11 0.8958 0.40 0.8703 1.70 0.1827 7.00 0.0009

0.12 0.8869 0.45 0.8378 1.80 0.1853 7.SO 0.0006

0.13 0.8781 O.SO 0.606S 1.90 0.1498 '.00 0.0003

0.14 0.8694 0.55 0.5770 2.00 0. 1 ~ ' .SO 0.0002

0.15 0.8607 0.60 0.5488 2.20 0.1108 9.00 0.0001

0.16 0.8521 0.65 0.5221 2.40 0.0907 - '-

kV = kilovolt =
energy of polycromatic radiation. 0.17 0.8437 0.70 0.4966 2.60 0.0743 - -
keY = kiloelectronvolt = energy of monocromatic radia-
tion.
0.18 0.8353 0.75 0.4724 2.60 0.0608 - -
For polycromatic radiation, as that emitted by X-ray
tubes, 1 keY "" 2 kV (see par. 2.5.22. and 2.5.23. Example: the I. intensity of radiation must be calculated,
page 71). having wave-length 0,080 $.., after 20 mm Aluminium
Examples: with 100 kV of a common X- ray generator, thickness, with original intenSity 10 = 100.
corresponding to about 52 keY, the absorption of Alum- The formula is:
inium is about 5 times that of waler or plexig lass
(1000/0,219). I. = 10 e-~

With 50 kV, corresponding to about 24,8 keY. the abo

sorption of Aluminium is about 10 times that of water Knowing that s = 2 em and Jl = 0,37 (see tab. 1/ 2,
or plexiglass (5000/0.501) . Aluminium column, in correspondence of = 0,080 AI.
the formula is:
Therefore, with 50 kV of a common X-ray generator, the - I" "" - (2 x 0,37) "'" - 0,74
absorption of 1 em of human body tissue roughly cor-
responds to 1 mm AI. Being ,
= 0,75 (approximation 1,3%), lh, table gives
Often diagnostic phantoms of 20 mm AI roughly corres- e- x value = 0,4724 and therefore e-jll = 0,4724.
ponding to 20 em of human tissues are used for reo Applying the former formula and keeping in mind that
search: these phantoms are equivalent to skull p.a. or 10 "" 100, it results:
abdomen a.p. of normotype person (see par. 2.5.23. pa-
ge 71) . 120 em = 100 X 0,4724 = 47,24% of entrance radiation

GI L.I\ROONI. RADIOLOGY - ELECffiOMEDICINE 39

From fig. 10/2 page 38 and the given formula it can be
seen that theoretically, radiation intensity never reaches
zero, that is, there is no material of any thickness that
can absorb radiation completely.
As a matter of fact, using heavy materials, like lead or
a sufficient layer of concrete, earth etc., the residual ra-
diation intensity can be so low as to be considered
negligible.
2.1.10. Half Value Layer (HVL) and Tenth Value Layer
(TVL)
Referring to fig. 10/ 2 (page 38), the thickness that halves
the incident radiation intensity is called Half Value Layer
(HVL) of a given material for a given radiation energy.
Likewise, the material thickness that reduces the inci-
dent radiation to one tenth is called Tenth Value Layer
(TVL).
Obviously, for the same material, HVL and TVL increase
with radiation energy (more penetrating radiation, harder
rays).
HVL and TVL characterize the radiation penetration and
are also used for the calculation of absorption and pro-
tection (see tab. 3/11 page 302).
2.1.11 . Photoelectric effect (absorption) and Compton ef-
fect (scanerlng)
The intensity of rad iation decreases when crossing mat-
ter.
This phenomenon depends on radiation interactions with
maner and it is quite complex.
Without entering Into detai ls it is sufficient to know that
the radiation absorption coefficient for energies up to a
few MeV is mostly due to two effects: the photoelectric
effect (fig. 11 /2). that is, true absorption, and the Comp-
ton effect (fig. 12/2). At higher energies, over 1-2 MeV,
a third phenomenon determines the energy decay of the
radiation: pair production.
A comparison with visible lig ht may help to explain the
photoelectric and Compton effects.
Consider a lig ht source, like that emitted by car head-
lights.
If a semitransparent glass filter (blackened) is placed
before the light source. only 50% of the light passes
through the filter while the remaining 50% is absorbed.
Fig. 11/2 (par. 2. 1.11.) - Photoelectric affecf (Absorption).
The incident quantum. or photon, represented by the
wave com ing from the right side, ~collides~ w ith the
electron and disappears trans ferring all its energy to the
electron thus freeing It from the nucleus attraction lorce.
The photoelectric ellect is possible only when the quan-
tum energy exceeds the threshold required to I ree the
electron.
The effect is more probable as the quantum energy gets
nearer the above mentioned threshold without going be-
low it
40
.fV\/\'""I'"
".!\/I II
""
Fig. 12/2 (per. 2.1.11.) - Compton effacl (Scattering).
The inCident quantum COllides wilh an almosl free elec-
tron and transfers to it a part 01 its energy.
In the colll:!l lon, part 01 the Incident quantum energy I:!I
translormed Into another quantum with lower energy (dif-
luse quantum) end the remaining part is utilized to expel
the electron.
The lower energy quantum and the electron take dillerent
directions like two billiard balls.
The elleet Is possible also with high Incident quantum
energy. The more the direct ion 0 1 d iffuse quantum diUers
Irom that 01 the incident quantum the lower is its energy.
Th is corresponds to the X-ray photoelectric effect (ab-
sorption).
If a light diffuser, for instance a glass bottle full of milk,
is placed before the source, the light is reduced due to
diffusion. This corresponds to the Compton effect.
With a semitransparent glass filter, the light passing
through increases proportionall y to the increase in light
intensity, allowing better visibi lity in distance.
With the diffuser (bottle of mi lk) the light passing through
and scattered away, will increase very little even if the
Intensity of the source is highly increased.
This is what happens with the car. On a clear night,
switching on the headlights, visibility Is well improved,
whilst with fog there will be no improvement.
Substances with high atomic numbers (metals) act as
more or less opaque glass and the X-ray attenuation is
mainly due to absorption (photoelectric effect) whi le for
substances with low atomic numbers (water, organic
substances, rubber. plastiCS, wood , elc.) the scattering
process (Compton effect) is predominant.
An energy increase, that is, increasing the radiation
hardness or the penetration effect, is advantageous in
substances with high atomic numbers (metals).
2.1.12. X-ray Ionization
Fig. 13/ 2 shows the ionization principle, basis of X-ray
dosimet ry. The radiation unit -Roentgen,. (A) itself is
based on ionization.
2.1.13, Primary and secondary scaHered radiations
Primary rad iation is that emitted by the tube focus and
secondary diffuse rad iation is that emitted by the irra-
diated object, the floor, the walls, etc. When irradiating
materials with low atomic numbers such as the human
body, water, wood, earth, etc. a large quantity of se-
condary diffuse (scattered ) radiation is emitted .
Its energy is lower than that of primary rad iation. Pri-
mary radiation comes directly from tube focus; secon-
dary scattered radiation has no specific direction.
GllAROONI . RAOIOlOGY - ELECTRQMEOICINE
 The impact determines two types of radiation called em-
ission spectra:
.. .. 1) continuous spectrum.. or .. Bremsstrahlung determined
Jl
?
by the abrupt stopping of electrons on the anode;
_ -.-
.... ._'0. 2) ..lines spectrum- or characteristic spectrum depend-

]
ing on the target material.
rT Fig. 15/2 shows the emission spectrum of a tube with
tungsten target working at 200 kV (see also fig. 17/2
? o . . . . --. . page 42) .
Tab. 3/2 (page 42) gives the energ y in keY of charac-
teristic lines for different elements.
Fig. 13/2 (par. 2.1. t2.) 0 Princ/ple of /onlzetlon and its mea-
surement.

The elementary component of an X-ray beam, also called

photon or quantum, represented by the left wave, when
striking matter molecules (In this case a gas) divides them
into their electric components: positive ions and negative
electrons.
II the Irradiated gas Is placed between two electrodes
charged + and - by and electric gonerator, a current.
called ionil:ati on current, flows between th e electrodes.
The ionization cu rrent Is proportional to the radiation
intensity.
X-ray dosimetry I, based on the measurement of th e
ionization current.

2.1.14. Negative effects of scaHered radiations on Image

quality and ways to eliminate them

Fogging the film, the secondary scattered radia tions re-
duce contrast and resolving power (see fig. 14/2) .
There are different ways to eliminate scattered radia-
bans:
1) antidiflusion grids (see par. 2.5.11 . page 53 and fol-
lowing ones) ;
2) good beam collimation in order to irradiate only the
useful field (see fig. 31/ 2 page 53).
Chapter 2.2. - X-RAY CHARACTERISTICS
2.2.1. X-ray tube emission spectrum - Continuous spec-
trum and lines spectrum
X-ray emission is produced by a bombardment of elec-
uons on the anode (see par. 1.1 .1. page 29).
Fig. 15/2 (par. 2.2. 1.) Spec/rum of Xreys ptodUCl by e
tungsten anode tube working at 200 kV.
Absclua: wavelength ( ~) expressed In A; ord inate: X-ray In-
tensity.
Continuous 'pectrum. II the curve without characteristic
line peaks.
_Lines spectrum are the peak, oller the continuous spec-
trum: they are dillerent according to the target material.
The characteris tic lines of a tung,ten anode correspond to
69.3 keV (K 'hell), to 12.1 keV (L shell) end to 2.81 keV (M
shell, out of IIgure) (see table 3/2).
The figure IhoW! that the delivered dose of the lines spec-
trum 18 small compared to that 01 the continuous spectrum.
Classic radio logy al ways relers to the continuous spectrum.
The lines spectrum Is used In crystallography.
The most Important wavelength, (~) 01 the con tinuous spec-
trum are (see fig . 18/2 page 42):
~ min = wavelength of mlxlmum energy corresponding 10
spectrum starting point (left ) determined by maximum tube
voltage (kV):
~ max = wavelength of maximum Intensity of the continuous
spectrum.

Fig. 14/2 (par. 2.1.14.) . Radiographs of the pelvis demonstrating effect of direct exposure (A), screen exposure (B), end screen
grid exposure (C). (From Fuchs).

~DONI . RADI<X.OGY ElEc:l"AClMEOICINE 41

 2.2.3. Voltage (kV) influence
TABLE 3/ 2 (par, 2,2,1,) - Energy in keV of charac-
teristic radiations for different elements (see fig. This is ill ustrated in fig . 17/2.
15/2, page 41),

Atomic
ELEMENT , L M N
5C~Y

~
" \
13
26
Aluminium
Iro n
1,55
7,10
-
-
-
-
-
- t
IA 1\
2.
29
N ickel .

Copper
.,29
.,86
-
-
-
-
-
-
,\
:J() Zin c 9,65 1,20 - - ., "I\ \
'2
.7
Molybdenum

Silver
20,0
25,5
2,87
3,79
0,51
0,72
0,06
0,10
, II I" " 10-
50 Tl o 29,1 4,49 0," 0,13 0.6
.l'. t:-..::
0.1 to
56 Barium 37,4 5,99 1,29 0,25 " _.I, l~ l

7. Tungsten 69,3 12,1 2,81 0,59 fig. 17/2 (par. 2.2.3.) - Voltage (kV) influence on continuous
7. Platinum 78,1 13,9 3,30 0,71 spectrum.

79 Gold 80,S 14,4 3.43 0,79 The figure shows th e effects of increasing kV (see also fig ,
16/2) . A = 10- 7 mm.
.2 Lead 87,8 15,8 3,85 0,89 1) th e minimu m wavel ength (), min) decreases (higher
energy);
90 Thorium 109,0 20,S 5,1 7 1,33 2) the maximum intensity wavelength (), max) Increases;
3) strong Increase of all wavelengths and consequently of
The table gives the energy values (keV) requested to the dose which correspond s to the area between abscissa
excite characteristic radiations of some metals, and spectrum lines.
It is shown that, operating below 69,3 keV, th e charac-
teristic K radiati on of th e W (tungsten) is not emitted,
The table shows the energy requi red to eject the pe- 2.2.4. Filter Influence
rlpherical electrons from thei r orbits.
Th is is illustrated in fig, 18/2,

2,2,2, Current (mA) Influence on continuous em.slon

spectrum

Th is is illustrated in fig, 16/2,

Fig, 18/2 (par. 2.2.4.) - Filrer Inlluence on continuous spec-

frum.

With increased filtrati on long wavelength s (soli rays) are

absorbed, dose decreases and the X-ray beam becomes
more homogeneous.

2,2.5. Minimum wavelength in function of tension (A min)

A min is the wavelength with the highest energy.

It corresponds to the beg inning of the spectrum curve
(see fig. 16/ 2) and is determined by:
, . ( ' ) _ 12.34
fig. 16/2 (par. 2.2.2.) - Current (rnA ) in fluence on continuous '" m in 1\ - --
spectrum emission.
kV
Single wavelength intensity and integrated intensity are pro-
where kV is the tube voltage.
portional to rnA. As shown in f igs. 16/2 and 17/ 2 A min has high energy
Spectrum (b) is obtained with twice the mA as (a); therefore but low intenSity.
the height of each intensity and the area of spectrum (b) are
twice those of spectru m (a). Tab. 3a/2 gives the minim um wavelength in function of
tension.

42 GllAROONI . RADIOLOGY - ELECTROMEDICI NE

 Chapter 2.3. PHYSICS OF THE X-RAY IMAGE:
TABLE 3a/2 (par. 2.2.5.) Minimum wBvfiJ.{ength in (DIAGNOSTICS)
function of tension
2.3.1. Unsharpness and definition

'-- -kV- -
_ 12.34 _ 3 . 1010
I
Unsharpness is the contrary of definition and images
are indifferently classified as sharp images or images
with good definition or without unsharpness.
as kV = 4.11 . 10- 10 I
where : ~ is in Angstrom (A = 10- 1 mm)

2.3.2. Film unsharpness

1 IH:) t (HI) ~ mIn In
" i. mIn In "
" It is in the order of 0.01 mm, so small as to be consi
50 1.22 . 10" 0.2468 700 1.70 . 10" 0.0176
dered neg ligible.
100 2.44 10" 0.1234 800 1.94 . 10" 0.0154
Normally, Xray films have an emulsion coating on both
150 3." 10" 0.0822 900 2.19 . 10" 0.0137 sides of the base (double coating). This doubles the
200 4.85 10" 0.0617 1000 2.44 . 10" 0.0123 sensitivity (see par. 2.5.2.1. page SO) and increases the
250 6.08 10" 0.0494 1250 2,03 10" 0.0099 photographic contrast (see par. 2.5.2.2. page 50 and
300 7,29 . 10" 0.0411 1500 3.66 ' 10" 0.0082 fig. 14/2 page 41).
350 8.53 . 10" 0.0352 1750 4.13 ' 10" 0.0071
400 9.45 . 10" 0.0318 2000 4.84 . 10" 0.0062
450 1.09 10'" 0.0274 2250 5.46 10" 0.0055 2.3.3. Screen unsharpneu and Intensification factors
500 1.22 . '0" , 0.0247 2500 6.13 '0" 0.0049
600 1.45 10" 0.0206 Medical radiography uses radiographic calcium tungstate
and rare earth screens with intensification factors of 5()...
100 and more which reduce dose, exposure time and
tube load by 5(}-100 times and more compared with ra
diographs taken without screens. They show, however, a
higher inherent unsharpness (0.2..Q.4 mm).
2.2.6. Maximal Intensity wavelength (A max) Fig. 1912 shows the enlarged unsharpness (x l0) of a
tungstate screen and the related microdensitometric cur-
A max is a lunction 01 A min: ves.
Screens improve photographic contrast, as illustrated in
18.5 lig. 14/ 2 page 41 and lig. 20/2 page 44.
A max (A) till: 1.5 A min = -
kV Fluoroscopic screens (direct viewing) have even higher
unsharpness (0.5...Q.6 mm).
where kV is tube voltage. Direct fluoroscopy may be used only for indicative exa
A max depends also on filtration as shown in fig. 18/2. mination.

r
ill
""-

..,
~

~

m

OM N Fig. 19/2 (par. 2.3.3.) Microd&n$ifomelric curves of enlarged

UnSharprlflS5eS.
f I : 10 times eolarged radiograph of a 2 mm lead wire witir

..,-.
out screen;
~
II : the same radiograph with tungstate salt screen:
III : mlcrodenaitometry of radiograph I:

~
IV: mlcrodensitometry of radiograph II.
The unsharpness -s- of fi9. IV. 10 times enlarged. is about 3
mm and corresponds to 0.3 mm In the lilm in real dimen-
sions.
Om
..... Observing the fig . II, the unsharpness appears to be of the
order of 1.5 mm (0.15 mm in real dimensions). that is. the
eyes are able to see half the microdensitometric unsharpness
01 fig. IV,

GIlAADONI . PAOIOlOOY ElECTROMEOICINE 43


Fig. 2012 (par. 2.3.3.' - Two posteroanlerlOf radiographs of a
Ihin parI ( hand' of the body.
(Left) made with intensifying screens: note shorter scale
con trast. (Right) made with out Intensify ing screens (From
Fuchs).
2.3.3.1. Practical simple evaluation of intensifying factor
of radiographic screens.
1) On the cassette containing the screens to be evalua-
ted , place a Cu filler 1 mm thick or 1,5 mm Fe.
equivalent to the absorption of a lung in a norma-
type person.
2) Select mAs to obtain a film density about 1 at 1
meter Focus Film Distance with 75 kV .. Standard
Rays (see par. 2.5.2.2. page 50); few attempts allow
to obtain a right exposure.
3) Us ing the same parameters, expose the fiim without
screen 40 times more; so it will receive a dose in-
creased 40 times.
4) Compare both exposed lilms; if they have similar
density, the screen intensifying factor is about 40. If
the density 01 the film exposed without screen is
lower, expose it 80 times more, Instead of 40 times.
If now they have similar density, the intensifying fac-
tor is about 80. Few attempts allow to approximate
the density of the two films, with and without screen,
and to obtain the screen intensifying factor.
2.3.3.2. Control of screen quality and resolution with
IOI-GIL or Lines Pair lest paHem
Expose 1 mm Cu filter (eq uivalent to a lung of a nor-
motype person, as indicated in point' of the preceding
paragraph) , with exposure data of point 2 of the pre-
vious paragraph, on which the Quality Indicator IQ-GIL
described at par. 2.5.15. 1. page 68 has been placed; In
this way it Is possible to obtain a numerical evaluation
of the quality and information power.
Resolution may also be measured with Pair Lines test
pattern (see par. 2.5.16. page 68).
2.3.3.3. Control of bad screen-film adherence with "net"
method and suggestions to elemlnate this fre-
quent defect
Bad sc reen-film adherence, causing bad radiographs. is
a frequent defect. particularl y in large size cassettes.
To control the screen-fi lm adherence, radiograph an iron
net with meshes of about 5 mm and wi res diameter of
about 0;5 mm, placed on the whole cassette area.
44
In correspondence of the zones where the adherence
screen-film is not good the net image is characterized
by unsharpness and the radiograph is bad.
To eliminate the delect, adjust or replace the compres-
sion foam and felt.
Periodical radiographic controls are recommended.
2.3.3.4. Balanced GUardonl HSU, Universal Screens for
Automation. Rare earth screens
There are two types of radiographic screens: High Speed
(HS) and High Definition (HD) screens.
The HS tungstate screens have a 40-80 intensifying fac-
tor and more, and a 0,3.(),4 mm microdensitometric mea-
sured unsharpness, which reduces to about haif value at
direct sight (see fig. 19/2 page 43) .
HD tungstate screens have a 20-30 intensifying factor
and more, and a geometrical unsharpness of about 0,2
mm; HD ones have lower contrast.
The rare earth screens have an intensifying factor 2-5
times higher than the tungstate ones, but also have a
little higher unsharpness.
- Balanced" Gilardoni HSU, universal screens represent
the right compromise between HS and HD screens and
semplify the automatized wor1<, with a single type 01
screen.
The resolution in Line Pairs per mm is about 10 for
Gllardoni HSU" screens and about 7 for rare earth
screen.
For angiography, serial radiography, pediatry and gener-
ally when dose reduction is important. rare earth screens
are recommended.
2.3.4. Geometrical unsharpneu (see also par. 2.1.7. pa-
ge 38)
II is proportional to focus size and to distance ratio ob-
ject-film/object-focus.
Usually the geometrical unsharpness does not exceed
0.2-0,3 mm, with good equipment.
2.3.5. Kinetic unsharpness and exposure times
Kinetic unsharpness is produCed by the object move-
ments during the exposure to X-rays and is expressed
by the relation: kinetic unsharpness = object speed x
exposure time.
The highest speeds take place in correspondence of
heart ventricles, lungs and during angiographies; they
are about 30 mm/sec. (Kimog raphic measurements), tha-
refore exposu res of 0,0 1 sec., or less, are necessary to
keep the kinetic unsharpness in the acceptable order of
0,3 mm.
The exposure times to keep the kinetic unsharpness In
acceptable values, may be the following ones: for lung
0,0 1-0,1 sec., for stomach 0,1-0,2 sec.. for other parts
0,1-1 sec.
For tess movable parts. such as skeleton, the exposure
times may even be of several seconds.
2.3.6. Resultant of the various unsharpnesses - Total
unsharpness
Total unsharpness is not given by the algebric sum of
the single various unsharpnesses described in the pre
GU.AROONI. RAOIOlOGY ELECTROMEOICINE
ceding paragraph but is determined by the predominant
unsharpness.
Generally, the quality 01 the radiographic image is the
result of the screen unsharpness that determines the to-
tal unsharpness (see par. 2.3.3. and fig . 19/ 2 page 43).
2.3.7. AbsorpUon conlrast (radiok)gical contrasl)
Absorption contrast is the difference (or ratio) between
radiation intensities emerging from two adjacent areas.
Absorption contrast is higher when radiation has lower
energy (soft rays - lower kV) and when there is higher
absorption difference in adjacent elements due to their
inherent composition and thickness (see par. 2.5. 12. pa-
ge 63).
2.3.8. kV Influence on contrast
Fig. 21/2 (page 46) and the relating comment show this
influence.
2.3.8.1. Three types of radiographies: standard scale
(Standard rays 40-80 kV), long scale (Hard rays
80-100 kV and more), short scale (SoH rays
10-40 kV)
Standard scale is represented by a Standard number of
normal contrast steps; long scale is represented by a
large number of low conslrast steps; short scale is re-
presented by a small number of high contrast steps.
Fig. 21 / 2 (page 46) shows the application of the three
radiographic melhods to lungs examination .
Fig. 23c/2 (page 48) shows the long scale method (hard
rays) applied to -Gilardonl Total Body Radiography.
(GTBR) with Homograph (see par. 2.4.4. page 48) .
Fig. 42/2 (page 64) shOws the short scale method (soft
rays) applied to analitic, detailed examinations (see par.
2.5. 12.1 . page 63).
2.3.8.2. High kllovoltage technique reduces pallent dOle
and Increase. Information power (long scale)
It is clearly demonstrated by fig. 21/2 (page 46) and by
i1s comment.
High kilovoltage technique requires good antiscatter grids
(see tab. 7/ 2 page SO).
2.3.9. Contrast and definition (sharpness), the basis of
the Information power
Purpose of the radiological image is to give the largest
amount of details and information. The possibility of
putting details in evidence is given by ..definition .. (the
contrary of unsharpness) and by the total contrast re-
sulting from absorption constrast (see preceding par.)
and photographiC contrast (see par. 2.5.2.2. page SO).
These two factors - contrast and definition - deter-
mine the information power and the amount of available
information.
It is not so easy to state whether a radiographic failure
is due to deficiency in contrast or in definition, because
ou r eyes see the resultant of both factors.
In order to have a separate evaluation it is necessary to
examine the projectional geometry determining the defi-
GIlAROONI. RADIOlOGY E\.EcmOMEDICINE
nition (sharpness) (see par. 2.3.4.), the radiation energy
(kV) in relation to the object, giving the radiological
contrast (see par. 2.3.7.), the film type and the deve-
lopment efficiency, factors affecting the photographic
contrast (see par. 2.5.2.2. page SO).
Sometimes an unsharp radiograph having higher con-
trast may give more information than a sharper one
with low contrast.
Chapler 2.4. - CONTRAST MEDIA AND COMPEN-
SATING FILTRATION
2.4.1. Use of contrast media
Contrast media are employed to render high tissue con-
trast in a viscus that normally has very low tissue con-
trast. These media comprise various nontoxic chemical
preparations that have high X-ray absorption properties.
They are either injected or ingested into the viscus be-
fore rad iog raphy is performed (fig. 22/2 page 47). Air is
also very useful on occasions because of its very low
X-ray absorption properties. The alimentary tract normal-
ly cannot be differentiated from surrounding tissue and
it must be filled with a -test meal .. containing barium
sulfate of high purity (A), fig . 22/2. For localization of
abnormalities of the brain, air is often used to outline
the ventricles (B). Study of the urinary tract function
requires the absorption of a contrast medium by the
body and upon excretion by the kidneys, details of the
urinary tract can be radiographically delineated. This
type of radiograph is called an intravenous pyelogram.
Study of the urinary tract can also be accompl ished by
inserting radiopaque catheters into the ureters and in-
jecting a contrast medium Into the pelvis of the kidney
(C) . This type of radiograph is known as a retrograde
pyelogram. Air is oflen injected into the large intestine
to augment the contrast properties of the barium sulfate
meal or enema. (D). The bronchi can be made visible
by injecting an opaque substance into the lung (E) .
To study the function of the gallbladder, a harmless dye
is injected into a vein . This substance is carried to the
liver by the blood stream and is secreted with the bi le
into the gallbladder. Since the dye in the bile is opaque
to X-rays, an image of the gallbladder and its contents
can be visualized (F).
2.4.2. Compen..tlng flilration to balance the density of
different parts absorption
There are occasions when it is difficult to balance den-
sities in radiography of large and irregular analomical
areas by making use of kitovoltage or the ...heel .. effect.
However, by selective absorption of various portions of
the X-ray beam before it traverses the subject, balanced
densities may be secured.
Absorption of the beam can be effected by placing an
absorbing medium such as barium impregnated clay or
graduated aluminum in the filler channel. The material
is so shaped that the beam must pass th rough the
larger amounts of absorbing material when directed to--
ward the thinner anatomical portions. The material should
be thin or omitted for that portion of the beam passing
toward the heavier parts.
In radiography of the entire spine on a 14 x 36-inch
film, a normal image wou ld exhibit high density in those
portions representing the thinner tissue areas. The upper
segment of the vertebral column wou ld be overexposed
because the exposure would necessaril y be adjusted to
45

Fig. 2112 (par. 2.3.8.) - kV Influence on contrast, short and long scala.
From Fuc hs Handbook Principle of radiograph ic exposure and processing (courtesy of Charl es
C. Thomas. Publi sher, Springfield, Illinois).
Comment Gilardoni:
1. Fuchs experiment is very
impressive, instl\Jctive and
allows interesting consi-
derations, that may be
summarized in the follo-
wing table.
2. Radiograph n. 4 requires
only the 16% of the tube
load needed for radio-
graph n. 1 and therefore
the focus and electric
power may be lower.
3. The skin dose decreases
with kV increasing (eva-
luation in graph of fig .
95/ 2 page 99).
4. Long scale radiographs
(standard or hard ray tech-
nique) give more infor
Comment Dr. Fuchs:
A circular area about 2
inches in diameter over
the inferior portion of
the right upper lobe of
the lung was selected as
a density guide since it
possesses average pul-
monary tissue density.
As the kilovoltage was
increased, the mAs was
ad;usted so that translu-
cent densities in this
area of each radiograph
showed essentially the
same details.
With each successive
rise in kilovoltage, de-
tails of heavier and more
dense tissue structures
gradually made their ap-
paerance in the entire
images, indicating gra-
dual penetration by the
more abundant shorter
wave lenght X-rays.
The 80 kVp radiograph
(3) demonstrates al/ es-
sential thoracic detail.
No added diagnostic fea -
tures become visible
when 100 kVp (4) is
employed.
However, unmistakable
evidence of an unduly
long scale of contrast
is shown in this radio-
graph.
Note that many details
are absent in the 50 kVp
radiograph particularly
those portions of the
mation than short scale visible 150 lines grid, ratio Images that represent
ones (soft ray technique) , 6. with 8 kVp increasing thick structures.
see par. 2.5.12. page 63) . as indicated in the table In other words, as the
5. Radiograph n. 4 would and as it is usuaUy made kilovoltage increases,
have a remarkably better nowadays (scattered radia- more densities become
quality, if made with in tion elimination). visible (the contrast sca-
le becomes longer) up
RADIOGRAf'l tS
TUS E LOAD SKIN DOSE OUAU TY AND to a certain point (00 kVp).
(F F.D 1Ml em )
, , INFO RM ATION
Afiove this level, the
"1 '"50 m"20 wan .ec
"""" scale of contrast is
~.,
1.000 100 20 100 NO GOOD much too long.
The experiment demon-
2 60 8,33 500 50 15 75 GOOD strates that kilovoltage
3 80 3,33 260 26 12 60 VERY GOOD is the factor of radio-
graphic contrast, i.e., ki-
4 100 1.66 100 16 10 50 GOOD lovoltage controls the
scale of radiographic
rfWI~ible densities by means of
108 1.66 180 18 65 EXCELLENT
""
RO " which image details be-
come visible.
GI LAR OONI . RADIOLOGY - ELEcrnOMEDICINE
suit the heavier or lumbosacral portion of the spine.
This condition would still arise on occasion because the
anode portion of the beam would ordinarily be directed
toward the thinner area-the cervical vertebrae. Despite
this arrangement, however, overexposure of the cervical
area often would occur, By constructing a suitable com-
pensating filter of barium impregnated clay, anteroposte-
rior and lateral views of the entire vertebral column that
exhibit balanced radiog raphic densities may be secured.
Radiography of chests wherein extensive consolidations
or thoracoplastys are present, shield ing the normal pul-
monary area with a compensating filter, permits using
an exposure that is more appropriate for the diseased
area or the one wherein surgery was employed without
overexposing the contralateral side.
, ...- -"
G ILAR DONI, RAOIOLOGY , ELECTROMEOICINE
Compensating filters are also used to advantage in pla-
cental studies and orthopedic radiog raph y. Herein, how-
ever, employment of the higher kilovoltages and the
heel effect are of great assistance.
2.4.3, Atumlnlum wedges 10 balance density of a.p. fool
Ap. foot is practically an anatomic wedge and Its ra-
diograph is overexposed in correspondence of phalanges
and underexposed in correspondence of tarsus.
A 120 x 200 mm base, 8 mm height alumi nium wedge
filter placed on the 1001 balances Ihe density and gives
a better radiograph.
Fig. 22/ 2 (par. 2.4. I,} - Radio-
graphs in which contrast medIa
havi been employed to de/mBatl
anatomic structures.
(A) Stomach and small int.tme.
(8) ventricles of the brain; (C)
kidneys and urete rs; (0) colon;
(E) bronchi: (F) gall bladder
(From Fuchs).
47
2.4.4... Gilardonl Total
Body Radiography
(GTBR)" with ..Ho
mograph and ra
diologlcal checkup
at a very low dose

.. GTBR" is the homoge--

neized, highly informative,
2 m single exposure ra-
diography of: sku ll , who-
le spine, humerus articula-
tion, ilium, coccyx, lungs,
heart, abdominal organs,
knee, tibia, tarsus, elc.
ant-post, and lateral.

2.4.4,1, Pr'ncipk! of ,<GTBR

with "Homograph"

Fig . 23/2 illustrates the

principle:
1) Tube focus.
2) Light centering-colli ma-
tor.
3) Homograph on slider.
4) Homograph slider.
The .. Homograph is a
brick, size cm 10 x 22,
with an incorporated X-
ray phantom like a low
rilief sculpture (bas riliel)
reproducing in reduced
scale, the different patient
parts with proper charac
teristic absorption.
To compensate for the
different heights of the
patients, the -Homog raph,.
(3) is placed on the slid
er (4) at a proper propor-
tional focus-Homograph
distance according to Leo-
nardo da Vinci's rules tra
ced 5 centuries ago on FIfI. 23c/2
the famous drawing of the man inscripted in circle and "GTBR" requires: precise patient positioning centering,
square (fig. 23a/2) . support and immobilization; Leonard armpit proportiona-
The .. LeonardGil .. system well compensates for patient lity factor evaluation to be transferred to the Computer;
height (fig. 23b/2). exact aligning Homograph-Patient shortime automatic ex-
posure and other auxiliary operations.
The Homograph kit is composed by 4 bricks: 2 for
Trunk a.p. and lat. 2 for Legs a.p. and lat. The "Leonard-Gil", by means of 3 push-battons, auto-
matically effects all these operations and other ones:
2.4.4.2. "Leonard-Gil" special equipment for " GTBR .. 1sl Push-botton Handle-crulch,. armpit support: posi-
tions, centers, immobilizes the patient and evaluates
The practical application for "GTBR.. suggested the de--
the Leonardo proportional factor to be transferred
velopment of specialized equipment to facilitate and op--
to the Computer for the other automatic operations.
timize the resu lts.
50 the ideal equipment for .. GTBR,., the .. Leonard-Gil".
was born. II is composed of (fig. 23b12) :
t /' ~

- --
1) Patient table. 2) .. Handle crutch .. armpit support. :1: '" ~~ ',-,' .--:;;7-
3) Exposure detector, grid and cassette lifting guide.
4) 5ymmetrcrponderometer for the evaluation and recording -
of weight discharged by each leg (scoliosi's, etc.). "\'1:;:X -~
- -
5) Unit containing: super power condenser X-ray gen~
rator .. Farad-Gil,.. special rotating anode tube, automatic
~

----~ ~
~ ,
Y
""
.. Homograph" positioner, etc. 3
All movements are automatic and computer aided. The
super power condenser Farad-Gil allows to take ",GTBR" Fig. 23/2 (par. 2.44. 1.) . Pun - Fig. 23a/2 (par. 2.4.4. 1.,
of lat. pelvis-spine at 2 meters in 0,05-0,1 sec. to elimi- ciple 01 - G TBR- wirh - Homo- - Leonardo's - Studio dl
nate kinetic unsharpness (see par. 3.2.9. page 119). graph. proporziQni .

48 G!LAROONI. RADIOLOGY - ELECTAOMEDICINE

2nd Push-botton Selec-
tion automatically
lifts the tube to the
right centering hei-
ght, positions the
Homograph in rela-
tion to the Leonardo
patient height propor-
tional factor and cen-
ters grid and casset-
Ie.
3rd Push-botton Exposu-
re: automatic exposu-
re device takes cor-
rect radiographs com-
pensating different pa-
tient absorption.

2.4.4.3. Two orientative ex-

amples of "GTBR..
are here reprodu-
ced (figs. 23cl2,
23012).

Original radiographs. 25
times area. (35x86 em)
are much and mueh more
info rmative; trabeculas
and fine datai ls are well
evidenced .
..GTBR .. size 43xl05 cm
(3 film 43x35 cm) also
avai lable contens skull
and arms.
Exposure with GTBR on
normotype patient is ab-
out 50 mAs with 100 kV
and skin dose in corres-
pondance of pelviS about
250 mrem (2,5 mSv). skull
150 mrem (1.5 mSv). lung
15 mrem (0,15 mSv).
The patient volume-dose
IS a small fraction of that
yearly delivered by natu-
ral radioactive background.
Such low dosage allows Fig. 23d12. 5) Simultaneous correlated vision of different body parts
efficient periodical radiological check-up without any risk. sometimes allowing supplementary informations, lost
by single standard radiographs.
6) Mass screening.
2.4.4.4. Some applications of " GTBR" (se also par. 4.5.10.
Chapter 8.11 . page 277 illustrates some anatomical
page 156) drawings by Leonardo da Vinci relating KGTBR.
I) General patients acceptance in Hospitals, etc.
2) Mass screening (military, schools, etc.). Fig. 23b/2 (par. 2.4.4.2.)
- Leonard--Gilp.
3) Periodical Check-up (skeleton , heart, lungs, etc.) sub-
stitution of mass fluorography.
4) Precocious diagnosis, prevention, etc.
5) High quality spine radiog r~ph, scoliosis, etc.

2.4.4.5. Advantages 01 " GTBR .. on single standard radio-

graphs are:

1) Very high information range.

2) Lower total patient dose.
3) Lower scattered radiation.
4) Reduced enlargement and geometrical unsharpness
(FFD 2 meters).

GllAR DON I. RADIOLOGY ELECTIlOMEDICINE 49

Chapter 2.5. - RADIOGRAPHY 2.5.2.1. Sensitivity or speed (a)

A film is more sensitive when (a) is smaller, that is, the

2.5.1. Densitometry film begins to blacken with low exposure (see fig. 25/2).

Density (or blackening) of a film area is the logarithm

of the opacity, that is, the ratio: incident lighVemergent
light (fig. 24/2).
Density is mathematicallv expressed as:

<1>, M_"
0 = log, o - -
<I>
.
w here: <1>0 = incident tight and <I> = emergent light.
At Density 1, incident light is 1 and emergent light 1/1 0 .
,
corresponding to 1 Tenth Value Layer (TVL) (see par.
2. 1.10. page 40). -
At Density 2, incident light is 1 and emergent light
1/ 100 corresponding to 2 TVL.
At Density 3, incident light is 1 and emergent light
1/ 1000 corresponding to 3 TVL.
:'1 ,.-
r
_
.. ...."...

For film density evaluation see par. 2.5.4. and explana~
tion of fig. 26/2.
Fig. 25/2 (par. 2.5.2.) Typical densitometric or sensitometric
curve of a radiographic film.

,_,
Abscissa reports exposure "d o rdinate density 10 tho
text, description of curve parameters: sens iti vi ty (film
(a). photographic contrast (b). fog (c), limit dan-
sity or saturation blacken ing (d) and exposure latitude (e).

"-
-- ...... 2.5.2.2. Photographic contrast (b)
..
......",-,
"" ", ,
High contrast films, with the same exposure, have a

--
-- --
-~ higher (b) angle (steeper slope of the densitometric
curve) and viceversa for those with lower con trast
(fig. 25/2) .

--- --- Tofal radiographic contrast is the resultant of photogra-

ph ic contrast and of the absorption or radiological con-
trast (see par. 2.3.7. page 45) .

--- ---
The slope of the densitometric curve (b angle) is called
gamma faclor.

--- - 2.5.2.3. tnherent fog (c)

Slight opacity noticed on non exposed zones (c). Fog is

--
caused: partly by the non perfect transparence of the
base and partly by processing . Fog shou ld not exceed
- ",,--
".,.............. 0.2-0.3 density, corresponding to an almost complete
transparence (see fig. 25/2).

2.5.2.4. Limit density (d) or saturation blackening

Fig. 24/2 (par. 2.5. 1.) Aim density (blackening).
It is the maximum density obtained when the film Is
Graphic representation of density (blackening) and opacity
(or its inverse: transparence) 01 a film .
completely exposed and completely developed (see fig.
25/2 ).
The limit density (d) reaches value 4 and over. There-
fore densities exceeding 3, corresponding to a deep
blackening (999/ 1000 of absorbed light), cannot be used
with normal negatoscopes (see par. 2.5.4.).

2.5.2. Blackening, densitometric or sensitometric curve 2.5.2.5. Exposure latitude (e)

Fig . 25/2 shows a typical densitometric curve. It is the useful exposure range (see fig. 25/2).

50 G ILAAOONI, RIIOIOlOGY . ELECTAOMEOICINE

2.5.3. Densogil. electronic densitometer
Fig. 26/2 shows the instrument and describes how it
works.
Fig. 26/2 (psr. 2.5.3.) - DeflSOgll - Pocket radIOgraphic densi-
tometer (11 K " K 3.5 em; 320 gr.).
1) meter: 2) 5 mm diameter pick-up with cable and jack: 3)
pick-up jack socket: 4) on--off and scale switch; 5) zero set-
ting ot densitometric scales: 6) scale indicating lamp.
OPERATION PRINCIPLE
It is based on the mathematical delinitlon 01 density (see
par. 2.5.1.).
The densitometric pick-up (2) is placed on the negatoscope;
the zero selling (5) is turned to bring the instrument indeIC
to ..0. on the first densitometric scale (right) .
By this operation the Instrument Is adjusted according to the
light intensity 01 the negatoscope.
By placing the film on the negatoscope and eICploring the
radiograp hic image with the pick -up, the indeIC immediately
gives the densities 01 e)lplored areas.
Green scale measures density between 0 and 2 and red
scale between 1 and 3. It Is possible to measure density up
to 4 or 5 with added lifters.
The centesimal linear scale is used to measure percent light
transmission.
GIl..AAOONI. RADIOlOGY - ElECTIlOMEOlClNE
2.5.3.1. Pocket comparison densitometer
Fig. 27/ 2 illustrates the densitometer, which is based on
eye comparison.
The human eye cannot make a precise evaluation of
density in absolute terms, but can compare with remar-
kable precision two adjacent densities.
Fig. 27/2 (par. 2.5.3.1.) Comparison denSitometer (apprOK.
reel sin).
It is small 111m with indication of different density !fleps.
Side by side comparison 01 densitometer scale with the
111m to be e)lamlned gives density values.
2.5.4. Practical direct viewing evaluation of density (fin-
ger method). Radiographic blackening range
tt is useful to estimate densities by direct viewing with-
out using a densitometer. This is possible considering
the following reference points:
1) Density 0.2 corresponds to film fog (see par. 2.5.2.3.),
that Is, to an almost complete film transparence.
Incident light 100% - emergent light 63%.
2) Density 1 is roughly the blackening still allowing to
see the text of a book or newspaper with 1-2 mm
types in daylight or with good lighting after placing
the film close to the printing (reflected viewing
through the film).
Incident light 100% - emergent light 10%.
3) Density 2 still allows to see the shadow of a finger
placed between film and negatoscope.
Incident light 100% - emergent light 1%.
4) Density 3 corresponds to a deep blackening and
does not allow to see the shadow of a finger placed
between film and negatoscope.
Incident light 100% - emergent light 0.1%.
Density around 1 corresponds to the middle blacken-
ing of the interested areas. that is the dominant
zones, basis of the examination.
51
2.5.5. Useful radiographk: density range
In the preceding paragraph it is stated that useful densi-
ty range lies between densities 0.2 and 3 respectively
normal film fog (almost complete transparence of non
irradiated zones) and deep blackening (finger no longer
visible in directly irradiated zones) .
It is important to use the density range 0.2-3 fully and
not only partially, due to underexposure or underdevel-
opment. as it often occurs, with the consequent loss of
contrast and resolving power.
A good radiog raph with a maximum of informations has
a density around 0.6-1 .5 in the "dominant zones that is
in the areas of more interest, provided density is ob-
tained with correct exposure and correct development
(see foll owing par.).
2.5.6. Underdevelopment effect (a common fault)
Fig. 28/2 shows the underdevelopment effects. Underde-
velopment does not exploit the useful density range.
thus reducing the available information .
Underdeveloped radiographs are grey, with poor con-
trast. and it is still possible to see the shadow of a fin-
ger even in di rectly exposed areas (see par. 2.5.4. point
3 page 51) .
Underdevelopment is a common fau lt. the main reason
underlying many radiographic failures. It is often caused
by exhausted developer.
Correct development gives beUer radiographs and reduce
exposure times (see par. 2.5.8.).
-'
~-:l
5) Once the "optimal development time- is determined,
/7
- I --=i
Fig. 2812 (par. 2.6.6.) - Underdevelopment elfects.
Reduction of available Information due to partial utilization of
useful density range (d smaller than d'. e.g. d :: 1.5 Instead
01 3 as it shoud be by COtl'eCt doosity range utilization (see
par. 2.5.5.).
- Grey radiograpn due 10 reduced contrast (b smaller than
bl
- Reduced exposura latitude (e smaller than e').
2.5.7. Qverdevetopment effect
Fig. 29/2 shows the overdevelopment eHects.
Overdevelopment slightly increases fog . contrast and
speed and slightly reduces the exposure latitude.
Overdeveloped radiographs exhibit high contrast. strong
black and white tones and a deep blackening in directly
exposed zones.
Overdevelopment is preferable to underdevelopment.
52
/T---
'I
_
,
,, ......... .......
"
~ , /~
,
,,"
!-- -L..- e
l
____ ___ .J(~ J
, ,.--.
Fig. 29/2 (par. 2.5.7.) Oll8rdeve/opmenl effects.
Slightly increased log (c > c'). Increase 10 contrast
(b > b'). improved speed (a < a'). slight reduct ion in
exposure latitude (e < e'). lull utilizati on of useful density
range up to 3-4 and over.
2.5.8. Useful hints for good radiography and develop-
ment eHlciency control by the '<S8mp'e strip me-
thod (see paragr. 2.6.2. page 74)
1) It is important to remember that the radiograph ic
quality greatly depends on good processing in the
dark-room .
2) Each developer bath has its "optima l development
time- which gives the best radiographic results.
3) The "optimal development time.. gives a tolerable fog
level in unexposed films (denSity 0.1-0.2 see par.
2.5.2.3. page SO) .
Th is time allows to obtain maximum contrast and
complete exploitation of the usefu l density range. that
is the best radiographic quality.
4) "Optimal development time- is determined by the
-sample strip method-. Fig. 3OJ2 illustrates the me-
thod.
all the radiographs taken in that day shou ld be deve-
loped using that time.
Never take films out of the bath du ri ng development:
air oxidation may damage the radiographs.
The developer bath gradually loses activity during
operation. Table 11/2 page 75 gives indicative develo-
pment times for the various temperatures as a func-
tion of the number of films previously developed
(average size 24 x 30 em) for a bath capacity of 10
liters and proportionally for other capacities.
6) The developer bath has its own life, whether It is
. used or not.
In any case it is necessary to Change it every 2-3
weeks even if not used.
7) A common fault is overexporuse and undervelopmenl.
This produces grey radiographs with poor contrast
and poor information (see par. 2.5.6.).
It would be sufficient to reduce (for example to hal-
ve) the exposure time and to double or triple the
development time to find out the mistake and im-
prove the results.
8) Automatic processors eliminate most of these unde-
sired effects because development is carried out with
optimal time, thus avoiding underdevelopment.
9) A da ily evaluation of the "optimal development time
by means of the "sample strip method" is recom-
mended.
GllAROON(. .v.OIOl..OOY - ELECTRQUEOICINE

Fig. 3fJ/2 (par. 2.5.8) - Optimal development time determined
by the ooSample strip method_.
Cut from film a strip of abou t 2 II 18 em and make a devel-
opment scate by immersing the strip 2 cm deeper in the de-
veloper bath every 2 minules in order to have as a final re-
sult a lilm wh ich has been In the bath lor min: 18 (16+2) -
16 (14+ 2) - 14 (12+ 2) - 12 (10+2) - 10 (8+ 2) - 8 (6+ 2) -6
(4+2) - 4 (2+2) 2 (0+ 2) - O.
The ~optim81 development time- is that correspond ing 10 a
film log 01 0.1 - 0.2 (see par. 2.5.2.3. page SO).
2.5.9. Dosimetric control of 111m, development and auto-
matic 111m processor efficiency
A conventional rad iographic film exposed with a lung
phantom (equivalent to filter of 1 mm Cu) , blackens to
a density of about 1 (the average density of dominant
lone), with about 50 mA without screens. 1 mA with
tungstate screens and about 0.5 mA with rare earth
screens.
With a suitable dosimeter, as for example the one des-
cribed in fig. 84/ 2 page 94 , It Is easy to select these
exposure data.
If the density is lower than 1, the film or the develop-
ment are not efficient and a control is requested.
2.5.10. film s with blackening dose printed on the pack-
Ing box
tt would be a good rule for the films manufacturers to
Indicate also the film speed without screen in mA for
density 1, as well as the decay data, on the packing
box. In this way the film waste and discussions would
be avoided.
The film speed expressed according to DIN or ASA me-
thods is insufficient. because it refers to visible light and
not to X-ray.
Fig. 31/2 (par. 2.5. I I.) - Screen -grid radiographs 01 the sinuses using an 8 1 grid ratio Potter-Bucky diaphragm and exposed with
the same factors.
A, employing no cone: e, large cone: C. 8-inch cone; D, 6-inch cone. Factors: 70 KvP: 60 mAs: 36-lnch FFD; average speed screens.
Note that, as the anatomical area Is restricted by the cone, the overall density of the image decreases. (From Fuchs).
GIlARDONI. RAOIOlOGV - ELECTROMEOICINE
It would be better to indicate the -m A film value, for a
given density.
We introduced the system of exposure on the basis of
the film dose in industrial radiography many years ago
with success.
2.5.1 1. Effects of scaHered radiations: tog increase and
contra. t decrease
The scattered (or secondary) radiations are produced
when the primary radiation (focu s radiation) interacts
with low density material, such as water, human body,
etc. (fig. 3212 page 54) .
Scattered radiations have no specific direction and are
detrimental to the radiographic image. because they fog
the film reducing the Image contrast and consequently
its information power.
Scattered radiations Increase with the thickness and vo-
lume 01 the Irradiated parts and with the radiation energy
(kV).
Diaphragming and use of cones reduce scattered radia-
tions, as fig. 31/2 illustrates.
2.5.11.1. AntllCllHered gl1cts. grids factor Met clean-up
The grids is the best system to reduce scattered radia-
tions and therefore the detrimental fog in medical Aadi-
ology.
X-ray grids trap scattered radiation improving diagnostic
quality (antidiffuslon effect or clean-up effect).
Fig. 3212, page 54, illustrates grid action.
X-ray grids are a piUar of diagnostic radiology; without
them Aadlology could not have reached such a high
point of development as nowadays.
Scattered radiation is low and not prejudicial with thin
parts; It is instead high and prejudicial with thick parts
like skull, abdomen. pelvis, etc.
53
 I IIII

I,
~
'. -.
~ kV .-r H'"
.... ,
, '"
70kV ,k' .

10QkV
c.,1
-
!
; .. I I I
i
o A.t lo ~ ,. I
~

Fig. 33/2 (par. 2.5. 11.1.1., - Xray grids efficiency (gr;ds
graph).
Primary and scallered radiation in lunctlo n 01 the rati o lor
100 kV, 75 kV and 50 kV. Measuremen t according to NB$-89
- USA ; water phantom 20 cm thick, 30 )( 30 em size equi-
valent to the skull p.a. or abdomen 01 normotype person.
Fig. 32!2 (par. 2.5. 11.1.) - I) Radiallon source (focus), 2) ana Primary rad laUon unoer the CUf\IM, sca tt ered one above the
lomlcal part, 3) X-ray grid, 4) film. curves (log).
The values sre practically valid IOf any kind 01 grid. Grid ra -
X-ray grid is composed 01 lead strips (black lines in figure) tio, that is the rallo resulting between Ihe grid tl'1ickness
and aluminium, paper, plastic strips (transparent interspacing (strips heigl'lt) and interspace thickness. is the lundamental
material, white lines in figure) . and determinant lactor lor the c lean-up.
Lead and interspacing strips. are focused at tube focal spot
(focused grids). Comment
Dotted arrows represent sca ttered or secondary radiation
with no specific direcllon, absorbed by lead strips. while con- 1. With ratio zero. that is without grid:
tinuous arrows represent primary focused radiation easy - the primary radiation Is 1~ lor 100 kV, 34,. lor 75 kV
passing through transparent interspaclng malerial. and 67'" for 50 kV.
Primary locused radiation determines the useful radiological - T he scattered radiation is 85% lor 100 kV, 66'" lor 75
Image. kV and 33'IiI lor 50 kV.
Witl'l grid ratio 12 the primary radiation is about: 78'11t lor
100 kV, 86% for 75 kV and 83'" for SO kV.
2. In practice, radi ographs wltl'l 60%-90% primary radiatio n
2.5.11 .1.1. Grid ratio "~I and grid characteri zation (20%-10% scattered radiation) were till now acceptable.
3, Suggested grid ratios are:
.. r. is the ratio between strips height and interspace ratio 6 lor spot-angio device and utilization as free
th ickness. grid Of in radiographic cassette;
- ratio 12 lor Bucky.
If the strips are 2 mm. high and the interspace 0.2 mm
large (as in the grids with 103 lines per inch , 4 per
mm) the ratio will be 10. 2.5.11 .1.2. Geometrical focusing
The strips height corresponds to the total grid thickness As shown in fig . 32/2, the geometrical focusing corres-
without covers. ponds to the locus grid distance when the alignement
of lead and interspace strips to focus is perfeclly real-
..,.... is a determinant factor o f clean-up. ized.
Higher ratio gives higher clean-up, higher grid absorp-
lion and more critica l grid centering.
The most used ra tios are r = 6 for spot, angio devices 2,5.11 .1.3. Practical focal range
and for other utilizations such as free grid , coupled with
radiographic cassettes and r = 12 for Bucky. A grid designed for a given geometrical focu sing has
practical applications in a certain focal range, detailed in
Clean-up, or grid efficiency, is given by the graph of table 3b/2.
fig . 33/2. The graph is the result of many measurements
made by Gilardoni Resea rch Laboratories on grids of
different types and manufacture according to the instn.JC-
l ions given in "USA Handbook No. 89 of National Bu- 2.5.1 1.1 .4. Characteristics and applications of classic X-
reau of Standard (NBSh ray grids
These measurements show that the radiological factors
stated by NBS Handbook 89 (transmission, Bucky effect, Table 4/2, page 56, gives these data.
selectivity and contrast improvemen t) with same ratio,
are practically the same for all grids, both in aluminium
or organic interspace, indipendenl'y of strips/ inch num-
ber. 2.5.11 .1.5. Grid density or number of lines/inch or c m
Modern grids are aluminium interspaced , (N)

Grids graph of fig . 33/2 is the practical basis for grid Table 5/2, page 56, gives the chronological progress of
characterization and utilization. grids their density, characteristics and applications.

54 GILAROONI. I'I... OIOLOGY . ELECffiOMEOICIN E

Normally, grid density varies from 50 to 150 lines/inch,
that is from 2 to 6 lineslmm.
Gilardoni has also developed a grid w ith 200 lines/inch
(81mm), which is used for special purposes.
50 lines grids are used in Bucky.
100 lines grids are used in Bucky and as stationary
grids. In stationary utilizat ion , the diagnosis is dis-
turbed by the residual strips images.
150 lines stationary grids are completely invisible; they
are also universally used to replace the moving
grids in Bucky.
200 lines grids with Carbon-Fiber covers, or similar, are
used l or special radiographs without screens, in
scientific or industrial examinations and in Mam-
mog raphy (see par. 2.5.11.4 . page 56) .
2.5.11.2. Bucky to cancel strips knItge
..Bucky", a mechan ism in which the grid moves during
the exposure, was created to cancel strips image.
It is a sophisticated device that may produce prejud icial
vibrations, geometrical enlargement and unsharpness. It
does not allow short time (ms) radiographs w ithout leav-
ing disturbing lines on the image.
2.5.11.3. StaHon.lry grids wtth invtlfbh Itnes:, a dream
tor Radlologltts
To overcome the d isavantages 01 Bucky moving grids
has always been a great desire of Radiologists.
Table 5/2, page 56, shows the Ch ronological progress of
the grids through whIch appear the efforts made to
have invisible stationary grids.
Gilardoni was the first to realize Invisible stationary grids.

TABLE 3b/2 (par. 2.5.11 .1.3.) - Grids focal range

i
The grids focal range is established by the formula:

f, f,
f, ~
12 = f'
1
+2 10 V,
1
_ 2 fo V2
R 'L R L f'

~ "
10 = focal distance Where:
f, ~
lower limit
'2 = upper limit I
V,= loss of primary rad iation at the lim it f,
V2 = loss of primary radiation at the lim it 12

""'''''~ ' ' ' ' ' \

R ~
Grid ratio
L ~
w id th of grid
.

Focusgrid distance limits (g rids l ocalrange) in lunctlon 01 R, 10 and L, with 50% loss of primary radiation at the grid
edges (normally admitted) evaluated through the above formula.

. '" 10 - loca l dlal8n<:f1

om - In. em 18

44-250
In. 7
1798
="
49-156
in. 9'12
19-61
L _ aR lO WIOTH

om 30
53-127
In. 12
21-50 55-117
= 35
22-40
in . 14 om"
58-106
in. 17
23-42
75 30
100 40 52-1430 20-563 59-335 23-132 64-225 2s.a9 66-192 27-76 72162 28-64
R S 150 63-~ 25- ~ 73- ~ 29- ~ 82_ 32..... 87-525 34-207 95-358 37-141
60
180 70 67 00 26- ~ eo- ~ 31 - 00 90- ~ 35-~ 971290 38-508 lCMHlOO 42-236
75 30 49156 19-61 54123 21-48 57-109 22-43 59-100 23-41 61-96 24-38
100 40 59-322 23-127 66-208 26-<12 70-172 2""" 72-161 28-63 78-141 31 -56
R8 150 74- ~ 29- ~ 84.... 33-268 9J.<l95 37-1 56 97.-326 38-128 104-268 41-106
60
180 70 80- ~ 31- 00 93-3000 371181 103-720 41 -283 109-514 43-202 118-375 46-148
75 30 53-129 21-51 57-109 22-43 60-100 24-39 62-94 2<h'37 64-90 25-<l5
100 40 64-227 25-89 70-172 28-08 75-149 J<>.59 78-141 31-56 81-137 32-54
Rl0 37-156 1()0.3()() 39-118 41-104 111231 44-91
150 60 82-882 32-347 93-395 105-263
180 70 90- ~ 35- ~ 103-720 41283 112-450 44-177 119-367 47-144 127-310 50-122
75 30 56-115 22-45 60-101 24-40 6295 24-37 6491 25-30 65-88 26-35
100 40 68-185 2773 74-154 29-61 78-139 31 -55 81-132 32-52 84-123 33-48
R12 150 35-191 99-312 39-123 106-258 42102 110-234 116-211 46-83
60 89-484 43-92
180 70 98-1060 39-417 111-474 44-187 120-360 47-142 126-316 50-124 133-277 52109
75 30 59-104 2341 6295 24-37 64-90 2535 66-" 26-34 6785 26-33

"...
100 40 73- 159 29-63 78139 31-55 82128 3250 84-123 33-48 86119 34-47
R1 5 150 96-341 38134 106-259 42102 11 3-224 116-211 46-83 122195 49-77
60
180 70 108-545 43215 120-360 471 42 129-300 51-118 134-273 53107 141 250 56-98
Example: lor a grid Rl0. 10 - 40 In , (100 cm), L - 12 In. (30 em) the local ran ge IS 30-59 In. (79-149 cm).

GI..AR~1. RADIOt.OGY ELECTllOMEOICINE 55

 TABLE 4/2 (par. 2.5.11.1.4.)
applications of classic X-ray Grids.
-
Characteristics and TABLE 5/2 (par. 2.5.11.1 .5.) - Grids chronological
progress.

--
Scattered
GeomeI~1 Cenlenng R.tio
,"-
....
Goo radill1ion .v '-
focusing
w I"'"
,- "'"
Applications
moo
=
ellmlnatton
"'" increase '" Stn~ Realized
AppilCltion
leelting
''''''
~
~
~- ""- ''''' '"
-- .",."'" ,." "'" ,,.,.-.
~

..
~
~~
Without
- 0 - ~ O
Thin ,~ ,
, " ,
grid parts
~, Mooring 8ucky

" 70 60-80 easy + 7 Spot

angio
Spot
"" "
,~
" ,
''''
..robott,lI
"um..,,,,,,
'" ''''
.'" ,."
,-,...
0.12 - . g Bucky
Mowing Bucky

_"II IkIcky

"
"-
tOO 60-80 easy - 7 Station."y Grit!
angio
~lIiR~

tSO 90-95
Lung tele-
radiography '"
1918
""""nium ." ,~

Starting 01 Invl.lble tlnM \Jrldl "

G i ~1Ioni SlIItionary IkIcky
St.t"""'Y Or.,
" easy + 7
and mobil
universal
,~ ,., "vml<>!um O.tO '.00 ,., Gi..rdoni
"""'''
""'mroogrllJl/1y
12 tOO 70-90 accurate +12 Bucky Threegrld allCky; R.tio 6.
12 tSO 70-90
''''' '" 12.20 Gilardool H.O Uni_...,
'aIIiog"'JI/1Y
accurate +12 Bucky ,~
Grit! Rotio 20
lint 30 ~ I!IO em with
Entire '" er"..
hOmogenlling .oJ ~
G ilarooni H.O S!lint
tet.<1odiogr.p/1y
12 200 7()-90 accurate + 12 spine tele- GriCI ~
radiography "" ot.onIIAn;t taIIiog'lIlII. 50 kII. 0 1 Gila_ OuItlity
-~"
Cross grid Entire
20 200 95-97 accurate +17 spine tele- A ..Gllardoni Grid 150 t i nes~ ratio 10, size 17
, 17 ,
radiography Inches (43 43 em), I, oompooed 01 5200 strips: 2600
Aluminium strips, 0,12 mm thick. 1,2 mm high, 430 mm
long and 2600 lead strips. 0,04 mm thick. 1.2 mm high.
430 mm long
Perfect allgnmenl. locusing Ihelng 01 5200 01 th.,.
strips require a very accurate engineering.
Strips thickness
'""
alignment mUSI be elttremety exact;
'""
the allowable tolerance is ot the OI'der 01 1/1000 mm.
This
grids. "
000 0 1 the reasons lor the high cost 0 1 tn.,.

The cross hatch varslon 0 1 the 150 lines/inch grid

2,5,11.4, Invisible statio nary 150 lines grids have greater
information pow er than 103 ones
As tab. 5/2 shows. since 1960, 103 lines grids (4/mm)
were used; it was a remarkable step forward (0 reach
the task of inviSibility.
Neverthless. the radiologist was not satisfied because
th. lines, still visible, distu rbed the vision and limited
the perceptivity and the amount of usefu l information .
Perceptivity comparison between invisible 150 and 103
lines grids stated that bone texture. fine structures of
lung tissue and o ther parts, small bone fractures etc,
"'. well p in-pointed by invisible 150 tines grids while
not by 103 lines ones.
Perceptivity and information power o ( 103 lines grids
rad iographs may be compared to the bad images with a
small number of elements for square mm (reticule) o(
the common news-paper figures, while those of the in-
visible 150 lines may be com pared to the good image
w ith h igh elements for un it area of the qualified maga-
zines (see comment of tab. 912 page 72).
The radiograph obtained with 103 tines grids is a ~mos-
a ic type image to be viewed at distance and does nol
evidence details.
Page 13 of handbook n. 89 of National Bureau of Stan-
dard U SA, reports about grids characterization: "When
the g ri d is used either stationary, or moving in a Bucky
that does not completely fade the shadows o f the strips
under a)) exposure conditions. a larger value of strips/
inch will reduce the visibili ty of their shadows and
'0
improve the perceptibility in the radiog raphs.
(" lines pe, mm). utilized 10 .. Total BOOy Radiography
with Homograph ~ 94 It 36 (365 It 900 mm) described 10
par, 2.4.4. page 48. Is composed 01 6 It 6 ::: 36 focused
mlcrochannels pe, square mm (- 22.000 pe' square
InCh). These are values 01 the order 01 good composite
elements of printed images (reticule) .
A cross grid 0 1 this type. size 14 36 inches (365 , ,
900 mm) has 365 It 900 It 36 '" tt ,664.000 precision 10-
cused mlcrochannels 0,12 It 0.12 mm through which the
primary rad iation passes.
~Gllardonl Grid 200~ is utilized only ;0 Science 10-
duSiry for special radiographs without intensifying screens ,,"
and in Mammography (see par. 2.5.11 .14. page 62).
..GUardonl Grid .so- I, the optimal grid for Medical Re-
dlology. The 100 lines grids are obsolete.
2.5.11.4,1. Grids optimum and Aluminium grid filter equi-
valent referred to Interspace, eOYeO' material
and clean up
The graph o( fig. 33812 g ives the grid absorption (0<>-
posite of transparency) in function of the G rid Ratio.
The graph of fig , 33b/2 gives the g rid lines invisibility
and clean up in function of lines/inch (N).
A detailed comment to the figu res gives fu rther info rma-
tion about this matter.
2,5.11.5. Scattered radiations In function of air-gap be-
tween radiographic cassette and patient
Graph of fig . 34/2, page 58, ill ustrates the matter.

56
GILAAOONI. RADtOl..OGY - ELECTI'lOMEOICINE
 COMMENT TO THE FIGURE 33a/2 AND 33b12.
AI-N75
1. The grid absorption increases linearly with the Ratio
V AI-N150 (Iig. 338/2).
{ Or,9-N150

-
5 2. Replacing the AI interspace with an organic one (card-
./ ;;;; Org-N150
board, plastic. etc.) the absorption filter mm AI eq . wi th

Filter eq
mmAI
L.....

.....
7
--
I.--
7 AI-N200
Org-N200
geometrical Ratio 5,
Ratio 10 AI eq. from
ferential AI filter eq.
small fraction of the
the lead content
from 2,5 mm becomes 2 mm AI , wi th
5 mm becomes 4 mm: that is: Ihe dif-
betwoon AI or organic interspace is a
grid filter. substantially determined by

o , II is known that. with same Geometrical Ratio_ (interspace

5 Ratio Geom. 10 12
Fig. 338/2 (par. 2.5. 11,4. 1.) Grid Inherent absorption (oppo-
sl18 of transparency) in mm Aluminium IIlter equivalent lor AI
and Organic interspace. (Oriental ive vaIUltS).
Lead strip thickness/AI strips thickness about 1/3. (Common
Lead coolent). Standard ray of 75 kV. N .", IlneaIlnch.
Covers absorption not included and 10 be added to have 10-
tal lilter grid value: about mm 2 x 0,2 AI with AI covers aod
zero with organic covers.
Front radiographic screen has an equivalent filtration of
about Imm AI and Iront cassette coyer Is about 1 mm Al
thick. This 2 mm AI eq. IiIler prelerenlially absorbs the scat-
tered radiation, soller than the primary one, acting so as a
~grid liller- (dillorentisl absorption In function 01 mass ab-
sorption coelliclen\ IJ and wave lenght -' . See comment
point 2).
strips height/lnterspace strips thickness) , the -Radiological
Ratio- which determines the effective clean-up. is about ~
higher with AI interspace than with organic one: this is due
to the higher absorption coelllclent (1.1) of AI interspace,
compared with organic one. as the scattered radiation is sof-
ter Ihan the primary one and conSeQuently better absorbed
by AI than by organic.
In other words. with high N grids (150) AI interspaced. the
~Geometrical Ratio- 10 corresponds to organic interspaced
grids of ~GeometricaJ Ratio- about 12: therefore. as shown in
the graph. with same - Radiological Ratio- the absorblion 0 1
txrth grids (AJ or organic interspaced) Is practically the same.
This Is also confirmed by experimental measurements made
over more than 20 gri<1 types with AI anct organic Interspace.
3. AI inlerspace grids are stronger. cllmate--proof. unoeforma-
ble.
4. The two covers 2 x 0.2 mm AI common ly used. are a neg-
ligible, small fraction of the total filter and are preferable to
the organic covers because stronger and c limale--proof (-.AII-
Melal. grids).

5. The line! grid Invisibility is beller reached by AI Interspace

than by organic one because late determines disadvantage--
lineslmm 4 6 8 ous higher contrast between Pb and organic Interspace due
100%
~~~i.-"'?-;:--/"'1:;":::::_:-i 100'. to the lower absorption of organic compared 10 thaI of AI
one.

50 "1. If-___~
c'.~"~"~"==~I~~~l-~ ____~ 50'1.
8. Conclullon.
8.1. AlumIn ium Interspaced grids are preferable for stationary
I invisible high lines grids (N 150).
8.2. Organic Interspaced grids are preferable for low lines
moving Bucky grids (N 50-75) considering however. the rele--
vant Bucky disadvantages (movement. elc.).
linerinch ( N) 100 150 200 8.3. The "Optimum- in stationary Invisible grids is 150-160
hnesllnch. (Fig. 33b12 Right compromise between invisibility
anct clean-up).
8.4. ~AII-Metal . grids with AI Interspace and AI covers are
preferable because the results are compa rable to those of
Fig. 33b/2 (par. 2.5.11.4.1.) - Stationary grid lines Invisibility organic in terspace-covers grids but also they are stronger,
and clean-up in functiOn of lines/inch (N). (Orientative values), climate-proof. undeformable and right invisibles.
Graph shows the ~Optimum . between lines invisibility and Nearly all used invisible high lines grids are ~ AII- Metal . type
clean-up Ihat happens al about 150-160 linesllnch, 6 per with AI interspace and AI covers.
mm.
Even with good Quality printed figures, lhe reticule, elements
are about 8 per linear mm; below such values the viewing is
disturbed (see Comment).

2.5.11 .5.1. Sca"ered radiations In lungs radiograph and

their elimination with suitable grids
Fog has two negative effects: first. less perceptivity due
to less constrast (as if the observation were made with
dark sunglasses) second. the morphology alteration of
the image.
Figs. 35/2 and 35a12 , page 58, show the advantages
reached using 150 lines invisible grid.
Table 6/2, page 59, shows the quality and the informa-
tion power in lung radiography through different me-
thods.

GILAROONI. RAOIOt.OOY - ELl:CTllOMEDlClNE 57

 2.5.11.6. PrinCiple and advantages of " Double Grid Ra-
'0 aD 3D 40 ~ diography" DGR system.
I
aD Fig. 3612 shows the prinCiple and fig. 3712 and 37a/2,
page 60, a practical utilization of DGA system in skull
BO - I
rad iog raphy.
The skull rad iograph of fig. 37a/2 is taken with 2 grids:
70
one, ratio 12, in the Bucky and a second invisible grid
BO 150 lines, ratio 6, closely coupled to the radiograph ic
casselle with strips set orthogonally to those of the
eo ~ eo
Bucky grid.

40 I-
'\ 0 -.
The two grids operate as a cross-hatch grid having
arithmetic ratio 12 + 6 = 18 but effective radiological
"-
lr-..... r-....
ratio over 20.
3D
II ........ ~
In fact, the primary radiation passing through the mi-
aD crochannels of the cross grid is not affected by the re-
...... sid ual scattered radiations contained in the lami nar ra ys
passing through the single grid with linear web.
The high ratio of DGA system (r = about 20) reduces
% practically to zero the scattered radiations even for high
o aD 3D 40 eo diffusion parts such as lateral spine, abdomen of thick
em patient ecc. giving excellent results out of these parts
as well.
Fig. 34/2 (par. 2.5.1 1.5.) Scattered radiation in function of
a/r-gap befw96n radiographic cassella and patient.

Abscissa: air gap In em.

Ordinate: '110 sca tt ered radiation of the total radiation re- 2.5.11.7. Scattered radiations of different human parts In
ceived by the Iilm (IOC1"11) , different techniques
1) lung teleradiography without grids (see lab. 612, poin t 2,
page 59). Table 7/2, page 60, gives these data.
With cassella close 10 chest: the sca tlered radiat ion is
about 40% 01 the lo\al rad iation (primary 60"lI0).
With 15 em air gap. scattered about 35'lt1 and primary
65"'.
With Invisible grid 150 lines, ratio 6, coupled to the cassel - 2.5.11.8. Practical utilization 01 stationary Invisible
Ie: sca ttered about 3'110 and primary 97% (see rig . 35a/2). 150 lines grids
2) Radiography 01 th ick parts (skull, abdomen. pelvis, ele)
with potier grid fatio 12. II would be ideal for every cassette of the X-ray de-
With cassette close 10 the Bucky grid: scattered about
15'110 and primary 85'110. partment to have its own incorporated invisible grid.
With 5 em air gap between cassette and Bucky grid: scat- This would requ ire a large investment since the cost of
tered about 30% and primary 70'1t1. these line, high precision grids is high.
With second Invisible grid 150 lines placed close to the
cassette and whatsoe~er air gap: scattered about 5% and An economical solulion was studied to utilize one or
primary 95%. few gridS to be coupled with every cassette in Ihe de-
part ment.

Fig. 35/2 (par. 2.5.' 1.5. '.j - Convenlional radiograph of lung Fig. 358/2 (par. 2.5.11 .5.1.) - Same radiograph made with in-
on a thick patient (28 em) made withoul grid. visible Gilardonl Grid ralio 6.
Exposure: 62 kV, 18 mAsec, 180 cm. tungstate screens. Exposure: 70 kV, 18 mAs6C. 180 em, tungstate screens.

The..8 kV increase compensa tes the blackening elimination caused by sca ttered radiat ion, corresponding to about 0.4 density.
The log density produced by scattered radiation in the radiograph on the lelt Is about 0,4 (see tab. 6/2 page 59).

58 GILARDONI. RADIOLOGY ' ELECTROMEDICINE

 TABLE 6/2 (par. 2.5.11 .5.1.) - Principal methods oJ
lung radiography (150-200 cm FFD) - Quality and
information power (indicative values). Optimum in
point 5.

I
\
Film radialiorl 'JIo t>ca nered Quality and
M~"""
,,-----~
_ .utt.red 01% . pIIm .y 33%
"'"""""
N
information pOwer
BUCkYG II~R
12 - - - - - - - ;"':'scatl.rtd 15% . pdm.ry 85%
!;oo"- Primary

Air g.p 1 Wilhoul grid OA NO GOOD

Grid R 6
__ K. It.rId 30% . prlm.ry 70%
- - - - - - - -;..:. tet n.red 5%. prlm.ry 95%
Film _ _ _ _ _ _- ' _
40%
"'" Elicessive scattered
l ig. 33/2
fog
I''''
page 54 aod lig.
3512 pa9' 56) .

Fig. 36/2 (par. 2.5.1 t.6.) - Double grid radiography (DGR)

The Rad iation emerging from a NBS water phantom 20 em 2 With 15 em 35% 65% 0.35 NO GOOD

""'" """'"-
of thickness at 75 klJ Is about 67% scattered and 33% prim- air-gap
ary (see lig. 33/2 page 54). Excessive scattered
In these conditions radiographs would be very bad and en-
.-,
cassette log. excessive enlar-
liscattering grids are required . gement and geome-
The radial ion passing through Ihe grid ratio 12 01 conven- trical unsharpness
tional polter bucky is about 15'1> scattered and 85% primary. (see fig. 3412 page
When radiographing thick parts as skull, spine abdomen. the 56).
air-gap between Bucky grid and cassette, particular1y with
inaccurate dlaphregmlng. produces a secood source 01 scat-
tered radialion In Ihe order 01 another 15% so Ihal the film 0.1 NO GOOD
3 With casselle
receives abou t 3()G)I, 01 scattered radiation and 7~ primary
one.
That is why the best radiographs are obtained with grids in-
i1 Bucky stand
with grid ratio
"'" """ 1. Dangerous wood
corporated in the cassettes and manulacturers try to reduce 12 panel absorption
to the minimum the poller grid-caasette distance. and excessive grid
The second Invisible GIlardonl Grid (150 lines/lnch) ratio 6, Ratio.
Incorporated In the casselle 01 DGR system. traps almost
completely not only the scattered radiation produced by 2.Dangerous inter-
Bucky grid-casaene al(1)8p. but also the one passing through space lorax cas-
lhe potter grid, thus determining very high quality radio- set-Ie and cons&-
graphs. quent enlarge-
With DGR system the lilm receives about 95~ primary radia- ment and ge0me-
tion and 5~ scattered radlallon (see table 7/2 points 5. 6. 7, trical unsharp-
page 60). n"'.
3.Cynetlc unsharp-
ness due to vibra-
Fi rst of all use a universal invisible 150 lines grid, size lions produced
35 x 35 cm ratio 6, locus 150, local range 110-300 cm by electro-mecha-
with Velcro coupling. nical device.
The Velcro is a special textile malerial used in sports- 4.lmage line distur-
wear instead o f zips: it Is radiotransparent, and does not bing in short tl
d isturb the radiographs. m, radiographs
A square 5 x 5 cm Velcro with beadhesive is fixed cen-
trally on the different cassettes.
Cou pling and detaching is instantaneous.
4 With 103 lines ,.. 9'% 0 QUITE
grids as Lys- ACCEPTABLE
Sma ll pieces of magnetized adhesive rubber on the cas- ho<m 103 "'" Dangerous lines vi-
sette corners may also be used. GUardoni 103
The universal Invisible grid 35 x 35 cm, rati o 6 is util-
IZed as single grid lor lungs, limbs, shoulders, etc; and
ratio
sibitity reducing per-
ceptivity aod in-
tormatioo powe!
as a double grid in DGA system for skull, pelvis, lateral
spi ne etc.
Al1er viewir.g the surprising results other sizes of grids
shall be required depending on department needs and
()(ganization.
.,
5 With invisible
Gridgil 150, ra-
tio incor-
porated or pia-
3% 9'% 0 EXCELLENT i""
lig. 35aI2 page 58)
Complete elimina-
lion of scattered ra-
ced close on- diation.
to the cassette
2.5.11 .9. Tomography and oblique projections with OGR Complete ellmina-
lioo of line grid
system image.
For DGA system it is suggested to place the second
grid coupled with the cassette with the strips orthogonal
to those of the potter grid to obtain the advantages o f
the cross grids.
Skull. abdomen
without grid
'0% 30% 0.' WORST

(referen ce ex-
Cross grids are not usable for tomography and oblique ample)
projections.

GIlAAOONI. RAOIOLOOV ElECTROMEOICI NE 59

In these cases it is possi ble to place the second invisi-
ble 150 lines grid on (into) the cassette with the strips TABLE 712 (par. 2.5.11.7 .) - Scattered radiations
parallel to those of the Bucky grid (generally of 50-100 and inducted radiographic fog in different human
lines/inch) without inducing detrimental interference fi- body parts with different techniques.
gures (Moire figures) . due to the remarkably different
spatial frequence of the two grids. Film rad iation
Scal-
.hlred
Ouality and
N- p", Grid Ratio
"",.
tered
Pri~

m'~
'og
density
information
pO~'

2.5.11.10. Invisible grids allow the use of hard rays techni- ($C.) (pr,)
que to reduce patient dose and tube load
without grid 10 9D 0,1 Good
Due to their property to eliminate scattered radiations 1 Hand
6 2 98 0 Excellent
almost completely, the invisible stationary grids. single
or by DGA system, allow the use of hard rays tech- Foot, without grid 15 85 0,15 Acceptable
nique reducing therefore the patient dose and increasing 2
the information power (see tab. 7a/2). Elbow 6 3 97 0 Excel lent

without grid 2D 80 0.25 Poo'

3 Ko",
6 3 97 0 High quality
2.5.11 .11. Grids quality and their radiographic control _ 0,_
concerning uniformity and detects. Warranty without grid 40_ 60 No good
Lung
6 96 0 Excellent
Every purchased grid must be accompanied by its own
radiography for quality warranty, because disuniformity 12 (Bucky) 2D_ 80 0,3 Poo'
and defects of the grids may compromise the diagnosis. 5 Skull
12+e (DGR) 96 0 Excellent
Grids manifactured with soft adhesive or thin dry solder-
ing, particularly for large sizes and mobile use, may de- Abdomen, 12 (Bucky) 2D_ 80 0,3 Poo,
form in time, therefore it is suggested to control these 6 spin e a.p.
(norm otype) 12+6 (OGR) 96 0 Excellent
grids every two years.
Grids with compact laminated lead strips are preferable Thick abdo- 12 (Bucky) 30 70 0,_ No good
to those with electrolitical microporous lead strips, be- 7 men; lat.
spine etc. 12+6 (OGR) 5 95 0 Excellent
cause they have a beUer clean up and streng hI.

Fig. 3712 (par. 2.5.11.6.) - Conventional skull radiogflJ.ph Fig. 37al2 (par. 2.5.11.6.) - Same radiograph made with DGR
made with Bucky grid ratio 12. system with Gilardoni grid ratio 12 + 6.
Exposure: 65 kV, 100 mAsec, 1 meter, tungstate screens. Exposure: 72 kV, 100 mAsec, 1 meter, tungstate screens.

Th e 7 kV increase for the radiograph taken with the second grid compensates the blackening reduction due to the scattered
radiation (fog about 0.3 d) and to the inherent second grid absorption.
The fog produced by scattered radiation (O.3-0A d) is of the order of 30% - 40% the middle value of the practical useful density
range of the radiographic image (0.5-1 .8 d).
The DGR radiograph (right) has: better quality, larger image latitude and higher information conten ts.
The reproduction reduces the quality difference between the printed images compared with that of original radiographs.

60 G ILAROONI , RAO IOlOGY - ElECTROMEOICINE

2.5.11 .11 .1. Grids Acceptance Standard Radiograph ..:
perfect uniformity with density 1 20% at
60 kV
The Grid Acceptance Standard Radiograph .. (GASA) is
taken at 60 kV, Density 1 2QOm, without screens.
If the ",GASA" shows disuniform ity, defects and mottles,
the grid must be rejected, because it may compromise
the diagnostic results.
Films may have inherent defects themselves and also
developing machine may cause some imperfections.
To diflerentlate lilms and developing delects from pos-
sible grids delects, take the control radiogram with the
grid placed hall only on the film.
The exposed ha lf fitm without grid (darker) shows the
fil m defects and the half l ilm with grid the possible
added grid defects.
Gilardoni's grids possible defects are lower than film
ones and therefore absolutely negligible.
Every grid must be accompanied by its own "Accep-
tance Radiograph .. bearing: Grid number, N lines, focus-
ing cm, Ratio, kV 60 and measured Density.
Repeat the "Acceptance Radiograph .. with declared ex-
posure data , because on rad iographs made with higher
kilovoltage and lower Density, defects disappear, the "Ac-
ceptance Standard Radiograph" Is counterfeited and re-
sults compromised .
12 for normal work with standard ray (around 75 kV)
for classic radiography of skull , pelvis, spine a-p and
lat. stomaCh, abdominal organs, tomography etc., the
other of rat io 6 for. th in parts (li mbs) and high contrast
rad iography with soft rays lor kidney, gall-bladder, etc.
By superimposing the two grids ratio 6 and 12, a th ird
grid is obtained (cross hatch grid) of arithmetical ratio 6
+ 12 = 18 and radiological ratio over 20 for all parts,
even the very thick ones, hard ray technique and Dou-
ble Grid Radiography system (DGR) obtaining high quali-
ty rad iographs with the almost total elimination of re-
sid ual scattered radiation and with the maximun infor-
mation power.
Fig. 38/2, page 62, shows "Bucky Threegrids in practi-
cal utilization and lable 7a/2 gives its characteristics and
performances.
TABLE 7a/2 (par. 2.5.11.13.) - ~ Bucky Threegrids
with invisible, stationary, interchangeable Gridgil
150, ratio 6, 12and6 + 12 (Cross Grid, DGR).
Indicative values referred to the same medium film
blackening.
Vanatioo referred
to 70 kV. Ratio 12
G... Radiographic
~
Util\ul!on 0
scatter
TCI(:hniq ... 0 00
~"" 0 M,
OkV mAo "'- p rimary

2.5.11,12. Stationary Inylslble 150 Iinesl1nch grids, the

~ ~
"""
~

Standard Ray
grids of the futUre
" (about 70 kVj
Classic
All parts
05-30

With the invisible grids 150 li nes per inch (6 per mm), radiography
Medical Radiology is decidedly oriented towards these
grids lor stationary applications which also eli minate the
grid movement inside the Bucky.
, Soft Ray
High contrast
Limb, Kidney,
liver, gall, etc.
-, +20 -,. +5 2- 10

The stationary application requires invisible grids of the

highest quality because otherwise defects, disuniformities
, Hard Ray (OGR) AU particularly +,. 0 +35 +15
,.-,5
etc., would not be reduced by the movement (as in the + Complete scat-
ter elimlnatlon.
thick parts +20 -4 +5 - 20
+4{)
I=: -3<J -60 ,..
case of Bucky with mobile grids) and radiographs would
result damaged.
" dose reduction +&l , -60 - 65 4'

The invisible grids allow the application of "Double Grid Evaluation through the fOllowing experimental data:
Radiography" system reducing the radiographic logging ') t5% kV variatiOnS = about 100% film dose varia-
caused by the residual scattered rad iations in thick parts tions.
such as abdomen , skull spine, elc . from 30% - 40% to
5%, thus substantially improving rad iographic quality and
2) Fm same film blackening . 15% kV variations
about 100 % mAs variatiOnS.
=
the consequent information power. 3) 150/0 variatiOnS =
about patient dose varia-
tions.
4) Tube load = kV . rnA sec.
"'"
2,5,11 .13, Bucky threegrids" with Inylslble stationary 5) Inherent grids absorption taken into account.
Interchangeable Gridgll 150, ratio 6, 12 and
6 + 12 (cross grid)

For years was envisioned the possibility of using Bucky

with interchangeable grids having different Ratios to im-
prove the rad iographic quality and to decrease the pa-
tient dose, as well as the tube load according to the
different util izations.
Some Firms had already manufactured Buckies with mo-
bile interchangeable grids of different Ratios but inter-
changeability difficulties connected with the mechanism
of grid movement and other problems have till now
preven ted their practical utilization.
The invisible stationary extra- thin Gridgil 150 lines/inch
(6 li nes/ mm) has made it possible to overcome these
difficulties and to achieve other important advantages.
Gilardoni has realized the .. Bucky threegrids>o with two
invisible, stationary, inter~hangeable grids: one of ratio
In future, "Bucky ThreegridS>t will replace the common
Bucky with a single moving grid allowing the lollowing
advantages:
1) General and substantial increase of radiographic qua-
lity due to reduction of residual scattered radiation
(15+ 30%) according to the examination needs (dif-
ferent parts and thickness) .
2) Reduction of patient dose (3Q-:-6O%) and tube load
(40+8O%) using the suitable grid according to part
thickness and its scattered radiation (see tab. 7a/2).
3) Millisecond radiographs without lines shadow distur-
bances.
4) Elimination of the vibration caused by the release of
mechanical devices.

Gt LAROONI. RADIOLOGY - ELECTROMEOICINE 61

 5) Reduction of object - film distance, with consequent
reduction of enlargement and geometrical unsharp-
ness.
6) Efficient utilization of hard ray technique and Dou-
ble Grid Radiography system (DGR)>> with cross grid
ratio 20 for thick and highly scattering parts.
The use of stationary invisible grids requires the grids
to be very high qual ity because defects, disuniformily
etc. would nol be eliminated by grid movement, as it
occurs in a common Bucky: radiographs and diagnosis
would be compromised if the grids are not perfect.
Warranty with ..Acceptance Standard Radiograph,. of each
grid is a must (see par. 2.5.11 .11 .1. page 61).
Fig. 38/2 (par. 2.5.1"'3.) - ToIag!1
Universal radiographiC stand providing conventional X-ray pi"O-
oedures and teleradiography: It assembles the ..Bucky Three-
grids equipped with two grids ISO Hneslinch ratio 6 and ra-
tio 12 allowing also operations with the two grids Crossed.
The crossing allows to reach an arithmetical ratio of 12 + 6
= 18 and a radiological one over 20 (see par. 2.5.1 t .6. page
58). Bucky T hreegrids has autocentered cassette. 17 x 17
Inches (43 x 43 cm) holder and automa tic exposure meter.
The grids are easily and Immediately interchangeable.
2.5.11 .14... Gllardonl Grldgll 200 GX". Stationary Invi-
sible lines soft ray grid for Mammography
(200 lines/ Inch)
The characteristics of Gilardon i 200 lines grid are: in-
terspace 0.1 mm Alu minium, lead strips 0,03 mm, focus
60 cm use range 40-90 cm, Ratio 3, grid thickness
62
0,3 mm total thickness with special ultratransparent covers
about 0,6 mm, inherent filtration about 0,7 mm, sizes 13
x 18 cm, 18 x 24 cm and 24 x 30 cm .
Fig. 38a/2 reports characteristics and applications of soft
ray grids ratio 3 and 6.
200 lines are required to cancel the image of the strips
without screens or with a single screen as used in
Mammography.
Because of the soft radiations and the large transparen-
cy variation of the breast, the kV choice is critical and
a variation of 1-2 kV may vary the film blackening.
Therefore, in mammography, automatic exposu re is
recommended
Fig. 38a/2 (par. 2.5. 11. 14.) - Gilardonl mammographic grid
graph (orientatlve data).
(200 lines/inch. 80 lines/cm. AI Interspace. GX covers).
% P.S. - Primary (P) and Scattered (S) radiation (P under
the curves. S over the curves. P+ S ". 100) .
Curve 1. 27-30 kV. Beryllium window tube. 2.5-5 cm water
phantom.
Curve 2. 3S kV, 7.5 cm water phan tom.
Curve 3. 40 kV. 10 cm water phantom.
mm AI == Aluminium grid IIIter equivalent.
Acceptance: 10% Scattered and 90% primary.
For same Ratio. the grids with AI interspace have better
clean-up than grids with organic fiber interspace because the
lower energy of scattered Is absorbed more than the higher
energy of primary (Iiller anti scattered elleet. due to specific
absorption coe ff icient 01 materials function o f radiation
energy).
CONCLUSION
1. Grid Aatio 3 is useful in any case because, with only 2.5
cm breast th ickness and 27 kV. scattered without grid is
about 25liii0 and primary 75% (curve 1).
2. Grid Aatio 3 Is also uselul for breast thickness up 10 7.5
cm (curve 2, sca ttered 6%. primary 94%).
3. Grid Aat lo 6 Is useful up to 10 cm and over 01 breast
thickness (curve 3. scattered 6%. primary 94%.
Taking into account scattered acceptance of 20'lIo instead
of 10%. grids with Aatio 3 should also be sullicient lor
th ick breasts.
4. Grid ratio 3 requires about two times the exposure (Dose)
01 that without grid. that is x 2 mAs Dr about 10% kV in-
crease (+3 kV) and grid Ratio 6 about three times mAs
Dr about 20% kV Increase (+6 kV).
5. Best results are obtained by incorporating the grid in the
cassette thus eliminating the cassette cover scattered radi -
ation not al ways negligible.
Oll.AAOON1. RADIOLOGY ELEC mOMEDtClNE
The advantages of 200 lines grid are:
1) Better image quality, because the grid is placed in
an ideal position, close to the film (no scallered ra-
diation caused by air gap and plastic cover entrance
of the casselle). soft hard
ray s rays
2) Simplicity: casselle with incorporated stationary grid.
3) Immediate utilization in any pre-existing equipment. 3
4) No lines disturbance, possible in short time exposure
with Bucky.
5) No vibration for absence of any mechanical Bucky
device.

2.5.12. Soft rays and hard rays 0,2

FigS. 39/2, 40/2, 41 /2, 42/2 and table 8/2 page 64 illus-
trate the effects of soft rays and hard rays. their charac-
teristics. advantages and disadvantages.
Soft rays give a high contrast image with black and
white tones showing few parts of the object (short scale
with lew high steps. figs. 40/2 and 4212) .
Hard rays give a low contrast image with grey tones
showing many parts of the object (long scale with many
low steps, lig. 41 /2).

2.5.12.1...Soft Gil System" and ..Soft Gil equipment.. for

high Information power radiographs of bone
and soft tissues (muscle, tendons, elc.) with
soft ray technique and soft ray grids.
Soft Gil is equipped with high current and low tension
(up to 10 kV) condenser generator. with berillium win-
dow rotating anode tube, special film/ screen combina-
tion and sot! rays grid "Gridgil 2()(}0.
Fig. 3912 (par. 2.5.12.) . Radiograph 01 an aluminium 8-slep
scale taken with both solt and hard rays to snow dilTerent
absorption conlrast (see par. 2.3.7. page 45).
Soft rays coyer the U$Ellul density raoge of 0.2 to 3 (see
2.5.5. page 52) with 4 Sleps of high contrast (short
scale with lew high contrast steps).
Hard rays cover the useful density range With 8 steps of
lower contrast (long scale With many low contrast sleps).

Fig. 4012 (par. 2.5. 12.) A dallodt! radiographed al 5 kV.

Solt rays give a high contrast image with. black and white
tones but they show lew parts 01 the object (short scale
with lew high steps).
A high conlrast technique (soil rays) is suitable lor line
analytical investigation 01 thin objec ts.
It is possible to detect also the seedbox and stem struc-
ture with soft rays (5 KV) by increasing mA - second.
Obviously in this case the petals structure image is lost.
Fig. 4 112 (par. 2.5. 12.) A daffodil radiographed at 20 kV.
Hard rays give a low contrast image with grey tones but
they show many parts 01 the object (long scale with many
low steps).
A low contrast techn ique (hard rays) is advisable lor
inspection 01 thick objects with high transparence
difference.

GIl.AROONI . RAOIOLOOV ELECT~EOICINE 63

 Fig. 4212 (par. 2.5.12.) - Typic81 radiographs showing Shorl-$C8Je (Jefl, soli-rays) composed of few high contrasl sleps and long-scale
(right, standard or hard rays) composed 01 many low contrasl sleps.
Long scale radiographs give more total Inlormation and reduce the patient dose, as shown in fig . 2t /2 page 46 and in the corres-
ponding loot-note.
The reproducing reduces the quality dillereoce between the printed Images compared with those 01 the original ones, particularly in
long scale low contrast radiographs.
From Fuchs Handbook ~Principles of Radiographic Exposure an(! Proceasmg _ (Courtesy 01 Charles C. Thomas Publisher, Springlield,
Illinois).

The results are brilliant and highly informative.

Soft-Gi l system produces shOrt scale radiographs with TABLE 8/2 (par. 2.5. 12.) - Characteristics, adv8n ta~
few high contrast density steps; it is a precious analitic, ges, disadvantages of soft and hard rays.
detailed method and allows the following examinations:
extremities: hand, arm, elbow, foot. leg, knee, etc. N. CharacteristICS
Sot! rays Hard rays
(short acale contra,t) (long tea lll controsl)
skull: cervical spine, mandible, maxillae, etc.
nose. paranasal sinuses, pharynx, larynx, trachea and , Image black and wh ile 10- grey tones
all those salt parts, which cannot be deeply investi-
gated with the standard technique. '"
Fig . 42a/2 shows the Soft Gil equipment and fig .
42b/2 shows some radiographs obtained with Salt-Gil.
2
""""""'
''''' " "'""
high 000'

3 Rad iographic Short scale with long scale with ma-

scales few high contrast rf'I low contrast steps
steps

4 kV low high
, mA oec high ~w

Radiological
power
low high

RP ... K-mA-ky-5

7 Exposure high low

times

8 Patient do.. high low

9 T,be load high (large locus) low (small focus)

'0 5canered radia- low high (grids are na-

tions ""''V)
Frg. 42al 2 (par. 2.5.12.1.) - SO/IGII. 11 Utilization parts with low ab- thide. parts with high
Special equipment for soft-ray technique, 10-SO kV, high mA sorption cont rast as absorption contrast,
emission, rotat ing anode tube with Berillium window. 100-300 kidney_ gallbladder, as stomacl1 with be-
mAo. bmas' (mammogra- rium , angiography_
Special screen-film combination an(! invisible soft-ray Gridgil. P"y) lateral spine, etc.

64 GILAAOONI. RAOIOLOGY - Et.ECTROMa>lCINE

Fig. 42b/2 (par. 2.5. 12. 1., Applications 01 Soil Gil, special
equlpm&nt lor -Solt Rays RadiologY" (SfHiI IIg. 42a/2,.
Soft Gil equipped with 50ft rays grids (200 lineslinch) gives
high informative radiographs of hand. foot. knee. etc. and al-
lows a good study 01 bone and muscle pathology.
Above aod below: reproductions of radiographs taken with
Soft-Gil (right) and with con .... entlonal equiprTlef'lt (left).
In the middle reproduction of lingers radiographs taken with
Soft Gil: on the right: fine glass splinters. on the left: cyst.
The reproduction reduces the quality dlflerence between the
printed Images compared with those 01 the original radio-
graphs.
2..5.12.2. Exposure, skin and volume dose, dose contrast
and THVL with soft rays, standard rays, hard
rays, and homogenized total body radiography
There are four principal types of rad iog raphic tech niques
reported in table Ba/2. They are:
is produced by absorption difference of different silver
concentration in the emulsion.
Figs. 43/2 and 44/2, page 68, illustrate some applica-
tions of this method.

1. Soft ray (N . 1-12).

10-50 kV, Beryllium window tube. added filter 0,5 mm
AI, high contrast. short scale, utilized for analytic ex-
ams of small parts (limbs, rhinopharynx , trachea): in-
fonnation is available on range composed of few steps
with very high contrast extensible with pluriradiographs
differentiated between them of few kV each.
High skin dose bul small irradiated fields. therefore
small volume dose (see lable points 1-12).
Evidentiation of diagnostic elements otherwise lost In
standard technique on muscles, tendons. capsule, li-
gaments, glass and plastic splinters etc. exams.

2. Standard ray (N. 13).

50-100 kV, standard contrast, standard scale utilized
Jar rou tine radiography of all body parts; middle skin
dose and high volume dose due to large irradiated
area (see table point 13).
In angiography with rapid film changer, sk in dose is
within Ihe range of 10ths of R and volume dose is
within the range of l 00ths of A . liIer.
The new protecl ion concept of the ralio: benefits/risk
tolerates such high doses.

3. Hard ray (N . 14).

100-150 kV, long scale composed of many low con-
trasl steps but of great information range. low skin
and volume dose (see Table 8a/2 point 14) .

4. Homogenized Total BOdy (N . 15) . (Trunk 35 x 86

cm) (see par. 2.4.4. page 48)
100-150 kV, homogenized long scale through selec-
tive parts pre-filtration (Homograph); many low con-
trast steps, but great information range on lolal body;
lower skin and vol ume dose due to the selective pre-
filtration (see table 8a/2 paint 15 and comment point
3) .
Utilized for scoliosis, radiological T otal Body Check-
up and generally for - mass screening - (military,
schools, hospital acceptance, etc.).
2.5.13. Information recovery of too high density overex-
posed radiographs
Fig. 43/2 (par. 2.5.13.1.) - Example of Informallon recOWtl)' 01
OWJrexposed radiographs wi,h ,he me/hod of solt ray radio-
graphy of the film (Jehenson. LUCh tmans).
At Aadlographs of an electronic calcu lato r at 50 kV
(left) and 400 kV (r'lght) .
A2 Radiograph 01 the Rt !lim with soft rays.
Exposure data: 12 kV. 10 mA, 50 cm locus-film distance.
2 min. Agfa 0 2 film without envetope. Beryllium window
tube.
In radiograph R2 on the lelt the printed circuit is well visible
and In radiograph R2 on the right the inner electrodes of the
batteries.

Sometimes, some parts of radiographs are overexposed
(density 3 or more).
With too hig h density no worthy information is possible
by the exam ination at the conventional viewer.
The following par. describe two methods allowing the
recovery of a lot of in formation from too high density
radiog raphs, otherwise not utilizable.
2.5.13.1. Information recovery of overexposed radiographs
wllh the method of soH ray radiography of the
film
II consists in X-raying the overexposed film with soft
ra y technique (10-15 kV, Beryllium window tube).
The radiographic image of the film exposed to soft rays
2.5.13.2, Infonnation recovery of overexposed radiographs
with differential photographic reprint method
It consists in reprinting the rad iograph in a series of
photographs (4-6) with different exposure times so as to
obtain a scale of images with different blackening and
contrast.
Substantially, the methOd is an image decomposition in
different blackening ranges, some of which cou ld not
otherwise be perceived by the human eye.
2.5.14. Exposure and Image quality factors
Radiographic quality. that is, Ihe attitude of a radio-
graph to deliver useful information depends essentially
on two factors: contrast and definition. These factors

66 GILARDONI . RADiOlOGY - ElECTROMEDICINE

 TABLE 8a/2 (par. 2.5.12.2.) - Exposure, skin and volume dose, dose contrast and THVL with different radio-
graphic techniques. (Indicative values).

N. Technique P.rt Ttlk:k GriO FF D ExP<*olre H,.. Skin VO Irrad. VO. CoM THYL
T = Tissue Conlr.
B = Bone ""'" "'""
COofl.

- -
, 2
om
3
om
5 "6 mAo
7
mm AI

R
9
I
70
" " "
RI mRlcm om

"
, Soft-ray Hand lingers T
Hand fingers B
2
2
No
No
35
35
15-17
1S-2O
300
300
0,20
-
1,6
2
0,1
0,1
0,5
1
0,025
0,06
800
1000
0,4
-
2 Soft-ray a.p. hand T 3 Vos 35 22-24 300 0.28 4 0,3 0,5 0,2 1300 0,55
a.p. hand B 3 Vos 35 2&-32 300 - ' ,5 0,3 0,5 0,85 2800 -
a.p. hand T 3 Vos 70 2&30 300 0.31 2 0,3 0,5 0,1 650 0,.
3 Soft-ray a.p. hand B 3 Vos 70 32,," 300 - 3,2 0,3 1 0,3 1100 -
4 Soft-ray Wrist T 5 Vos 70 2&-32 300 0,32 2,2 0,5 0,5 0,18 450 0,65
Wrist B 5 V" 70 34-38 300 - 4 0,5 1 0.1 800 -
5 Soft-ray Elbow T 7 V" 70 32 38 300 0,35 3 0,' 0,5 0,4 420 0.1
Elbow B 7 V" 70 38-42 300 - 5 0,' 1 1,3 700 -
Soft-ray Shoulder T
Shoulder B
12
12
V"
Vos
70
70
4044
4&-50
300
300
0.39
- 3
3
0,5
1
3

500
850
0,'
-
TOM T 3 No 35 1S-2O 300 0,23 2 0.15 0,5 0,05 850 0,5
7 Soft-ray TOM 3 No 35 2224 300 - 4 0,15 1 0,2 1300 -
Soh-ray Lat. foot T
Let 1001 B V"
V"
70
70
2&-32
36-40
300
300
0,33
-
2,2
4,4
1
1
0,5
1
0,35
1,5
270
540
0,85
-
K .... T 12 V" 70 300 0.37 4,2 2 0,5 1,4 380 0.15
9 Soft-ray K ..... 12 Vos 70 "'"
4044 300 - 5,' 2 I 4 480 -
Femur T 15 V" 70 4&-52 300 0,41 ',5 3 1 ' ,5 560 0,'
10 Soft-ray Femur B 15 Vos 70 4&-52 300 - ',5 3 1 ',5 560 -
11 Soft-ray Cervical B
Max. face
12 V" 70 4&-50 300 0,40
3 1
660 0,'

Soft-ra y Rynopnarinx T
12 Trachea 10 V" 70 3&-42 300 0.37 5 3 0,5 2,5 500 0.75

4
Standard Pelvis B 100 50 0,. 24 1 large
13 (35x 35 em) 20 V" 70 2 5 30
lield
4,5
Hard-ray Pelvis B 20 Vos 100 100 12 0,25 24 1 2 12,5 large
14
(35 )( 35cm) 3
field
4,5
15
Homogenized
lotal body
Trunk
(35 x 86 cm)
20 Vos 2DO 100 50 3
0,12
medium 50 1 2
large
field

COMMENTS:
I) Volume dose (Vd) ill 1/3 . k . Skin dose in R . dm3 (1IIres) of Irradiated part.
Where k ::: C8 0,5 for soft ray tissue radiographs of: hand, elbow, foot, knee (white radiographic parts) and K ::: 1
evidentiated bone parts.
,"
In comparison, the Individual volume dose delivered by natural radioactive background is about 35 R . 1/year (60 pR/h).
2) Dose contrast (Dc) ::: Skin dose In mRlcm part thickness.
It Is an index of Imaging contrast; with soft ray radiographs Dc is hundredth times higher than that 01 standard and
hard ray ones.
3) Homogenized Total Body Radiography (point 15) reduces skin dose aboul 5 times and volume dose about 2 ti mes
compared with those 01 standard radiographs though areas and volumes of Homogenized Total Body are 3 times
greater: this is due to the selective preliltration of different parts (Homogenization) .

depend on about 20 other factors as indicated in fig . power, also determines radiographic otCharacter (see par.
45/2 page 71 . 2.5.12. page 63).
Radiographic dose (0 ) is given by the relation:

o = K . rnA . sec . kV5/d 2
that is, exposure is directly proporti onal to mA . sec
and t o the 5th power kilovoltage (kV) and inversely
proportional to the square of focus-film distance (d).
kV, besides strongly influencing exposure w ith its 5th
2.5.15. DIN Wire quality Indicator for Industrial radla.
logy
In industrial radiography of weldings, casted pieces, et c.
the official international Authorities state that the radio
graphs must be controlled with the DIN - indicator
(Deutsche Industrie Normen) .

GlLAROONI, RAOKlI..OGY - LCTROMEDICINE


Fig. 44/2 (par. 2.5.13. I.) - Information recovery of overell"-
pos&d photographs with solt rays proc&dures (see fig. 43/2
page 66).
Above, overellposed photograph: below, radiograph of over-
exposed photographic film .
The DIN indicator is composed of a series of metallic
wires, made of the same metal, having increasing dia-
meters and inserted in a plastic transparent envelope.
This DIN indicator must be radiographed and placed on
the piece being exam ined in front of the tube.
If, for example, on the radiograph of a 50 mm thick
iron piece, the thin iron wire of the 0,5 mm DIN indica-
tor appears, the resolution of the radiograph is 1'Kt.
68
Official Norms fix the acceptability of radiographs on
the basis of the DIN-IOI indications.
2.5.15.1 . IOI-GIL wire Image Ouallty Indicator for medi-
cal radiology
Gilardon l developed a similar IQI for medical radiogra-
phy; it is illustrated and described in fig. 46/2 page 70.
Practical experience suggests the following composition
of IOI-GIL: wires diameters: nylon 3-2-1-0,5 mm, Alumi-
nium 2-1-0,5-0,25 mm and Copper 0,2-0.1-0,05 mm, pta-
ced into a plastic transparent envelope at 10 mm from
each other.
Nylon absorption may be compared to that of soft tis-
sues, that of Aluminium to that of bone and thai of
copper to that of foreign metallic bodies (splinters, nee-
dles, etc.l .
The IOI -GIL of fig . 46/2 has a different compOSition ,
now replaced by the new one, as above ind icated.
2.5.15.2. Indicative values of radlotoglcal resolution power
determined by 10 I-GIL. Radiography 0,5-1 %
Fluoroscopy 4-8% - TV Fluoroscopy 2-4'% -
Digital Fluoroscopy 1-2%.
They are reported in the title.
2.5.16. Resolution evaluation using Line Pairs/mm method
This method is described in par. 3.7.2. page 143 with
other X-ray patterns for the evaluation of the focal spot
size, Modulation Transfer Function. etc.
Line Pairs per mm Is a good and practical method for
quality evaluation (see table 9/2 page 72 column 3).
2.5.17. Modulation Transfer Function (MTF) for contrast
evaluation In function of spatia' frequency
When an Image is passed through an acquisition system
it is obviously affected by the performance of the sy-
slem itself.
The image quality of an acqu isition system like the digi-
tal flu oroscopy, depends on the properties of the video
image chain , as well as on the design of the dig ital
processing system. Every component of the imaging
chain should be evaluated and optimized to obtain the
best results.
Before optimization a component has to be character-
ized . Typical component of the imaginin9 chain are the
image intensifier and the TV camera.
They must be characterized also in terms of loss of
spatial resolution on contrast transfer function.
The spatial resolution is measured in line pairs per milli-
meter (Iplmml, considering each pair formed by a black
and a white line of equal width; in this way a sort of
spatial frequency is defined, measured in pairs of lines
per millimeter or centimeter.
The contrast transfer function is a description of the
law relaung the btack and white levels in the image, at
the input of the component, to the corresponding gray
levels in the image, at the output, as a function of the
spatial frequency.
FOf many physical factors, the difference between the
grey Ievets in the output image corresponding to the
GILAAOONI. AAOIQlOGY . ELECTAO MEOICINE
 :~:
.r---~
=f - - I,..,.." 1 .-1
----- _ ,,.,; '~J

,. ,. ,.
Fig. 468/2 (pal. 2.S.17.) Example of Modulation. 'ransfer Fig. 48&/2 (par. 2.5. 11.) - Black and white levels at the Input
Function. that gives the conlfsst transler versus spatial of the video component (continllOU$ lina) and the corres-
frequency, 01 a component. ponding gray /e1lB1 behaviour 8t the output.

black and white levels at the input, decreases with the

Fig. 460/2 (par. 2.5. 17.) Slmp/f1 pal/ern thaI allows to corain
dillerenr spatial freqUflncy ~alU6s al dllfeffml positions.
increase of the spatial frequency (see fig. 46a/2).
If we assume the behaviour shown in fig 46a/2 as typi-
cal of a TV camera, this can be interpreted as follows:
at the lowest spatial frequency Fo, the contrast in the
image al the output assumes the maximum values, i.e.
at the output the electrical signal corresponding to the
input black level is that corresponding to the dark on
the monitor and the electrical signal corresponding to
the input white level is that corresponding to the maxi-
mum light level on the monitor.
The characteristic shown In fig. 46a/2 is referred to, as
- Modulation Transfer Function_.
Consider now a very simple pal1em (fig. 46bl2), to show
how the spatial resolution, or contrast transfer, is de-
graded passing through a component having the MTF
shown in fig. 46a/2.
At line a) , which corresponds a spatial frequency 01
1pl/ cm, the MTF 01 fig. 46a/2 gives a good response lor
the component, I.e., as shown in fig. 46c/2, the input
continuous line black and white levels, are quite correct-
ly reconstructed (dashed line) after passing through the
system .
At line b) , which corresponds a spatial frequency of
2pllcm, the system gives an image having only a 50%
of the original difference in gray levels between the
bjack and the white levels, at Its output (fig . 46d/2) .

-- ''''I'~f ,ro, '.v.1 Finally, at line c), which corresponds a spatial frequency
---- ."I'~I ,,,,,/0_' of 4pl/ cm , we assume the maximum degradation of the
spatial resolution and, consequently, we obtain an image
in which the original black and white levels are no
more distinguiShable, I.e. the original 100% grey level
Fig. 46c/2 (par. 2.5. 17.) Black and while Jovels respectively modulation , corresponding to the black and white, is
81 the input (con tinuous lina) and outpul (dashed liM ) of a
component transferred in a small percentage of the dynamic range
of the output monitor (fig. 46e12).
We could extrapolate this result to the limit consequence
thai a physical system presents a zero contrast at infini-
tive frequency.
-- 1-,.",, _ 1
-----o ..,I'~, I~ In conclusion, the MTF schematically shown in fig. 46a/2
characterizes a system. or a component, for image ac-
.- 'V"," ' ''''Y t-.! (,t . .....,.. " ' '- ) quisition that allows a good image transfer for the por-
.. ~"'Y""".' ''1 t'. "". ,~", MIA 1.".,/ tion presenting a smooth spatial variation, gives a quite
acceptable reconstruction of the portion of the image
presenting details of intermediate denSity, while it does
not allow to visualize the high density details in the
image at the output.

Fig. 46d/2 (par. 2.5. 17.) - Black and while levels at the input
of a component (continuous line) and the corresponding
gray level behaviour 8/ the outpul.
In practice, a convenient method to achieve the MTF of
a component is to use a microdensitometer to measure
the spatial contrast distribution at the input and at the
output image, respectively.

GlLAROONI. RADiOlOGY ELECTf'IOMEOICINE 69

 Fig. 4fJ/2 (psr. 2.5.15.1.) GI/ardoni Ima-
ge-Quality Indicator (1.0.1.) on gal/-blad-
der f adiograph (actual radiographic di-
mensions).
( Original radiograph is obviously better
than print9d reproduction).

l.a .I.-GIL is co mposed of a set of

d ifferent metal wires placed on a II-ray
transparent suppo r t (p lastic s heel.
cardboart, etc.) lit 10 mm. distllnce from
each other.
I.O. I.-GIL placed on the abdomen facing
the tube.
Abdomen thickfltlSS 20 cm, FFO 150 cm.
focus width 1.5 mm., 1.0.r.-GtL at 25 em.
from the film and Gall-bllldder at 10 cm.
from the film.
Exposure : 54 kV, 200 rnA, 1 sec.
rotating anode tube.
Practica l ellperience sug gests the
following composition 01 l.aJ.-GIL wi res
d ia m eters : nylo n 3-2- ' -0 .5 mm .
Alumin ium 2-1-0.5-0.25 mm lind Copper
0.2-0.1-0.05 mm, placed into a plastic
transparent envelope at 10 mm from 4
each Olher.
5 3 2 2 nom
Nylon absorpt loo may be compared to ny t o n AI
that of soft tissues, that 0 1 Atuminium
to Ihat 0 1 bone and that of copper to
thaI of foreign metlill ic bodies (splinters
needles, etc.).
The 1.0.i.-GIL of lig. 4612 has a different
com posilioo now reptKed by the new
one II! aboYe IOd.cated.

1) Resolution poww CICiIItCHiIm distllnce

The thin nest visible ,.,.. . . . .
Therefore ~ ~ ..... _ _ _
200 mm th ick II 1
co rresponds to a hIgt\
bladder stones may be ....
, ;;;;'':
...e .... - _
---".- s
:a.
r....
~
5a2S
- 2S
=
37
125
:: 0.3 mm

01 tne unsharpness o f rad iographic

. . __ ~ r.:Iiography and therefOft! it is
____ .

-
~

WI 01 "IIQh quality also from the poln! 01

2) Enlargement (E)

E = -'==::..::==-
Focus-film d. . . .
Focus-object ~

'::~~~;~:~~~;':

----
... ~ of AI wires images (2.7 density)
correspond
That is. theing wtoires
the ~ ~ . . 01 nykIn wires (1 .1 density).

-
distance of the wires " ~ __ .. .-.c ............ ICIe.-.ce 01 contrast: bonse-AI and
aClual distance of 1.0 I. _ all ...
The gall-bladder i~ --C
enlarged.

.~Il of contrast and definition. The

_ . ..
.......... -..oouced in figure Is of high quality
3) Definition

The wi re image i s ....... . . .

projectiooal geometry [1.50 c. ~
_

:
_
..
=:~_~:..
~

:.:JCe
.-.cI definition are good.
of contrast: the Images of nylon and
boch with a diame ter 01 1 mm have the
because they are determ ined by the
width). _ ~ geometry, but At w ire is more
The geometrical unste .. _ 1 ~ Myton wire because the former gives a
relation {see par. 2.1.7. ~ . . . . . . ____ uwn the latter.

70 GllAROONI. RADIOLOGY ELECTROMEDICINE

 SEll51T1V1Tl
I
DUINITION

,~, Yl1lA11011
n,i OUAliTl
Of UOlATlOil
KHllNS
Fig. 45/2 (par. 2.5.14).
Factor determining a
radiograph and ils
qualify.
Two fun damental
'"'""
M
MOlAnO!!
' .... IN IlSOLUIION
lacto r s: contrast
and definition, de-
O('I'ull'Mllll pendind on about
20 other lactors sc-
I
DUElO""UlT ,ob.L me 01 which in op-
position between
I '"''
100lllCl them. A good ra-
I
~'llll I ON TIM(
I
1(1l~tURl ltRENGTH
DliTlIIU diograph is the re-
sult of a correct
I compromise bet-
ween them.
I
2.5.18, Image elements per mmtq and cmtq, lines pairs A 15% kV variation corresponds to about one rad io-
per mm and em, contrasVdellnltlon evaluation graphic unit...
with IQI-GIL, information power and applications For an overexposed radiograph It is necessary to reduce
of principal diagnostic methods, Including CT, kV by 15% thus improving contrast.
US, NMR , ECT, etc,

Table 912, page 72, gives these data.

2.5,22. Explanation about keY, kVcp, kVp, kV, Standard
ray and Normal ray

2.5.19. PracUcal radiographic exposure data for different keY = Kiloelectron Volt energy of monochromatic radiation.
anatomical parts of human body kVcp = Kilovolt constant potential : used for polychro-
matic radiation.
These data are reported In table 1012 page 73.
kVp = Kilovolt peak : max value of pulsating voltage:
used for polychromatic radiation .
kVcp = 1.15 kVp In terms of the dose.
2.5.20. Methods to reduce exposure patient dose KV without other specifications, generall y means kVcp.
They are: Standard ray = 75 kVcp: conventional voltage value for
reference purposes; 75 kV allows radio-
1) Collimation (see IIg. 31/2 page 53) , graphs of all human body parts.
2) Tube filtration (2mmAI) . Normal ray = POlychromatic radiation value having the
3) Reasoned technique (exposure and positioni ng) . same quality of monochromatic one.
4) High tension technique (see fig. 21/2, page 46). Practically the kVcp of Normal ray are
about twice the keV (2 kVcp 5! 1 keV).
5) Fast films and fast intensifying screens use. Example: A 2400 kVcp generator pro-
6) Proper darkroom technique. duces the same effect of Cobalt bomb
7) Gonad shilding. tMt. as known emits monochromatic
radiations of 1200 keV.

2.5.21. Radiographic unit = 100% exposure variation

Photographic cameras generally have 2 exposure varia-
tion possibilities: exposure time and lens aperture. The
exposure ratio between 2 steps of these regulations is
1:2.
This because, if a photograph is underexposed, an in-
crease in exposure time of only 20-30% is not enough:
rt should be at least 100-200%.
Each step, representing a 100% exposure variation, is
called "photographic unit...
Also in rad iog raphy it is useful to operate with 100%
exposure variations (radiog raphic unit).
It is important to remember that exposure is a linear
function of mA . sec. and a function of the 5th power
of kV. For Instance. to correct an underexposed radio-
graph it is necessary either to double exposure time (or
mAl or increase kV by 15%.
2.5.23. Aluminium and Copper fillers with absorption
equivalence to different human body parts for
phantom, purposes, Examples.
Table 10at2 page 74. gives these data, wh ich are de-
rived from tab. 1/2 page 39.
Chapter 2.8. - RADIOGRAPHIC TECHNIQUE
2,6,1. Radiographic film
The main parts constituting the X- ray film are the tras-
parent support (base) and the two sensitive layers (dou-
ble coated 'ilm).
The support, generally of transparent plastic, on ly has
the mechanical function of su pporting emulsion.

GIlIDONI. RADIOlOGY EL.ECll'IOMEOICI NE 71

 TABLE 9/2 (par. 2.5.18.) 4 Image elements per mmsq, lines pair per mm, contrast/definition evaluation with
IQ/4GIL information power and applications of the principal diagnostic methods. (orientative values).

..
Resolution Information power

N.
"""""
,
,~

e"""".
""
mm"
Line
Pairs

""
mm
"""./
Delin.
IQI-GIL
Image
T,,,. Image
Quality
- "".
Radilll.

,
Synthelic

~-
.'" Analytic Dynamic """ ApplicatiOllS

2 J
-
5
conti 4
-
9
" "
-
"
Reproductions
1 Photography 1000 16
nuous ''''I
good
78",
good "'"
good
78",
good
(cine)

2 Printed 25 2.5 - conti 4 good - good good none - Reproductions

Figures nuous

3 Radiography
with ''''' 5 0,,,," conti4
nuous
78",
good
'ow ""'" ""'"
good good
"0'" medium Principal method with
TV Fluoroscopy. ~ 01
screens tOlal examinations
made with classic TV
".
Fluoroscopy and Rad io--
graphy.
, , , ,,. con ti- high fairly fa irly fairly 'ow With Rad iography ."
"""'"
Fluoroscopy nuous
000'
good good good tho principal methods
rad iography) . 0'
g ,.. conti-- fairly medium medium
I'"
g lial Fluoroscopy allows
TV
Fluoroscopy
' ,5
"uou. good
good good
"''''
,ood
also: enhanced image
technique, video subs-

Digital , t ,,. conti- fa irly 'ow good

traction angiography,
medium image processing. 111m
Fluoroscopy "uou. good
good
"'"
good saving.

5 Computed 0,5 0,35 - mosaic 000' high fairly 78", 00... high Skull I"", good) .
Tomography ,ood ,ood Abdomen (fairly good) .
(CT)
6 Echography 0,5 0,35 - mooa~ fairly good good 'ow Kidney, foetus , prostate
(US)
000'
"""" good heart, liver, g8l1blader,
etc.

7 Radionucllde 0,16 0,2 - mosaic medium poo< good medium Thyroid , fiver, eocepha -
Scanning
000'
"""" lon, ",.
mosaic none fairly good none Skull 4Research.
8 Nuclear
Magnetic
0,5 0,35 000'
good
''''I
high
Resonance
(NMR)
g Emission 0,16 0,2 - mosaic 000' medium 000' good 000' 78", Physiology.
Computed h~h
Tomography
(PET -SPECT)

'0 Compton
Compu ted
0.16 0,2 - mosaic 000' medium 000' good 000' medium Physiology.

Tomography
(COSCAT)

COMMENT:
Second column: Viewing physiology teaches that good Image
perception requires a minimum 01 about 25 elements per mmsq
reticu le (5 per linear mm) . This va lue Is that normally used in
good Image printing on line glossy paper, In qualified maga-
zines and for invisible X-ray grids, 150 lines per inch, 6 pef
mm (see par. 2.5.11 .13. page 61 ).
The image are of -continuous type- by normal viewing condi-
tion s.
Newspaper"! ligures are normally printed 00 rough paper, with
abou t 9 elements per mmsq (3 per linear mm): Ihe images are
poor and begin to appear of -mosaic typeoo.
Retlcul elements per mm of printed Images are easily measura-
ble with common magnifying glasses with millimeter scale (or
mm p8pef) placed on the image.
Third column: Una Pairs pet" mm value is hall the square root
of the value of the image elements. LP/mm Is measured with
test patterns reported in fig. 3.7.2. page 143 Bnd determines the
image resolut ion, that is, an index 01 definition.
Fourth column: Image Quality Indicator, IQt-GIL described in
par. 2.5.15. page 67 gives visible " of parts thickness and ai-
lows a practical evaluatloo of the resulting contrast and delini-
tlon of the radiological image.
II Is very simple to use. gives Immediate figures. and does not
disturb the rad iological Images.
Classic Radiography Is Ihe best static Image method and the
area beam Digital Fluoroscopy the best dynamic one; both are
the basis of medical d iagnostic and 90% 01 tota l ellamlnations
are made by them.
Digital Fluoroscopy,
-'"of 'ts
good Information pow."
(morphologic, dynamic, analytic), film economy, image storage
and recall , shall develop strongly and partially substitute Radio-
graphy.
Other methods. above all Ecography US, are very useful and
complementary for specific examinations, as Indicated
lumn . Apptlcatloos. '" ro-
Electronic scanned images, as CT, US, etc., have generally low
spatial resolution, that is. about 0,5-1 information elements per
mmsq (mosaic type image).
Tnese images are presen ted in a reducted scale,
-~.
presentation In actual anatomical size would be unacceptable.

72 GllAROONI. RAOIOlOGY - ElCTROMEOICI N

 TABLE 10/2 (par. 2.5.19.) - Orientative radiographic exposure data for normotype patient. ( For Radiological
Anatomy see also Part. 9 page 281).
1) Universal tungstate screens (with rare earth screens, exposures are 25 times reduced).
2) Three-phase X-ray generators (6-12 pulses); with monophase generators kV increase (about 15%).
3) 1 cm. thickness variation i!: 2kV.
4) 10 kV variation i!: mAs doubling or halving.

r<k FFO Th<k FFO

N. PART GriO ,V mAo rnA ~ N. PART Grid kV mAo mA ~
= om om om

1 Hand p.a. 2.' 100 no 35 7.' 25 0.3 18 nbia-Tarsus proj.

Hand lat. 9 100 no 10 100 0.1 a.p.
Tibia-Tarsus proj.
8 100 00 40 SO 100 0.'
lal. 7 100 00 40 SO 100 0.'
2 PhalanJ( 2 100 00 30 7.' 25 0.3
19 Skull a.p. and p.a. 20 100 60 lSO 100 1.'
3 Wrist p.a. 4 100 00 35 7.' 25 0.3
Skull lal. 100 " SO 100 100 1
Wrist lal. 6 100 00 '0 10 SO 0.2
15
"
20 Skull inf.-sup. proj. 25 100 65 lSO 100 1.'

Elbowa.p.
Elbow lat.

Shoulder a.p.
8
8

11
100
100

100
00
00

no
40

.
40
15
15

SO
SO
SO

100
0.3
0.'

0.'
21 Mandible 13 100
"
00 . SO 100 0.'

22 Teeth (Intraoral)
8 Cervical
Vertebrae a.p. 1. 100 40 100 100 1
Without screens
Teeth (Intraoral)
100 00 SO lSO 100 1.'

Cervical
Vertebrae lat. 13 lSO
"
no 65 20 100 0.2
Without screens
SO no 40 SO 100 0.'

23 Chest p.a. lSO no SO 0.04

Chest lat.
23
30 " 600
0.04
7 00""
Vertebrae a.p.
00",'
21 .00
" 55 100 '00 1
' SO no 65
" 600

lSO
Vertebrae lat. 30 100
" 60 100 100 1
" Children chesl p.a. 10 no 40
" 600 0.04

25 Heart p.a. SO 0.04

21 'SO 00
" 600

.
8 Lumbar
Vertebrae a.p.
Lumbar
19 100
" 60 100 100 1
,. Thoracic Ribs (8-12) 20 100 60 600 0.08
Vertebrae lat. 27 100 ,i 70 200 100 2 "
27 Esophagus p.a. 22 ,i 0.20
9 Pelvis a.p.
Pelvis lat
20 100
100
,i 65 100
2SO
100
100
1 70 65
" 200

.
33 70 2.'
" 28 Stomach a.p. 23 70 75 40 200 0.20
10 Children pelvis 100 0.04
"
9
" " 600
29 Intestines a.p. 23 70 ,i 75 40 200 0.20
11 Abdomen a.p. 100 lSO 100
Abdomen iat.
"
27 100 "" 60
70 lSO 100
1.'
1,' 30 Cholecystography
a.p. 19 100 ,i SO lSO 200 0.75
100 100 100 1
12 Femur a.p. 15
" 45
31 Urinary System a.p. 19 100
" SO lSO 200 0.75
13 100 100 100 1
Hip. a.p. 19
" 55
32 Pelvimetry a.p. 32 100 ,i 75 200 200 1
20 100 100 100 1
" CoceyK a.p.
Coceyx iat. 26 100 "" 60
70 lSO 100 1,'
33 Hysterosalpingo-
graphy a.p. 20 100 ,i 65 225 300 0.75
15 Knee a.p. and p.a. 12 100 no 30 60 100 0,.
Knee lat. 12 100 00 30 60 100 0.6 34 Chest Tomography
a.p. 23 130 ,i SO 200 200 1
16 Foot a.p. 8 100 00 40 30 100 0,3 Chest Tomography
Foot lat. 10 100 no SO 30 100 0.3 lat. 30 130 ,i 60 200 200 1

17 Tibia 35 Skull Tomography

and Fibula a.p. 12 100 00 45 SO 100 0.' a.p. 20 130 ,i 60 350 200 1.75
Tibia Skull Tomography
and Fibula lat.
100 no 40 SO 100 0,' lat. 15 130 ,i 55 350 200 1.75

GIlARDONI. RADIOlOGY - ElECTAOMEOICINE 73

Low temperatures slow down the action of the solutions
and cause underdevelopment and incomplete fixation
thus worsening radiographic quality (see par. 2.5.6. page
52).
Temperatures exceeding 26C. fog films and can alter
the emulsion.
The recommended processing temperature for good con-
trast and negligible fog is 22-24"C. Keeping solution
temperatures constant gives the benefit of standardized
processing times.
Di rect inspection of radiographs during processing is
not reliable and it negatively affects the quality of the
final image.
Instead, it is advisable to find the optimal development
bath time by the "sample strip method .. every morning,
as described in par. 2.5.8. page 52.
2.6.3. Essential steps in film processing
1) Stir developer and fixer solutions to get uniform
temperatures (use different spatules for each to
avoid possible contamination).
2) Check solution temperature with a good thermome-
ter (wash it before dipping it in each solution). Ad-
just temperature by means of a thermostatic device.
3) Load processing hangers avoiding touching, scra-
tching and bukling the films.
4) Pre-set development time according to developer
temperature (see table 1112).
5) Carefu lly immerse the film completely in one go in
order to avoid stripings. Start timer.
6) Agitate processing hanger withOut taking it out to
allow both film surfaces to be uniformly wet. Re-
peat every minute.
7) When timer stops, lift the film immediately and let
it drip for a while between the two tanks, by tilting
the hanger.
8) Immerse film in intermediate acid bath or in run-
ning water. Agitate developing-hanger vigorously.
Rinse fi lm for 30 seconds.
9) Immerse film in fixing bath. Agitate hanger vigor-
ously. T he film shall remain in the fixing bath for
twice the cleaning time (when its milky aspect has
disappeared) .
10) Put film in running water tank. Leave enough space
between processing hangers (water must flow over
the upper edge) . Washing has to be thorough: 20
minutes at least.
11) Place processing hanger with film a drying cabinet
or on a rack in light draught. Leave space between
films.
TABLE 11/2 (par. 2.6.3.) - Indicative development
times as a function of bath tamperature and pre-
viously daveloped films. (The temperature of
22-24OC is recommended as in automatic processor).
Films developed in 10 lite~ 01
(see text)
Temperature
0 30 60 90
18"C 7' 8' 9' 10'
2O"C 6' 7' 8' 9'
22"C 5' 6' 7' 8'
24"C 4' 5' 6' 7'
GILAADONI. RAOIOLOGV - ELECTAOMWICINE
2.6.4. Unsatisfactory radiographs, causes and corrective
actions
Table 1212 page 76 summarizes the subject.
Chapter 2.7. - FLUOROSCOPY
2.7.1. The fluoroscopic image
The fluoroscopic image is formed in the same way as
the radiographic one.
The fluoroscopic image detector consists of a zinc-cad-
mium su lphide screen which, when irradiated by X-rays,
shines with yellow-green light.
Fluoroscopic information is inferior to that of radio-
graphy for two reasons: firstly fluoroscopic viewing is
poor in contrast and defi nition, secondly fluoroscopy is
an instantaneous image while radiography gives an im-
age which builds up according to the exposure time.
Fluoroscopy is determined by radiation intensity, radio-
graphy by radiation quantity (dose). that is, by the pro-
duct: intensity x exposure time.
Fluoroscopic luminosity or brightness is low and the
image is to be observed in the dark.
2.7.2. Image Inlenslfler (1.1.) wllh dlrecl or TV viewing
To eliminate the disadvantages of poor luminosity in
traditional fluoroscopy, Image Intensifiers have been de-
veloped which allow to operate in normal light having
luminosity intensification factors from 3,000 to 10,000 on
output screen.
Fig. 48/2 illustrates the Image Intensifier (1.1.) principle.
(r.~.
:1'
'. .,_. __ ---
...::.:/><:::,
d
, ..
30 M~
'-_-j II ~ _ _...J
Fig. 4812 (par. 2.7.2.) - Image Intensifier (I./.) principle.
a) Fluoroscopic screen or input screen. b) photocathode
placed on input screen. c) output fluorescent screen,
d) etectron path.
The radiological image of the object is formed on the
input screen (a) made of Cesium iodide. The light emitted
by the input screen excites the photocathode (b) made of
Cesium antimonide.
The electrons emitted by the photocathode are accelera-
ted by high voltage (30 kV) applied between cathode
and anode and hit the output screen (c), producing an
solution image 3.000-10,000 times brighter than the original.
Suitable electrodes operating as electronic lens deter-
mine the image focusing on the output screen.
120 The most common types of 1.1. have an input screen
diameter of 23 cm (9 in.) or t5 cm (6 in.) and an output
11' screen diameter of 2 cm (3/4 in.).
10'
9' It is possible to use 1.1. in direct viewing by means of
an optical enlarger or through a television system as
8'
shown in fig. 49/2 page 77.
75

TABLE 1Qaf2 (par. 2.5.23.) - Aluminium and Cop-
per lurers with absorption equivalence for different
human body parts for phantoms purpose (see also
tab. 1/2 page 39).
Absofplion coefficients (water = body tissues - 1)
carried out. When drying, the gelatine layer returns ap-
proximately to its original thickness but. swelling, it tends
to become fragile and easily damageable. Excessive
swelling can be limited by hardening the gelatine during
production; this operation, however, cannot be exagger-
ated, otherwise the developer action would be delayed.

"50 ",V Water

, ...,..'" Culwatllf
""''' 2.6.2. PracUcai hints for good radiographs
25 '0 350 35
Besides those recommended in par. 2.5.8. page 52 the
75 37,5 1 6,5 200 30 following suggestions should also be considered.
'00 50 1 5 100 20
125 1 4 70
'50
62.5
75 , 3,5 50
17,5
14
2.6.2.1 . Film storing

Radiographic fil ms are very delicate and sensitive to dif-

ferent physical elements: heat, moisture, electromagnetic
With reference to Standard ray of 75 kV, keeping the radiations (light, X-rays, beta rays, gamma rays) . Furth-
same thickness, AI absorbs 6,5 times more than water
(or human body) and Cu 200 times more than water. ermore, time itself alters the film properties.
Cu absorbs about 30 times more than AI. Consequently, avoid leaving films in places where chem-
Examples: i-cals are kepI. Keep films in a cool, dry place free
1) P.A. skull, thickness 20 cm; water equl...alence 200 mm from ionizing radiation (fig. 4712). Boxes of X~ ray films
should always be stored upright.
At 75 kV absorption equiv. A' 30 mm (20016,5)
At 75 kV absorption equiv. Cu 1,0 mm (200I200)
At 50 kV absorption equiv. A' 20 mm
At 50 kV absorption equiv. Cu 0,6 mm.
2) PA lung. thickness 23 em, (1/2 tissue and 1/2 air):
waler equl ...alence 115 mm.
At 75 kV absorption &qui .... AI I. mm (115/6,5)
At 75 kV absorption &quiv. Cu 0,6 mm (115J200)
At 50 kV absorption equiv. AI mm
At 50 kV absorption equiv. Cu 0,3 mm. "
All other body parts may be considered water absorp-
tion equivalent.
For standard e...aluations. IiIter phantoms of AI 20 mm
and Cu 1,0 mm are used.

The emulsion is mainly composed of small crystals 01

silver bromide suspended in gelatine.
Silver bromide crystalS are the sensitive components of
the emulsion . With radiation absorption, the crystals
change becoming metallic silver (black) during develop-
ment. Without going into more details concerning the
formation 01 the latent Image, it is sufficient to say that
this Image develops when a number of electrons are
expelled by a special process from the atoms constitut-
ing the crystals.
The result is that any agent capable of extracting a suf- Fig. 47/2 (par. 2.6.2.1.) - FoggfKJ film.
fi cient number of electrons from a crystal can produce Fogged especially on the edges with typical spots. due to
a latent image. storing In an o...erheated room.
Among these agents, X-rays and the blue-violet fluores-
cence 01 intensifying screens are used to produce the
image, radiographic films being very sensitive to these 2.6.2.2. Film handling
radiations.
Thanks to its properties gelatine responds well to the Films should be handled with care in order to avoid
principal function of fixing the silver bromide crystals to creaSing and kinking, which are damaging. Dry places
the film support, protecting them and allowing develop- and rapid unpacking of films can cause. due to friction,
ment at the same time. static electricity discharges, which damage the radiogra-
phs.
First of all, gelaline melts in warm water; this makes it
possible to mix sensitive emulsions and to spread them It is important that, when handling a film, fingers only
easily on film support. But even after hardening, the touch the edges, taking care not to bend the film.
gelatine can still melt if the finished film is processed at
a temperature 10 degrees over the recommended one,
unless special tropical solutions are used. The second 2.6.2.3. Darkroom processing
property is that a dry gelatine layer swells up when put
in a water solution, absorbing part of the solution and Processing solution are more effective when operating
thus allowing development. fixing and washing to be in the 20-26"C temperature range.

74 OllAAOONI. R,\OIOt.OGY ELECTflOMEOICINE

 TABLE 1212 (par. 2. 6.4. )
page 66 and par. 2.6.2. page
- Unsatisfactory
74).
radiographs, causes and corrective actions (see also par. 2.5. 14.

O".CI P.obabl. CIY Co".ctl.. Iclion

," H;gn density
(See par 2.5.2 .... ."
O"' UOO IU .'
(common laun )

O de.eloomenl
Vi ....... ,In n'lIher i,,'enli 'y ,llum ,nalOon
CI> et~ X '.y lime. Ind m.I . .. . ,1 eo".c!. duel pOlur. 30'10 0' rna'

o.ec_ d ~.oom ' ,m

C/"Iec~ 10< high d "Op.' I.mpe.llu ..

AI ,nd, CII. d III., (polnl 8)

, Low dronsily
'"
Und"exPOI Y'. ChiCk K"l y Irme, InO m.'.'I . ,I cor,.c l. 'nC ..... npolu'. 40'10 0' mar.
ISee pat. 2.5.2. page 50)
unlll.de lopmln, Ch.C k III.k. oom I,ml'
(common t.uln Ch.ck 10' 10'" d . . .lop ' ImP I'"u
Ch.ck 10' ... . k (d.pll l.1I 1 dl .. IOp.,

MII'''II bel .... . n IC ' een and 1, Im A. ,nd,c e"d

, HiOh conl...1 " 'g l> lu DIIC I contrl" Inc ..... k,lo.ollall l Inll dIC'I.,1 mA :nln
(See pw 2.5.12. page 153)
H'II1> " Im con trll' Uu 1,lm ... 111> 10.... . con trlll c'""e,.,I,IICI

Low COI1I1I1'
(See par. 2.5.12 .
..,. '"
LOw luDlle l eon l . .. , R.lluc. k, lo.olll ge In d 'nc 'I'" rnA min .

Lo .. ' ,1m co ntr .. 1 Uu ', 1m .. ith I> 'g".' co nI" " th"' cllIl,lIc,

Und.,d IOpmlnt Ch.c~ 1I ~. oom Ilml'

(COmmOn lIull ) CI>eCk 10' 10" de-.lop., temlM"lu'.
Ch.C k '0' ... . k (depl",dl d ... IOP"
, POOf <IeIlnltlon O lonll I PICimen . 10 101 m d" tl nce Dec ' .... I pec ,m en ' 10 ' 111 m d,"tlnCI . Ine"" e IO U" . 10 ' "Im d,"t enc i
(See 1*. 2.1 .7.
-'" Too I hOll lou'cl . '0 . him d,.,lnCI InC ..... 10u'c . 10 him d,"lInC.

Too I, . g. 10Cil IPOI U" lub. . . ,tl> I m illa, tOCII . pOI 0, 'nC' . . . . thl lub 10 him d' SlInce

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Sc,"n. Ind " 1m nol 'n ClOse conllCI A. ,nd '':'lld

F,lm 1I ,n,n... use I,n., 1I n.d " Im

'"
(SM chapter 2.5. page 50)
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no ted

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th . P'OllCI,on In Ihe , to,"g ea

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, F,n.ly mOIU.II 1011 $tll. 01 him use """ ' ,Iml

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Keep le" . n' cleon

76 OILAROONI. RAOIOlOGY ELECTROMEDICIN


Fig. 49/2 (par. 2.7.2.) Image Intansll/or with television
sys tem.
a) Image Intensi fier. b) optical system to transfer image.
c) TV--camera. d) TV monitor for the operator. e) TV monitor
for observers, I) monitor with photo or cine cam era for
photographic documentation. g) videotape recorder.
Using an Image Intensifier, the amount of information
obtained is more than that given by traditional fluoro-
scopy but less than in radiography.
Fig . 5012 shows principle and application of 1.1 .
Fig. 50/2 (par. 2.7.2.) Image Intensll/er with electronic
(magnification It 2) and shot accessories.
t) Vacuum glass cruet. 2) Entrance primary fluorescent
screen. 3) Photocathode. 4) Focusing elactrooe. 5) Second
anode (zoom) lor the electronic magnlflcatioo )! 2. 6) First
anode. 7) Secondary screen lor image going out.
2.7.3. Image Inten.lfler and television technique
(Reproduced by kind permission of Philips, Eindhoven
from Prlnclplas 01 Diagnostic XRay apparatus, edited by
O.R. Hill. published 1975 by The Macmillan Press Ltd .,
london and Basingstoke).
2.7.3.1. Introduction to Image Intensification
From Roentgen's first experiment until about 1950, the
only satisfactory method ' of viewing the X-ray image
was with a fluorescent screen which emits tight when
X-ray quanta are absorbed. The intensity of the light
emitted by the fluorescent screen is proportional to the
rate of absorption of the X-ray quanta. The energy is
transformed into heat and light: very little heat but a
relatively large amount of light.
GlLARDONI. RADIOLOGY ELCTROMEDICINE
To appreciate why it was necessary to depart from this
method of viewing the image, the characteristics of the
eye must be unterstood. (see fig . 5112).
Fig. 5112 (par. 2.7.3. I.) The Human Eye.
Two kinds 01 light sensitive cells are presented in the
eye, namely rods and cones. These cells form the layer
in the eye called the retina. The rods are highly sensi-
tive to light, but cannot diHerentiate colour. The cones
are concentrated in the area of the fovea centraUs and
these are less sensitive but able to differentiate colours.
The combination of the two accomodate a brightness
range of about 109 . (A normal camera will cover a
brightness range of 5 X H)3) .
Since there is an increase in the number of cones at
the centre of the fovea central is, this is the area 01
greatest visual acuity, although it is rod free.
As the level of light is reduced the cones cease to
function whereas the sensitivity 0 1 the rods increases,
giving a gradual improvement in vision due to the abili-
ty of the rods to adapt to low levels of illumination.
Since the fovea centralis does not contain rods the area
of keenest vision is nOw just off the centre where the
rods are most numerous. The density of the rods is,
however, not as great as that of the cones in the fovea
zoom central is. so that the visual acuity is not as great. Vision
depends upon cones down to about 0.1 millilamberts
(an average daylight scene is about 1 lambert) and bel-
ow this depends on the rods, although there is no
sharp transition.
The amount of tight available for X-ray film read ing is
about 10 millilamberts. which is in the range of cone
vision giving extremely good acuity. The amount of light
emitted from a fluorescent screen during fluoroscopy is
about 0.001 millitamberts which is in the range of rod
vision.
In order to increase the amount of light avai lability to
the amount required to give cone vision, it is advisable
to effect an improvement of about 5O(X} times. This
could be achieved by a 5O(X} fold increase in radiation,
but since this is not acceptable, other means have to
be sought to bring about the required increase in light.
Over the years. a number of devices have been pro-
posed having light gains ranging from 10 to 100 times.
Although it may seem worthwhile to effect a reduction
in dose rate of this order, it is not the principle reason
for adopting image intensification. The main reason for
using intensification is to raise the light level to a point
where cone vision takes over, giving both an increase in
visual acuity and contrast perception.
n
Many ways of increasing the amount of light have been tion of one high energy photon of X-radiation must re-
tried (see Fig. 5212), but only the X-ray image intensifier lease a larger number of photons of lower energy. For
system has been widely adopted. example, with a zinc cadmium sulphide screen, one X-
ray photon yields 5000 light photons.
The photocathode is a thin layer of caesium to which a
small amount of silver is added. This layer emits elec-
trons under the influence of light, giving off one elec-
tron for every five light photons absorbed. In fact the
photocathode also gives off electrons under the influ-
ence of X-rays, but since the absorption of the photoca-
thode is low, the effect is negligible.
a) Fluorescent Screen It should be noted that two factors are concerned in
the efficiency of the input screen:
a) the number of light photons emitted for each X-ray
photon absorbed,
b) the number of X-ray photons absorbed against the
number of X-ray photons transmitted.
b) Solid State Amplifier The first factor mentioned is a function of the composi-
tion of the phosphor, whilst the second factor is a func-
tion of the density and the thickness of the phosphor.

~ 0==--;::-- 0 The gain of an intensifier is also dependent on two fac-

tors:
a) the acceleration of the electrons across the gap be-
C) Image Orthicon X- Ray tween cathode and anode.
Intensifier b) the geometric reduction in image size. which results
in a smaller and brighter image on the output phos-
phor.
The input screen converts the X-rays into visible light
which is readily absorbed by the phOtocathode. which
then gives off electrons and these are accelerated by a
d) Electro-Optical Light potential difference of about 25 kV towards the cylind ri-
Intensifier cal anode. The electrons pattern is reduced in size and
focussed by an electro-static field onto the output screen.
This electro-static field is produced by the potential dif-
ference between the anode, cathode and the focussing
electrode. The output screen then emits light in propor-
tion to the number of electrons absorbed .
eJ X- Ray Image Intensi f ier Using a linear reduction of about 10 times (ratio of in-
put to output screen diameters) the area within which
the electron energy is concentrated is reduced by a fac-
tor of 102 Thus the luminous flux is emitted from an
Fig. 5212 (par. 2.7.3. I.) - VariOUS System of Image
area about 100 times smaller than it would be with a
IntensificatiOn.
reproduction scale of 1:1. An increase in luminance by
a factor of 100 due to the electro-optical reduction is
therefore achieved.
2.7.3.2. The Image Intensifier It may be felt that the gain in light due to the minifica-
tion is not a true gain and so should be disgregated .
An X-ray image intensifier consists of an evacuated glass This is in fact not the case where electron-optics are
or metal envelope with a fluorescent screen on the in- concerned, as can be seen from fig. 54/2.
side front surtace as shown in fig. 53/2. A photo-ca-
thode Is deposited on this, using a chemically inert ad-
hesive. co"
'm ......
Stokes' law states that a phosphor may be excited by a
radiation having an energy equal to, or greater than, the
photons to be emitted. In order that the principle of
conservation of energy may be preserved, the absorp-

Photo - e. ,,,,,,,,,

Fig. 5412 (par. 2.7.3.2.) Comparison between Focussing

Systems.

a) Light Optical System.

Fig. 5312 (par. 2.7.3.2.) - The Image Intensifier. b) Electron Optical System.

78 GILARDONI. RADIOLOGY ELEcrno~EDlcINE

In the case of the lens system, only those rays of light
rom the point of origin which travel at the correct an
91e are refracted by the lens to come to focus on the
output screen. However with the electron--optical system,
all electrons, including those travelling almost parallel
with the photocathode, will be turned to focus on the
output screen.
2.7.3.3. Converslon Factor (or Gain)
It is essential to have a measure of the efficiency of an
intensifier and until recently a figure of gain or amplifi
cation was otten quoted .
The gain of an image intensifier is expressed as the ra
tio of illumination from a standard Levy West fluores
cent screen to the illumination from the output phos
phor of an intensifier when both are irrad iated under
Identical conditions. This is a very difficult measurement
to undertake because the quality of the incident radia-
tion is, in part, dependent on the waveform of the X-ray
generator and will influence the result. Also the low lev
el of illumination raises further problems.
The International Committee on Rad iolog ical Units has
now recommended that the conversion factor would be
a more realistic measure of intensifier efficiency. The
conversion factor is ex pressed as the ratio of lum inance
of the output phosphor to the dose rate at the input
phosphor.
Conversion Factor = ~ ever a second screen is introduced and a real sized Im-
R age projected onto this then the advantage of the small
where L is light output in Candela per square meter
(cd/ m2) and R is radiation at input screen (mA/sec.)
A comparison between the two methods of measure
ment is possible since a gain of 5000 times approxi
mates to a conversion factor of 70.
2.7.3.4. Inlormation Content
The resolution in the centre of a modern 23 cm (g")
image intensifier is beUer than 35 line-pairs per cm.
(EaCh line-pair is one black and one wh ite bar spaced
by their own width) . If there is provision for enlarging
the image to cover a 12 cm (5") field, the central reso
lution will have Increased to about 45 line--pairs per cm.
It must be noted that when the 12 cm field of a dual
field intensifi er is in use, the image forming area of the
input phosphor is reduced to about 1/3 that of the 23
cm field. Thus a corresponding increase in dose rate is
required to produce the same number of electrons per
unit area at the output phosphor. It Is usual to increase
the Xray tube voltage by about 15 kV when using the
12 cm field to compensate for th is loss of gain (de--
crease in conversion factor) .
It is possible to see variations in contrast of about 2%
with a typical intensifier, providing an adequate dose
rate is used to produce enough Xray quanta per unit
area on the input screen.
If the dose rate reaching the in put phosphor of the im
age intensifier is too low, there is sufficient quanta per
unit area to visualise all the information. In order to o~
tain a relatively -grain free .. image, a minimum dose
rate of about 2S JlA per second at the in put phosphor
is required.
As the number of X-ray photons falls, the effect of each
one becomes more noticeable.
OllAROONl. RADIOLOGY ELECTROMEDICINE.
An example of this is shown in fig . 55/2 where (a)
shows a small number dots representing the image pro-
duced wit h a low dose rate on a intensifier. Figs. (b)
and (c) show the improvement in detail by inc reasing
the dose rate (increase In the number of dots per unit
area).
b) ... .. .... .
oj
Fig. 55/2 (par_ 2.7.3.4.) - The EfffICl 01 Quanla on Resolulion.
2.7.3.5. Vk!wlng Systems
The output phosphor can be directly viewed, but is too
small to be conveniently observed in this way. If viewed
via a si ngle lens (magnifying glass), then providing that
the diameter of the lens is greater than the diameter of
the pupi l of the eye, there will be no detectable loss in
brightness even though the lens enlarges the image up
to the apparent diameter of the input screen. The image
so viewed is called the aerial image (fig. 5612-a) . If how
bright image will be lost.
This is shown in fig. 56/2b where it can be seen that
the translucent screen once again diffuses the incident
light to cover all angles so the eye is able to make use
of only a small fraction of the light from each point.
al Aerial Image bl Projected Image
Fig. 56/2 (par. 2.7.3.5.) - Oplical Viewing Systems.
a) Aerial Image.
b) Projected Image.
There are clear advantages in viewing the aerial image.
The disadvantage is that the exit beam is about the
same diameter as the lens and in order to see the out-
put phosphor the eye must remain within the beam . For
econom ic reasons it is necessary to use a comparatively
small lens, which then causes difficulty in viewing . For
binocular viewing, the exit beam needs to be large
enough to cover both eyes si multaneously which involves
the use of a lens of about 2 1/:l' in diameter. As those
who are interested in photography will appreciate, a
fully corrected lens having a diameter of 21/z" is very
expensive.
There are a few people who still use an optical viewer
although nowadays television is more or less universal.
However, the large diameter lens is still retained but for
79
, ,
2.7.3.6.1. Television Image Formation
Like the cinema, television makes use of the persistence
of vision: if the information can be assembled sufficient-
ly rapid ly on the screen, Ihe viewer will see a complete
pictu re. The picture is formed by moving a spot of light
over the screen area in a regular system of lines (called
scanning) and by increasing or reducing the spot inten-
sity to make light and dark areas (see fig. 61/2). The
picture is scanned by starting the spot at point 'A',
movi ng it to '8' by electromagnetic deflection, then re-
turning it instantly to 'C'. From there it is moved to '0'
and the process repeated until point 'X' is reached; from
there it is quickly returned to 'A' to begin the cycle
again. This systems of lines is called the raster or frame.
--- - ,
-'-, -
<
- --- - 0
_ _ _s
-
=_
- - - - -- -
:::... X
Fig. 61/2 (par. 2.7.3.6.1.) . The Telev/slon Rasler.
Most television systems in Europe use 625 lines per
frame to give good vertical resolu tion and require 50
images per second to give a flickerfree picture. For the
picture to have sufficient horizontal resolution, each line
must contain about 300 pieces of information and this
represents a frequency of over 10 million cycles per se-
cond (10 MHz). Since a frequency of this order is di ffi-
cult to process, a system known as double interlace is
em ployed to give the same resolution, but using only
half the frequency.
In this systePl , the first vertical scan only covers the
odd lines (see fig. 6212-a) . The next time, only the
even lines are scanned (see fig. 6212-b) . A com plete
picture scan is termed a frame and consists of 2 fields
as shown in fig. 62/2-c. Thus there are 50 fields (im-
ages) each of 3121/2 lines.
In order to obtain the full benefit of the double inter-
lace system it is obvious that the lines must be equally
spaced. To achieve this, the monitor uses time base
circuits which are controlled by sinchronising pulses in-
corporated In the complete television signal from the vi-
deo amplifier.
\ _ r---
.!~
~ The photo-conductive material is a fairly good insulator
\\ ~~
,J
~ ::;;z- - r--=-
- > -,
< which does flow is called ~ dark cu rrent) . If however an
1 _ <:: c)
Ml ~
bJ
Fig. 62/2 (par. 2.7.3.6.1.) - The Double Interface System.
GILAAOONI. RADIO LOGY ELECTROMEOICINE
2.7.3.6.2. The T.V. Camera
The T.V. camera converts the optical image appearing
at the output phosphor of the image intensifier into a
series of electrical signals. Inside the camera housing
there is a set of deflection coils, a camera tube and a
video pre-amplifier.
Several different types of camera tubes are avai lable,
the most common of which is the vidicon tube shown
schematically in fig. 63/2. It may be assumed to consist
of three sections; the electron gun, the scanning section.
and the target.
The electron gun consists of a heated cathode wh ich
emits electrons, a grid (gl) controlling the electron beam
current, and a second grid (g2) which accelerates the
electrons and focusses them into a fine beam.
The electron beam released by the second grids enters
the space enclosed by the cylindrical electrode (g3)'
This is the sca nning section where, by means of the
adjustable electrostatic field of g3 and the axial electro-
magnetic field of an external coi l, the electrons are fo-
cussed onto the target%
\
Fig. 63/2 (par. 2.7.3.6.2.) - The Vidicon Camera Tube.
The target section is ill ustrated in fig . 64/2-a where it
can be seen that a conductive transparent layer is laid
down on the glass faceplate upon wh ich is formed a
layer of photo-conductive material. The optical image to
be televised is focussed onto the conductive film by
means of a lens system. The targ et can be considered
to consist of a very large number of target elements
(see fig. 64/ 2-b page 82), each element acting as a
small capacitor (C~), with one end connected to the
signal electrode and in parallel with a light dependent
resistor (Rk;1 ). If the electron beam is now made to scan
the face of the target in exactly the same way as des-
cribed for the monitor, each capacitor will be charged
to nearly the same potential, provided the faceplate is
not illumi nated .
so that only a very small part of this charge will leak
away between scans. This means that very little beam
current will flow and there will be hardly any voltage
drop across the load resistor RL . (The small current
optical image is focussed on the faceplate, those largel
elements that are illuminated will become more conduc-
tive and the capacitors concerned will be partially dis-
charged to an amount proportional to the ill umination.
As a consequence the electron beam, while scanning
the charge pattern, will (e-charge depleted elements to
their original state. This current also flows thorugh AL
81
a different reason. If the intensifier is to be used only
for television, then in theory, a single lens system as
shown in fig. 57/ 2 is sufficient. The diameters of the in-
tensilier ouput phosphor and the standard camera tube
are the same. For an image size equal to that of the
object size, the nodal point (centre) of the lens is 2
times focal lenght of the lens from the focal plane. Also
the distance from lens to object must be the same as
the distance from lens to the plane of focus. However,
under these conditions problems may be encountered if
the lens is not designed for this short distance.
Fig. 57/2 (par. 2.7.3.5.) - The Single Lens System.
Under close-up conditions such as these, the normal
method of calculating lens elliciency ('I' number) does
not apply. For a 1:1 ratio the 'f' number must be multip-
lied by 2 (thus an f8 lens is equivalent to f16) so that
the amount of light is now + 4. In addition to this, at
short distances the depth of focus is very small , so that
unless the lens is rigidly mounted. variations in the de-
finition of the picture will occur. This is due to slight
changes in the position of either phosphor, lens or ca-
mera tUbe.
Where the output from the Intensifier Is required to
supply a number of different opt ical devices some other
method must be used . The Tandem lens system, shown
in lig. 58/2 is the one generally adopted.
c.-,. ....
~ diagnosis overcomes several of the limitations of the
'"
Fig. 58/2 (par. 2.7.3.5.) The Tendem Lens Sys tem.
Here two lenses are used. The object lens is rigidly
mounted on the Intensifier and is adjusted to bring the
image of the output phosphor to focus at infinity. The
light output from this lens is therefore a parallel beam
of light. The camera lens is adjusted to bring to focus
an object at infinity (that is, it will focus parallel beam
of light).
The size of the image will be determined by the relative
focal lengths of the two lenses:
output phosphor diameter image diameter
object lens focal length camera lens focal length
The camera lens is rigidly mounted on the camera and
the focus set to infinity. Where the two lens systems
are mou nted as shown in fig. 58/ 2 the focus is inde-
80
pendent of distance between the lenses, although too
great a distance will produce vignetting (the image will
be brighter at the centre than at the edge).
Since there is now considerable flexibility in the relative
positions of the two lenses, it is a si mple matter to ex-
change cameras, etc. The operation of the equipment
can be further simplified by inserting a surface si lvered
mirror into the light beam (fig. 59/ 2) so that by rotating
the mirror the light beam may be directed into the ap-
propriate lens. A specially made mirror having a very
thin coating may be used so that on ly 90% of the light
is reflected. The other 10% of the light passes th rough
the mirror so that two devices may be used simultane-
ously (TV and Cine).
E ."'. '~'
- ",..
,.",,,,, "!.!....
Fig. 59/2 (par. 2.7.3.5.) - Image Imemlller with Accessories.
2.7.3.6. T~eYI .lon
Television is the transmission and reception of moving
pictures over a distance. The use of television in X-ray
previoulsy discussed systems. namely:
a) Since a number of moveable monitors can be used
to display the image. the operator's freedom of move-
ment and angle of viewing is not limited as it was
with the optical viewer.
b) Any X-ray Image is essentially of low contrast, (in
fact X-ray films compensate for th is by an inherent
contrast increase of about 1.5 times). but with T.V.
systems the operator has control of image contrast
and brightness, allowing daylight viewing.
A simplified block diagram of the closed circuit T.V.
system used in medical diagnosis is shown in fig. 6012.
The following sections will discuss each part in detail.
0
"':::-j::'=]----jI ,,'"
,.{'~
ct Ampl".er
I11-----1
I
TV ManiTa<
Fig. 6012 (par. 2. 7.3.6.) Bioek Diagram of B T.V. System.
GI LARDON ~ RADIOlOGY - ELECTROMEDICINE
 The main advantages of the Plumbicon are:
a) As the diodes are reverse biased , virtually no -dark
current will flow. Th is is important because the "dark
current is not constant across the face of the tu be
and is temperature dependent.
b) The Plumbicon has a much faster response (shorter
lag) than the vidicon, since the photo-d iodes react

J bl .
"
more quickly than the light dependent resistors of
the vidicon.
The Plumbicon can thus be used to advantage to tele--
vise fa st moving phenomena.
Fig. 64/2 (par. 2. 7.3.6.2.) - The Vidicon Target.

and produces a varying voltage drop across it. The vol-

tage, negative going for highlights, is the video signal
and is fed to the pre-amplifier stage. An example of the
"
type of voltage waveform produced during this process
.--_. -,
,..... .
: II ,
is shown for one line in fig. 65/ 2. ~ ., . , ~,""

Another type o f camera tube now available is known as

the .. Plumbicon". The construction 01 this device is very I-
similar to a vidicon, except for the target which is shown
schematically in Fig. 6612. '.
The target structu re can be considered as being formed
of a large number of tiny photo-diodes, reverse biased
by the electron beam. Fig. 6612 (par. 2.7.3.6.2.) The Plumb/con Target.

2.7.3.6.3. The Synchronising Pulse Generator.

Having seen how the picture is traced out line by line

and frame by frame in both the TV. monitor and came-
ra, it is fai rl y obvious that the electron beam in the
monitor must move in exact synchronism with the beam
in the camera. Not only must the beams move at exact-
ty the same speed, but in addition, they must always be
at the same relative positions in their scan. This result
lS achIeVed by sending suitable synchronising pulses
(sync pulse) to the T.V. camera and combining the
same pulses into complete television signal leaving the
VIdeo amphfier. At the monitor, the sync pulses are se--
parated from the picture signal, and are used to control
the time base circuits.
The sync pulse generator is shown in block diagram
form in fig. 67/2. The master osci llator runs at a very
accurate fixed frequency which is fed to two sets of
electronic frequency dividers. The upper divider chain
counts the number of lines for each field and generates
a vertical sync pulse (50 Hz) whilst the lower divider
generates the line sunc pulse (15625 Hz). 625 lines
were chosen because it is easy to make an electronic
divider for this number .
. . .. WOo. L ....

Fig. 6512 (par. 2.7.3.6.2.) - T.V. Camara Ou tput Voltage for

One Line.

Inc ident light focussed onto the face of the plumbicon

falls on the junction of these diodes and generates cur-
rent carriers. This means that when the electron beam
scans the target, current will fl ow through those diodes
whose junctions are illumi nated and in doing so will al-
so pass through the load resistors Al . The voltage drop Fig. 6712 (par. 2.7.3.6.3. ) . BlOCK Dlegfam of a Sync. Pulse
thus produced across Al will be proportional to the il- Generator.
lumination of the diode being scanned.

82 GllAROONI , RADiOlOGY El ECTROM EDICINE

2.7.3.6.4. The video Amplifier
The video ampl ifier is used to amplify the small voltage
variations from the camera to a suitable level to drive
the monitor. At the same time as amplifying the camera
signal, it must also mix in the sync pulses to form the
complete television signal which is fed to the monitor
via a single co-axial cable.
The main point to be remembered about th is ci rcuit is
that compared with say, an audio amplifier which may
have a frequency range (bandwidth) of 50 Hz to 18
KHz, the video amplifier must be capable of handling
frequencies from 0 Hz (~.C. ) up to 5 MHz without dis-
tortion. Also, any spurious signal must be eliminated to
avoid degradation of the T.V. image.
2.7.3,7. Automatic Gain Control (A.G.C.) Circuits
Du ring T.V. fluoroscopy, the amount of radiations ab-
sorbed by a subject will vary over wide lim its, so that
unless an automatic system of control is used, the set-
ting of kV and mA will have to be continually varied in
order to bring the video output voltage to the desired
value.
Because of this, the earliest types of X-ray television
used a system of automatic gain control. The system
worked by measuring the amplitude of the output signal
from the camera and comparing the resu lt against a
reference voltage. This generated a control voltage which
altered the gain of the video amplifier and so main-
tained the brightest part of the picture at 1.4 V, this be-
ing the voltage selected as an international standard.
Although the system can be made to work very satis-
factorily it must be remembered that it can only operate
by reducing the gain. The dose rate must be set to
give an Input to the face 01 the intensifier which is suf-
ficient to produce an acceptable picture of the thickest
part 01 the patient. When a less dense area is under
examination, the gain of the video amplifier will be re-
duced, so that an acceptable picture will still be ob-
tained, but still at the original dose rate.
A better system maintains a constant gain but automati-
cally varies the kV. mA or both to give suffi cient dose
rate to produce an acceptable picture.
2.7.3.8. Automatic 0018 Rate Control
The first development In dose rate control took the
lorm of an add-on un it which used a small mirror to
direct a percentage of the light out of the intensifier in-
to a photomultiplier tube (see fig . 5912 page BO). This in
turn controlled the X-ray tube filament current, and so
stabilised the brightness of the image on the intensifier
output phosphor. The same photomultiplier tube is often
switched between the brightness stabiliser circuit and a
phototimer. The same tube can thus be used to control
radiographic exposu re times as well.
The main disadvantage of this system is that it is area
sensitive. If the collimating diaphragm is set to give a
SQuare and the dose rate noted and then the diaphragm
closed to reduce the irradiated area by half, then the
dose rate will approximately double. The problem may
be overcome by using system which detects the level of
the brightest part of the picture rather than the average
brightness, but to do this one would have to scan the
picture in some way. Since the television camera does
Glt..AROONl. RADIOLOGY ELEClROMEOICINE
just this, a peak level sensing circuit can be built in to
the television unit. There will still be some increase in
dose rate when the irradiated area is reduced, but th is
is due mainly to the reduction of scattered.
To be effective, the automatic dose rate control circuit
must operate on only a small area, so that under nor-
mal conditions it is not area sensitive. This in turn can
produce problems if, lor example, o ne is examining the
stomach in the lateral position where the area of inter-
est is close to the surface of body. The area of peak
white due to direct radiation falling on the input screen
may easily be 100 times brighter than the average brig h-
tness. This can be minimized by arranging that the
senSing circuit looks at an area less than the whole pic-
ture area. This causes problems if the entire sensing
area is covered by a bolus of contrast medium.
These difficulties are best resolved by having a switch
which permits selection of the most appropriate area for
the exam ination. This Is normally preset to operate on,
for example, 40% and 80% of the screen area.
Advances in the field of semiconductors have given im-
proved signal to noise ratios, increased bandhwidths,
and reduction In the number of breakdowns. Camera
tubes have undergone similar improvements to give grea-
ter output, shorter lag, more even sensitivity across the
lace of the target an d lower "spot count (blemishes on
the target).
One would expect there to have been a similar im-
provement in the gain of intensifiers, but although in-
tensifiers have indeed improved in a number 01 ways
there has not been any significant reduction in the dose
rate required for the following reason . As has already
been stated, the X-ray Input to the intensifier consists of
a relatively small number 01 high energy X-ray photons
wh ich strike the Input phosphor to produce a larger
number of lower energ y light photons. A reduction in
dose rate causes a lall in the number 01 X-ray photons
striking the input phosphor per unit time. An increase in
the intensifier gain raises the number of light photons
produced by each X-ray photon, but cannon make up
for a shortage 01 X-ray photons which are the only in-
formation carriers. Thus a low dose rate gives rise to a
granular image due to what is called quanta noise.
Particularly where only television is in use, the noise is
often blamed on the T.V. system itself, although exactly
the same effect can be demonstrated on cine and pho-
toflu orographic film s. The only way in which this noise
may be reduced is by increasing the number of X-ray
quanta available, In other words, increaSing the dose
rate.
The combination of a high gain intensifier and camera
tube produces sufficient light to operate the T.V. sys-
tem , but the dose rate is too low to give an image with
an acceptable amount of quantum noise. The solution is
to stop down the lens which allows the dose rate to be
set to an acceptable level. This also improves the per-
formance of the lens system, giving an overall increase
in picture quality.
An alternative approach is to use a different type of
material lor the input phosphor of the image intensifier.
A new type of phOsphor (caesium Iodide) is now avail-
able which has a greater absorption thus converting a
greater proportion of the input dose rate into light. Th is
also makes possible the use of a th inner phosphor layer
which , by reducing the lateral spread of light. gives im-
proved resolution.
63
2.7.3.9. Klnescopy
When X-ray television first became available it was ob-
vious that it would be advantageous to be able to re-
cord the T.V. monitor image on film. Even the introduc-
tion of the video recorder has not totally replaced this
method of recording , si nce video tape cannot easily be
edited or spliced .
When a cine film is recorded from a T.V. monitor the
procedure is known as Kinescopy.
A study of the make-up of the T.V. image has revealed
that it is composed of a spot of light tracing 312'/2
evenly spaced lines across the monitor screen in '/~ of a
second. The spot then returns to the top of the monitor
and repeats the operation, the second set of scanning
lines being interlaced with the first. Th is makes one 625
line interlaced picture in '/"15 of a second.
The cine camera shutter should be opened when the
spot is at the top of the monitor (start of the picture
field) and closed when the spot is at the bottom of the
monitor (end of the picture field). Since the television
image frequency is synchronous with the mains cycle,
tha camera shutter must be driven by a special motor.
This is a synchronous molor which may be locked to a
certain part of the mains cycle. thus keeping the T.V.
image and camera shutter in phase. A table to indicate
the sh utter openings and fram e speed combinations
which can be used for Klnescopy is shown below .
diagnostic quality of the image which is dependent up-
on blackening (gamma) and contrast (grey scale). These
two factors can be adjusted by means of the brilliance
and contrast controls on the T.V. mon itor built Into the
kinescope. The success of this system is dependent up-
on the ability of the equimenl to provide adjustment to
both gamma and grey scale and the ease with which
they can be matched to the characteristics of the re-
cording film.
Kinescopy thus provides a method of recording with the
advantage of low dose rate, bul with the disadvantage
of some loss of Information.
2,7,3,10, Video Tape Recording
The basic prinCi ples of magnetic tape recording are not
difficult to understand . A plastic tape coated or impreg-
nated with a ferrous oxide is passed in front a small
electromagnet (the recording head) . The coil of the re-
cordi ng head is fed by the input sig nal and as the tape
passes across the gap in the head the oxide coating
becomes magnetised in proportion to the strength and
frequency of the Sig nal (see lig. 68/2) .

. Frames Shulter ' nlormation Inlorm atlon

po< Opening Recorded per Lost per
Se<ood Angle Cine Frame Pull Down
121J2
8'/3 ,.,.
"",. 2
3
Monitor
Monitor
Fields
Fields
2
3
Monitor
Monitor
Fields
Fields
4 Moni tor Fields 4 Monitor Fields
6'/.
"'" ,
,...
162/3 240' 2 Monitor Fields 1 Moni tor Field
8'/3
25 ''''' 4
1
Monitor
Monitor
Fields
Field
2
1
Monitor
Monitor
Fields
Field

The most satisfactory system for medical use has proved

to be a shutler opening of 240'> and speed of 16213
frames per second. Using th is system. the shutter is
closed and the film moved through the camera gate
during a T.v. fi eld (11~ second) . The film is then held
stationary and the sh utter opened for 2 T.V. fields ('/as
second) whilst the image is recorded . It can be seen
that there is a loss of 113 of the information during the
film pull down time. (Shutter opening angle is discussed
In section 2.7.3.11 . page 85) .
The dose rate at the face of the image intensifier dur-
Ing fluoroscopy is normally about 50 pR per second
and as Kinescopy is recorded at these factors it can be
seen that the amount of radiation for each cine fram e
is only about ~/'l5 pAlframe = 2 pR per frame.
When the film Is being projected the eye integrates the
individual frames, and the grain caused by the X-ray
quanta , into one continuous moving image. However, if
the film is analysed frame by frame there Is then insuf-
ficient quanta per unit area in '/25 of a second to con-
vey all the available information and the result is a
grainy low resolution image. This can be rectified by
increasing the fluoroscopic current during recording and
a factor of 1.5 or 2 gives a noticeable increase in pic-
ture quality.
In finite terms it is possible to resol ve about 20 line-
pairs per cm. in the centre of the field of a 9~ image
intensifier, but when this has been passed throug h the
optical and video system less than 10 line-pairs per em.
can be seen on the film. This determines smallest detail
which can be Isolated by its own diameter from sur-
rounding objects but it does not tell us much about the
....... -
Fig. 6812 (PBr. 2.7.3. 10.) Principle of Magnetic Recording.
Playback is ach ieved by passi ng the tape in fron t of a
similar coil (replay head) and the variable magnetic flux
from the tape induces a signal, simi lar to the original,
in the replay head winding . The range of frequencies
which can be recorded is dependent on the speed of
the tape and the width of the ga p across wh ich the
magnetic flux is developed.
A modern domestic audio tape recorded with a tape
speed of 19 cms/sec. (7 1/z inch . per sec.) will record
frequencies up to 15 KHz. The range of the recorded
frequencies is termed the bandwidth of the instrument.
To record a video signal of reasonable quality, a band-
width of at least 3 MHz is requ ired. This frequency
range is 200 times that of the audio recorder and re-
quires a tape speed across the head in excess of 96
kmlh (60 m.p.h.) assuming that a simple recording head
is used. The mechanical problem of this high tape speed
is overcome by passing the tape in a helical configura-
tion around a drum inside wh ich the recording head or
heads rotate at 3000 r.p.m. as shown in fig. 69/2. Con-
sequently the actual tape speed can now be reduced to
19 ems/sec. since the recording head is made to rotate
in the opposite direction to tape movement, giving the

84 GllAAOONI . RAOtOlOGY - ELECTRQI,IEOICINE

same relative tape to head speed. It is normal practice
to use the same heads for recording and playback.
Several geometrical arrangements are available for form ~
III"Ig the helix around the drum, the most popular being
the Omega (0) wrap formal. The drum is 15.25 cm (6")
11"1 diameter and the tape starts at the top and comes
off at the bottom, passing round the drum in a helix of
almost one loop. There is a slit all the way round the
CIrcumference of the drum through which the head pro-
trudes to wipe the tape. If the head is rotated at 3000
r.p.m. then the peripheral speed of the head is " 15.25
x 3000 which is approximately 85 km/ h (53 m.p.h.).
Added to this there is the linear tape speed of approx-
ately 1 km/ h.
Soo, '"
DrUI.
Fig. 69/2 (par. 2.7.3.10.) - The Video Tape Recording.
During the recording process the tape speed and head
rotation are synchronised to the mains frequency. The
vertical synchronising putses are recorded separately on
the tape to mark the start of each T.V. field (see fig.
7012). During replay these pu lses are compared with the
mains frequency and any difference signal converted in-
to a control voltage used to keep the speed and angu-
lar rotation of the head such that the start of each T.V.
fiel d coincides with the start of recorded magnetic track.
It is not always possibte to replay a video tape on a
machine other than the one on which it was recorded
because the drum diameter determines the length of the
magnetic track. II compatibility is required, the drum
has to be manufactured to very close tolerances. The
geometry of a helix of tape around a 15.25 cm drum
records a 45 cm magnetic track at an angle of approxi-
mately 10" for each head revolution. As the tape moves
forward at about 19 cm/s, a series of parallel diagonal
magnetic tracks are recorded very close together. Each
Fig. 7012 (par. 2.7.3.10.) - The Recorded Video Tape.
GlLAAOONI , RADIOlOGY - El ECTROMEOIC!NE
sloping magnetic track on the tape contains aU the in-
formation for one T.V. field (2 interlaced fields are re-
quired for one complete frame).
Stationary images are obtained by stopping the tape
and allowing the head to continue to revolve, playing
back only one magnetic track continuously. With a sin-
gle head recorder only half the picture (3121/2 lines) is
played back, and a considerable amount of information
is losl. A slight amount of information is also lost at the
top and bottom of the field because the tape is now
stationary and the path of the head and the recorded
magnetic track do not have the same geometry.
X ~ ray television installat ions require the video recorder
to be connected in the monitor circuit such that it is
available for immed iate use during the examination. The
video signal to the recorder is fed by a matched co-ax-
ial cable, thus the recorder ca n be located at any reas-
onable distance from the examination room, provided
remote switching facilities are available. Several monitors
can be used with a recorder or T.V. installation and
may be located at any convenient point in the hospital.
A simultaneous sound track can be recorded on the
edge of the tape for commentary.
II the tape is kept clean, it can be passed across the
head about 200 times but just a small amount of dust
or dirt will reduce this very drastically and also degrade
the quality of the pictu re.
The signal on the lape is in the form of a variable
magnetic flux and, if the tape is stored too long without
being replayed. an increase in signal to noise ratio is
noticeable due to the "print through .. from one track to
another. It is recommended that the tape should be re-
wound backwards and forwards on the fast rewind posi-
tion of the recorded every six months to reduce this
degradation .
2.7.3.11 . Cinefluorography
In its simplest form cinefluorog raphy consists of filmi ng
the images on the output phosphor of the image inten-
sifier.
Cinefluorography has many useful applications where
dynam ic studies of physiological are undertaken. Events
may be speeded up or slowed down by varying the
speed of the camera or projector. Film loops may be
made to study repetitively a single event. Editing and
splicing can easi ly be undertaken for teaching or stor-
age purposes. Conventional photographic optical systems
are unsuitable for filming from the image intensifier whe-
re the object to image ratio is in the reg ion of 1:1 or
less (see section 2.7.3.5. page 79).
This problem was solved with the early intensifiers by
using two ordinary photographic lens systems in tandem
so that the image produced at infinity by one is fo-
cussed by the other onto the film (see fig . 58/2 page
80) ,
Th is system uses each lens in a manner best suited to
its optical design; the optical efficiency, is twice that of
a single optical system forming an image in the ratio of
1:1. Modern image intensifier installations al ready have
part of th is tandem lens system in the form of the bas-
ic objective (see fig . 59/ 2 page 80) so that it is only
necessary for the ci ne camera to be mounted in a
manner which accurately aligns the two optical axes.
The focal length of the camera lens can then be chos-
en to produce the required image size and the focuss-
ing mechanism adjusted to infinity to produce a sharp
85
image. This point was discussed in section 2.7.3.5. and A disatvantage of this system is that the exposure time
the method of calculation follows: is determined by the camera speed and if it is required
to analyse the frames individually there is often move-
To calculate final image size ment blurring, unless the camera is run at a high speed.
If the radiographic factors and camera film speed are
Let 01 diameter of image on output phosphor of
:::; constant, the film blackening will vary considerably due
intensifier to variations in patient density and the amount of opa-
O2 :::: diameter of final image on film que medium used in the investigation. A small propor-
F, :::: focal length of basic objective tion of the light from the centre of the image on the
F2 :::; focal length of camera lens output phosphor of the intensifier is therefore monitored
by a photo-multiplier with a prism optical system (fig
F, 59/2 page 80). The result is displayed on an exposure
then O2 = 0, x - meter (E-meter) so that the X-ray tube current can be
F, varied to keep the meter read ing constant and hence
the film correctly exposed. The signal from the photo-
Example for 16 mm cine camera
multiplier may also be amplified and used to vary the
0 1 :::; 20 mm X-ray tube current so that the film blackening is auto-
Fl :::: 65 mm matically kept constant. The sensitivity of the exposure
F2 :::: 25 mm meter can be varied to suit different film speeds.
O2 :::: 20 X 25/ 65 :::: 7.6 rnm (diameter of image on film)

Example for 70 mm camera

0 1 :::: 20 mm
2.7.3.12. Pulsed Cinefluorography
Fl :::: 65 mm
F2 :::: 220 mm
A considerable increase in efficiency, image quality and
O2 :::: 20 X no/ 56 = 68 mm (diameter of image on film)
reduction in patient dose can be obtained by synchron-
ising the X- ray exposure with the camera shutter such
Example to find lens focal length for a 70 mm camera
that there is no radiation when the film is being pulled
0 1 = 20 mm through the gate. If the X-ray exposures are pulsed for
O2 :::: 70 mm each frame and are relatively short, (between 1-10 ms.) ,
Fl = 65 mm each frame will have less movement blurring and will
F, :::: F 1 X0 2 = 65x70 = 4550 = 227 5 mm be suitable for individual analysis.
1 20 20 . The mAs per frame is calcu lated by multiplying the
Cameras used for cinefluorography have an intermittent pulse width by the tube current. For example, if the
film movement, lhe film being stationary white the shut- tube current is 120 mA and the pulse width 3 ms., then
ter 15 open and pulled down through the gate while the mAs per fram e = 0.003 x 120 :::: 0.36 mAs.
shutter ts closed It is usual to locale the film in regis-
Automatic control of density is again achieved by divert-
ter WIth a pin lhrough the perforations while the shutter
ing a small proportion of the light from the centre of
tS open, so that d cannot move causing the image to
the field to a phOto-multiplier, and the amplitude of the
be blurred.
pulses integrated to give a meter reading proportional to
The shutter is in the form of a rotating disc with a film density. The signal from the integrator can also be
segment removed , and is situated between the lens and amplified and used to control the X- ray tube current
the film as shown in fig. 71 / 2. and thus the film blackening .
The pulse wid th must be shorter than the shutter-open
time and thus the exposure time per frame is independ-
ent of camera speed . Various pu lse widths may be se-
r-- lected to provide minimum film blurring, consistent with
M
a;os~ [Q
X-ray tube loading and film blackening .

c:J I-.~
IP,"
I.
I


~ -:=- I"
L.... \ s...",.,
Cia"
. ~ -~
~~.
' ~
l ...... ". ~" "
2.7.3.13. Bi-plane Cinefluorography

It is advantageous in cardiac procedures for cine films

Fig. 71 12 (par. 2.7.3. 11.) - The Camera Shutter and Gate.
If, in a complete cycle, film pu lldown and exposure oc-
cupies 36()0 and the shutter is open for 50% of the cy-
cle, the camera is then said to have a 180" shutter.
Likewise if the shutter is only open for 25% of the cy-
cle the camera is said to have a 90'> shutter. .
It can be seen that if camera has a 18()<> shutter, rotat-
ing at 25 revolutions per second, the exposure time will
be '/00 sec. (or 0.02 sec). If the radiation is continuous
with an X- ray tube current of 20 mA, then the mAs per
frame = 0.02 x 20 = 0.4 mAs. Only 50% of the patient
dose contributes to the film blackening; the other 50%
is wasted because the shutter is closed.
to be taken in bi-plane so that lateral and AP (antero-
posterior) views can be recorded at the same time.
In order to obtain satisfactory results in bi-plane opera-
tion, it is necessary for the cameras to be accurately
phased such that the film is passed through the gate in
one plane, while the exposure takes place in the other
plane. If the two exposures are allowed to take place
simultaneously, or overlapping one another, the cross
scatter between the two channels will cause a noticea-
ble loss of image quality and contrast.
The need for more dia,9nostic information has produced
a demand for higher camera frame speeds. It is possi-
ble to achieve up to 1150 f.p.s. with 35 mm cameras, but
16 mm cameras are used for speeds above this due to
mechanical and power considerations. The max imu m
speed currently in use is 200 f.p.s.

86 G ILAROON 1. RAD iOlOGY - ElECTROMEDICINE

2.7.3.14. Cine Film Marking
It is possible to mark the cine film to concide with the
start of an event such as the injection of contrast me-
diu m or the R ~wave of an E.C.G. Such a device is
called an event marker and would consist of a small
light emitter in the film gate. A more compleJl: system,
using computer principles, is available which records
two physiological traces on the edge of the film (see
fig. 7212).
~ .. ,,'. ea..
,,
_ _ __ I
" in daylight. As the response of the intensifier oulput
Fig. 72/2 (par. 2.7.3.14.) A Cine Film PhysiOlogical Marker.
About a second of the phySiological waveform is con~
verted to a computer type signal consisting of 300 pie-
ces of information. This is then stored in a ferrite core
memory bank unti l it is required.
The con tacts on the camera which Initiate the X-ray
pulse circuits also produce the signal to command the
stored data readout. This data is led to a small osci llo-
scope mounted on the side of the camera and focussed
via a lens system onto the edge 01 the film.
The stored signal is renewed 300 times per second so
even at the highest frame speeds, the patient's data re-
corded on film Is always the latest information available.
2.7.3.15. Spot Film Fluorography
As we have seen, the image recorded on 16 mm or 35
mm film is best suited to dynamic examinations be-
cause ind ividual cine frames do not record all the in~
formation available on the image intensifier output phos~
phor. tn order that the high definition image on the
output phosphor can be adequately recorded, a larger
film format was necessary. Therefore, systems have been
developed utilising 70 mm or 100 miniature film.
70 mm cameras are capable of operating up to 6 frames
per second, and have a magazine which will hold up to
45 metres of polyester based film (approJl:imately 600
shots). The camera operates without a conventional shut-
ler, film eJl:posure being controlled by the length of time
X~rays are emitted from the tube. A mirror in the image
distributor turns during the X~ray set preparation time to
reflect the radiographic image onto the film . After eJl:po-
sure, the mirror is returned and light cannot therefore
enter the spot film camera during fluoroscopy.
For consistent resu lts a photo-timer is necessary, the
eJl:posu re being about ,/. to 'IB of that required for a
full size radiograph . Provision can also be made to re-
cord patient data in the space between frames.
GIlAAOONI . RAOIOLOGY ELECTROMEOtCINE
Films are available for normal or rapid processing. It is
usual to attach a large film as a leader to one end of
the 70 mm film to feed it through the automatic pro-
cessor.
100 mm cameras are now available.
The magazines are loaded with cut film and although
the storage and take-up cassettes are generally easier to
load and unload, proceSSing can be difficult unless spe-
cialised equipment is installed.
Also 105 mm rollfilm cameras are available now.
2.7.3.16. Films for X-ray Cinefluorography
The spectral response 01 the image intensifier output
phosphor has a peak in the green region at about
5400 A and it is necessary to ascertain that any film
used for recording this image also has a high sensivity
in this region.
Many manufacturers market film stock with a spec-
tral sensitivity which matches this colour. The graph
fig. 73/2 depicts the sensitivity of a film. used for cine-
fluorography, compared with lhe response of the intensi-
fier output phosphor.
It should be noted that the ASA or DIN standard rat ~
jngs given to films by manufacturers refer to a polych-
romatic light source which includes all the colours found
phosphor is monochromalic, or mainly one colour, these
ratings are not always an indication of relative lilm speed
when used for ci nefluorography. The only certain me-
thod of checking the compatibility of a lilm for cineflu o-
rography is to make a test run, process the film in the
usual manner and then examine quality and blackening
against an image 01 known quality.
~A'bllfa,y 100
Unltl)
-
F,lm
" OIl ' IlUI
Ph osphor
SO
"
o
' 000 5000 6000 700 0 )" a
Fig. 73/2 (par. 2.7.3. 16.) Speclral Response Curves.
2.7.3.17. Magnification Techniques
It is very difficult to record and visualise all the informa-
tion from the image in tensifier due to the limiting reso-
lution of the lens, film, developer combinations which
are available and the losses in the prOjection system.
The information obtained during analysis of film s taken
during cardiac investigations is often li mited by the de-
tail in the recorded image. This can be improved by en-
larging or magnifying the image before it reaches the
film.
87
The most satisfactory method of achieving this is by 2.7.4. Large f}ald Image Intensllier (1.1.) with Orthicon
electron-optical enlargement within the construction of lube
the intensifier. The inclusion of a second anode at a
potential 01 17 kV, while keeping the first anode at 25 Fig. 75/ 2 shows the princ iple and fig. 75a/2 shows a
kV, still gives a 9" coverage. If the second anode is al- practical Gilardoni realization.
so connected to a potential of 25 kV, this alters the
divergence of the electron beam within the glass enve-
lope, and enables a 5" diameter circle in the centre of
the 9" input phosphor to be enlarged to cover the
whole of the output phosphor (fig. 7412).

Fig. 758/2 (par. 2.7.4.) - Cameragi/. made according fa the

principle 01 lig. 75/2. Input diameter 40 cm .
...
.. ..... ......
2.7.5. Panel Electron Tube for Fluoroscopy (PET-Scope),
Principle and applications

PET is a high gain, flu oroscopic screen; it is lour inches

. IIOW'" "", .. . . . . .
thick and has 9" diameter input and output phosphors.
['0<" ,," _ . . . . Od
According to its manufacturer (Xonics - U.S.A.) , PET is
a device with good contrast and high resolution.
Pig. 74/2 (par. 2.7.3. 17.) - The Dual Field Image In/ensilier.
Fig. 75b/2 shows the operation principle and fig. 75c12
the practical utilization of PET.
The resolution is increased by this method from 20 line
pairs per em to approximately 28 line pairs per em, but
the input dose at the face of the intensifier has to be
increased in proportion to the area enlargement in order
that enough X-ray quanta per unit area are available to
resolve the increased information (fig. 55/2 page 79) .
An alternative arrangement is to provide a long focus
lens to project an enlarged image of the output phos-
phor onto the film as discussed in 2.7.3.11 . This method
provides an improved information content by enlarging
the Image and removing much 01 the lim itation on reso-
lutIOn by the film-developper combination . In practice
the irises of the two lenses have to be adjusted to give
equal light transmission so that the film blackening is
the same for each lens without adjustment to the con-
trol on the X-ray set.

" ---
...--
-----
"'_

F1g 75b"2 ( pM. 2.1.5.) - Principle 0 1 Panel El&ctron Tube

(PH-5c0pe).

Fig. 75/2 (pa r. 2.7.4.) - Principle 01 Image Intenstf"1fN wttn

Orthicon tube.
2.7.6. Photodiodes Image detectors: principles and ap-
1) X-ray lube: 2) X-ray beam. 3) test spealllel ( .. ..,.. plications
rescent screen: 5) light beam am,rt.:! by c. ~
6) mirror; 7-8) optical system of l'IIIIJjIe ~ II) me
Onhicon lube; 9) high gam 0nhI00n -.be: 1'" ..,.. n:nIOf
"These solid state image detectors are based on the use
Input screen diametef 40 an .., more. of sermconductor diodes (p-n ju nctions) as photovoltaic
c::onveruon elements.

88 GllAROONl. IV<DIOI..OGY ELECTROMEOICIP\IE


FIQ. 75c!2 (par. 2.7.5.) - Practical utilization 01 the Panel
EIt1on Tube (PET-5cope).
Fig. 75012 (par. 2. 7.6.) Imagfl :scanning with photodkxies
array.
The detectOr Is placed perpendicularly to the direction of
scanning, Immediately under the scanned object. In the flux
of the X-ray fan beam.
The image Is taken line by line. reconstructed and held by a
semiconductors memory and converted into a standard TV
picture fOr the display.

For the radiological imaging application , the photodiodes
(from 500 to 1000 items) are arranged in a linear array
(with a pitch from 0,3 to 0,6 mm) and are physically
connected to an X-scintillator layer.
All the photodiodes are connected to the inputs of a
basing and multiplexing ci rcu it.
The single element is reverse biased to a reference p0-
tential each time the mu ltiplexers ad ress it; during the
remaining time, the photodiode is left floating (see figs,
75d/ 2 and 75e/ 2).
As the X-ray flu x hits the detector, the charge, at lirst
stored In the photodiode inherent capacitance, leaks
away . When the photodiode must be read, it is con-
nected again by the multi plexers to the reference vol-

---LJJJ~l m.-
tage via an integ rator preamplifier.

- -- -
- .- .- . -
2 3 4,

._ .
t
.....
The charge is restored and the consequent current flux
places a similar charge on the integrator capacitor.
The output 01 the Integrator Is then read and reset to
zero prior to the next transfer.
-----
~

-...---
~

~
~

....
] J'
L...-
f----tf--
~
G-(voo,p"
The detector is placed perpendicu larl y to the direction
of scanning. immediately under the sca nned object and
in the flux of the X-ray fan beam.
In this wayan image can be taken line by li ne; the
generated signal, which is proportional to the differenl
X-ray intensities along the various lines, is sent, via an

~
Vee 6 analog to digital converter to a semiconductors memory,
no'
Fig. 75(112 (par. 2.7.6.) - Principl& diagram 01 the photooiooes
detector.
1) X-ray photons: 2) X-scintillator: 3) photodiodes; 4) multi-
pl exer; 5) reset: 6) Integrator preamplifier.
As the X-ray flux hits ,h,detector, 'ho charge. as first
stored. leaks away.
When the photodlode must be read. it Is connected again by
the multiplexers to the reference vol tage via an integrator
preamplifier. The consequent current flux places a similar
charge on the integrator capacitor.
The output signal of the integrator is then read and the ca-
pacitor is decharged prior to the next transfer.
where the Image Is reconstructed, held and converted
into a standard T.V. picture for the display (see fig.
75e12) .
The great advantage given by these detectors is their
compactness, especiaUy when compared to equivalent
large field (50-60 em) image intensifier tubes.
They allow medical analysis of large areas (lungs, pel-
vis, limbs, etc.) with a scan ning time of 1-2 seconds.
In addition. these detectors allow distortion free images,
have excellent uniformity and have no problems for scat-
tered radiation.
The princi pal factors limiting the pholodiodes detector
petiormance are: the li mited resolution (compared with
the film one) and the increased load for the X-ray source.

GII...oV1DONI . RAoOlOLOGY ELECTROMEOICINE 89

2.7.6.1. Flying spot solid state scanners A dynamic angled inspection increases the diagnostic
information remarkably.
These radiograph ic systems use a high quantum detec-
Fig. 76/2 shows a simple equipment for dynamic gonio-
tion efficiency linear detector scanned by a thin X-ray
scopy manufactured by Gilardoni in 1950.
pencil passing through the patient.
The scanning motion is obtained by passing the main
beam through two linear collimators opposite each oth-
er: one is fixed and the other is cut in a rotating disk.
The relative movement of the two slits generates a small
mobile opening that sweeps the entire scanning line at
constant velocity.
The analog ic to digital conversion and the storage of
the scanned line are then executed synchronously with
the rotating movement of the disk (fig. 75f/2).

Fig. 75g12 (psr. 2.7.6.2.) Operating principle of solid sla/e

(CCO) Inlenslfled IIn9sr scanner.
Accord ing to Oldelft th is system allows film-equivalent reso-
lullOl1 (4.5 Ip/mm) and reduced tube load ing.

Fig. 751/2 (par. 2.7.6. 1.) - Flying SPOI solid slale scenner:
operating principle.
1) Rotating disk; 2) IIBt collimator, 3) X-ray source; 4) ampli-
fier, 5) AID converter, 6) solid state Image processor and
memories: 7) O/ A converter and video output circuit; 8) TV
monitor.

The image Is constructed in the digital memory as a

sequence of continuous lines acquired during the exe-
cution of a constant velocity translation of the patient
with respect to the acquisition system, or viceversa.
The advantages of this approach are the absence of
scattered radiation and the high quantum detection effi ~
ciency which allow a high dynamic range.
Some limitations obviously are the impossibility of mak-
ing dynamic examinations and. due to the relatively long
scanning times, the possibllty of having movement arti-
facts.

2.7.6.2. Solid state (CCO) Intensmed linear scanner

This radiographic system uses. as scanning detector. a

two dimensional image array with 10-100 parallel pixel
rows. It is made with CCDs (Charge Coupled Devices)
coupled to an intensifier by optical fibers.
According to Oldelft this system allows film-equivalent
resolution (4.5 Ip/ mm) and reduced tube loading.
Fig. 75g/2 shows the operating principle of the system.
2.7.7. Gonioscopy and dynamic examination with angled
fluoroscopy
A lillie animal still in the undergrowth is hard to dis~
cover but it Is easy to detect when it moves.
So. a small Interesting part. for example in lung fluo~
roscopy. is hard to detect in complex lung parenchima
stalic fluoroscopy.
Fig. 7612 (par. 2.7.7.) . Gi/ardoni Gonioscop (1950).
T he fluoroscopic screen. properly X-ray protected. is hung
on top slider through metallic flexible wires ; its counter-
weigh t moves In the rig ht tube-column.
The X-ray unit (behind the table) is also hung through a m~
talilc flexible wire on another top slider. its counter-weight
moves In the left tu be-column.
Screen panel and X-ray unit are rigidly coupled by means 01
a metallic arm (left in the picture).
Holdir'19 both screen hendles. it is possible to move the tube
screen sys tem uP. down and laterally. to obtain gonioscopic
performance with in a spherical angle of about 40'>.

90 OllAflOON I. RADIOt.<XiY - aECTROMEDICINE

 3

Fig. 7711./2 (par. 2.7.8.) - Gi/ardon!

Anti-tarrorism equipmenf with "Pno-
4 lodiodes arraY" detector (see fig.
75e/2 page 89).

The images are produced In scan-

ning mode. Using two linear ar-
rays (as in th e picture) tridimen-
sional. images are displayed: 1)
. tube-head: 2) high tension genera-
tor: 3) two solid slate pholodiode
array detectortl lor tridimensional
Images; 4) conveyo r.

Fig. 78/2 (par. 2.7.8.) - Anti-terro-

rism equipment Sec tion of the
equipment In I'g. 77/2 page 91.

I) X-ray genera tor; 2) Fluore-

scent screen; 3) Optic m irror;
4) Image video display device:
5) Conveyor: 6) Radiation pro-
tected cone.
Designed lor checking the con-
ten ts 01 suitcases. baggage, par-
cels, etc., to detect explosive as-
semblies. weapons. primer de-
viCes and other offen sive or dan-
gerous objects.
Safeguards baggage con tents
(including fil ms).
Pro te cti on against rad iation
tor operators and passengers.
Sale operation.
Easy use.

92 GILAROONI. RAOtOLOGY - ELECTAOMEDICINE

2.7.7.1. Spatial vision (tridimensional) through rotational
fluoroscopy
The spatial perception in rotational fluoroscopy is due
to the vision memory Ihat correlates the different ima-
ges produced by the conlinuous projectional variations.
The rotational speed is little, few grades per minute,
and not critical.
Rotational spatial vision may advantageously replace ste-
reography, above all in dig ital lIuoroscopy.
2.7.8. Anti-terrorism equipment
Figs. from 77/ 2 to 80/ 2 pages 91 , 92 and 93 show this
equ ipment and describe the operation principle.
This equipment is utilized in Airports, Banks, Exhibitions,
Business Centres, Custom Posts. Embassies, Government,
Establishments, Museums, Nuclear Centres, Police Sta-
tions, Post Offices, Intelligence Departments, etc.
Chapter 2.8. - X-RAY MEASUREMENT (DOSIMETRY)
2.8.1. X-ray dose and X-ray IntenSity or output (R and
R/ mln)
Just as the Volt (V) is the tension or voltage unit and
the Ampere (A) is the current unit, for ionizing radiation
the unit measuring dosage is the roentgen (A).
R.. is a un it of dose, defined as the quantity of X- ray
or gamma radiation such that the associated corpusco-
lar em ission per 0,(X)1293 g produces, in air, ions carry-
ing one electrostatic un it of quantity of electricity of
either sign.
Fig. 77/2 (par. 2.7.8.) Gllardoni Anti terrorism equipment.
X-ray checking system with motorized conveyor, image video display device and Image storage installed at every Italian airport
checking point.
GlLAROONl, RAOIOLOOV - Et.ECTAOMEDlCINE
Submultiples generally used are the "mR,. (one thou-
sandth of a R) and "!JR,. (one millionth of a R).
Radiation intensity or dose rate or output is expressed
in .. R/se<>, A/ min, Rlhour...
2.8.1.1. RAD (Radiation Absorbed Dose) and
REM (Roentgen EquivaJent Man)
RAD is unit of dose absorbed by the human body cor-
responding to 100 erg per gram of tissue.
REM is the absorbed dose of any ionizing radiation
which has the same biological effect as one AAD of X
radiation.
For energies common ly used in Radiography R, AAD
and REM have about the same value.
New units, proposed for X-ray measurements are re-
ported and described in chapter 11 .1.: all units and their
equivalences are assembled in table 2/1 1 page 300).
2.8.1.2. Ionization viewing by means of a Wilson chamber
Fig . 81 / 2 page 93 shows the effect of an X-ray beam
detected by a Wilson cloud condensation chamber.
2.8.2. Dosimeters - Principle
Radiological dosimeters are generally based on the air
ionization produced by radiations (see par. 2.1.12. page
40).
Fig . 82/ 2 page 93 illustrates the principle of ionization
dosimeters.
91
 Q q c::-J :~
~

b ~- 0 :~
Fig. 82/2 (par. 2.8.2.) Dosimeter principia 10 measura in/an-
slty and dose.
a) Intensity measurement.
The Ionization cu rrent produced by the irradiation of the
ionization chember, passes through the resistor Rand
Fig. 79/2 (par. 2.7.8.) Anti-terrorism equipment. causes a voltage drop proportional to the ionization cur-
Control unit 01 equipment 01 lig. 17a/2: see also lig. 80/2. rent. The Instrument Is ca librated in R/sec (Intensimeter).
b) Dose measurement.
The Ionization current charges condenser C; voltage on
C increases and th e instrument reads the dose in R.
lonizallon currents are very low, in the order of plco-am -
pere (to- ,2 Amp.). Therefore, the insulating material must
be very good because possible leakage of curren t woold
al ter measurements.

Fig. 8012 (psr. 2.7.8.) - Anti terrorism Bquipmenl (Irldimen-

sional display).
Images obtal nables using the equipment of flg . 17812. A high
sensitivity photodl ode detector together with a very high
resolution s\orage device allows brighl and well detailed
images to be obtained.

- ' -~,
."""-.:.

~-:
: \\~
~~ Fig. 8312 (par. 2.8.2. ' .) Vic/oreen inlflgraling dosimeter
with normal lonlzaf/on chambers. according 10 principle b)
of I/g. 82/2.
J
Chambers are Introduced inlo the lop plug lor charging
and dose reading. Reading Is made through the eyepiece
near the handle.
Chamber characteristics are:
b)
Fig. 8112 (psr. 2.8.1.2.) Wilson cloud condensatiOn chamber N. Range (R) Energ y (KeV)
and Ionization effect of Xray beam in air (40 kV - 0.2 sec.).
1 0.25 30 - 400
a) Wilson chamber. b) 'ionization effect.
The ionization is visu alized during a rapid rarefaction of 2 25 400 -1300
air in the chamber that. leaving a trail of condensed
water droplets, reveals the trajectory 01 ionizing particles. 3 250 6 35
The ionization trajectory outside the central path of rays 4 25 30 400
is determined by scettered air radiation.

GllNIOON I. RAOIOLOGY - ElECTROMEOICINE 93

 2.8.2.1 Victoreen Integrating dosimeter

The Victoreen dosimeter (fig. 83/ 2 page 93) is generally

accepted as a sta ndard measuring instrument

? tilt
Fig. 85/2 (par. 2.8.2.2.) GI/ardonl multicontrol dos/ma/rlc
kit.

II consists of a small light case (22 x 16 )( 12 cm, 2 kg)

fo r easy carrying, co ntaining a number o f accessories
to all ow 12 measurement possibilities in the radiological
and electrica l fields from micro roentgen to megaroen tgen.
Fig. 84/2 (par. 2.8.2.2.) - Gi/ardonl Inl&gratlng dosimeter [ope_
ration principle III specified in IIg. 82/2 (b) page 93J.

The Instrument case Includes a ionization chamber of 30 mR

full scale. At lis right, two chambers of 20 and 100 A. The
scale Ms decimal division for utilization ot d ifferent chambers.
Operate as tollows:
1) Remove protection caps trom chamber and dosimeter.
2) Insert chamber In the hole on the leU of the instrument.
3) Charge chamber with built-In generator by turn ing
the knob on the right.
4) Replace protection caps and e)(pose the chamber to
X-rays for measurement.
5) Aemove protection caps and Insert chamber in the
hole on the left side of the Instrument.
6) Instrument needle lall Is proportional to the dose
abOeorbed by the chamber.
The figure on the rlghl shows the dosimeter with aer ial
chamber. ThIS Increases sensitIVIty 10 100 mlcroroentgen
lull scale allowing control of natural radioact ive back-
ground, contamInatIOn, etc.

Fig. 86/2 (par. 2.8.2.3.) - Dogil.

2.8.2.2. Gllardonl Integrating dosimeter
Fig. 84/ 2 shows the dosimeter and fig . 85/2 the dosi-
metric kit for mu ltiple controls (1 2 measuring possi bili-
ties).
The dosimeter is autonomous requiring no external gene-
rator. as it is charged directly by an incorporated elec-
trostatic generator.
Eloctronlc dosimeter for instan taneous (Intensi ty) and inte-
grat ed (dose) measurement according to the two principles
in fig. 8212 page 93).
Three Intensity ranges: 10 - 100 - 1000 R1min.
Two dose ranges: 20 and 500 A.
Optional chamber 0.2 mAth.

2.8.2.3. Oogll, Integrating dosimeter and Intenslmeter

Dog il is an Instrument for quantity (dose) and intensity

(dose rate or output) measurement.
Fig. 86/2 shows a Dogil.

2.8.2.4. Geiger counters

Geiger counters, like scinti llation counters, are indirect
radiation measuring instruments using as a detecting
element a geiger tube or crystal scintillator instead of a
classic Ionization chamber.
Figs. 87/2 and 88/2 show two Geiger instruments.
Fig. 87/2 (par. 2.8.2.4.) - Ra togil. Prote)(imeter with ge/ger
lUbe direct reading In milliroentgen/hour (mR/h).
3 ranges: 1 - 10 - 100 mA/h.
lis high sensitivi ty (1 mR/h full scale) makes it possible to
evaluate Intensities 01 the order of 1110 01 perm issibl e dose
(see par. 11.2.3. page 300).

94 QILAROONI. RA.DIOLQGV _ ELECmOMEDtCINE

 Fig. 88/2 (par. 2.8.2.5.) - Con-
fagil. Proteximetric geiger COUll-
ter with instantaneous luminous
and acoustic indicator (approx.
real size).

Above: open instru ment:

1) battery 1.3 V. 2) geiger tube,
3) elec tronic circuli, 4a) lumi-
nous discharge tube, 4b)
acoustic indicator, 5) on-oll
switch. 6) sensitivity change-
over switch.
Below: Conf/lgi/ principle:
1) voltage generator (5CXl V dc.).
2) geiger tube, consisting 01
a melat tube lilled with rare-
lied gas (argon or neon) that
constitutes Ihe cathode. Tha
anode consists in an insula-
ted tungsten wire inside the
tube.
Opera tion: Ionization photons
pen etrate geiger tube ioni-
zing the gas inside it (pres-
sure 50--200 mm Hg) thus pro-
ducing a discharge between
the electrodes and conse-
Quently a current impulse in
the external circuit.
The current Impulse passes
th rough a resistor producing
a voltage impulse wh ich is
amplilleo by means of an
electronic circu it (3) to feed
a small luminous discharge
tube (4a) and a small micro-
phone (4b). Photons crossing
, geiger tube are therefore de-
lected through a lIashlng light
c, and simultaneous acousUcal

-
+
ticking.
" The number 01 flashes and
, tickings per second Is pro-

" C,
J portional to th e number of
photo ns detected per second.
Th e very high sensitivity al-

" lows the evaluation of natural

radioactive background.

2.8.2.5. Scintillation counters

Scintillation counters are normally made in crystal or

special plastic material, which under the action of X, P.
r radiation emit small flashes of lig ht which are counted
and analized by means of photomultiplier lubes and
electronic amplifiers.

Crystals are of o rgan ic material such as: anthracene,

stilbene, triphenyl, tetraphenylbutadiene and inorganic ma- Fig. 89/2 (par. 2.8.2.5.) - Principle of scintillation dosimeter
lerial such as: zinc, sulphide, cesium iodide. for radlologlcsl use.

Scintillation counters have a very high sensitivity and
are very important instruments for measurement and in-
vestigation of: X-rays, gamma rays, neutrons, etc. with
mertia of the order of microseCOnds; spectrometry of fJ
and y from radioactive substances with activity of the
order of microcurie: spectrometry of simple and heavy
corpuscles, observation of meanlife of mesons, positrons,
etc.
Fig. 89/2 illustrates the principle of scintillation dosime--
ters for rad iological use.
I) Plastic scintillator, 2) light guide, 3) photomultiplier,
4) amplifier, 5) integrator, 6) Indicating Instrument, 7) oscil-
loscope.
The X-ray beam eXCites the plastic scintillator (1). Part
of the radiation energy is converted into light quanta that,
through the light guide (2). reach the photomultiplier (3).
The photomultiplier signal (proportional to Incident ra-
diation) is sent, by means of a switch, either directly
to an oscilloscope (7) for analytical examination. or to
an indicating Instrument (6), to measure intensity through
an amplifier (4) and to measure dose through an inte-
grator (5) and a condenser (C).

GllAROONI. RADIOLOGY - ELECTROMEDICINE 95

 2.8.2.6...Gilardoni BoHle

The geiger counter is the best instrument for protex ime-

Fig. 90/2 (par. 2.8.2.6.) Small
0.2 /iler prO/6lCifT/fIfric bottle auto- 7- try but the home-made bottles are simple, inexpensive,
without tubes, without batteries, without delicate elec-
nomous, Individual, portable, very :=~~~l'
simple /0 manufacture, Measure ," tronic components and can extend proteximetric con-
range from 0 /0 20 mR /,9. trols to more people and more localities in case of nu-
S mR/mm. clear attack.
,. Common 0,2 liter Schwepps
bottle, diameter 5 em, height Fig. 90/2 shows the small 0.2 liter proteximetric bottle,
15 em, accurately cleaned and autonomous, portable, very simple to make and gives
dried. manufacturing instructions.
2. Alum in ium strip. 0.012 mm Fig. 91 / 2 indicates the electrical, radiological and protex-
thick, about 3 m m large, 8 em
long, cut from common kitchen i-metric characteristics of the 0.2 liter bottle.
wrap-up aluminium paper. 101-
ded, to form the two repulse Fig. 92/2 page 97 shows the 2 liter bottle giving manu-
strips 01 electrometer, 2 x 4 facturing instructions. II is a little more complicated to
em tong. manufacture but it is more precise and allows other in-
teresting applications as listed below.
3. Iron wire, diameter 1.5 mm,
10 em long, with one end ham-
mered as a screwdriver, On Fig. 93/2 page 98 indicates the electrical, radiological
thi s end the lolded aluminium and protexi-metric characteristics of the 2 liter bottle.
strips are slicked lor about
3 mm with a small piece 01 Fig. 9412 page 98 illustrates the 2 liter bottle, completed ,
adhesive tape. ready for use and aluminium screened.
4. PoIitene bushing, diameter ab-
out 3 mm. The bushing is ma- Table 13/2 page 99 gives data for proteximetric use for
de with 8 polilene strip. 2.5 em baCh 02 liB a1CI 2 i1er IXJttIes ~ and with antenna-<:t"I<rber.
large and 20 em long, cut trom
a common dry (not greased) Table 14/2 page 100 gives electrical , radiOlogical and
kitchen wrap-up politena sheel , proteximetric cha racteristics for both 0.2 liter and 2 liter
wound around th e iron wire to
reach a diame ter 01 about bottles without and with antenna--chamber.
3 mm.
The bushing ends should not be touched wi th fingers not
to compromise the insulation.
The good Insulation of poIitene is controlled by the elect
ric attraction of small pieces of paper with previous elec
trlzatlon o f politene Itsell by rubbing on wool or nylon
cloth (jacket, pullover, etc.).

5. Rubber cork longitudinally cut to insert the iron wire with

pollteoe bushing.

6. Terminal to charge the electrometer with a plastic pencil

eloctrlzed by rubbing on w ool or nylon cloth (jackel. pul
lover, etc.). To discharge the electrometer tOUCh the elec
trometer with a finger.

7 Home-made cap of thin cardboerd (abou t 0.5 mm) fixed

wrth adhesive tape on the top. For transportation. li x the
cap on the bottle with two laterat pieces 01 adhesive tape.

8. Connec1lng terminal to allow the Inserting of an iron-wire

antenna, diameter 1.5 mm, leng th 50 cm, to obtain a great
Ionization votume.

9. Measure scale cut from a common millimeter paper and

fixed on the front of the bottle with transparent adhesive
tape.
Fig. 91/2 (par. 2.8.2.6.) . Small 0.2 liter bottle of fig. 00/2.

Milliroentgen (mR) and Volt In function 01 the strips opening

The useful measure range is 4 mm, wh ich corresponds to
the dose 01 20 milliroentgen (mR) tor the bottle alone and
0.2 mR lor the bottle with 50 cm antenna.
It is not necessary that the strips close themselves complete-
ly when the electrometer is discharged; 1 or 2 mm strips op-
ening with discharged electrometer is acceptable; obviously
with charged electrometer the opening must be respectively
5 or 6 mm in order to utilize the 4 mm useful measure
range.
Scale reading is made with e single eye at about 50 cm dis--
tance waving the head.
Tables 1312 page 99 and 14/2 page 100 give data for protexi
metric use.
(strips fa ll).
Natural radioactive background in function of time (hoors)
measured in closed room in Mandello Lario (60 Vh).
The strips lall for 50 hours Is about 0.6 mm corresponding
to about 3 rnA, that is 3000 .oR lor 50 hours, that is 6000 .oR
for 1000 hours, that Is 60 Vh.
To screen the bottle use common kitchen aluminium paper.
29 x 50 cm. wound three limes around the bottle and then
groonded by copper wire having 0.5 mm diameter connected
to water pipe or to a simple wall nail used to hang paint
ings. etc.
For easier and more precise background evaluation sensitive,
large volume ionization chambers shall be utilized, as the 2
liter bottle (or 16 liter cage chamber) described in figs. 92/2
and 9312.

96 GILAROONI. RAOIOlOGV ElECfflOIo4EOICrNE

 Fig. 93/2 (par. 2.8.2.6.) - Two IitfN rome of fig. 9212.
Milliroentgen (mR) and VOl t In fu nction 0 1 strips opening
(stnps faU) .
Natu ral radioactive background in function of time (hours)
measured In Mandello Lario (Como) - Italy.
line (I), backg round in free environment (about 30 pR/h):
ine (2), in closed room (about 60 \!h).
The bush electrical leakage correspoods 10 about 4 \!h, the
bush resistance is about t .S . t o' ohm and the bush leak- Fig. 9412 (par. 2.8.2.6.) - Two liter bot/hi, scrooned wllh alum -
-oe current about 7 . 10-" Amp. Inium paper for grounding with opened reading window and
corrugeted aluminium cap (see figs. 9212 and 93/2).
A simple sensitive. largo chamber rang ing from 0 to 1000 pR
(50 pRImm) is made with a metanlc wire basket. of cylindri- The screening eliminates the inlluence 01 the eiectrlzed air
cal shape, CQVefed with thin metallic net as .II cage, and is necessary lor the evaluallon 01 Ihe nalural back-
The dimensions of the cylindrical basket are: base 30 cm, ground,
h.!IIght 20 em, YOIume 14 liter tilat, added to the 2 titer bottle,
gl'ol8S 16 liters. An tenna outside the bOllte neck about IS cm.
The bottle with the cag&-Chamber measures natural back-
ground In relall~ely short time, In Its Integral radiation com- 5, electrlzed air for medical research on respiratol)'
position. I.e. alia. beta and gamma radlallon thus eliminating and nervous systems
the air electrlzatlon influence.
Screening the cage-chamber with cardboard 0.5 mm thick, it
6. very high resistance from 1010 to 1()20 ohms (quality
measures beta+gam ma rad iation. while screening It with 01 insulation materials)
2 mm aluminium sheet il measures gammA rad iation only. 7. very small electric capacity, order of picofarad
By making the differences it Is possible to evaluate the three
different kinds of radiat ion of the background separately. 8. voltage from 500 to 1500 Volt without current ab-
In natural background, the gamma rad iation Is prevalent. sorption (electrostatic voltmeter)
Natural background ranges from 10 pR/h to tOO pR/h de-
pending on ambient cond iliona. 9. vel)' small radioactivity as by uranium prospection
In houses with granit wailS or in places near uranium mines etc.
the background may largely exceed 100 pR/h. 10, radiological output control of medical and industrial
In the same place the background remains practically con-
stant and, once measured. It may be accepted as low le~el
X-ray equipment.
calibration source.
The botlle with SO cm long antenna allows to evaluate the Characteristics and performances of the bottle are repe-
inlluence of the electrlzed air, thai may cause an electrome- titive.
ter strips lall 5 - 10 limes quicker than Ihal of the back-
ground. These bottles are made by wrapping up common poli-
The electrized air is an Interesting medical research field tene alumini um paper used in kitchen; their cost is neg-
because of its influenC(l on resp iratory and nervous systems. ligeable and they can be made by anyone.
The home-made bottles constitute a vel)' important op-
portunity to develop the spirit of research and eng ineer-
2.8.2.6.1. Some evalualion possibilities of Gllardonl ing in young people.
Bottle The bottles interest also experts of radiology, radiation
physics and electrology.
These are:
1. natural radioact ive background from 1 to 1000
microroentgen/hour (pRlh)
2. contamination from 1 to 1000 milliroentgenlhour
(mR/ h) 2.8.2.6.2. Manufacturing Instructions and use of the
"Bottle"
3. co'ntamination from 1 to 10 roentgen/hour (RJh)
4. separate components at alia, beta and gamma They are given in fi gs. 90/ 2, 91 /2, 9212, 93/2 and 94/2
radiation and in tables 13/2 and 14/2 page from 96 to 100.

98 GllAA DONI. RAOIOlOGV - ELECTROMEOICINE

 1\
9 ------1 \
Fig. 92!2 (par. 2.8.2.6.) Two liter bottle, measure range 'rom
o to 8 mR, i.e. 0.4 mR/mm. I \
7 (
I
1
1. Common glass bottle. 2 liter capacity, diameter about
I
10 cm, lenght about 36 cm.
6 ' I
=
The bottle must be accurately cleaned and dried.
I
I
2. Aluminium strip, thickness 0.012 mm, size f x 29 cm,
lolded to obtain two strips 14.5 cm long, cut from a
common kitchen wrap-up aluminium paper.

3. Hook of Iron wire, diameter 1.5 mm. to hang up the

51 I
r- - I
I
,
4'I
lolded aluminium strip.

I
4. Polltene bush. diameter about 3 mm. The bush is made ,
with a strip 01 common kitchen politene paper, 6 cm large
and 20 cm long, wound round the iron wire.
8-l-i )'
Y,
5. Rubber cork longitudinally cut to Insert the iron wire with It
polltene bushing.
/,
h ~
6. Connecting terminal to allow the Insertion of an external
/, ~

~~~
an tenna chamber (7) IOf great 1onlzatloo volume.

!.
7. Antenna 01 iron wire, diameter 1.5 mm, leoglh 50 cm. /,
8. Screen made of aluminium paper (see lig. 9412 page 98).
h ~
t.
9. Removable aluminium cap to complete the electrical
~
screening, made with common kitchen aluminium paper,
corrugated to slrengthen It. 3

The electro meier Is charged touching the terminal 6 with a

plastic pencil previously Charged by rubbing It on wool or
nylon cloth (jacket, pullover, etc.).
When starting measurement the slrips opening should be
12.5 em right and 12.5 cm lelt from scale center and the
useful measure range of 10 mm right and 10 rnm left. The
useful measure range of 20 mrn corresponds to the dose 01
6 milliroentgen lor the 2 liter bottle alone and to 0.2 rnA lor
the bottle wilh anlenna 50 em long.
Tables 13/2 page 99 and 14/ 2 page 100 give data for pro-
leximelric use.
,
I 2
I
I
,I - I
I
I - 1
100mm ,I
I
I Sc ala 1 :2 I
t )
" _0'

GILAAOONI . RAOIOI..OGV ELECTfIOI,IEOtClNE 97

 T A BLE 13/2 (par. 2.8.2.6.) - Measures lor civil-military defence, contamination etc. with 2 liter and 0 .2 fiter
proteximetric bottles (indicative values)

2 Iotsr bottle screened and groun-
<led. Basic strips lalt t2.5 mm to
N. Measure Intensity 2.5 mm (20 mm). flange lor bolUs
alone: 0 to 8 mA: with antenna 50
em: 0 to 0.2 mA.
0.2 liter boUle nol screoeed. Basic
strips fall 4 mm. Range for bottle
alone: 0 to 20 mR: with antenna
50 em: 0 to 0.2 mA.

S URVE Y
, Max. surveyir"lg intensity
""""'" RIh
- -
2 Immediate evacuation
pl.
0' poo- ' 0 RIh 3 sec. with 2 liter bottte 7 sec. with 0.2 liler bottle

3 Rescue squad 5-10 R!h 6-3 sec. with 2 liter bottle 15-7 sec. with 0.2 liter bottle

4 Evacuation within 24-48 hours , RIh 30 sec. with 2 liter bottle 75 sec. with 0.2 liter bollie

5 Levels be surveyed in houses, 10 mR!h 50 min. with 2 liter bollle 2 h with 0.2 liter botlle
recovery works, etc.

C ONTAMINATI O N

6 Cloth conlamlned 5 mR/h 2 min. with 2 liter bottle and 2 min. wi th 0.2 liter bollle and
antenna antenna
7 Food and water contamination Hundreds 01 Vh 10 min. with 2 liter bottle and '0 min. with 0.2 liter bollle
antenna and antenna
8 Territory survey HundredS of Vh 10 min. with 2 liter bollie and '0 min. with 0.2 liter bottte
anteona and antenna
9 Natural backgrOtind '0 uncon- Tens of pA/h - -
tamlna ted places

1) Unconta mInated places: basic strip lall:

- 2 titer bollie screened and grounded: 50 hours or more;
S - 0 .2 liter bollie not screened: 24 hours or more.
U
A 2) No danger but survey sugg9S/ed: basic strips lall tor both bollIes about 1 hour.
V
E 3) Contaminated places to be evacuated In 24-48 hours (point 4): basic strips lall;
y
- 2 liter bollle: 30 sec.
- 0.2 titer bollle: 75 sec.

C 4) Clotfl survey: use bottles with antenna and inspect from about 20 cm distance. Contaminated cloth (point 6) with
0 basic lall l or both bottles in about 2 min.
N Particularly suitable Is the small bottle of 0.2 liters with antenna.
T
A 5) Food, drinks survey; place them In a long basin or In a fish dish.
M
I
With 0.2 liter bottle with antenna inspect from about 20 em.
N Danger with measure basic fall in less than 10 min.
A With 2 liter bottle utilize a 75 cm long antenna instead 01 50 em antenna. bent along the bottle without touching
T it and horizontat on the basin. Danger with measure basic fall in less than 10 min.
I
0 As the above indicated times are relatively short. the Influence of the electrized air is negligible and consequently the
N screening of the bottle is not necessary.

2.8.3. Fundamental orlentatlve data to be remembered
1. 1-4 mR. is the radiograph ic film d ose w ith tung-
state screens (patient emergent dose) . 1 rnA w ith
High Speed sc reens, 4 mR with H igh Definition
screens.
Rare earth screens require 112 -;- 1/5 of the tung-
state screens dose fo r same b lackening (see par.
2.3.3.4. page 44) .
Values are lower fo r the H igh Defin ition screens
and higher for H igh Speed screens.
40 -;- 300 is the intensifying factor o f rare earth
screens.
4. Sk in do se (patient incident d Ose) for some typical
radiog raphies is reported in tab. 15/2 page 100.
5. 1 -+- 5 mR/min . is the sk in rate (patient inciden t
dose rate) in Fluoroscopy.

6. 0,2 mR/ min. is the flu o rescent sc reen dose rate

2. 20 -;- 80 mR Is the radiographic film do se withou t (patient emergent dose rate) .
screens.
7. 10 mR/ m in . is the d ose rate absorb ed by a person
3. 20 -;- 60 mR is the intensify ing factor of tungstate who, agan inst the safety rules, stay s near the pa-
screens. tient during fluoroscopy.

GILARDONI. RADIOlOOY - ElCffiOMEDlCtNE 99

 8. 0,01 -:- 0,1 mR/min. is the emergent dose rate com
ing from the fluorescent screen with protective glass TABLE 15/2 (par. 2.8.3.) . Skin dose for typical
(2 mm, lead equivalent). radiographies Normotype patient, Tungs tate screens
9. 600 rad is Ihe dose of lotal body irradiation in a (wirh rare earth screen dose is reduced to 1/2-:-115).
single exposure, causing death.
400 rad is half lethal dose (50% death). Po" Skin doM (!tid )

10. A radiographic equipment is well calibrated when Haod O,Q1-o,03

its output corresponds 10 the value reported in tab.
17/2 page 101 . Skull lat 0,3-1,0
11 . ~ cm is the average T issue Half Value Layer Skull ..p. and p.a. 0,5-2,0
(THVL) of the radiation usually employed in Depth
Therapy (HVL = 0,65 -:- 5 mm Cu with High Vol Lumbar Vertebrae lat. 3,o-a.O
lage = 160 -:- 500 kV) .
Lumbar Vertebrae a.p. 1,5-4,0
9 em is the T HVL in Cobalt Therapy.
Chest p. . 0.05-0,15
12.. 1 cm is the Tissue Half Value Layer (THVL) of the
radiation usually employed in Contact X-ray T he- Stomach a.p. and p. . 1,()-3,0
rapy.
13. 1 Curie of Caesium 137 produces 0,35 roen tgen When patient thickness Increases skin dose (patient in
per hour at 1 meter (Rhm) 1 Curie of Cobalt 60 eiden! dose) increases strongly, while film dose remains
produces 1,35 roentgen per hour at 1 meter (Rhm). constant.
Hard ray technique reduces skin dose (see comment in
14 The natural radioactive background value is about lig. 21/2 page 46).
10-100 microroenlgen/ hour (pRIh) .

TABLE 16/2 (par. 2.8.4.) Probable early effects of

acute radiation doses over whole body (nuclear
TABLE 14/2 Electrical, radiological and protexi explosion etc.)'
metric characteristics for both 2 and 0.2 liter bot
tJes without and with antenna (see also figs. 93/2, Probab Je effect Doe!! In rad
page 98 and 90/2 . 91/2 page 96). (Indicative No obvious injury 0-25
values).
Possible blood changes bot no serious injury 2$-50
2 liter !)otlle
0.2 IIlet' bollle 8100d-cel1 changes, some Injury no disability 50-100
and~-
not IICreened
grounded
[.. I 'yp. Unit Injury, possible disability 100-200
With With
Injury and disability certain, death possible
A""" antenna A""" antenna ItJ0.400

--
...... 00= 00=
100'1II death within two weeks alIef exposure 6IXI or more
,~ Liter 2 80 0.2 80
1' (equlv.) (equlv.) 600 rad Is the lethal dose, 400 rad half lethal dose and
'00 + 300 rad non-Ielnal moderate dose .
Measure basic
~ 1811
mm 20
(25 to
SO)
20 For Irradiation distributed in time and on small areas as
Xray and cobalt therapy, local doses of 5000 rad and
over can be totalized; they are common doses In radio-
1 Vobge with Voll 1500 1500 1250 1250 theraphy.
basic
~ 1811

, Dose with ba91c Milli- S 0.2 20 0.2 2.8.5.1. Efflclency measure of radiographic equipment and
-.pi laU roentgen control of exposure factors (kV, rnA, sec.) with
~tion
JOO kV ~metric method
:;';;-8 mm Pb
It is exemplified in footnote of tab. 17/2.
strips lall hours over over
I' """ ;!me In unconta-
0",'
SO
0",'
24
awa:t places '"
hour
1/'
hour
2.8.6. Skin dose evaluation In RaeUography and Fluoro-
8ootnco1 picofarad 5 10 3.0 ' .0 scopy
""'""" Fig. 95/2 gives the evaluation dala.

2.8.4. Radiation effects on human body
Racf.13tion effects listed in tab. 16/2.
2.8.5. Dosimeter output of X-dlagnostlc generator
Thts outpvt is given in tab. 17/ 2 page 101 .
2.8.7. Dose volume evaluation (R . liter) in Radiography,
Fluoroac:opy and Therapy
The Dose volume, Dv, expressed in Roentgen' liter
(R . I) (R ' dm3 ), is function of: Incident dose, radiation
energy, skin field size and part thickness.
Dose volume has proteximelric and therapeutical impor
tance (see par. 2.9.14. page 110).

100 GILAROONI, RAD IOLOGY ELECTROMED ICINE

 TABLE 17/2 (par, 2.8.5.) -
Dosimetric output of To'" Focus ro Fluorosc~y Radiography
,
.'
tension f ilm Rjmln'm mRjmAs
X-ray diagnostic generators (Gilardoni Dosimeter d Istance
in fig. 81 /2 page 93) kV< kVp
P' fs Rltff"

,-
10 mmAI 2
mA/sec /Of every rnA _ Dill. FC. 1 meier - Filter 1 mm Cu
'" 50
2lJ
10
02 ,
3

"". 4 rectililn and o;J 5

~'" v~
hall_a...e equipment equipment 50 '" JO 15
'" ~ _____ F-~'----
"""""
kVp

m_ 5<opy Graphy $copy and Grapny

,~ ___ L.
"
V '
10
(Div;I:) mRl~ (Oiis,') eo
,. mRl~ (DMs,')
90 ~
2S 1
20

55
0,006
0,02
-(0,0027)
(0,0067)
0,0 1
0,03
(0,0033)
(0,01)
0,012
0,04
(0,004)
(0,013)
10. 110
120
120 '50
- 2
JO
QS-" 2
"3
30
'0
50
300
60 0,03 (0,01) 0.06
- (0,02) 0,08 (0,027)
'~':
65 0.06 (0,02) 0,08 (0,027) 0,12 (0,04)
150 11lO
"'"
500 3'5 '00
10 10
0, 10 (0,03) 0,13 (0,043) O, t8 (0,06) ko 200
15 0,13 (0,0 43) 0, 17 (O,057) 0,25 (0,083) 15 250
IlO 0, \7 (0,057) 0,23 (0,077) 0,32 Fig. 95/2 (par, 2,8,6,) - Incident, sl(ln and emergent Doses in
(O, 11) fluoroscopy and radiography,
0,23 (0,077)
f-~
0,30 ,(0,1) 0,40
90
- -
0.3<) (0,1) 0,37 (0,12) 0,50
(O, ~ :~ El lmp'. '

95 0,36 (0,12)
- 0,46 (0, 15) 0.60
~~~
(0,20)
1) INCIDENT DOSE (0,)
Fluoroscopy (dolled line)
kVp 70 (sel /rectlfier and 4 pulse generator) Focus Skin
'00 0, 44 (0,15) 0,57 (0,19) 0,72 (0,24) distance 40 cm, inherent tube lilter I mm AI, radiation in-
'05 0,52 (0, 17) 0.68
-
(0,22) tensity 4,5 A/min,
~. ~~ Incident Dose In 5 min fluoroscopy with 3 mA is:
' .63
"'
liS 0,75
(0,2 1)
(0.25)
0,8 1
0,95
(0,27) _
(0,32)
1,10
1,25
(0,37)
(0,42)
4,5 ' 5 . 3 - 67,S R.
Radiography (con tinuous line)
kVcp 80 (6 - 12 pulse generator) Focus Skin Distance
>2, '.90 (0,3) 1,10 (0,37) 1,40 (0, 47) cm, IiIter 2 mm AI, 6 rnA/mAs,
Radiography with 20 mAs delivers an Incident dose of
'"
~ '.05 (0,35) 1,25 (0, 42) 1.60 10 . ~~ 6, 20 ::: 120 mR - 0, 12 R.
'3<) 1,20 (0, 40) 1,40 (0,47) 1,80 (0.60) 2) SKIN DOSE (0.. )
- Skin Dose (0 .) ., Inciden t Dose (0 ,) Ie Back-scattered
13S 1,32 (0,44) 1.60 (0,53) 2.00 (0,67) coefficient (8); 8 =
ca 1,3 lor skin field area of 10 dm2
140 1.50 (0,50) 1,80 (0,60) 2,25 (0,75) (ca 30 Ie 30 cm),
1,2 lor field of 1 dm2 (10 Ie 10 em) and 1,1 for field of
14S 1,65 (0,55) 2.00 (0,67) 2.50 (0,83) about 0,25 dm2 (5 x 5 cm),
With above radiographic eleample, 30 Ie 30 em skin field,
'" ' .1lO (0,60) 2,20 (0,73) 2.70 (0,90) the skin Dose becomes 0,12' 1,3 = about 0,16 R.
3) RADIOGRAPHIC EMERGENT DOSE
(OM., - Olv, 01 the Gltardonl Dotimeler, ' " per, 2,8,2,2, page 1\ corresponds to radiographic casselle Dose and varies
94, wllh 30 mA lutl ICfIle), from I to 4 mR; 1 mR for high speed tungsta1e screens,
4 mA for high defin ition tungstat e screens, For rare ear1h
Practical eleamples: A right calibrated 4 rectifiers equip- screens, cassette dose Is reduced to 1/2 - 1/5 01 tungstate
ment must output: screens one,
70 kVp with 100 mA for 1 sec. at I meter: 4) FLUOROSCOPIC EMERGENT DOSE
0, 13 Ie 100 ::: 13 rnR (Oiv, 4,3) With normal fluoroscopic screen it is about 200 rnA/mi n
(screen Dose),
100 kVp with 100 mA for 0,5 sec, at I meter: With Image Intensifier lind TV il Is about 2 mAimin.
0,57 Ie 100 : 2 = 28,5 mR (01'0'. 9,5)
100 kVp with 100 mA for 0,1 sec, at I meter:
0,57 Ie 100 : 10 ::: 5,7 mR (01'1, 1,9) M o n ochromatic radiation decay ;s expressed by the
Above reported data relate tube with inherent filter equi- exponent ial relation:
valent to 0,5 - 1 mm AI.
For inherent litter equivalent to 2 mm AI, the outpu t de- D~ = 01 B . e- "" . FS[)2 / (FSO + xF
creases 01 abou t 10%,
w here:
D, = inCident Dose In R at the surface of the sk in
B = Back sca ttered rad iat ion factor
2.8.7.1. Theoretical general relation: Dose volume (OY) Is D, B= D ", = skin D ose
given by:
= neperian logarithm base = 2,718
absorption coefficient (variable with the rad ia-
(1) D. = , / D, . S, . dx
"FSD t ion energy)
Focus Skin Distance in dm
where:
D. = Dose volume in R ' I (R . dm3), Ratio FSD2 / (FSD + X) 2 introduce distance square law,

D, = Dose in R at x(dm) under skin, Field Size S. is expressed by re lation:

S, = Field size in dm 2 at depth x to wh ich ;s asso-
S. = S'" (FSD + X) 2 / FSD2
ciated Ox'
thi ckness ;n dm of the irradi ated part. where: S'" skin field size in dm2

GllAROONl, RAOIOt.OGY - ELECTROMEOICINE 101

Introducing the two above relations in (1) is obtained
the Dose volume integral relation:

0. = f , Dj'B'Sso:; ' e- ""' dx '.5

,/'

T he solution of this relation is difficult because the ra

diation used in practies is polychromatic and therefore JJ
and B are variable with the energy of the rad iation. II
0 .5
/
2.8.7.2. Mayneord relation (for Dose Yolume) /
A practical but complicated relation was proposed by
Mayneord : 0
t / THVL 5

D. = 1,44 . 0 ... . $ ", . THVL . 11 + 2,88 . (THVUFSD)

Fig. 958/ 2 (par. 2.8.7.3., - fJ coetriclent In function of rtJe fa
- [1 + (2 . VFSD) + 2,88 (THVUFSD) ] . e -tf1,44 THVI.} lio thlcknessl THVL
fJ is about: 1,5 (wilh ral io tfTHVL more lhan 5) .
where: This condition is veril ied in Diagnostics with part thickll9ss
THVL = Tissue Half Value Layer in dm: Tissue thick above 10 em. and in Therapy with part thickness above
20 em.
ness halfing the skin radiation
(for other factors see precedent paragraph).

2.8.7.4.2. Therapy (Dose Volume)

2.8.7.3. Gilardonl's simple practical relation (for Dose Yo-
lume) In deep therapy the THVL is about 7 cm = 0,7 dm.
Therefore:
Gilardoni's relation is derived from practical physical con-
siderations mathematically elaborated. According to them, D.... 1.5 . Dill . 5", . 0.7, and
Dose volume (Dv) is expressed by:
D. =00: 0 .0; S...
D. = /JD ... S... ,THVL
that is Dose volume in A . I is the product of skin
D. = Dose Volume in A . liter. Dose and skin field area.
p = Coefficient function of thickness / THVL rat io
(see fig. 958/2).
D. = Skin Dose In R (see fig. 95/2, page 10'). 2.8.7.5. Comparison between Mayneord's and Gllardonrs
s.. = Skin Field Area in dmz. ~atlons gtves very ~ mllar ngures

THVL = Tissue Half Value Layer in dm of the em ployed
radiation.
Interested people may have additional detailed papers
about this matter.
2.8.7.4. GUardonl's slmp'e mnemonical r~atlon
Volume)
When In diagnostics and therapy there are parts with
lJCkness over 4-5 THVL of employed rad iation, it is pos-
Sible to utilise simplified relations as in:
2.8.7.4.1. Diagnostics (Dose Volume)
In d18gnostics T HVL is about 3,3 cm = 0,33 dm.
Therefore:
D. "'" 1,5 . 0 ", . Ss.. . 0,33, and
Mayneord's and Gllardoni's practical relations give very
similar figures.
Calculations for d ifferent parts give figures that do not
exceed 5%.
Gilardoni's mnemonical relations give figures less accu-
rate but sufficient for general practical use.
(for Dose
Mnemonical relations allow immediate calculations and
immediate discovery of dangerous Dose volume.
Some practical tables are given hereunder.
2.8.7.6. Table with Dose Volume for typicat Radk)gra-
phkts and comments
See table 18/2.
2.8.7.7. Table with Dose Volume for typical Fluoroscopy
and comments

See table 19l2.

That is: Dose volume (D. in A . I) is about half the

product of skin Dose (D'k in A) and skin field area (5... 2.8.7.8. Table with ski n dose and Dose Volume for dif-
in dm'). ferent types of examinations
SkIn Dose is also a function of part thickness because
for thick parts 0 ... is high, for thin parts 0 ... is low. See table 20/ 2 page 104.

102 GI\.AROONI. IVd)ICX,OGY _ ElECTROMEOICINE

 TABLE 18/2 (par. 2.8.7.6.) - Dose volume for typical radiographies.

Part dimension (1) Exposure (2) Hall Value Layer (3) Patient Dose (4) Dose Volume (5)
GUardonis relations
p,"
FSO
-
DisulIlee
Focus Skin
Irra-
dlated Ihickness volume
""
tension
milli-
" VL
amper- aluminium
"""""
THVL
(ti~)
Incidenl
,0,
e",,,
~".
lacto< (8)
Skin
,0oJ
pr&etical

R. ,
mnemonical

R ,
dm' dm d"" kV, mAo mm = R R
Skull B.p. 2 2 4 42 300 1,35 2.5 1.2 1,2 1, 1,08 1,4
FSO = 80 em 2 2 4 SO lSO 1,60 2.75 0,94 1,2 1,13 0,94 1,1
Field :: 1.3 ;.: 1,5 dm2 2 2 4 58 75 1,85 3,00 0,75 1,2 0,90 0,81 0,'
Skull lal. 2.7 1,5 4 38 200 1,30 2.4 O,SO 1,2 0,60 0,58 0,8
FSO "" 80 em 2,7 1,5 4 45 100 1,45 2,6 0,41 1,2 O,SO 0,53 0,6
Field = 1,8 xl,S dm2 2,7 1,5 4 52 SO 1,65 2,8 0,34 1,2 0,40 0,45 0,5
Abdomen a.p. 12 1,9 23 SO 300 1,60 2,75 2,0 1,3 2,e 12,9 15
FSO "" 81 em
Field = 3 x 4 drn2
12
12
1,9
1,9
23
23
60
70
lSO
75
1,90
2 ,20
3, 1
3,45
1,e
1,15
1,3
1,3
2,1
1,5
11 .7
9,3 ,
12

Pelvis and spine lat. 8 2,3 26,5 60 500 1,90 3,1 7,5 1,3 9,7 36,1 38
FSO "" 67 em 8 3,3 26,5 70 2SO 2,20 3.4 5,5 1,3 7,1 29,0 28
Field :c:: 2 x 4 dm2 8 3,3 26,5 81 125 2,SO 3,75 3 ,5 1,3 4 ,S 20,3 18
Torax a.p. 9 2,3 20 47 48 ,,SO 2,65 0,10 1,25 0,125 0,450 O,SO
FSO = 127 cm
Field = 3 x 3 dm2 ,
9 2,3
2,3
20
20
55
64
24
12
1,75
2,00
2,9
3 ,2
0,08
0,06
1,25
1,25
0,100
0.075
0,390
0 ,325
0 ,45
0 ,34
Hand a.p. 1,e 0,25 0,4 30 15 1,00 2,1 0.012 1.15 0.014 0,0043
FSO = 97 em 1,15 0,010 1,15 0,011 -
"
1,8 0,25 0,4 35 7,5 0,0033
Field = 1 ;.: 1,6 drn2 1,e 0,25 0.4 40 4 1,30 2,4 0 ,008 1,15 0,009 0.0027 -
1) Part dimenSions ".
expressed In dm and dm ' bees,,,, Figures obtained with practical Gilardoni's relation are com-
ldml = 1 liter. pared with Mayneord's relation checking 5% difference only.
2) Exposure with tungstate screens (with rare earth screens, Figures obtained with mnemonical Gllardoni's relati on can
mAs, patient dose eod Dose Volume are 113 + 1/8): be accepted for practical purposes. This relation Is very ea-
there are 3 exposure values: Ihe middle one corresponds sy to use Aadiographlc volume Dose (0..) varies from 'hou-
to normal radiography, the upper one to sort ray tech- sandth of A . I for hand to 1 A . I for skull and a few de-
nique, (1 5% kV decrease and mAs 2 times) and the low- cades of A 1 for abdomen. spine, etc.
er one to hard ray technique (15% kV Increase and mAs D. figures referred to a normal palient (about 70 kg weight).
halving).
Stout patients req uire Increased exposure and consequently
3) Half Value Layer gives Aluminium HVL and Tissue Half
D. Increases 01 about thickness square.
Value Layer.
4) Patient dose: fig. 95/2 page 101 gives Incident Dose (0 1) Exsmpll1: normal abdomen rad iography, 60 kV, 19 cm. part
Ihat multiplied by back scattered lactor (6 ) gives skin thickness, deliveres to Ihe pallent 10 A . I: 35 cm. abdomen
thickness radiography, dellveres D. of (35/19)2 = 3,4 times
Dose (Op.l-
mont that is aboul 3,4 . 10 = 34 A . I.
5) Dose volume (D. ): calculated with two Gilardoni's rela-
lions: Dose volume decreases utillzlng hard ray technique (high
kV). Therefore, when possible, hard ray technique is prefer-
practical: O.= fjOps..,THVL
mnemonical: D. ... 1/2 DIIC . S",
able because
scale.
0'
low D, end more steps object density
(see par. 2.8.7.3 and 2.8.7.4.).

TABLE 19/ 2 (par. 2.8.7.7.) - Dose '1oJuml1 for typical fluoroscopy.

p.n
FSO - Focus Skin
Olstance
Imldla
Part dlmenalon (I )

ted area thlckr.ess volume

18,.1
ExpOeYre (2)

l&nllon curren t
Hall V.lue Layer (3)

" VL
aluminium)
THVL
(liS!lue)
Incidenl
,0,
."
Patient Dole (4)

~"~
laclor (8)
Skin
(0..)
Ooee Volume (5)
GllardQnrs relations

practical mnemol1lcll

,
dm' dm d"" ", mA mm ,m Rlmln - Rlmln R . Vmln R . Vmin

C"'"' 2,3 20 SO 3 1,eo 2,75 3,5 1,25 4,4 16 20

FSO "" 47 cm
Field 3 x 3 dm2 ,
9 2,3
2,3
20
20
60
70
3
3
1,90
2,20
3,10
3,45
5,5
7,5
1.25
1.25
6,9
9,4
29

31
42
Stomach-Intestine wilh
Barium (panommic) 9 2 18 eo 3 1,90 3,10 5 1,3 8,5 27 30
FSO = 50 cm
Field 3 x 3 dm2 ,
9 2
2
18
18
70
80
3
3
2,20
2,SO
3,45
3,75
7
8,5
1,3
1,3
9 ,1
11,0
42
56
40
SO
Stomach-Intestine with
Barium (anali\ic) 1 2 2 eo 3 1,90 3.10 5 1,2 6 ,0 2,8 3,0
4,4
'"
FSO "" 50 cm 1 2 2 70 3 2,20 3,45 7 1,2 8,4
10,2
Field 1 x 1 dml'
Hand
FSO "" 67,5 cm
1
1,6
1,6
2
0,25
0,25
2
0,4
0,4
'"
30
40
3
3
3
2,SO
1,00
1,30
3.75
2,10
2,4
8,5

0,9
1,2
1.15
1,15 1,04
5,7

0,31
5,1

-
Field 1 x 1,6 dm 2 1,6 0,25 0,4 50 3 1,60 2,75 1,6 1,15 1,84 0,56 -
For colum n explanation (1), (2), (3), (4) and (5) see tab. 1812.
Table 1912 indicates that prolonged fluoroscopy gives high and dangerous Dose volume (D.) .
Image intensifier and TV reduce 0 ... about H~20 times (see fig. 95/2 page 101, point 4).

Q./I..AAOONI. AAOIOLOGY - ELECTA0f04EOICINE 100

 TABLE 20/ 2 - Skin and volume Doses for different
techniques.
Thickness Parr 20 cm (approximate fig ures).
Dose volume I, obtained using Gilardoni's mne-
monical relation :
Dy = 1/ 2 . 0 ... . S. (DaI< in A and Sa in dm2).

,>I"(0..""'"
)
Dose OIume
(0,)
EXAM'
R R . ,

Spot Film with Image Intensiller (II )

1 eXpo$tJre
FI8id diameter 23 em (s... '" 4.2 dm2) 0.Q1 0,02

5001 Film with ,

FI8Id diameter 23 em
"
20
100 exposures (5 photos/sec)
(s... ""
4.2 dm2)
"'" 1 2

Angiography X 20
""
100 exposures (5 radiographies/sec)
Field 30 II 30 em2 (S.~ '" 9 dm2)
Tungstate screens (with rnrn oorth
screens. eo.. 0, 113+ 1/8) SO 225 Fig. 9612 (par. 2.9. 1.5.) Dose d&cay In the lirsl tissue em.
""
1/SO ,
for dillerenl therapy types.
elM with II : 20 TIssue deptlts are Indicated in abscissae. the oose % in ordi-
100 exposures
F"1&k:I diameter 23 em
"'" "'"
(s... '" 4.2 dm2) 1O
nates.
20 1) Deep therapy (lor depths beyond 1 em.: see Isodose

Normal Iluoroscopy ,
20
eurve of X-Bomb and Cobalt Bomb l igs. 108/2. 10912 and
110/2 page 107).
continuative "'" 2) Semi-deep therapy.
Field diameter 23 em Is... "" 4.2 dm2)

,
3
3) and 4) Plesiotherapy.
5) and 6) Superficial Th8f8py or Dermoth8f8py.
In deep therapy (eurve 1) dose increases In the first em.
with II-TV
"'""'' ' ' ' '
continuative
Freid diameter 23 em (s... -
20
"'"
4.2 dm2) 0,2 0,'
(110 %), because of the baek scattered radiations (Bulld-up,
see par. 2.9 .8 . page 108).
Tissue Half Value Layer (THVL) is determined by horizontal
line at 50%.
Fluoroscopy with II-TV
Magnetie Recording 20 , "" ...,
Video
Example: THVL 01 therapy No. 6 is 0,7 mm. (very solt ray.
continuative grenz ray). THVL of therapy No. 5 Is about 2.5 mm. and
Freid diameter 23 em (s... "'" 4.2 dm2) 0,2 0.4 THVL of therapy No. 4 is about 7 mm.

Chapter 2,9. - PHYSICS AND BIOLOGY OF RA- 2.9.1 .6. Charactertstlcs and applications of fundamental
DIOTHERAPY radiotherapy apparatus

Table 21/2 gives these data.

2.9.1 . X-therapy types

X-therapy is based o n the physical and biological inter-

action of ionizing radiations on living tissues.
2.9.2. Ratio: tumour dose/ tissue dose (Dtu/ Dts), basis of
The principal applications of X-therapy are the following: Radiotherapy

2.9.1 .1. Superficial Therapy, Dermotherapy (5-50 kV).
2.9.1.2. Plesio Therapy, or Contact Therapy of rapid dose
decay, for affections tm 1 cm. depth (30-80 kV).
2.9.1.3. Anti-inflammatory and anti-pain Therapy: arthro-
sis, rheumatism, etc. (100-15O kV).
In Plesio or contact therapy, where tumour is superlicial
and ratio Dose tumour/Dose tissue (Dtu/ Dts) favou rabl e.
success is good.
In deep therapy, where ratio Diu/ DIs is not favourable.
success is limited .
Obviousl y. success does not depend onyl on ratio
Diu/ DiS, but also. substantially on the type of neoplasy
(benignant or malignant).

2.9.1.4. Semi-<leep Therapy for treatments until 5 cm.

depth (100-200 kV). 2.9.3. BalistJc Efficiency (BE) and methods to Improve It

BE: shows the methods and techniques 10 improve ratio

2.9.1.5. Deep Therapy against deep tumours (400 kV Dlu/ Dts.
50 MV), Exact centering and delimitation (d iaphragming ) of the
treatment fields are the basis to reach a good BE, par-
F.g 9612 shows dose dacay in the firsl tissue cm. ticularly in multiportal and kinetic therapy.

11)' GIu.ROONI. RADIOlOGY aeCTAOMEOICINE

 TABLE 21/2 (par. 2.9. 1.6.) - Some Gi/ardonl equipment for radiotherapy.

N. Equipment
Tissue penetration with
10 x 10 em' field
at 50 em distance

" THVL mm
Build
'P

mm
--
Muscle

abeOrption
Ratio R
Focus
size

mm
Approximated
output
In air at 50 em
Filter mm Rlmin
Applications

, 2 3 5 6 7 8 9
, Neooeono Be ...., - - - Grenz ray. Caustic, Su-
( - fig. 3/10) (5 rnA)
0.3-10 1,5
"'" perllclal, Pleslo. Dermic
Therapy.
, Tp 250 70-250 10-70 0,5 0,56 4 1,5 Cu 30 Superl lelal, medium

,....
( - 11g. 5110) (6 rnA) ood doe, therapy.
3 Monogil400 1()().4()() '0 0,' 4 3 C, 20 Superl lclal, medium

,....
( - IIg. 6110) (6 mAl ood doe, therapy.

Bomb X with static arid

dinamic centering with
1()().4()()
(10 rnA)
1,3 1,0 5 3 C, 70 Superllcial.
ood doe, therapy.
medium

II-TV
( - IIg. 9712)

5 Cen tered Therapix with 11JO.500 ,..as 1,5 1,0 S 3 C, 130 Superlicial, medium and
incorpored centering Si- doe, tumour therapy.
mulat()( II-TV
( - IIg. 11512)

(,' -
...
6 Gllalroo 3000 1. 1,3 MeV 95 S 1,1 20 80 000, tumour therapy

. --,
3000 Curie Cobalt) (2,6 MV) lor 1000 ooly.
( l ig. 8/10) Curie

7 Gllbetron (Beta tron) 35 MV 14().260 70 1,0 0,3 - 600 Obsolete

(see 110. 11 / 10)

COMMENTS:
1) Column 3: THVl (TIssue Hall Value la6Qr) glvos an idea
of the radiation penetration. Over 80-1 mm THVl, the
fundamental ratio: tumour volume dose/ safe tissue volume
3) Column 8, Deep tumour therapy requires about 300 A
per treatment and an output of 50-100 Almln is sufficient
I, _
for this purpose also because the treatment time

dose (GTE = Geometrical Therapeutic Eff iciency) practi-
cally does not improve (see table 26/2 page 110).
2) Column 4: Build-up Is Important for skin erythema. 0 ..,
1 mm, Build-Up erythema does not give problems.
...
fraction of preparation, positioning and centering time.
4) The -Therapeutical Optimum- (TO) in deep tumour treat-
ment is Obtained in th e energy ra nge 400-600 kV (
fig. 11412 page 112).

2.9.3.1 . X-TV Bomb. Now replaced by ..Centered The- lems Is proposed by -Centering Therapix Equipment",
raplx.. (par. 2.9.19 page 112) described in fig. 115/2 page 112 and table 21 /2 point 5.

This equi pm ent , illu stra ted in figs. 9712 to 107/2

page 106-107, has been conceived to obtain a good Ba-
listic Efficiency (BE) by the centering and collimation of
the treatment fields through TV fluoroscopy telecontroi.
Figs. 10812, 10912, 110/ 2 page 107 show the penetration
and collimation of radiations In Cobalt Bomb and X-TV
Bomb in static and kinetic therapy, by means of iso-
dose curves.
X-TV Bomb all ows fluoroscopic centering control during
the treatment of thorax, skull and normally th ick abdo-
mens, though projectional geometry and radiation hard-
ness are not favourable.
With such a hard radialion, bone-muscle absorbtion is
about the same (see par. 2.9.7. page 108) and radiolog-
ic contrast is poor.
The electronic amplifying allows an acceptable TV view-
ing for centering purposes.
TV control during treatment is not possible for thick
abdomens.
In this case small plastic covered lead balls used as
reference marks, are placed on the patient in a prelimi-
nary centering, effected with 100 kV, withOut filters.
During the treatment at 400 kV, the image of lead balls
is visible and telecontrol possible.
A better solution for the centering and collimation prob-
2.9.3.2. Simulator
Fig. 11112 shows a classic therapy Simulator.
Simulators -simulate>o trealement conditions, i.e. distance,
centering. collimation. utilizing a common X-diagnostic
equipment with II-TV.
Their aim is to increase the .. Balistic Efficiency ...Stand
alone.. simulators require the patient transfer and mov-
ing, which may compromise both centering and collima-
tion.
2.9.4. Relative Bk)togk:al Efficienc y (RBE)
ABE characterizes the radiation efficiency of different
energ y radiations on tissue.
ABE decreases with energy increase.
ConSidering as basis 100% the ABE at 200 kV, ABE at
1000 kV is 90% and for higher energies. like that emit-
ted by Betatrons and by Linear Accelerators. is about
85%,
ABE of Cobalt Bomb seems to be even lower, probably
because of its monochromatic radiation , that may have
a lower possibility to interact with cells than the po-
lichromatic one (continuous spectrum), emitted by X-ray
generators.

G ILAAOONI. RAOIOLOGY ELECTAOt.!EOICINE 105

 Fig. 9712 (par. 2.9.3. I.) Gllardonl XTV Bomb for static and
klns/ic d8fJp tharapy with cantering-collimation device, large
size TV comers and motorlzod /olecon trollfJd bed.
Above on the lelt: X-ray tube head with Ileid collimator, tele-
controlled by the bench reported on Ilg. 98/2.
Below on the right: large field image detector Cameragil. il-
lustrated in IIg. 758/2 page 88 lined up on the central beam.
The plexiglass (ore better. Carbon-Fiber) motorized and tele-
controlled bed allows the patient positioning: longitudinal,
transve~1 and in elevation (see fig . 99/2 - 10712).
The 400 kVcp generator Is placed behind the large gonio-
metric dial.
..centered Theraplx. illustrated In IIg. 11512 page 112 is the
new version of X-TV Bomb and reaches 500 kVcp with 10
mA that Is, with an HVl of 5 mm CU, It gives out about 130
Rlmin. at 50 cm.
The - Incorporated SimutatOflo with separate d iagnostic gener-
ator equipped with mlcrolocus rotating anode tube allows Fig. 98/2 (par. 2.9.3.1.) - Control Bench of X- TV Bomb.
precise centering and collimation and therefore a better On the top is placed the c ircular scale to program the an-
Geometrical Therapeu tical Elliclency- (GTE) (see par. 2.9.13. gles of Kinetic tnerapy all(! the TV monitor lor the centering
page 110). control, connected wUh the Cameragil image detector.

Fig. 9912 (par. 2.9.3. t. ) - Vertical stat- Fig. 10012 (par. 2.9.3. 1.) - Horizonlal Fig. 101/2 (par. 2.9.3. 1.) - Angled sla-
Ic therapy Wllh lelecentering and co/- slatlc therapy. tic therapy.
lime/ion through the iergs field im-
age delector (Cameragil).

Fig. 10212 (par. 2.9.3.1.) Angled sla- Fig. 10312 (par. 2.9.3.1.) - Swinging Fig. 10412 (par. 2.9.3.1.) - Swinging
tic Iherapy on chair. (40") kinetic Iherapy. (6Q kinetic therapy.

100 GllAADONI. RADIOLOGY ELECTROMEOICINE

 Fig. 105/2 (par. 2.9.3.1.) - Rotating Fig. 106/2 (par. 2.9.3. ' .) - Rotating Fig. 10712 (par. 2.9.3.1.) - Rotating
therapy (360'. therapy (J6O' , therapy (360").

100 m FIOO ~

90- ~90-
eo- reO-
70-
p..70 A,I

- 60
50-
~50
40-
,
30- - 4 I

20 030

Bomba
Bomba - X Coball0
20 ~ Bomba-X Bomba Coball0
10'"
10 5
Fig. 108/2 (par. 2.9.3. I.) - Comparison b6twaan typical Iso-
dosa curves o( Cobalt Bomb and 400 kV with 3 mm. Cu,
equipment (X-TV Bomb). focus skin distance 50 cm., skin Fig. 10912 (par. 2.9.3. I ,) - Isodose CU(Vfl$ o( :Jtj(J> rotallonal
field size 10 x 10 cm'l. therapy Of Coba" Bomb and X- TV Bomb.
THVl 01 Cobal t Bomb Is 9,5 cm. and 01 X-TV Bomb is 8,0 Rotational axis field width 4 cm .: focus-rotational axis dis-
om. tance 65 em.
Note the belter collimation of X-TV Bomb, doe to ilS small Note the more rapid decay around the hOI zone tor the X-TV
local size compared to that of Cobalt Bomb. Bomb with a consequently less detrimental Dose Volume.

Bomba ~X BofT'ba Cobolto

Fig. '/0/2 (par. 2.9.3. ' .) Isodose CU(VfJS of IW swinging

therapy of Cobalt Bomb and X-TV Bomb.
Rotational axis field width 4 cm.; focus-rotational axis dis-
Fig. 11112 (par. 2.9.3.2.) - Simulator lor Radiotherapy.
tance 65 cm.
Note the higher dose under the hot zone lor Cobalt Bomb ~Stand aloneoo simulators require the patient movement. com-
with a conseqll6ntly detrimental Dose Volume. promising both centering and collimation.

GLARDONI . RADIOI..OOV - el eCTRO ~E OICINE 107

2.9.5. Copper Half Value Layer (CuHVL). second CuHVL,
homogeneity dog ... TABLE 2312 (par. 2.9.5.) - Copper Half Vafue Lay -
er (CuHVL) in function of primary filtration and
CuHVL is copper (Cu) thickness halving the inc ident tube tension from 300 up to 1000 kVcp. For ten -
radiation (see par. 2.1.10. page 40) ; it characterizes ra- sion from 100 to 300 kVcp, see table 22/2,
diation penetration.
CuHVL of deep therapy radiation is more than 3 mm.
Cu and CuHVL of superficial and semi-deep therapy is
0,5-2 mm. Cu.
The second HVL is Half Value Layer measured after the
-~
fillflll
mm Co

0,5
ion

1.75
..
T_ion at tube (kVcp)

2.4 3,0
,."

3,7
first one; the homogeneity degree of a radiation is:
1.0 2.3 3.1 3,6 4,7
w = 1st HVU 2nd HVL 1,5 2,5 3.5 4.1 5,5
2.0 3.0 3,8 4,4 6, I
The 400 kVc radiation filtered by 3 mmCu , has the first
HVL of 4 mmCu, the second HVL of 5,2 mmCu and w 3.0 3,4 4,3 5.0 7.1
= 4,315,2 = 0,83. 4,0 3,7 4.5 5,3 7,8
Table 22/2 and 23/2 give HVL in function of tube vol- 5,0 4,0 4.8 5,6 8,5
tage (kV) and filtration.
6,0 4.2 5,0 5,9 9.0

~__~7,~0__
8,0
-t__~,,~'__-t__~5,~2__1-~0~,2~-t_ ~~ ._
4,4 5.3 6, 4 9.6
TA~ LE22!2 (par. 2.9.5.) - Copper Half Value Layer 9.0 4,5 5,5 6.6 9,8
(CuHVL) in function of primary filtration and tube
10.0 4,6 5,6 6,7 10,0
tension from 100 up 10 300 kVcp. Fo, tensions
from 300 to 1000 kVc, see table 23/2.

Primary Ten,;oo al tube IkVcpj

littration
mm Cu
I-
'00
'"
.., '" '" "" '"
,.,
0,1 0. 10 0. 15
-
0,20 0,30 0,35
- - 0,45 - -
--
0,2 0,20 0,25 0,35 0,45 0,50 0,60 0.85 1.05
0,' 0.25 0.35 10.4s 0,55
- 0,65 O,BO 1,05 1,30
\- 0,0 0,30 0. 45 0,55
- ---
0,65 0,80
_.- -
0,90 1,20
- --
1,55
--- - ,-
0,50 I O,OS 1,40 t--;js
L

-r
I-~'S _
~~
0,75 0,90 1,05
- -- .- -- 1, ,
0,0 0.45 0,60 0,70 0,85 1.00 1.1 5 1,60 1.85
-0,' - - -- -- , .;,
~ /-T-t
1,0
0,50 0.70 0 ,85
--- --
0 ,60
\- - - - -
0,80
~
0.95
1,00
1, 10
1.1 5
1.35
~
1-:30
1.45
1,80
2,00
2. 10
2,30 .> , ~ H- '-'-_
I
,
~ .. I ",""'01
. IT
u
.2 __ ~~:
1,0 0,70
0,85
0,90
1--'--
1,20
-, -- 1,60 2,15 2,50


Mu,t,,,:!~
(tlrj
.:","I-'lIrf -

f., . 1'.
.

- - -- I .~' 10 1,30 1,55

- --
1,70 2.30 2,70
t
I
C ... I . .. -0 ... _ 't
1.6 0,75 1,00 1,20 1,40 1,60 1.85 2.45
-55
2,90 o. ~io
" ......,. . r. .....".
L.

" ....." .-i;~ v

E. .,..u.

*.
I.' -
-
0,80
-- 1.05
-- - - 1.25 1,50
._- 1,70 1.95 (3,00)
c.
2,0 0,85 1,10 1,30 1.55 1,80 2,OS 2,70 lito) IG IICI lOG
,... ........ . 1UIht.ao _
lOG .$01 1_ In Coo<!
_ T...I... doll .........tL"'"
v ...wo oW tubo

Fig. 112/2 (par. 2.9. 7.) - Absorption coe /ficiems of muscle

2.9.6. Tlilue Half Value layer (THVL)
THVL is tissue thickness halving the incident radiation,
THVL is very important because it gives a direct indica-
tion 01 the dose distribution in tissues during treatments.
(waler), bone ana far In function of energy.
Note that at 400-500 kV the three absorption coefliclents
practically have the same value and human body can be
considered homogeneous if referred to absorption (Irom
Wachsmann).

At 400 kV human body may be considered homogene-

2.9.7. Musclelbone ablorptlon ratio
Fig. 112/2 gives absorption coefficients in function 01
energy radiation for bone, fat and water (whic h is prac-
tically muscle equivalent).
Fig. 112/2 shows that
') at 200 kV bone absorbs about 85% more than water
(muscle)
2) at 250 kV bone absorbs about 50% more than water
3) at 300 kV bone absorbs about 25% more than water
4) at 400 kV bone absorbs about the same as water.
ous and this improves therapy possibility, because bone
does not ..screen .. the under placed tissues, and the use
of precalculated isodoses tables is allowed .
2.9.8. Maximum Ionization depth (Bulld-up)
Fig. 96/ 2 page 104 shows that, when high energies are
employed (deep therapy) , the radiation intensity inc reases
in the first tissue layers reac hing a maximum under the
skin; th is is caused by back scattered radiation and the
maximum is called .. Build-up...

108 GILAAOOHI. RADIOI.CX>Y - ElECTIKlMEDICINE

 If _Bu ild_up.. reaches 1 mm. or more, skin is partially
protected and the risk of a cutaneous erythema is re-
duced,
Table 2112 page 105 column 4 gives the Build- up of
the principal therapy equipment.
2.9.9. Dosimetric output of X-therapy equipment with pul-
sating and constant potential voltage.
TABLE 2412 (par. 2.9.9.) - Dosimetric output (R/min)
in functio n of pulsati ng voltage (kVp) and filter
(mm Cu). Curren t 1mA, Focus Camera distance
50 cm, measurement in free air.
For consta nt potenti al voltage (kVcp), values are
double d.
Rlmin lor each mA F.C. dist. 50 em

""....
M.
Table 24/2 reports these data. Filtef Filler Fitter Finer
(kVp)
2 mm Cu 3 mm Cu 5 mm Cu 10 mm Cu
Output increases with about the 3rd power of tension
according to the relation: R/ min ~ k . mA . kV3. -

2.9.10. Back scattered radiatio n (%) In function of CuHVL

and treatment field (Wachsmann).

Table 25/2 gives these data. i-

I-
i- ~-I -

TABLE 25/2 (par. 2,9, 10,) - Back scattered radia-

~
tion (%) in functio n of HVL and treatment field.

Field (c~)
HVL
~ ~ 100 200
--
""
0.5 mm C u
' ,A
1.5 . ~


21
22
21
29

'"
28
37
38
38
"
<3 ....
47

2,0
17
-
23 " .,
- '"23 36
3,0
"9,0 17
,. 28 33
<,0
5,0

' ,0
13
10 15
,.
23 27
22

',0
<,' ',5 12 C-,'6 _ 19
-.---

7,0

- ' 3.7 7,0 10 13 17
,.
',0 3,2 ' ,0
',' 12
,-
---
9,0
2,'
-
5,3
.---- -
7,' 10
--, ~ .- ~
10
2,' 5,0 7,5 9,7 12
- ;-,

.,. .,.
-" 2,5 5,0 7,2 9,0 12
12
2,5 <,' 7,0
"
13

,. 2,< <,< ' ,3
"
- ----
2,< <,3 ',7
"
."
2.9.10.1. Deep Dose In functio n of energy for typ:al
therap+es: 500 kVe, Cobalt Bomb, Linear Ac-
celerato r 5 MY. Betatron 35 MV

These data are reported in fig . 113/2 page 111 .

2.9.11 . Techni ques of Radiot herapy treatm ent (from

F. Wachsmann and G. Drexler)

The fundamental techniques are:

Example: output at 500 kVp. 10 rnA. 3 mm Cu at 50 em ==

2.9.11.1. Pteslo or Contac t therapy 6.5 x 10 Rlmin that doubles (130 Rlmin) with 500 kVcp
(constant potential).
Skin Dose 400-500 rad every day (small field). kVp output may reach kVcp one. increasing tension of about
25%.
Total Dose 5000-10000 rad.

GJI..AROONI. RADIOLOGY ELEC"llIOMEOICINE

109
2.9.11.2. Arthrosk; antipaln, antinflammatory therapy, ecc. 11) Tolerance of the mucous membrane
of the rectum and bladder using
Skin Dose 10-100 rad each treatment. fractionation 6500 rad.
Total Dose: 200 rad max. 12) Dose required to destroy
melanoma 10000-20000 rad .

2.9.11.3. Tumour therapy 2.9.12. Dose Volume evaluation in therapy (R . liter)

Tumour Dose 4000-6000 rad (single field, multiple field,
kinetic). Skin Dose 100-300 rad every treatment for 30
or more days.
oy in X-therapy may be calculated with Mayneord's rela-
tion (see par. 2.8.7.2. page 102), Gilardoni's practical ra--
lalion (see par. 2.8.7.3. page 102) and Gilardoni's mna--
monical relation (see par. 2.8.7.4. page 102), the latest
being expressed as foll ows:

2.9.11.4. Fundamental doses In Radiotherapy (from

F. Wachsmann and Dirnolsts) where:
D, in A . liter
1) Clearly affected lymphatic tissue 25 rad. 0 ... = Dose skin in A
2) Damage to the testicle 50-200 rad . S... = Surface skin In dm 2.
3) Damage to the bone marrow 50-100 rad.
2.9.13. Geometrical TherapeuUe EHldeney (GTE) equlva-
4) Castration dose of the ovaries 250-300 rad . tent to Ballstic EHleleney (BE)
5) Ephitellum of the gastro-intestinal
tract. visible histological changes 3()().5OQ rad. Geometrical Therapeutic Effi ciency (GTE) , is expressed
6) Epilation dose 35Q.400 rad. by the ratio: tumour Dose volume/Total Dose volume.
7) Thresold erythema dose 800 rad. GTE is determinanl for therapeutic success.
8) Tolerance dose of the skin depen- Balistic Efficiency (BE) is the ratio: tumou r Dose vo-
ding upon the irradiation conditions: lume/ safe tissue Dose volume.
sing le Irradiation 1100-3000 rad .
- fractionation over a period of 2.9.14. Fundamental Doses and Geometrical Therapeuti-
30 days 3600-8000 rad . cal EHldency (GTE) tor dltterent therapy types.
9) Cataract formation 500-1000 rad. Table 26/2 gives these figures for the following thera-
10) Dose required to destroy malignant pies 500 kV with HVL 5 mm Cu, Cobalt Bomb, Linear
tumours 4()()().6()()() rad . Accelerato r (5 MV) , 35 MV Betatron (see fig. 113/2).

TABLE 26/2 (par. 2.9.14.) - Fundamental doses and Geometrical Therapeutical efficiency (G. T.E.) for different
radiotherapy types (see par. 2.g.13.).
Th. table shows that G.T.E. 10' MedIum-Energy (500 kV), Cobalt Bomb, Linear Accelerator, Betatron {,
practically the same.
Constant data: Tumour dose = 4000 R
Part thickness = 20 em
Tumour diameter = 7 em
Irradiated area = 10 x 10 em2
Medium energy (500 kV) Linear Accelerator Betatron
Thlfapy HVL - 5mmCu CObalt Bomb (5 MVI ($ MV)

FSO - 50 em FSO _ 50 em FSO ,. 100 em FSO = 100 em

Tumour deep (em) Tumour deep (em) Tumour dIIp (em) Tumour deep (em)
""""
Skin dose R
"
10500 8300
6

6700
5
" 6 5
"
1700 1500
6

1350
5

1300
" .10 5

Emergenl dose R 1100 870 700

5900
62Q
3500 3000
1900 1600
2&10
1500
2350
1250 2200 1900 1750 1670
660
2700
""
2500 2450
600
2400
TOlal ""I. dooe 7600 7500
A . )ller 9600 6100 5400 8750 6400 5900 8000 7100 8300 6000 7300 6750 6500 6400
(D"'ol)
Tumour vol. dose 720
(0",) A . Iller 720 720 720

GTE 0
D.,.IOYlOl 0,075 0,095 0,118 0,133 0.082 I0,096 0,112 0,122 0,09 0,101 10,114 0,120 0,098 I0,106 0.1 10 10,1 12

Fig. 113/2 gives depth Dose curves employed in Tab. 2612.

Dy figures for Medium Energy and Cobalt Bomb are calculated with Gilardonl's practical relation: D. = fJ 0.., . S.k . THVL.
Similar values are also obtained with mnemonical relation: D. = D... . S..,.
D. figures for Linear Accelerator and Betatron are calculated with graphic integration of respective curves of lig. 11312.
G.T.E. strongly depends on collimation. Simulators with 1.1. and TV improve G.T.e. because of good centering and collimation.

110 GILAAOONI. AAOIOlOGV ELECTAOMEOICIN E

Dose vol ume is calculated with the use of Gilardoni's
practical rel ation. constant factors being : tumou r diame-
ter 7 cm. (0.7 dm). tumour dose 4000 rad and ski n
irradiated field 10 x 10 cm2. (1 dm2).
Calculation for other techiques is easily made.
Other information about G.T.E. can be found in par.
2.9.16.
'".'17'r"'" ,.,..."",,::---,---,---,--- ,
B.3 5 M V
5 00 KV'-t~......
% 5) G.T.E. i.e. tumour Dv I total Dv. is about 10 times
.~'~m----~5C-----~,*.C-----~'~5------2~.C-----~25
Fig. 113/2 (par. 2.9.10. 1.) . DfHlp dO$e in lunctlon of energy
for typical therapies: 500 kV (HVL = 5 mm. Cui. Cobalt
Bomb. 5 MV Linear Acx:elerator and 35 MV Betatron.
The curves are relerred to 100'lI0 maximum dose. 1 dffi2 skin
field area (SO em FSD lor 500 kV and Cobalt Bomb therapy.
100 em FSD lor Linear Accelarat01' and Belatron).
It is observed that with Linear Accelerator and Betatron the
emergent dose can be greater than the Incident one.
The Geometrical Therapeullcal ElIlclency (G.T.E.) practically
is the same lor all 4 therapies (see table 2512).
2.9.15. Skin, tumour, Doses yolume and GTE In Pleslo
or Contact and deep therapy
Table 27/2 gives contact or rapid dose dacay therapy
figu res. compared with those of deep therapy.
It is observed that plesio-contact o r rapid decay dose
therapy gives GTE ten times better than deep therapy.
That is a reason of the success 01 plesio-contact and
similar therapies.
2.9.16. Dose Yolume (D~) and Geometrical TherapeuUe
EHk:leney (GTE) with dlHerent equipment: 500
kV, Cobalt Bomb, 5 MV Linear Accelerator, 35
MV Betatron
Table 26/2 allows important consideration with a same
tumour Dose of 4000 rad:
1) with 8-10 cm . tumour deep the total Dose volume is
about the same for all 4 therapy types.
2) w ith tumour deep lower than 6 cm., the total dose
volume is lower with 500 kV equipment.
3) w ith tumour deep lower than 10 cm .. the total Dose
volu me is lower with Betatron.
4) GTE is practically the same for all the 4 therapy
types. GT E improves with Simu lator employment Ima-
ge Intensifier and TV equipped. because better cen-
tering and collimation of the tumour are allowed.
GllARDONI. RADIOlOGV ELECTAOMEOICINE
TABLE 2712 (par. 2.9.15.) - Skin tumour, volume
doses and geometrical therapeutical efficiency
(G. TE) in contact and deep therapy (approximated
figures).
N. "'d~
1 Skin Dose (A)
2 Tumour Dose (A)
3 Total irradiated volume (I) 0.001-0,005 '5
4 Total volume Dose (R' I)
5 Geometrical Therapeutical
Elliciency (G.T.E.) good no good
6 Tumour Volume Dose 1
Total Volume Dose = G.T.E. about 1 0.08-0/12
1) Skin dose: fractloned.
2) Tumour dose: as Indicated in par. 2.9. 11.3.
3) Irradiated yolume: few cm3 (thousandth of liter) in
contact therapy and few liters (dm3) in deep therapy.
4) Total yolume Dose: 1000 times more in deep therapy
than In contact or rapid decay therapy.
better in contact therapy than in deep therapy.
6) Tumour D. is obtained multiplying tumour yolume by
Dose at center 01 tumour.
2.9.17. Other factors characterizing therapy efficiency.
They are hereunder reported.
2.9.17.1. Relative Blologk:al Efficiency (RBE) of radiation:
ABE decreases with the radiation energy increase.
If ABE of 200 kV equipment Is 100% It becomes 90%
with 1000 kV equipment and 85% with hig her energies
as with Betatron.
Cobalt Bomb may have lower RBE because of mbnoch-
roma tic radiation, that may have lower probability to In-
teract efficiently with cells than polychromatic one.
2.9.17.2. Muscle/ Bone absorption ratio
Fig. 11 2/2 page 108 gives curves 01 this ratio in func-
tion of energy for: bone. fa t and water (practically mus-
cle equivalent) .
Percentage absorptions 01 the bone compared with wa-
ter ones are: 200 kV 86%, 250 kV 55%, 300 kV 23%.
400 kV 4%.
Only at 400 kV the absorption homogeneity between
bone and tissue is reached.
2.9.17.3. Build-up and skin erythema
Build-up is an important factor in the occurrence of
skin erythema (tolerance skin dose in treatment); 200 kV
therapy has low bui ld-up and high ski n erythema.
Up to 400 kV heavy filtered therapy. Cobalt Bomb and
Betatron have higher build-up and lower erythema: that
allows better treatments.
111
Betatron can save the skin at the incidence but su r- 2.9.19, Gilardonl X-therapy (CCentered Theraplx operat-
charges the tissue at the emergency (see fig . 113/2 Ing at ..Therapeutical Optimum with Incorporat-
page 111), ed Simulator to Increase .. Geometrical Efficien-
cy),

On the basis of the above mentioned studies, Gilardoni

2.9.18, " Therapeutical Optimum (TO) Is In the range of
400-600 kV
Fig. 114/2 shows the ",Therapeutical Optimum" (TO) that
takes place in the energ y range 400-600 kV.
has developed an X-ray generator of 500 KVcp (con-
stant potential) as a good solution to the problem of
radiotherapy; it is illustrated in fig. 11512.
For Radiotherapy applications, techniques, equipment
and installation see also Part 10, page 293 and chapter
10.4. page 298,

",., Fig. 114/2 (par. 2.9.18.) - _Tharapeutlcal Optimum- .

Basis factors lor Radiotherapy are:
\ 1) Relative Biological Efficiency (RBE)
2) Bone/muscle absorption RatiO
3) Skin protection (Build-up).
Graphs give these 3 lactors in function 01 energy (kV): the
Ilrsl is given by FriU-Niggli, Wambersle, Outreix, Tubiana,
50. Ward, lhe second by Wachsmann and the Ihird by Rousseau
and COli.
From graphs il Is observed that . Therapeutlcal Optimum_ is
obtained in the range of 400-600 kV.
Under 400 kV, bone absorbs too much compared wllh mus-
+ '00 200 300 ~ 600 1000 5000 KV
cle (+ 85'110 at 200 kV) and skin is overcharged.
Over 600 kV. RBE decreases disadvantageously (-10'lI0 - 15'!1t
and probably less .....ith energy increasing as several Re-
searchers have indicated) and bone becomes more transpar-
enl than muscle (- 10'lI0).
Therapeutical Optimum range (4Q0-600 kV) has the 3 factors
near Ideal cond ition (5'!It).
- Geometrical Therapeutical Elliciency (GTE)_, i.e. ratio: tum-
50. our volume Doaeltotal volume Dose. Is also fundamental for
Radiotherapy efficiency.
Further information in table 2612 page 110.

Fig. 115/2 (par. 2.9. 19.) - .Cenlered-

Theraplx~ (see Chapler lOA.
page 298).
X-therapy equipment ..... Ith II-TV Si-
mulator operating at high Geometri-
cal Therapeullcal Elliclency (GTE)
(see par. 2.9. 16. page 111) and in
"Therapeutical Optimum" range (1Ig.

-.
114/2). For movemen t facil ities see
frg. 97/2 page 106 and follo ..... lng
Performances: 500 kVcp, constant
tential, with 10 rnA. liltration 3 mm.
CU: output Is about 130 Rlmin al 50
p0-

=I) Generator wi th 500 kVcp two sta -

ges tube.
2) ~13O kVcp microfocus rotating
anode tube head.
3) 23 em. Image Intensifier lined up
wrth rotating anode tube focu s.
"'1 Patient motorized, telecontrolled
bed with elevation. longitudinal and
transvefS81 movements.
5) Goniornetric wheel.
6) CentfJl'ing telecontrol with TV mo-
nitor (placed in the control box).
Behind the wall ..... lth goniometrlc whee! are placed: 500 kVcp generator, that leeds tube head 1, the 50-100 kVcp generator that
feeds tube head 2 and II-IV Simulator (3 and 6) feeder.
The superiority of the .. incorporated SimulatOf" like that realized in ..Centered Therapile.-, that allows the cen lering without moving
the patient. is obvious in comparison with thai of the Stand alone Simulato!"$, that Involve patient transfer.
.. lrK:Oq)Orated Simulato,," allows the best Geometrical Therapeutical Efficiency (GTE).
The feeder generator of the double focus rotating anode tube has 400 rnA ..... ith 80 kVcp power and allo ..... s, th rough the special
cassette holder, to realize documentation radiographies .
..centered Tharapix,. Is equipped ..... lth precalculated isodoses tables lor Slatic and kinetic therapy. thai make treatment planning
easier.

112 OIl.ARDONI. RAOIOLOGV - ELECTRQMEOICINE

 PART 3

RADIOLOGICAL ELECTROTECHNIQUE
 PART 3
RADIOLOGICAL ELECTROTECHNIQUE

Chapter 3.1. - GENERALITIES

3.1.1. High voltage (H.Y.), the basis of Xray generators

An seen in the preceding chapters (see par. 1.1.1. page
29) in order to produce Xrays, rectified high voltage is
needed because of the required unidirectional flow of
electrons from cathode to anode.
3.1.2. High voltage production
H.V. is generally produced by H.V. transformers. They
deliver alternate voltage; unidirectional tube current (see
precedi ng paL) for Xray production is assu red by elect
ric valves allowing current to flow in one direction only.
A cold anode X ray tube can itself provide for the uni-
directional flow of current without the use of a rectifier
(self-rect ifying tube, see table 1/3 pas. 1, page 116).
3.1.3. High voltage transtonners
Fig. 113 illustrates the transformer principle, fig. 213
shows an open X-ray generator with self rectifying tube
and fig. 3/ 3 shows a High Power Transformer for the
12 pulse generator.
Fig. 1/3 (par. 3.1.3.) - Trans
10ffner principle.
I )Prlmary w inding : few
2 turns of large diameter
wire.
Fig. 3/3 (par. 3. 1.3.) Dodecasi/ix (Gilardoni).
High power translormer lor 12 pulse generator (12 silicon
rectil iers), according to m principle shOwn in pos. 5 01 table
1/3 page I t6.
Current till 2400 mA and voltage till 150 kVc, con;tant poten-
tial (see fig . 8/3 page 119).
3.1 .4. SOli,d state high voltage rec!lfiers: selenium, Silicon,
etc.
In the past, vacuum thermoelectric valves were used to
recti fy high voltage in complicated an:! powerful X-ray
equipment.
Nowadays, semiconductors (solid state), seleni um or sili-
con rectifiers are used .
Semiconductors are composed 01 special materia ls, with
varying electrical conductivity: high in one direction, very
low in the opposite direction (valve prinCiple) .
They consist of small thin plates. Selenium plates can
rectify tensions of 30-40 Volt (peak inverse tension) while
silicon plates act in the 200-400 Volt range.
The piling up of many plates allows to cover any H.V.
value required for radiological generator.).
Fig. 4/3 shows silicon rectifiers used today in radiology.

!
~~~~F Secondary
2) many turns of wind i ng .:
thin wire
..... 1 3) Magnetic core.
II primary turns are 100
and secondary 100.000
2 trans former ralio is 1000.
I Volt at primary winding
gives 1000 Voll (I KV) at
secondary w inding : 100
Vol t al primary winding
give 100 KV at second<y
winding.
3 These vOltage are:
Vp "" 1,"1 . Veil. In rad io-
logy the peak voltage states the A min vaUe and so the con-
linuous emission spectl\.lm.

Fig. 413 (par. 3. 1.4.) SIlcon recflflers lor Xray generators.

The longest, 22 em. w_hstands 150 KVp nverse potential;
Fig. 213 (par. the medium, 20 em. supports 125 KVp nverse potential
3. 1.3.) Small and the shortest, 18 em , support 100 KVp inverse
Xray genera- potential.
tor, monobloc
type, self-ree
I/Iying. up /0
110 kVp. Chapter 3.2. - HIGH VOLTAGE (HV) GENERATORS
FOR X-RAY PROOUCTION
I) HV trans-
"""'" .........
tic core: 2)
high voltage
3.2.1. The main H.Y. generators, electric circuits, features
and perfonnances
(HV) """"""'"
ry winding su- Table 1/3 page 116 summarizes the princi pal radiologi-
perposed on cal high voltage generators with electric circuits, charac-
primary wind-
ing; 3) X-ray tube see lig. 212 page 36); 4) C<fhode with in- teristics and performances.
candescent l ilament to produce electrons; 5) anode with Medical rad iology requ ires short exposure times (a se-
X-ray window: 6) anode radia tor; 7) transformer to heat ca- cond, one tenth or even one hundredth of a second) in
thode Iilament, earth Insulated at 55 kV.
The unit is housed In a metallic container, vacuum treated order to eliminate kinetic unsharpness caused by mov-
and filled with hig,ly insulating all, also vacuum treated, to ing parts of the body such as heart, lungs, stomach etc .
support high kl lovol tage. The circuits described in table 1/3 are used in medical,
industrial , and art rad iology.

GIlAROONI. RAOIOlOGY aecTAOI.!EOlClNE 115

 TABLE 1/3 (par. 3. 1.2,) - Principal circuits of high voltage ( H. V.) generators for Radiology.

Circu it. va - tube volta ge without load

V - HV tran.To rmer \/ol tag o Ve - loaded tube voltage EOU IPMENT
with e uftent (I)

1) SelHectitied e quipme nt

J.AA
L'!' ,V--'.j A ,
Xray tubes 01 this equipment are cold anode type to a llow se lf.rectlTy ing (see par t .2. t
page 301.
II local spot. with heavy lo ad I. becomes incande.cent. electron. may Tlow trom toca l spot to
cathoda during inva,"e haltw ave dutroying th e tube (inve ,"e current phenome non)
Wit h hi9h load I h ~lIwa. e vo ltage lalls from Vo to Vc wh ile the in.e,"e h~llw~.e inc,e aSeS e n

V
dangetong tube and transformer. Su itab le a rt ifi ce. can el iminate such trouble .
U ti llz~tlon: . m ~1 1 ~ nd medium diagnost ic gene rators : 550 m,o.. with 70'1 00 KVp . me d icel th e
ropy.
NonD u trucU.e Te.tlng : 5 tO mA up 10 1000 KVp an d over.
"
"
t're"tlfle, e qu ipm e nt
" ,0.. rectitie, in saries 10 the lube le i. curre ni llow on ly in rightd irec llon . uppre'! ing non ' loaded

~,
J.U ,ollag e hall wa .

L'!' ,Y-.!J ,,
Th il allow. higher cherg e s be ceu $e , s hould 10c~ 1 spot be com e Inc~ nd . scent, no Inve r.e cu r
renl I. pe rm in e d ,
Cu rrent li s not s inuso idal becau.e 01 tube sa turation .
, Uillization: me d ium dl.gnost ic g e nerators 50 ' 100 mA with 10' 100 KVp
, ,I
,L ___ ____ _______ l, \,-~"

3) 4- re"lIlIe r e qulpme nl
Monophue Graelz clru it p4I rmiUlng tM ul iliza tlon 01 both helf we. n . Tube volt age pul se
,- from Z& rO 10 P&al< .elue (KVp).

~, E/ An ,
- - y - -
Ut,lizallon : large diagnostic generators up to tOOO mA - t50 KVp .

~i'", ,
a) II- rectilier e quipme nt
Three pha se. 6 pul l " c ircuit . dall.erlng almo" con l tant potential (.olleg e fluCluetion eboul
t3'11o ),

.fNYY\l:\~~ Three -phlle generaloll allow higher load s (m,o..j wi thout unb a lanc l~ g power supply and gl.e
hlghe' X' ley outpu t du a to CO~SI8n l pOl e nt ial (about twic e tMI of mOnOphU& gen e rators
with IBm4I KV and mAl
Utiliutlon : la'ga diagnostic generato,. up to t 000 rn .... t50 KVp.

~~ , ,
5) 12-. ectllle. eoulpm,nt
~ Three phue. 12 pull& l clrCUI!, dall_erlng ev&n more levalled volt age (vo llage lluctuatlon
about 3.5'110).

~~
Ut ilization : I.. ge diagnostic gan&rltotl UP to 1000 mA -I50 KVp.

II) VIII d volle\le double,.

---t,.~f
Yo.2 V Voltlge doubling circu it by means 01 reCtill&rs and condens &rs

AIl,
Tube vo ltage Is pull8\1ng . from a 10 2 V, V be ing Ih& I'ens fo,m e , peek .allege.
Utilization: medlC l l therlpy g e nerator. 5tO mA. 200 300 KVp.

"
"
7) Llebenow-Cre ln l ch e r 0(>lllg 8 doubl&

, ,
, "" ,2V
Tube .ol lige II conlllnl pollHttial of 2 V .a lue, V bllng Ih a Iran.lormer
.oll'ge

'ml
~" Voltegl Uuctualion, Ihal l. VoNe, i. normally abo ut to" 01 voltage wit h
out load (Vo)
Ut,h.atlon med,cel the'apy gene'alor. 520 rnA, 200400 KVc.

" " , Fluctuation (KV) _ cur.. nl (mA) cepeclty (F) charge Ireq ue ncy (tw ice
$upply frequency)

"

: ,:~i\jj~:~
8) C,ooke.-Hltt orl .oltagl mulllpile r.
Yo,n' b) Volt ag a drop Vc _ 2 ,.
a ) Voltage ' without load Vo _ n . V:
,,
~.
'" I c:
c) Voltage fluctuat ion VoVc - i 0 (n + t)12
whare,
(2 V - translorme , peak 'Olllg l:" - $18gU number: i- tube currant: I - fraquency a t transfo r-

" "" " -

(l
mar: c _ cond.nse, capac' ly.
Re lellons b) and c) .re .alid fo' sama capac; ly condensers wit h Ihe exception 01 thatin 5e ries
(2V) , to transforma r which mu.t have double capacity
A. ,ollage lallincrease , 10 th e 3", pow e r of sta get numbe r it il a dvisabla not to e xc ee d 8-10
stagu lor nigh currltnt.
Ut ilization; very hi gth ,ollag e gene,a to," upto 1000 KV and ove,lormedica1the,apy , Non De -
" struc tive Tes ti ng. Rete ..ch

116 GILAROO NI. RAD iOlOGY - ELECTRO MED ICINE

3.2.1.1. High frequency (H. F.), high voltage (H.V.) X-rays
generators
The 50-60 Hz mains frequency is normally used for X-
rays production in H.v. generators.
A frequency increase reduces the iron core mass of HV
transformers and, to a certain extent, its dimensions and
weight.
Practically, the cut is modest because dimensions and
weigth of the H.v. transformer are determined above all
by the transformer H.V. insulating components.
High frequency is used for special equipment operating
between 500 and 3.000 Hz (see par. 4.4.2. page 152).
Solid state converters are used to produce H.F.
3.2.2. Advantages of threephase, 12 pulse generators on
L1ebenow-Grelnacher monophase condenser gene-
rators for therapy equipment
Uebenow-G reinacher (LG) (see table 1/3 pos. 7, page
116) is a generator with a very small inherent impe-
dance.
The X-ray tube is fed directly by HV condensers and
this causes some disadvantages.
When the tube ionizes (possible event even with the
best tubes). the condensers dicharge their own energy
on the tube instantaneously, determining overvoltage,
which are very dangerous for tube, cables and other HV
components.
The disadvantages may be reduced, but nol eliminated ,
introducing 50-200 kilohms in HV condenser circuits.
The 12 pulse generator (see tab. 1/ 3 pas. 5 page 116)
can have high inherent impedance avoiding in this way
dangerous overvoitages and increasing the life of tubes,
HV cables, etc.
3.2.3. Advantages ot selt~ontained equipment without HV
cab~ tor therapy appUcations
HV cables and terminals that supply X-ray tube housing
wi th voltage over 300 .... 400 kV, are a weak point at X
Terapy equipment.
These disadvantages are eliminated using self-contained
equi pment without HV cables.
Fig. 5/3 (par. 3.2.3.) - CPGiI SOOl lO.
Constant potential equipment lor X-therapy: self-contained,
12 - silicon rectil iers (see table 1/3 pos. 5 page lIS). 500
kVcp and 10 rnA.
G1LAROONI. AAOIOl.OGY - El ECTAOMEOICINE
Fig. 6/3 (par. 3.2.3.) Monogil 60016
Radiological equipment: sell-contained. sell-rectified tUbe. {see
table 1/3 page lIS pes. 11. 600 kVp and 6 rnA.
Hv generator. X-ray tube and eventual rectifiers are con-
tained into metallic cases.
Fig. 5/3 and 6/3 illustrate this type of equipment.
The Megavolt-TI)erapy equipment (Betatron-Linac-etc.) are
self contained types without HV cables%
3.2.4. Electric power (EP = k . mA . kY) and radlogra
phlc power (RP = k . mA . kYS)
The electric power (EP) of an X-ray equipment is given
by: EP = k . rnA . kV and is expressed in KW.
Coefficient k is 0.7 for equipment without rectifiers or
with 1, 2 or 4 rectifiers (see table 1/3 page 116), 0.95
lor equipment with 6 or 12 rectifiers and 1 for equip-
ment with continuous constant potential.
The radiographic power (AP) is given approximately by
the relation: AP = k . mA . kV5 and is expressed in
A/sec or Rlmin.
The result is that EP is a linear function of kV, that is.
it doubles as the kV double, while AP is an exponential
function of kV, that is, an increase of about 15% in kV
is sufficient to double AP' and vice versa.
3.2.4.1. Output of Hlfrectltying X-ray units and constant
potential equipment
For same voltage, the output of constant potential equip
ment is twice that of selHectifying equipment. Since the
radiographic output increases with 5th power of kilovol
tage, it is sufficient to increase kV by about 15% to ot>---
tain the same radiography.
This is expressed by the relation : kVp 2! 1.15 kVc and
it is illustrated in table 213.
TABLE 2/3 (par. 3.2.4. 1.) - kVc (cons tant potential)
and kVp (pulsating voltage, self-rectifying equipment)
/0 obtain, with same mA, same radiographic
output.
(kVp 2! 1.15 kVc).
kVc 100 150 200 250 300 350 400
kVp 115 172 230 287 345 402 460
117
3.2.5. Electric mains resistance and its measure
The knowledge of the electrical mains resistance, that
can infl uence the tube kilovoltage, is necessary for the
good calibration of X-ray generators.
Measure:
1) Fix a metallic plate of about 10 x 10 cm2, connected
to a pole of the mains with an insulated 10-20 mm2
wire, on the inner side of a plastic bucket.
2) Place another similar plate on a wooden stick and
connect it to other mains pole with a lIexible wire.
3) Insert an Ammeter of 100-200 Amp. in the wire con-
nected to the plate fixed on the plastic bucket.
Connect a Voltmeter to the two mai ns poles.
4) Fill the bucket with water containing about 100 gr.
01 kitchen sail and switch the mains on.
5) Gradually dip the mobile plate in the sail water of
the bucket.
The elect ric mains resistance is given by the ratio: Vol-
tage drop/ Amp load, that is: (Vo - Vel /A, where Vo =
Vollage without load , Ve = Voltage with load at a cer-
lain immersion level and A = Amp with load at the
same level of immersion.
Example: if with 100 Amp charge the voltage drop is 10
V, the mains resistance is 10 V/ l00 A = 0,1 ohm. This
resis tance can be transferred on the tube. HV circuit.
mu ltiplying It by the SQuare of transformer ratio (see
explanation of lig. 713).
Fig. 713 (par. 3,2.6.) - Radiographic Eff9C/ graph (E, dsnsi/y)
01 a portable genera/or, monophass, 4 51 (&eOliers, 220 V
mains (MD-4R Gilardonl).
Manufacturer's data: mall no toad tension 120 kVv, 60 mA
with 80 kVe, 100 mA with 50 kVe.
/st curve (kVc) : the previOUS data allow to draw the stra ight
~ Ioad line-: kVc = kVv - R . mA, where kVc = kV under
load, kVv = max no load tension (zero mAl, R = equivalent
electric Resi$lance, rnA - load in mA, mAce :: short Circuit
current (zero kV).
The limit values, zero mA and mAce. have no practical
meaning but are necessary lor the theoretical studies. the
curves' tracing and to derive the conclusions.
2nd curve (E): E = k . mA . kV.~ :: k . mA . (kVv - R . mA)5
= Radiographic Effect % (blackening or density): the sym-
bols' meaning is as above; k is a constant dimensional coel
tieien!.
118
3.2.6. "Radiographic optimum
Every X-ray generator has a combination of KkV - mA
giving the maximum of Radiographic Effect (E, density),
called "Radiographic Optimum- of the equipment.
If in a generator inserted at the maximum available ki-
lovoltage. mA are increased, the radiographic effect E,
that is the film density, inc reases at first rapidly up to a
maximum and then decreases slowly to zero.
This is due to the kilovoltage drop caused by the mains
resistance and the generator electric impedance (or equi-
valent resistance) . In practice it is an important factor
the efficiency of radiographic screens, function of kV
(Hondius-Boldging Van der Plaats-Gilardoni).
Since 1936 Gilardoni A. has studied the laws relative to
the way of working of X-ray generators and has made
some pubblications about th is matter, which are at dis-
posal ot anyone who is interested in them.
For semplicily, just two practical examples and .conclu-
sions are reported.
Fig. 7/ 3 shows the characteristics 01 a light portable
monobloc generator and fig. 813 page 119 those 01 a
powerful threephase. 12 pulse generator.
3.2.7. General radiological relation: YIn) = k . mA . kVc(n)
Fig. 9/3 page 119 gives a synaptical graph of the above
relation and table 3/3 page 120 gives the practical use-
ful data derived from it.
The curve, according to Gllardoni's study, is drawn Ihrough
4 slnglar points (see fig. 9/3 page 119 and lable 313 page
120).
Is/ point: abscissa 0 rnA and ordinate 0 kV.
2nd point: peak E value: abscissa 1/6 mAce ::: 1/6 . 180 mA
= JO mA (_Radiological Optimum- of the equipment).
3rd point, tie)!; point: abscissa 1/3 . mAce "" 1/3 . 180 mA =
60 mA and ord inate 65% 01 E peak.
4/h point: abscissa 180 mA (mAcc) and ordinate 0 KV.
3rd curve (kWJ: kW, '" 0,74 . mA . kV. "" tube and generator
power curve. The curve with ordinate In kW on the right
gives (he thermal load of focal spot.
The peak thermal )oad value is reached with 90 mA and
60 kV. and amounts to 0,74 . 90 . 60 "" 4000 W :: 4 kW,
In this condition the radiographic Effect (E) Is 22'It of E
peak.
The same E = ~ E peak Is obtained with a 2 mA and
118 kV. (- 0.17 kW) that Is with 1120 01 previous lube load.
In the first case soft rays are used (low kV and high rnA)
corresponding to descendent pan of curve E. In the second
one, hard rays, (high kV and tow mAl corresponding to the
ascendent part of curve E, are used.
Referring to curve E one may con tinuously adjust tube ten-
sion from 100 kV. to 25 kV. varying cu rrent from 30 to
140 rnA (descendent part 01 curve). Other data are derived:
transformer ratio: 0,7 . V./V_ :: 0,7 . 12(UXXl/ 220 = 385
generator impedance: Z :: 0,7 . V./A",. = 0.7 . 120.000/ 0.18
= 470.000 ohm.
generator impedance triangle: Z :: 470.000 ohm. R ==
250.000 ohm and X :: 398.000 ohm.
GILAAOONI. AAOIOLOGY ElECTAOMEOICINE

Fig. 813 (par. 3.2.6.) Radiographic Effect graph (E density)
01 8 powerful generator, throophese, 12 51 rectifiers, 380 V
mains (DodecasiIiJ/ GI/ardon/).
Manufacturer's data: 1200 rnA with 125 kV e 160) rnA with
100 kV.. 2000 mA with 75 kVe and 2400 rnA with 50 kVe-
lsI curve (IIV. ): IIV. '"" kV. - A . rnA = generator . Ioad line.
2nd curve (E!: E = k rnA kVeS = k rnA (kll, - R . mA)5
:: Radiographic Effect " (Density). It is a curve 01 6th order
with e peak value at 1/6 of generator short circuit current
(mA..,). thai is 1/6 . 3200 550 rnA (see ta b. 313 page 120).
In this condition, the tension under load (kV.I Is 5/6 of the
no load tension (11'0'.). thai la, kVe = 5/6 kV v = 516 200
165 kV (with 550 rnA).
The c urve 01 Radiographic EUect (E) is easily drawn refer-
ring 10 lab. 313 that gives 4 fundamental poin ts.
3rd curve (kW,) : kW, - k . rnA . klle = lube and generator
power c urve, where k := 0,74 lor monophase generators with
4 recti fiers, 0,95 for threephase generators with 6 recti fiers
and 1 for threephase generators with 12 rectifiers,
The peak thermal load value is reached with 112 mAc., and
amounts to 1 . 1600 . 100 := 160.000 W, '"" 160 kW,.
On the curve the Characteristic Electric PoWef (PEC) of the
gen6f'8tor is shown: PEC ;; 150 kW.
4th curve (kW,): kW, := kW, + kWg "" mains power curve.
It is the sum of the delivered genemtor power (kW, ;;
k . mA ' kVol and the internally dissipated generator power
(k~i _- R, . 12); A, Is Internal generator resistance (about
10.000 ohm in th e specillc case) and I the tube current.
The curve has the ma:o:imum at 190 kW r
With threephase mains of 380 V, the current corresponding
to the maximum is: W, I (1,73 . Ve) = 190.000 I (1,73 . 380)
"" 290 Amp.
3.2.8. The "Radiographic Optimum 01 a generator at
1/6 01 short circuit current (mAsec) and 5/ 6 01
max klloYoltage without charge. Example
One of the most important deductions drawn from the
above studies is the determination of . Radiographic Op-
timum .., as indicated in the title.
Example; the "Radiographic Optimum of a portable gene-
rator (Iig . 2/3 page 115) with max kilovoltage without
charge of 120 kV and short circuit current of 180 rnA,
takes place at:
116 . 180 = 30 mA with 5/6 . 120 = 100 kV
GIlAROONI . RAOIOLOGY - ELCTR()MEOICINE
F, .. i.",., m "' Ce
r~~Y2 ""
~ }'3 I
,J;~~'~':"~'~':'''~<~~--~--~~~';~~S>~
~"'A 1'3 % Y2
...
v
2f.l " ...... tt
F''' 'oft ' ~ I "'A c<
Fig. 9/3 (par. 3.2.7.) - Synoptic graph of refalions:
V,nl "" k . mA . kVt (see tabl e 3/3 page 120) where:
PE = ElectriC Power (n - I), 10 = Diagnostic X-ray output
(n = 2), IT :::: Therapy output (n = 3). PR .. Radiographic
Power (n = 4). E = Radiographic Ellect (density) (n :::: 5).
Zero points: at mA - 0 and at mA ". mJ\." physically cor-
respond ing to the following cond itions: no load (0 mAl and
short ci rcuit (0 kV).
Peak point: (1~) mathematically derived and e:o:perimE!f1tally
checked by the Author and by Gilardoni Research Laborato-
ries (see table 313 pag e 120).
FI6X point: It also has been mathematically determined and
experimE!f1tally checked; It correspoods to twice rnA value de-
termining the peak point.
The dotted line links the !lex points' coordinates and reaches
2fe = 212, 71 74" by n - 00.
Note that the curves:
PR ;; Radiological Power (PR = k . rnA . kV.~) find
E= Radiogmphic Ellect (E= k . mA . kVo~). are c lose together.
This allows to assume:
E :::: kmAkV5
as general lundamental radiographic relat ion.
The "Radiographic Optimum may be also evaluated
experimental through radiographs with scaled exposu-
res, varying the mA , or with the detector illustrated in
lig. 48/3 page 143, or similar ones.
3.2.9. Universal "Condensor-GII 150 kV, 5/JF - "Farad-
Gil. New powerful generators advantageously re-
place the conventional three phase 6--12 pulses
ones for all diagnostic purposes: a revolution In
X-ray diagnostic generators
The conventional condenser generators have 1 microfar-
ad (1J.1F) capacity and only operate until 125 kV.
They are suitable equipment for emergency and mova-
ble use, but their radiological capacity is limited and the
radiographs of thick anatomical parts, such as lateral
sacral spine, also with rare earth screens, are not
achieved .
To allow universal performances as obtained with the
powerful threephase generators, such as general radio-
graphy with short exposure time, seriography, flash ex-
posure technique for digital subtraction angiology, cine
X, etc., a radiog raphic capacity 10 times greater that of
the conventional 1J.1F, 125 kV condenser generators, is
required.
The radiographic capacity of a condenser generator in-
creases linearly with its electrical capacity and with about
the 7th power of the kV.
119
 TABLE 3/3 (par. 3.2.7.) - Practical useful relations and characteristics derived from the general relation:
Y(II} ::: K rnA . k\{,"
II' = dimensional constan~' rnA = tube current; kv., = tube tension with mA charge; n ::: exponent over kv., ;
mAot; = generator short c rcult current.
Max point Flex point
Exponent Radiological relation Utilil1llion field
Practical Simbology and Units rnA rnA
" 1("1" 11"1"

I PE
PE =
- k'mA'kVcl
Electrical Power In kW
112 mAce HX", - - Generally

k = 0,74 for monophase genera~

tors: 0,95 for threepha5e 6
rectifiers generators;
1.00 for threephase 12 recti-
fiers.

= k . mA kVl HX", Diagnostics 50 .;- 150 kV with

2 I,
I, = Output emitted by diagnostic
generators (A/sec).
113 mAce 213m'"
"'" ,"I IiIter.

, I, - k . mA kVc3 1/4 mAce HX", 1/2 mAce 59% Therapy 200

IIIter.
+ 400 kV with
I, = Output emitted by therapy
generators (Rlmin) .

4 PA = k'mA'kVc' 1/5 mAce 1~ 215 mAce 63.. Diagnostics 50 .;- 150 kV with
PR = Radiograph ic Power or oul I mm Co filter (",. normal
put from patient or after fit human thorax absorption).

-
ter equivalent (mA/sec) (pa.
tienl emergent dose).

5 E = k mA . kVc5 1/6 mAce 100.. 113 mAce Diagnostics 50 ,

150 kV with
E = Rad iograph ic Effect (denslty) 1 mm Cu filte r+ Intensify ing
or radiographic blackening. screens.

The radiog raphic capacity of a condenser generator of
SpF and 150 kV in comparison with a lpF, 125 kV one,
is about:
5 . (150/ 125)7 =5 . 1,21 = 5 . 3,5 = 17,5 times higher
Gilardon l first realized such a generator, the - Universal
Condensor-Gi l 5pF, 150 kV. for radiographic and fluo-
roscopic use which, coupled with the new computer
operated Multi focus-Gi l tube (focal spot size is auto-
matically selected in function of loads) (par. 3.4.4, page
135), represents a great progress in X-Diagnostics.
The new generator requires only three KW mains power
to charge the condenser and supplies the tube with a
radiographic power of 100-150 KW and more, that is
100-150 kV with 1000 mA.
The limit is fixed by the tube power: with and hypothet-
ical tube of 5000 mA, 150 kV, the _Un iversal Conden-
sor-GiI" could be able to supply the power of 750 KW.
This new condenser generator can be considered as a
big X-rays container, ready to Instantaneously and re-
peatedly supply current loads from 5 mA (fluoroscopy)
to 1000-1500 mA and more (radiography) with tensions
variable from 30 to 150 kV.
Powerful threephase generators (6-12 pulses) for diag-
nostic use require high mains power (50-100 KW and
more), thus producing a lot of technical and economical
problems.
It is illogical to require high mains power sources for a
utilization which only takes few seconds a day.
It is possible that in future conventional high power
threephase 6-12 pulses generators shall be substituted
by powerful condenser ones, as above described, with
Multlfocus- tube, acting also as inertia free HV (see
par. 4.4.1. page 152) timer switch for pulsed digital ra-
diography and Cine-X (see par. 3.4.4. page 135).
A powerfull condenser generator of 150 kV, 5JlF. the
Farad-Gil , is used for GTBA (Gilardoni Total Body Ra-
diography) - (see par. 2.4.4. page 48) in special equip-
ment for Mass Screening, Hospital general acceptance.
period ical radiolog ical check-up, etc. (see par. 4.5.10.
page 156).
Chapter 3.3. - COOLIDGE TUBES, TUBE HEADS
AND HV CABLES
3.3.1. Generalities and references
The Coolidge tube is the heart of an X-ray generator. It
is delicate and has to be well known.
Par. 1.1 .1. page 29 indicates the principle of X-ray pro-
duction and par. 2.1.1, page 36 and relating figures il-
lustrate the tube wilh stationary and rotating anode.
It would be usefull to refer to them.
3.3.2. Some Gilardoni X-ray tubes
Table 4/3 pages 123 and 124 illustrates some X-ray
tubes manufactured by Gilardoni, giving their character-
istics and applications.
3.3.3. X-ray tubes manufacturing
Tubes manufacturing is a difficult task; it is a struggle
against molecules. That is why there are only few X-ray
tube manifacturers around the world .

120 G1LAAOONI. AADIOlOGY aECTFIOMEOICINE

This type of production involves almost all the branches Welding operations are carried out in a controlled, non-
of science and technology: chemistry, electronics, elec- oxidizing atmosphere inside the tube envelope so as to
trotechnics, mechanics, metallurgy, vacuum technique, avoid oxidation of the electrodes.
glass technique etc. and even Art! Special care is paid to the elimination of thermo-me-
Certain steps of glass processing can only be carried chanical glass stress.
out manually, involving to a great extent the glass-blow-
er's personality just as in artistic glass blowing.
The following paragraphs are meant to give an idea of
the manufacturing process of a tube at Gilardoni works.

3.3.3.1. Raw material selection

Metals melled under vacuum are generally used. Special

care is paid to the selection of the raw materials. Only
with materials of high purity and optimal chemical and
physical characteristics can efficent tubes be produced.

3.3.3.2. Pre-degaslng of metallic parts

Metallics parts, after mechanical processing and prelimi-

nary cleaning with chemicals, ultrasound etc., are sub-
mitted to pre-degasing under very high vacuum (10- 7
mm Hg) at high temperatures (about lCXlO"C) in special
Fig. 1113 Par. 3.3.3.3.} - Sierile cabins.
fu rnaces lor many hours.
Fig. 10/3 shows one of these furnaces. The Ilgum ahows one ot the 8t9(ile cabins with air purified
and filtered down to Iia submlcron corpuscles. installed
at Gilardonl lac tory lor assembling delicate X-ray tube
po"'.

Fig. 10/3 (par. 3.3.3.2.) Eleclrodes pre-degaslng /n high

vacuum furnace 17(}(J> and Itr' mm Hg vacuum (from
Gllardonl Tube Manufacturing Labs.
Fig. 1213 (par. 3.3 3.4.) - Blo wing glass by hand.
Electrodes treated under high vacuum at high tempera-
tures for many hoors expel occluded gases facil itating
tube manufacturing.

3.3.3.3. Assembling In sterile cabins

Fig. 11/3 shows a sterile cabin for assembling delicate

tube parts.

3.3.3.4. Glass processing. Tube sealing

Anode parts are welded with special glass, before pre-

degasing (fig. 1213) . This metal-glass welding operation
is highly delicate and is carried out on a glassworking
lathe.
Glass stress control is made by polarized light (fig. Fig. 1313 (par. 3.3.3.4.) - Glass stress control.
13/3).
II is made by polarized light during tube glass blowing
In the same way, other electrodes, pre-degased and with lIame at glassworking lathe.
pre-assembled, are welded to the tube envelope.

GllAAOONI. RAOIOt.OGV ELECTROMEDICINE 121

 3.3.3.5. Tube vacuum
Once the electrodes are welded to the tube envelope,
the tube is connected to the high vacuum group In the
furnace for the final air evacuation, lasting many hours
(fig. 14/3).
During evacuation. the tube envelope is heated up to
4()(C by means of hot air circulation and the elec-
trodes are brought to a temperature of 700>C by means
of high frequency heaters and high tension charges in
the tube itself to eliminate any gases which may still be
trapped in the electrodes.
The final vacuum in the tube must be about 10-7 mm
Hg.
3.3.4.1. Max tube voltage
The maximum tube voltage depends on the manufacture
characteristiCS of the tube itself and on its length (see
table 4/3 pages 123 and 124).
Generally diagnostic tubes are not critical to voltage,
because they operate at a relatively Jaw tension (max.
150 kV). Therapy tubes are more critical to voltage, be-
cause they operate close to their tension limits.
3.3.4.2. Maximum Electric Power in continuous working
(fluoroscopy and therapy)
Maximum Electric Power is determi ned by admissible
temperature of focal spot, anode, glass-metal seali ng.
It is expressed by the relation : Watt = k . mA . kVp
where: k = 0,7 for monophase, 1 and 2 rectifier genera-
tors. k = 0,95 for threephase, 6 and 12 pulse generators
and k = 1 lor continuous constant potential (condensers).
Diagram of lig. 28/3 page 130 gives the relation be-
tween Electric Power and focal spot size.

3.3.4.3. Radiographic power In kW referred to 1 sec.

load for stallonary anode tube and to 0,1 sec.
for rotating anode tubes. Power of the most used
tubes

The most practically used tubes and their powers are

the following : with stationary anode: 2 kW and 10 kW,
with rotating anode: 20 kW, 40 kW, 50 kW and 100 kW.
Table 5/3 gives the maximum powers in function of fo-
cal spot size of some tubes.

Fig. 1413 (par. 3.3.3.5.) - High ~8Cuum Irealment of X. ray

tubes (from G!lardonl Tube Manufacturing Labs).
The tubes In the furnace are treated up to 4OO'C and
the electrodes up to 700 to l2()()OC by means 01 a high TABLE 5/3 (par. 3.3.4.3.) - Optic and actual focus
frequency heater and H.V. charges to e1lpell any occluded
gases. in some diagnostic tubes.
Pre-vacuum pumps and turbo-molecular pumps are used
to rach the final vacuum of 10-' mm Hg. TV,", .",,"
. ng ~
Opl;c locua Actual locu.
Stationary anode
3.3.3.6. "Getters" chemical vacuum refiners 10 kW 20' .311 4.3 mm 4.3 11 12.9 = 55 mm2

After many hours of degaslng in a heated vacuum fur- Staliona'Y anode

8 kW 20' .3 )( 3.3 mm 3.3 )( 9.g = 33 mm2
nace, the tube is tipped off the vacuum group.
Tube vacuum may be further increased up to 10-10 mm Stationa'Y anode
2kW 20' .8xl .8mm 1.8 )( 5.4 = 10 mm 2
Hg by healing and evaporating special chemical refiners
(getters) of barium, magnesium , zirconium, mounted in RotatIng anode
appropriate sites Inside the tube. 40 kW 1.- ,0)( 2.0 mm 2.0 )( 8,0 = 16 mm2
The -gettering.. operation not only allows to increase
inherent tube vacuum but also to keep it during tube
life when electrodes and glass overloading might free
Rotating anOOe
20 kW
.
, .2 )( 1.2 mm t.2 11 4.8 = 8mm'
some gas molecules.

3.3.4. Additional Information about Coolidge tubes. Fea-

tures, maximum tube load, tube life, etc.
The principal characteristics of Coolidge tubes are:
1) Maximum kilovoltage.
2) Maximum power with continuous charge (fluoroscopy
and therapy) .
3) Maximum power with interm ittent charge (radiogra-
phy) .
3.3.4.4. Focal spot and radiographic load limit (max al-
lowed load). Diagram tube power In function of
load time
Fig . 15/3 page 125 gives the tube power in functi on of
load time (in sec),
In self rectifying tube generators and in 1 or 2 rectified
pulses generators, the tube load is about 70% of 4, 6,
12 pulse ones.

122
Q!LAROON!, RADIOlOGY Et.ECTROMEOICINE
 TABLE 4/3 (par. 3.3.2.) Some Gilardoni X-ray tubes ( 1 ..;.. 8: classic tubes: 9 ..,.. 14 special lubes).
Olmen.lon .
M.. load
FigUf. mm
" m' lenllll'1
UTILIZATION

80 10 100 40 Portable extralight units. Medicine.

2 Biloca l lor tubehead s and powerfu l

120 100 210 50 units. Medicine.

Rolating anode lube lor powerlul dia-

3 150 1000 134 gnostic equipment 3000/9000 rpm, bi-
2000 230 50 local. Medicine,

Rotating anode tube with Beryllium

4 20-80 400 230 120 window (3 mm) for mammography.
50 Medicine.

5 300
240 100
80 2 sta ges tub e. Industry.

300
240 150 Circumferential ra diography (360"').
Industry.

7 400 10 415 2 stage s t ube, bilocal. Indust ry and

140 Medicine (tumor therapy) .

GIlAAOQNI, RADIOLOGY ELeCTROMEOICINE 123

 UTIL IZA TIO N

m' len g th <lIam

Grounded anode tube, Beryll ium win -

B 200 20 300 115 dow (3 mm.), bifocal, watercooled.
Industry.

Extra-thin Beryllium window (0.25 mm)

9 5-80 10 130 40 lor contrast te chnique.
Art Radiology.

9 stages tube lor 1 million Volt, groun-

10 1000 1000 80 ded anode, water-cooling. Industry and
Medicine (tumor therapy) .

Pulsed tube for fl ash radiography (10- 9

11 250 200 A 200 90 sec.), cold cathode electronic emission .
Industry .

12 1S0 3 240 100 Rod anode tube for Internal Inspection .

530 Industry.

Battery generators: circu mferen t ial ir-

13 200 0.1 270 50 radiation lor internal inspections (pipe-
lines elc.). Industry .

14 Betatron doughnut (Gilbetron).

35000 0.01 400 Research, Medicine, Industry .

124 G llARDONI, RAD IOLOGY - ELECTROMED ICINE

As fig. 15/ 3 shows, the load capacity of rotating anode
tubes for short exposure limes is greater for 6, 12 pulse
generators than for 4 pulse ones. This is due to the
higher thermic stress during the charge of 4 pulse gene-
rators compared to that almost uniform of 6, 12 pulse
ones (constant potential).
-..
<OkW - ~.*
-- .""aI'
40 kW - .' 1,01. _
-" .
I
20 kW , , 01.01 . _
20kW -
I
....... -
10 kW _ ._,. h l 1.....
6 kW _ .""",. t ..1,01.
2 kW _ . _f,h l .01 .....
- r1-1- _.
1
o '
---
2 3
Secondl
Fig. 15/3 (par. 3.3.4.4.) 3000 r.p.m. ro rarlng anode tubes
power (k W) lor rectlli&d voltage In function 01 load time.
Dorr&d lines lor starlonary anode tuoes.
Reproduced focus sizes are about the same as the actual
ones. Rotating anode lubes 20/40 kW (bifocal) have an
anode disk 01 70 mm diameter and 30/60 kW ones have a
d isk 01 90 mm diameter, at 3000 r.p.m.
At 9000 r,p.m. and short load time (below 1 sec) the power
doubles.
Each tube is supplied with ils proper load chart.
The ..Specific area load,. represents the ratio between
power and actual focal area (Wattlmmsq) .
It increases when focal area decreases, because in large
areas, heat transfers almost entirely through tungsten
thickness, while in small areas, as in tube with microfo-
cus 0,3 x 0,3 mm2, a large quantity of heat transfers al-
so laterally.
It is known that tungsten melts at J4OO>C; the tungsten
local spot temperature reaches about 26OO"C (max al-
lowed temperature) at the max load (kW . sec) expressed
in the previous paragraphs with rectified equipment.
This temperature is characterized by a white brig ht light
of the focal spot; halving this temperature, I.e. 13OO"C,
the focal spot is characterized by a red light.
These figu res are practically used to control the maxi-
mu m allowed load at sight.
Once reached the red focus light, the maximu m allowed
load is about twice with recti fied voltage and 1,4 ti mes
with self rectifying tubes.
GllAROONl . RAOIOLOGY ELECTROMEOICINE
3.3.4.5. Relation between tube life and maximum tube
load. Suggestions to improve tube life
Tube life is remarkably increased by operating a little
under the maximum load, as indicated in fig. 1613.
11
, I
-
--
.! - - - - - - - -
:
~
I
j
t-
,
,
." m n.
" 11. III
hh II " "
Fig. 16/3 (par. 3.3.4.S.J - Tube liIe in luncl/on of the % of
rube load.
It can be noted lhat a reduction 01 101M. 01 ma)(imum load
Increases tube lile by 6O"iIo. This Is true above all with kV re-
duction (see fig. 32/3 page 132).
4 3.3.4.5.1. Effect 01 overfoading on the tubes
It is interesting to know what happens when the max i-
mum load is largely exceeded (accidental overload) .
At the beginning the focus temperature is about 200c
(room temperatu re) . Alter 0,1 sec. the temperature rises
to about 26Q()QC (max allowed temperature). after 0,2-0,3
sec. it can reach 34000 and tungsten begins to melt and
to vaporize.
The hot tungsten vapours hit the hot filament, overheat-
ing it and so increasing its electronic emission, thus
producing a further temperature increase of the fi lament
until its melting poi nt is reached. T his phenomenon is
called "filament back fire...
Sometimes the hot tungsten vapours reach the tube
glass craking it.
In self rectifying tubes, overload brings to a different
tube stress.
When the focus temperature reaches about 15OO"C the
focus emits electrons. that bombard the filament during
negative anode half waves, melting it.
This phenomenon is called .. inverse firing".
Th is setback is avoided by hole" anode tubes (screen-
Ing cup anode tubes), in wh ich the electric field can
not reach the focus.
The screening cup has a window, sometimes in Beri ll i-
um, for X-ray passage.
This cup acts also as an efficient X-ray protection be-
cause it is very close to the focus.
Oveloads crack the tungsten focal area. Small superficial
cracks are not detrimental; deep cracks instead , reduce
X- ray output as illustrated in fig . 31/3 A page 131 and
red uce also the tube life d rastically if loads are not re-
markably reduced.
125
 3.3.4.6. Gllardonl condenser generator for extra short
radiographies (less than 1 ms) using current of
about 5000 rnA.
It was realized in 1939 for research purposes.
A condenser of 0.1 microfarad is charged at 100 kV
and discharged on a 10 kW stationary anode tube heat-
ed lor 500Cl mAo
Fig. 17/3 gives some data about the generator. With this
eq uipment it has been possible to lake radiographies of
heart: lungs, etc. with moving patient in a fraction of
millisec.
., " ,
..
~W.r< .W
. --
~...,
"
"
. --
-'"
" -;; ~
. :::;: -;
~ ..
-
-=-
Fig. 17/3 (par. 3.3.4.6.) - Dltu:harge characterisllcs of 0,1 pf
condenser charged at 100 kV on an X-ray stationary anode
tube heated lor 5000 mAo
Eleclric discharge time is about 1 ms, but the real radiogra-
phic exposure time Is a fracl lon 0 1 I ms, because it is de-
termined prevalently by the values 01 kV.
The critical power 01 500 kW does not crack the local area
because the load lor such short times Inlerests aod vaporizes
only some superl lclal molecular layers 01 tu ngsten, leaving
the focal spot area smooth.
If the tube lOCUS has been previously cracked, II will become
smooth again after some discharges.
3.3.4.7. Tube cathode screen (or grid eHect, or intra ef-
fect) and Its inrtuence on focal l pot, emllslon
and output
The electron source in Cool idge tubes is composed of
a flat or cylindrical tungsten fil ament heated at the tem-
perature of electron emission.
The incandescent filaments are always surrounded by
small caps that determine the focal spot, the mA emis-
sion and the characteristic- of the tube.
3.3.4.7.1. Focat spot formaHon
Fig. 18/3 shows the focal spot formation in a planar hot
filament.
3.3.4.7.2. Striped focal lpot In linear focus tubes (cylin-
dric '"ament)
The focal spot of usual tubes having cylindric filament,
as the radiograph taken with a pin hole camera shows
(see par. 2.1.8. page 38), is not a perfect square with
uniform electron distribution, but is composed of emis-
sion strips of different intensities , as illustrated in
fig. 19/3.
126
1 , 1f , ~~
", ( ..s. s,
Fig. 18/3 (par. 3.3.4.7. 1.) - COOlidge lube principle.
A) anode: F) focal spot, C) principal electron beam:
Sc) screening and focusing cap: Sp) incandescent filament.
The dimension of the local spot depends on tile depth of
the filament in the cap: the deeper is the filament. the
smaller the locus produced and viceversa.
Polarizing the cap negatively, the local spot narrows and.
over a certain negative tension value. the electron fl ull to the
anode is completely interdicted.
This screening effect. enhanced by a negative polarized grid,
is util ized also as electronic switch in HV lubes.
POSITION 1
Anodlt
1111
POSITION 2
II FUCUS
POSITION 3 1111
A B B A
FILAMENT
R)CUSING
CAP
CATHODE
Fig. 1913 (psr. 3.3.4. 7.2.) - Focal spot formation In standa rd
Coolidge lubes with cylindric filament.
A) trajectory of the electrons emitted by the upper part 01
the hot filament.
8) trajectory 01 the electrons emitted by the lower part of
the I"Iot filament.
Right: locus shapes In positions t , 2, 3 Of electronic fl ull. as
they appear in the radiograph taken with a pin hole camera
(see par. 2.1.8. and IIg. 912 page 38).
Position 2 Is the optimal condition. because the eleclrons
lIux A and 8 overlap, determining a Iwo strips local spot.
The IwO strips' spot-shape is advanlageously utilized 10 pro-
tect the central part of the spot from overheating.
The filament depht In the focusing cap Is critical: small varia-
tions 01 this depht determine great varia tions of local shape
and size, rnA emission curve and characteristic.
3.3.4.7.3. rnA emlsston curve and tube characteristic
The ..emission curves" of a tube are expressed by the
diagram of current (mA) in function of filament heat
power, with different kilovoltages.
The electronic emission rises with the increase of fila-
ment temperature, at about the 5th power of the tempe-
rature (Richardson law).
The .. characteristic of a tube is the curve: rnA in func-
tion of kV, with constant filament temperature.
GII..AROONI. RADIOlOGY - ELECmOMEOIClN E
Fig. 20/3 shows the ..characteristics" 01 two tubes, one
with low screen effect and the other whit high screen
effect.
Fig. 2213 (par. 3.3A.B.) -

a stationery anode tube

having 4,5 x 4,5 mm2 local
spot, frx monophase 2 pul-
se generators. .,
Example: rna)!; load at
60 kVp. 1 sec. "" 200 mAo

4.5
Fig. 2013 (par. 3.3.4.7.3.) Characteristic: mAkV. with con-
stant li/ament temperature.
Left curve (low screen effect): it is typi ca l with no deep l ila-
ment in the focusing cup. 3.3.4.9. Radiographic load ratings of rotating anode tubes
Right curve (high screen ellect): It is typical with deep fila-
ment in the focusing cup.
In the low screened tube, saturation, that is when aU the Fig. 23/3 shows single load ratings for an up-to-date
electrons generated by the filament are caught by the elect X-ray tube with 9000 r.p.m. rotating anode.
ric lield, Is reached at about 50 kV.
In the high screened tube, saturation Is reached at about
170 kV.

Belastung kleiner Fokus

3.3.4.7.4. Ettlclency (outpul) of tubes fed with pulsating .,
HY (seU-rectlfylng and 4 rectifktrs generator)

FIQ. 21/3 shows the efficiency dependance of tube screen

effect on alternating or pulsating voltage

,
,
!:'- ,
I {~iQ~ '(r . . n ,tr,e!)

i (Igw le run ,1ft<:1)
,
'"
rnA ("'Q~ ltlnn ,rrl<t)
rnA (lew wnn .trIC!)
, , , , , , .-~

Fig. 2313 (par. 3.304.9.) Single load raling charI of rotafing

anode tube for three-pha!fJ 6 or '2 pulses generators.
Fig. 21/3 (par. 3.3.4.7.4.) Tubes output with high and low Focal spot 0,6 x 0,6 rnm2.
screen elttlet, with aitfJ(naling and pulsating voltage. Target angle: 1:20
kVp = half polsating voltage wave; Anode disc diameter. 90 mm
i = outpul (mR): Anode speed: 8500 rpm
mA = tube current. Nominal power: 37 kW
The maJClmum outpul Is achleyable from tubes haYing an Supply circuit: three-pt\ase 6 or 12 poIses.
high screen eflect; ils yalue, In theory, Is Ihe same achieva- Example: maJC load lor tOO kV 0,1 sec. = 370 rnA corres-
ble from constant potential fed tubes. ponding to the nomInal power o f the tube (see par. 3.3.4.3.
In practice, it Is possible to obtain. at most. 75% of this maxi- page 122).
mum value, with high screen elleel tubes and 55% with low
screen ellect ones.

3.3.4.10. Heating characteristic of anode and assembled

tube head
3.3.4.8. Radiographic load rating. of stationary anode
X-ray tubes The anode heating capacity is the maximu m heat quan-
tity that can be accumulated in the anode of an X-ray
Manufacturers give the radiographic load ratings as tube and is given in Heat Units (H.U.) .
curves. Heat Units (H.U.) = KV",." . rnA . sec. (single phase)
Fig. 2213 shows typical single load ratings for stationary = 1.35 ' kVmu . rnA . sec. (three-
anode tube. phase) .

GtlAROONr. RADIOlOGY - ElECTROMEOICINE 127

Fig. 24/3 shows anode heating and anode cooling curves 3.3.4.11 , Rotating anode tubes with tungsten-rhenium-
of a rotating anode X-ray tUbe. molybdenum-graphlte disc
Fig. 25/ 3 shows heating and cool ing curves of an as-
sembled tube head (see tube curves fig. 24/3). When an X-ray tu be is used near its maximum rating.
the tungsten anode begins to open up in a minute cra-
zy-pavi ng pattern. .
The addition of rhenium to tungsten (3-10%) reduces
"'" crazing.
- r-- r.-
'" ur-- ~
"",l-' 1- These anodes are composed of a molybden um disc 3 -:-
- r-- ~ " 5 mm thick coupled with a tungsten-rhenium disc.
V' fc' c.- I- f- I-
H ~
i--,
"'" r-- 1- "'- - /
The improvements are: lower c razing , greater heating
capacity, lower bea ring wea r.
5<: F-
"'" r-- I-- ~ i'<:
I--
I--
e-
-1= I--I-- Other improvements may be achieved replacing molyb-
denum with graphite and are: lower weight and greater
1- - anode cooling (fig. 26/3).

V -- I-- ,f-- i-'

1- ~ "-
f- 1-
I--
" "" 1- - - r-- r---
0
o ,
Fig. 2413 (par. 3.3.4.10.) - Anode heating and cooling curves
01 an X-ray tube (see rube raring charr in fig. 23/3).
HU - Heat Unit :: kV, mA . sec
(for single phase
generators) and
~ 1,35' kV mA . sec (lor threephase
genarators) .
The maximum anode heat capacity is 300.000 HU.
Applications;
1) Fluoroscopy (continuous rating) ,
Example: operating al 100 kV - 2 mA, anode heating
curve Is 200 HU/sec. one. That is, alter 3,5 min. 01 fluo-
roscopy. the heat accumulated into the anode is abou t
40.000 HU.
2) Radiography.
For single radiographic exposures, the loads fire limited
by _single load rating chart. (fig. 23/3): the anode heating
is negligible.
3) Rapid sequence radiography.
Example: operating with cooled anode (after at least
7 min. ott duty) 300.000 HU of heal capaci ty are availa- Fig. 2613 (par. 3.3. 4.11.) - Ro tating anode X-ray tube with
ble. tungsten-rhenium-graphite dISC.
Proposed series: 100 kV - 350 mA - 0, 1 sec. lor 12 expo-
sures al 3 exp/sec. rate (4 sec. total). The tungsten-rhenium surface reduces focal track crazing.
The tOlal heal units of the proposed serie are: Graphite (high heat capacity and high heat emission) im-
100 . 350 . 0,1 12 = 42.000 HU. proves the anode heat capacity 01 more than 1()()%.
Consulting the _load rating chart~ (lig. 2313) at 100 kV,
4 sec.. the malt current value allowed Is 170 mAo
Therefore. the lotal permissible heal lor an exposure 01
4 sec. is: 100 ' 170 . 4 :: 68.000 HU.
The therm al load value of the proposed series, 42.000 HU. Is 3,3,4.12, Metal-glass rotating anode tubes
lower than 68.000 HU (permissible load) and also lower than
300.000 HU (max anode heal capacity): therelore the pro- Fig. 27/3 shows the melal-glass lube.
posed series are perm issible.
The metal envelope has hig her heat conductivity than
the glass one and It is nol damaged by stray electrons.
The main applicat ion of this tube is in installations with
a high work load such as heart angiography and cin&-X.

HU
1~ ~8-
r-
l ,
r:: ~
'"
~.

Y- -. ~

~ rn:
, :-

~ ~
*- m
Fig. 2713 (par. 3.3.4. 12.) - Mata/-glass fotating anode X-ray
manufactured by GI/ardoni.
Fig. 25/3 (par. 3.3. 4.1 0.) - Healing and coolmg curves Of an Thi s tube, with tungsten-rhenlum-graphite disc, is used for
assambled tube head (sae lube rating chart in fig. 23/ 3 and high loads in fast sequence angiocardiography and cinera-
technical remarks in lig. 24/3). diography.

128 GlLAAOONI . RAOIOlOGY - ElECTROMEDICINE

3.3.4.12.1 . Metal ceramic rotaling anode tube
Fig. 27aJ3 illustrates this tube.
Fig. 278/3 (par. 3.3.4.12. t.)
Metal-ceramlc rotati ng anode tube: the envelope Is metallic
and the H.V. insulators are ceramic (Philips).
3.3.4.13. Rotating anode tubes with grid
A grid controlled tu be is similar to the rotating anode
one but incorporates a third electrode buil t into the ca-
thode, called "grid.
Applying a negative potential (1000 -;- 2000 V) to the
grid, the electron passage may be stopped (grid effect).
The grid controlled tube in th is case operates as a high
voltage, inertia free, switch.
3.3.4.14. Mlcrofocus tubes and enlargement technique
Microlocus tu bes used in X-diagnoslics have 0,3 xO,3 mm2
focal spot.
The new types of microfocus tubes have a high anode
input power: about 10 + 15 kW.
The mai n features of these tubes are the foll owing :
Molybdenum or graphite anode with tungsten-rheni-
um focal traCk.
Anode disc of 90 + 100 mm diameter.
Anode rOlat ing at 9000 RPM .
Anode angle loa + 12".
The 0,3 x 0,3 mm 2 focal spot allows a linear enlarge-
ment x 2, with 0,3 mm unsharpness, like Ihe intensify-
ing screens do.
This is the maximum achievable enlargement with tradi-
tional equipment; for special techniques, tubes have been
realized with 0,1 x 0,1 mm2 focal spot.
3.3.4.15. Tubes for mammography and high contrast ra-
diography
Tubes for mammography and high constrast radiography
have a beryll ium window with 0,05 + 0,1 mm AI-equi-
valent inherent filtration (see tab. 4/ 3, n. 4, page 123).
Manufacturers su pply the following two types of tubes
fo r mammog raphy:
X- ray tube with tungsten anode and beryll ium win-
dow.
X-ray tube with molybdenum anode and window.
GllAROONI. RAOIOt.OGY - ELECTROMEOICINE
3.3.4.16. Pulsed tubes for flash radiography {10-i sec.}.
Pu lsed tubes (see table 4/3, n. 11 page 124) have a
cold point shaped cathode, placed near the anode tar-
get.
When a potential is applied to the tube, on the cathode
point an high voltage gradient is generated, which sets
up an electron discharge forward the target, with X-ray
emission.
The em ission time must be short, otherwise the lube
will be broken by involved high power.
These tubes are used with condenser discharge pulse
generators.
3.3.4.17. Monostage 300 kV therapy tubes
Tab. 4/3 n. 6 page 123 shows a 300 kV tube for self-
rectifying X-ray generators.
This kind of tube is utilizable up to 300 kV.
3.3.4.18. Multistages tubes with metallic discharge cham-
ber for high potential (up to 600 kV and over).
The metallic discharge chamber protects the tube glass
from metallic depositions and stray electrons throughout
the whole tube lile.
3.3.4.19. Beryllium window tubes
Beryllium window tubes are used for rapid dose decay
therapy.
Tab. 4/3 n. 9 page 124 shows a tu be having a very thin
beryll ium window (0,5 mm) lor low energy radiations
(10 kV).
This tube is also used for artistic radiography (paint-
ings) and industrial radiography (light alloys).
3.3.4.20, Grounded anode lube for endocavltary therapy
It is illustrated in tab. 4/3 at point 12 (page 124).
The sa me tube is used for internal inspection in indus-
1ry.
3.3.4.21 . Focal spot and tube load in continuous work
(fluoroscopy, therapy)
The focal spot size of stationary anode tubes is deter-
mined on the basis of the load applied to the tube it-
self. Load is given in walts (for Electric Power, see
par. 3.2.4. page 117).
Fig. 28/3 shows load in function of focal spot size.
3.3.4.22. X-ray tube housing
The X-ray tube housing is a contai ner where an X-ray
tube is assembled for normal use, providing protection
against ionizing radiations and electric shock.
Fig. 29/3 shows a rotating anode X-ray tube for dia-
gnostics assembled in an X-ray housing.
129
 411'
Witt
L
... 311D ~
=

L

un
-l'
,
"
~
.n' +
lU I

m
c
, ,
f l nf 1, l t sill
II

l,
Fig. 3013 (per. 3.3.4.23.) Sec tion of a therapeutic housing
with insert tube.

MaJl:imum load: 300 kV with 12 mAo

R is an electric resistor 01 about 100 kO to protect the
Fig. 28/3 (par. 3.3.4.21.) - Electric power (EP) in Watt In tube agaln9t dangerous inner ionizations.
function of optical focal spot size In mm for continuous foed
("uoroscopy and therapy, stationary enOde tube).

1) Constant potential equipment wilh an anode inclinallon 3.3.4.25. Tube life and suggestions to Improve It
of ZOO (Wan "" rnA . kV).
2) Sell-rectifying equipment with an anode Inclination 01
ZOO (Wan = rnA . kV). They are listed below:
3) Constant potential equipment wilh an anode inclinallon
01 3( (Watt = rnA . kV).
For constant potential equipment the load Is expressed by 3.3.4.25.1. Tube pre-heatlng after an off duty period (fluo-
the relation: Watt - 800 . focal spot size (In mm) for an
anode Inclination of ZOO and Watt = 550 focal spot size roscopy, therapy)
(in mm) for an anode Inclination of 3(.
FOf self-rectifying equipment (pulsating voltage) the load After an off duty period the tube vOltage shoud be ap-
is expressed by: Watt := 400 . focal spo1 size (In mm) with lied gradually, following the times scheduled in lab. 613.
an anode i"cllnallon of ZOO.

TABLE 6/3 (par. 3.3.4.25.1) - Tube preheating

ter an off-duty period (fluoroscopy. therapy).
.,.
Off DUTY PERIOD

T ime

"", 0'
required 10 reach
kV maJI:.
11'1 10 8h

5 oec.
"'~
3d".
30 ""'.
3 daya to
''-
1 min.
.-
0""
S min.

. 0'
Time required 10 Increa-
10 kV from 70%
to lOO'11t 01 kV max.
20 ooc. 1 min. 2 min. 5 min.

If during the preheating the tube current becomes un-

stable (rnA meter swings). it Is necessary to decrease
the tension until the instability stops; atterwards ;t ;,
possible to start again the pre-heating procedure with
Increased limes.

Fig. 2913 (par. 3.3.4.22.) - Section of a diagnostic X-ray rota-

ting anOde tube hOUsing.
1) glass envelope; 2) Insulating oil; 3) anode disc; 4) anode
rotation stator coli; 5) rotor bearings; 6) expansion bellows;
7) negative HV cable socket; 8) cathode with filaments;
9) X-ray window 10) positive HV cable socket.
3.3.4.23. Therapy X-ray tube housing
3.3.4.25.2. Load and voltage limits to prolong tube lite
The tube l ife is remarkably increased operating a little
under the maximum load. as indicated in fig. 16/3
page 125 and under the maximum voltage as shows in
fig . 32/3 page 132.
X-therapy tube life is mainly determined by tube vol
tage.

Fig. 30/3 shows a therapy stationary anode tube as
sembled in an X ray housing.
3.3.4.24. X-ray tube failu res: remarks, defects and causes
They are listed in fig. 31 /3.
3.3.4.26. High Voltage CalMs
High voltage cables are used to connect the X-ray hous-
ing to the generator. The length of high voltage cables
should be kept at a minumum and the radius o f a bend
in a cable should not be less than five times the cable
diameter.

130 G!LAAOONI. AAOIOt.OGY lECmOMEO!C!NE

 31/3 (par. 3.3.4.24.) - Typical tube failures: remarks, defects and probable causes.

, A) X-ray output decrease. The Do'''''

," : X-rays generated into the
,," "Valleys are absorbed by ANOOE
, the . hills_. As tungsten

~
' ~:
, I _ ~
absorption is high, X-ray
output falls completely
Fall in rad ia- Crazing of focal area Usually, decay 01 local
tion output (see fig . A) track (see fig .' B)
- -, when the anode crazing
becomes very severe.
c . ...." onad.
(.. nl.,110"''1 )

Instability 01 Melted anode (tungsten)

anode currenl
or discharge In
B) Small crazings on focal

,...
X-ray tube
track due to the normal

anode (tungs-

Melted anode (copper) with

cooling (see

C) Focal track meltings due CATHOOE

to the conllnuous overload.
current Broken
olf and
wire I F)
0 1 the

Broken lIIament: overload

med and melted supply (see

0) Localed melting due to ac- Broken

cidenlal overload occured balls In
on a non rolaling stalion- 0 1 the
ary anode. "'00'
GLASS ENVELOPE

"..
Regular and anular brea-
king on glass envelope .""
during

0'
E) Anode melting and and splin ted I shock caus-
cracl<ing due to ~ on glass enY&- hard stroke
loads In stationary
anode tube.
on the Glass electrolysis caus-
ed by stray electrons ac-
cumulated on the glass

holes on
"
F) Broken filament: extended wall
overload of filament.

Film 01 tungsten on the Tungsten ro-

internal ,ul1ace 01 the from filament or
I envelope caused by over-

G ) Broken filament: instanta-

neous overload or wrong
supply. VACUUM

generation in the period off duty

Overload or wrong coo-

ling with high heating
H) Broken liIamen!: overload and consequent gas e-
on the focal track with re- mission from metallic
verse emission from the parts
target.
Vacuum leak on glass-
metal

GILARDONI. RADIOlOGV - ElECT~ EOICIN E 131

High voltage cables and their terminals are the weak
points of an X-ray unit.
o
3 4

111
--1'
III
o 2-11it---'--fl<O
, -, --
-
~
II , Ctll,
, r-- fit-- l D

;;

--'
II
~

J-
~

" --,-
" III 111
"hlih ,.
I
'" ... 5
7
Fig. 3413 (par. 3.3.4.26.2.) - Cross secllona/ view of X-/h6rapy
high voltage cable.
One cable to earth '" 250 kVdc
Fig. 32/3 (par. 3.3.4.25.2.) - Tube life In function of % of the Two cables - 500 kVdc
tube voltage (see fig. 1613 page 125). All relerences are those reported In fig . 3313.
Being the tube lile va lue high. the X-ray tubes may lait lor
oU16r reasons. (Filament breaking. vacuum deterioration. etc.).

3.3.4.26.1. X-diagnosll ics high voltage cables

A c ross sectional view of a cable used in diagnostics is

shown in lig . 33/3.

o
4

o 2 -!J--~<>t--'-Il- l D

5 6
7

Fig. 3313 (par. 3.3.4.26. 1.) Cross sectional view of X-diag-

nosf/c high vol/age cable.
One cable to earth '" 75 kVdc
Two cables '" 150 kVdc
0) com mon filament conductor; 1) small liIament conductor.
2) large filament conductor; 3) semi-<:OOductlng rubber; Fig. 3513 (par. 3.3.4.27.) - Longitudinal sec tiOnal view of high
4) non-conductlng rubber. or eiastometric compound. pro- voItags fermina/.
vides insulation against high voltage; 5) semi-conductiog
rubber; 6) earthed copper; 7) protective layer. 1) cable ring nul; 2) socket insulator holding nut; 3) mount-
ing lIange; 4) cable insulator gasket. 5) socket insulator
gasket; 6) cable Insulator. 7) socket insulator.

3.3.4.26.2. X-therapy high voltage ca~es

A cross sectional view of the cable for X-therapy equip-

ment (500 kVcp) is shown in fig. 34/ 3. Chapter 3.4. _ CONTROL DESKS

3.3.4.27. High voltage tenninals 3.4.1. Classic control desks

Fig . 35/ 3 shows a sectional view of a high voltage ter- The control desks, or control benches, contain Dower
mmal for a X-diagnostics equipment. supply, generator regulation and control devices.

132 G!LAROON!, RAOIOI..OGY . EL.ECll'IOMEO!C!NE

3.4.1.1. KY regulation
The control of the KV applied to the tube is normally
achieved by means of an autotransformer, which has
many voltage outputs and a switCh, known as the KV
control.
Various voltages selected in this way, are applied to the
high voltage transformer and the resulting high voltage
is applied to the X-ray tube.
As the tube voltage drops under load, because of the
generator impedance and of the main resistance, the
input voltage must be increased to maintain the sche-
duled KV value, at the increasing current (mA) demand .
High voltage (KV) is a fundamental factor of the expo-
sure because it determines the quality or penetrating
power of radiation and the characterizes the image (soft,
ray, hard ray).
Therefore KV value must be read with precision . The
KV meter is substantially a primary voltmeter that takes
also the vol tage drop caused by the generator impe-
dance and the main resistance into account, showing
the effective voltage applied to the X-ray tube during
the exposure.
3.4,1,2. mA regulation and stabilization
A variable resistor (rheostat) provides the control of the
filament heating current: so the tube current (rnA) is
regulated .
X-ray tube generally operates in saturating condition and,
as the tension (KV) changes, the current (mA) should
not vary too much.
However, to avoid also slight rnA variations, special de-
vices are sometimes provided .
Stabilizers are used to make sure that supply voltage
variations are not transm itted to fil ament, causing chan-
ges in tu be curren t.
3.4.1.3. Exposu re electronic limer
The electronic timer is generally based on the fact that
a condenser takes constant times to charge, in functi on
of the values of the different resistances in series.
Particular care is applied in the elect ronic circuit. to
-phase the exposure." or to realize that the switching
contacts open or close at -zero" paints of alternating
current.
3.4.1.3.1. High voltage timer with triodes or tetrodes, in-
ertia free switches for Cine X and flash-pulsed
digital techlnque
Cine X and digital techniques require high rate of high
intensity X-ray flashes (in the order 01 mill iseconds) .
The primary electronic timers are not suitable to reach
this goal and HV electronic switches with triodes and
tetrades are utilized.
Fig. 36/3 shows the principle of an HV electronic timer.
3.4. 1.3.2. Pulse-G il, 500 KW power generator (5000 mA
al 100 KV)
Pulse-Gil is an extra powerful threephase + condenser
generator realized by Gilardoni with inertia free switches
for flash-pulsed digital radiology.
G1LAROONI. RADIOt.OGY ELECTf'IOMEDICINE
It is also used as a special extra power generator and
is realized according to the principle illustrated in fig.
36/3.
10
3
I~-o
' , f---.
11
Fig. 3613 (par. 3.4.1.3.2.) - Principle of HV elec fronic inertia
frH. timer telrocies opereted (Pulse-Gil).
1) 12 pulses HV generator; 2) HV condenser (1 microfarad.
150 kV); 3) anodic MV tetrode; 4) cathodic HV tetrode;
5-6) letrodes filement healing transformers; 7) X-ray tube;
8) lube filament heating transformer; 9) electronic timer
contrOlling the tetrode grid; 10) electronic balance for HV
stabilization; 11) clnecamera or digital electronic device
synchronizing the X-ray flashes.
Pulse-Gil Is an exIra powerful X-ray ~threephase. 12 pulses
cond&nSeflo gen&f8lor realized by Gllardonl utilizing this prin-
ciple.
The generalo r (1) is the ~ Dodecasilix . described in fig. 813
psg 119. allowing current of 1600 rnA at 100 kV (160 kW
power).
The condenser (2) of high capacity can supply very high in-
stantaneous c urrents. The lelrodes can control currents unlill
5000 rnA.
The ~ Pulse-G II. can prod uce fla sh-radiographs 01 a fraction
01 msec. eKposures untill 100 flash/sec. with intensity 01
5000 rnA al \00 kV (500 kW power) .
Pulse-Gil Is used In Gllardonl digital DMD-GIL_ equipment
and 8S special extra powerful generator.
3.4.1.4. Tube overload safety device
To avoid tube overloading two kinds of safety devices
are provided : previous or cumulative (real time) overload
protection.
3.4.1.4.1. Previous overload protection
Electromechanical or electronic devices, laking the values
of exposure lactors (KV, rnA, sec.) into account, are
provided in order to stop exposure when a tube over
load condition is reached.
Sometimes a meter Indicates the percentage of the rea-
ched limit charge.
3.4.1 .4.2. Cumulative (real time) overload protection, par-
ticularly useful with high exposure rate (angio-
graphy)
Electrothermic or electronic device simulates the anode
temperature during the rapid series 01 rad iographs, and
switches the generator off when the anode temperatu re
becomes too high.
133
 -1_-
3.4.2. Automatic and electronic control desks (GUardoni
Multilogix System)

Nowadays the utilization 01 the most advanced electro-

nic techniques allows the construction 01 completely au-
tomatic control desks,
- - -
Moreover, the use of integrated logic and linear circuits - --
allows the realiza tion of small and compact units.
The distribution of the different functions on several
electronic printed boards eventually makes the service
easy and quick. . ,

"

Fig. 37/3 shows the control desk of the Muflilogix Sys-
tem and fig. 38/3 the Muitimatix one, a supplementary 0 -
control unit.
8 ...
..
I ~
Fig. 38/ 3 (par. 3.4.2.) - Mulr/malix: supplementary contrOl unit.

-~
. ..'
.,o .
-
.- ffffiHE -

On the upper square: automatic anatomic techniques selec-
tion contrOlS.
On the lower square: automallc-dose (Dasemat) controls.
It allows the automatic set-up of the radiographic parameters
by a simple choice of the anatomic part
This unit includes:
1) Numeric keyboard to select the automatic radiographic
techniques.
2) Automatic dose-meier (DaHmat) lor optimal film ellpG-
sore.
3) Possibility 01 varying the ellposure In function of the pa-
:0:
.
tient size.
4) Controls and display 01 the alarm sigllllis.

Fig. 37/ 3 (par. 3.4.2.) - MultiJogl/f Gllardonl: cOn/rol desk.

On the left square: all the security displa)'3.
On the right square: radIOgraphic ellpo$Ure controls: kV, mA,

"'"
On the lower square: radioscopic kV and mA controls.
It is a fully electronic control desk aUowlng:
II The driving of four separate X-ray lubes.
2) Choice 01 the radiographic .... ol tage (kV) by a numeric
keyboard and digital display.
3) Radiographic current (rnA) selection and automatic fo-
cus switching when o.... erloading.
4) E)(posure time selection with digital display of the sec.
and mAsec values.
5) Fluoroscopic kV and rnA continuous selection.
6) rnA stabilization.
7) Percent Indication 01 the radiographic load and over-
loads Inhibition.
S) X-ray tube heating Indication.
9) Anode rotation check.
to) High speed angiography up to 12 e)(posures/sec. with
3 msec. flash time.

3.4.3. Computed aided radiological control unit (logix)

It is possible to regard the entire X-ray diagnostic equip-
ment as a completely computer controlled system.
In this case, a central processing unit co-ordinates all
the equipment functions managing also the exposure
parameters (KV, mA, sec.).
Further, the com puter checks the working conditions of
the X-ray generator and prevents accidental overloads.
The operator enters the examination data through a
key-board and reads the information about the machine
status on a CAT display.
Fig. 39/3 represents an integrally computerized control
desk, Gilardoni ~Logix System and the video display
appearing in Tomography.
Fig. 3913 (par. 3....3) - Legix Gllardoni: complelely compule-
rized control desk.
On the left: service TV monitor and control unit.
On the right: lIuoroscopy TV monitor.
On the lower ligure: video display appearing in Tomography.
The values 01 the radiographic and radioscopic ellposure pa-
rameters are digitally entered by means of a keyboard.
On a service TV monitor appear the selected data, the per-
cen t radiographic load and the anode temperature calculated
values. all the alarm conditions and instructions for the ope-
rat or.
For the latter two kinds 01 signaling. speech capability is al-
so available.
A second TV monitor set beside displays the radioscopic
images.

134 GllARDONI. RADIOLOGY _ ELECTROMEDICINE

3.4.4. New Multi focus-Gil Tube.. computer operated: fo-
cal spot size automaUcally selected In function of
loads and Inertia free HV switch also for flash-
pulses digital radiography, Cine-X, etc.
The electric factors determining the radiographic expo-
sure are: kV, mA and sec.
Every tube focus size (F) is a lunction 01 these three
factors; they are given by the .. maximum rating charts
(l max) and are mathematically expressed by the func-
tion:
(1) lmaoc = I (kV, mA, sec, F)
The Radiolog ist selects kV, mA, and sec. according to
the different anatomical part deciding % of the max
load admitted (% l ....... ) to increase the tube life.
The optimal focus (Fopd, that is the small focus accord-
ing to the preselected load , is expressed by the func-
tion:
(2) Fopt = 1 (kV, mA, sec., % LIM.)
The computer, according to the relation (2). gives the
optimal Focus sizes In function of different combinations
01 radiological lactors.
The Multilocus-GII tube.. has a single hot filament with
a pair of focusing electrodes, which are parallel to the
filament itself and another pair of focusing electrodes,
which are orthogonal to the first ones.
With a suitable negative polarization 01 these electrodes,
it is possible to obtain every locus size: for example,
from 2 x 2 mm2 to 0,3 x 0,3 mm2 . With a strong nega-
tive polarization, it is also reached the complete inter-
ruption 01 the electron flux (H.V. inertia-free electronic
switCh).
This characteristic of Multifocus-Gil tube is determ ined
by its own "Polarization curves.. and is mathematically
expressed by the function :
(3) F = f (V polarization)
The computer, according to functions (2) and (3), gives
the polarization voltages to the tube locuslng electrodes
so as to realize the optimal focus sizes for every prese-
lected load, or electron flux interruption (H.V. switch).
The "Multifocus-Gil tube.. realized first by Gilardonl is
metal-glass type as that described in fig. 27/3 page 128.
Chapter 3.5. - kV, rnA AND lec.: ELECTRICAL
AND TIMING FACTORS OF RADIO-
GRAPHIC EXPOSURE AND THEIR
CONTROL
3.5.1. Generalities and references
As previoulsy seen in par. 3.4.1. page 132, to wh ich re-
ference is made, electrical and timing lactors of radio-
graphic exposure have been dealt with.
They are: kV, mA and sec.; kV determines the image
character and quality of the radiograph.
In particular: the X-ray tube current (mA) and the time
(sec.) act on the exposure according to direct propor-
tionality law. while the high voltage (kV) plays a heavier
role because of Its exponential influence.
KV. moreover, determines the film contrast (see par.
2.3.8. page 45).
GllARDONl. RADIOLOGY ELECTAOMEOICINE
Consequently, it is basic to check carefull y all of the
three quoted parameters, so that the control desks
measuring meters may be calibrated in order to gain
the best radiographic results.
Below is explained how to procede.
3.5.2. kY and wave shape conlrot
The voltage (kV) at the X-ray tube electrodes is the
most difficult parameter to control because, in this case,
very dangerous high tensions must be handled .
Immediate measurements with a kVmeter are hence not
easy to execute because of Insulation problems.
Direct check methods and wave shape control are ex-
clusively performed In the manufacturing plants with
special devices.
Practically, less exact (but less dangerous), methods ex-
ist, which are carried out either by indirect electrical or
dosimetric measurements.
3.5.2.1. kV control with primary Vmeter
An approximate Indication about X-ray tube voltage is
obtained reading the primary voltage on the high ten-
sion transformer with a Vmeter (kV calibrated).
This is an indirect measurement method based on the
tums ratio between primary and secondary windings.
Nevertheless, it is subject to some mistakes because it
doesn't take into account neither the secondary voltage
drop at a given load nor the form factor.
Therefore, the above mentioned Vmeter must be conve-
niently compensated and carefully calibrated, so that its
dial mari<s indicate the actual kV values at the tube.
Such an instrument is employed in practice on control
desks and it Is only one which the radiologists refer to.
to set kV values.
3.5.2.2. kY control with a sphere spari< gap
A sphere spark gap is a device that measures the high
voltage peak amplitude (kVp). Th is is the most signifi-
cant radiOlogical value both in diagnostics and in thera-
py and moreover it determines the shortest wavelenght
in the emitted X-ray beam (see par. 2.2.6. page 43) .
The sphere spark gap system is based on the fact that
such high voltages are able to jump in air between me-
tal spheres of opposite polarities. but however has to
overcome practical difficulties. especially during the shor-
test radiographic load times.
The device connected in parallel to the X-ray tube elec-
trodes, is only used in laboratories or in testing rooms
to evaluate possible overvoltages or any change in vol-
tage symmetry as well as to avoid distruptive discharges
either inside the X-ray tubes or along the H.V. cables.
Table 8/3 page 141 gives Peak Voltage (kVp) in func-
tion of spark-gap distance in air.
In fig . 40/3 a sphere spark gap device is shown to
evaluate overvoltages and dissymmetrical voltages.
3.5.2.3. kY control wIth resistor voltage divider and ca-
thode-ray oscilloscope
It is possible to use a less dangerous and more sophis-
ticated equipment set to measure kVp, which is also in-
dependent of air umidity.
135

Fig. 4(J/3 (par. 3.5.2.2.) Spark gap device to evaluate over-
voitagfJs and e/fJ(;trical dissymmetries.
t ) Earthed cenlral sphere.
2-3) Spheres at H.V. poles. connected and mounted on insu-
lating columns.
....S) Current d ischarge dampers made 01 waler resislors In
plas1ic tubes.
On the righl and left side 01 Ihe device, lhere are two op-
posile H.V. cable sockets (black coloured) to connect the
geoerator and X-ray tube.
Each of the insulating sphere columns can be filted in
three holes to establish rough distances from the groun-
ded central electrode, while the alive spheres can be
pulled back or forward for tine adjustemenl.
The working distances are selected relerlng to the calibra-
tion table 813 page 141, taking into account the evaluation
of a voltage which must be 10-15% grealer than thai on
control table.
Possible overvoltages or electrical dissymmetries will be
detected by a discharge belween one of the two alive
spheres and the earthed one.
It has no exposed high tensions and works with two
voltage resistor dividers (In oil bath).
The resistor containers can be previously arranged with
standard I. E.C. specifications quickly coupling cable
shoes to facilitate the measurement proceedings.
The stepped down high voltage can now be measured
or displaced on a memory double channel scope screen
to visualize the wave forms even at the shortest times
and to evaluate, apart from other fact ors, how the H.V.
cables' capacitance acts on the voltage shape.
Schematic diagram of this equipment set connections is
shown in fig. 41/3.
3.5.2.4. Quick kV evaluation with a dosimeter
The working method Is described in detail in par. 2.8.5.
page 100, is easily applied and quite exact.
Only a dosimeter such as the one in fig. 2812 page 52
and in table 17/2 page 101 together with a 1 mm cali-
brated copper filter is needed for operation.
In practice this technique is suitable to check the
kVmeter of each control desk.
3.5.3. mA controt
As for kV measuring the anode X-ray tube flowing cur-
rent should be directly checked in a part of the circuit
involving high electric potentials.
Insulation and safety problems of such a measurement
suggested a substitutive indirect method.
Both systems will be discussed hereunder.
136
2
-- .,"-
,",,,,H.V
>=-
.. 4=.U ', 6
@5~(;=1 1
Fig. 41/3 (par. 3.5.2.3.) - PrinCiple schematic diagram of H. V.
measurement with resistor volrage dividers.
t) X-ray tu be; 2) positive voltage resistor divider (in 011 bath):
3) negative voltage resislor divider (In 011 bath): 4) memory
capacitor; 5) high impedance Vmeler; 6) double channel
memory cathode-ray oscilloscope to display and study posi-
tive and negative waveforms with respect 10 earth.
The connection H.V. cables Irom the voltage dividers to
the X-ray tube must be as short as posslb!e. to avoid In-
terposed capacitances.
The reslslor voltage d ividers scale down the H.V., each
one by a lactor 01 to.ooo. That means that 100 kV will be
reduced to a 5 Vp signa! to each scope channel Input
with respect to earth.
The capacitor (4) Is necessary to read peak voltage values
with an electronic Vmeter (without oscilloscope).
The worKing principle Is the lollowing; the stepped down
high vol tage will charge the capacitor, which acts as a
momentary memory element.
Quickly switching the SO Charged capacitor on the high Input
Impedance Vmeter will allow the latter to detect a value di-
rectly proportional to the X-ray tube H.V. peal( supply.
The measure must be carried ou t without oscilloscope 10
avoid leakage currents.
II the resistor voltage dividers ratio is t :l0.ooo, as above said,
the Vmeter Will read out 10 Vpeak in the schematic conligu-
ration represented in the ligure.
3.5.3.1. mA control In high voltage circuit
A mA meter is directly connected in series to the X-ray
tube anode.
Th is is the most dangerous operating method and must
be used exclusively in testing rooms by skill workers
operating with adeguate equipment.
3.5.3.2. mA control In low voltage circuit
In all high voltage generators there is a secondary cen-
tre pOint generally grounded to ensure a symmetrical X-
ray tube voltage with respect to ground.
Thanks to this configuration, it is possible to insert a
mA meter in that part of the ground connected circuit
to read the current flowing through the X-ray tUbe.
The instrument is therefore working at low voltage with
respect to ground and can be safely displaced on the
control desk panel.
Nevertheless, it must be taken into account that paraSit-
ic circuit elements, such as the already mentioned H.V.
cables capacitance, may playa distributing role, altering
the actual anode current value.
Hence, some correction factors have to be applied on
the mA meter reading circuit.
G ILARDONI , RAOIOLOGY - ELECTROMEDICINE
3.5.3.3. mA check with milliampere-second meter (mAs.)
At short exposure times, less than 0,5 sec., the rnA me-
ter does not have enough time to give an accurate cur-
rent indication even if the mechanical pointer is replaced
by an electronic digital display.
In order to obtain a correct cal ibration of an X-ray unit
under these ci rcumstances a special meter, which mea-
sures and memorizes the product of the current and the
exposure time, is used.
Such a unit is called milliampere-second meter (mAs.).
The operator can easily evaluate the current magnitude
(rnA) dividing the memorized mAs value by the expo-
sure time.
Such a method is the only one used in practice nowa-
days, since it is practical and rather exact.
3.5.3.4. rnA control with cathode-ray oscilloscope
Connecting a known low value resistor (e.g . 10 ohm) in
series with the ground side of milliamperometric ci rcuit
and setting a cathode-ray osci lloscope in parallel, it is
possi ble to dl play a voltage waveform, in the course of
0.0" -
Fig. 42/3 (par. 3.5.3.3) - mA and sec control during radio-
graphic exposures with ca thode-ray tube oscilloscope.
The horizontal 8}!;ls was previously calibrated, setting the
appropriate time knob on the scope front panel.
In the represented case. the sweep time Is 0,1 sec full-
scale.
The vertical a:w:is was previously rnA calibrated using an
edernal testing circuit provided with 8 suitable and well
known d.c. voltage source and a low value resistor.
In the represented case, the full-scale Is 1.000 rnA. .
The oscilloscope input is set parallel to the low value resI-
stor. whiCh is itself connected in series to the ground side
of the miUiamperometric circuit.
The oscilloscope trigger selector Is switched on e:w:ternal
source so that the same testing signal can be used to re-
lease the C.R.T. scanning spot at the slart of the radio-
graphic e:w:posure lime.
In such a way, the displayed waveform will begin al zero
sec. on the horizontal a:w:is.
Observing the figure. the following working leatures can
be read out
a) 0,08 sec. ::: electrical e:w:posure time.
b) 0,07 sec. ::: true radiographic e:w:posure time.
c) 5SO rnA = average radiographic current.
A memory cathode-ray oscilloscope would be helpful since
the displayed waveform would remain on the C.R.T. screen
until it is needed.
This instrument allows to study the image for a long time
and to photograph any detected pheJ"lOlTlena.
GILAROONl. RADIOlOGY - ElCTROMEDICINE
the exposure time, whose amplitude, according to Ohm's
law, will be proportional to the flowing current.
Because of this simple relationship, the scope's vertical
axis can be previously mA calibrated as shown in
fig. 4213.
In the meantime, the observation of the displayed wave-
form along the horizontal a:w:is gives the opportunity to
evaluate the true exposure time.
Moreover, the scope plotted wave-shape allows to point
out any anomalous behaviour of the high voltage, such
as discharges inside the X-ray tube, etc.
Such phenomena appear as high-frequency noise on
wave crest.
3.5.4. Exposure time control (sec.)
On the control desk of a diagnostic eqUipment, beside
the knobs and meters used to set and read both kV
and mA there is another basic adjustement unit allowing
the correct operation of the X-ray tu be.
This is the exposure time selector acting on the so
called .. X-ray switch,. via proper electronic circuits.
T hese elements must be accurately calibrated because
much depends on their correct working behaviour.
In fa ct, as previously seen, the reliable use of both mAs
meter and kV measuring dosimeter is exclusively based
upon the actual knowledge of the exposure time.
There are many simple methods to check it which are
explained hereunder.
3.5.4.1. Time control with electronic pulse counter
The electrical exposure time can always be measured
by inserting an electronic digital display demi-CY~l e
counter in parallel with a primary wind ing of the hIgh
voltage transformer, at the output of " X-ray switch-.
Th is is because, if the mains' frequency is 50 Hz, such
an Instrument will be able to clock up to 0,01 sec ..
With regards to the radiographic exposure time evalua-
tion , instead , there is a higher limit.
In fact , it must be taken into account that the so men-
tioned short electrical time does not represent an equal
rad iographic exposure time, due to underpowered pre
and post insertion times (ranging from 0,Q1 to 0,03 sec.)
when the primary electromechan ical X-ray switches are
employed.
Therefore, this method gives a true radiographic time
indication when these transit-times shOrten to a negligi-
ble value (1110), in comparison with the overall duty-cy-
cle.
This means that when the pulsecountmeter is used for
this purpose, the operation times must be greater than
0,1 sec. with standard diagnostic apparatus.
3.5.4.2. Time control with radiographic spinning top me-
'hod
The most widely used and simplest method of checking
true exposure times employs a horizontal 10 cm. dia-
meter lead disc provided with stroboscopic marks and
drilled hole (or a radial rift) along its circumference (see
fig. 43/3 page 138).
The d isc is mounted on a solid base with a bearing
that allows the disk to turn around its own axis.
137

F;g. 43/3 (par. 3.5.4.2.) - Radiographic spinning top.
A lead disc of about 10 cm diameter and 2 cm. thickness.
can rotate freely around its own vertical axis upon the film
loaded cassette.
Near the disc circumference a clean hole or II small radial
rift is drilled.
Stroboscopic marks wi ll be very helpful to evaluate the rota-
tion angular velocity in some particular circumstances.
In technical language such a device is called spinning top~.
If the disc. displaced upon the cassette under the central X-
ray beam, Is spun while an X-ray flash is shot, then the ra-
diati on going through the hole will exposure the film along
an arc of a circle, on which each H,V. ripp le peak will be
detected as a black dot (after the film has been developed).
The dots' con figuration will depend upon the type of rectifi-
cation ci rcuit. So when the main frequency is known, it Is
possible to establish the exposure time by counting the
number of dots (see example In fig . 44/3).
Sometimes. although the contrOl desk timer is working cor-
rectly, the test can be wrong because failures In the H.V.
rectification circuit have happened. Therefore, particular care
must be taken in evaluating the spinning-top results in these
situations.
Spinning the top on a film loaded cassette at a well
known stroboscopic velocity and lIashing a perpendicu-
lar X-ray exposure, it is possible to detect a certain
number of hole tracks, on the developped film.
These displaced along an arc of a circle, will represent
the X-ray tube voltage pulsations.
All the black dots co nfigurations, obta ined with different
types of generator will be recorded during the exposure
time, as shown in fig . 44/3.
Measuring the arc amplitude of the dotted line, it is
possible to evaluate the exposure time, as the strobos-
copic r.p.s. is known.
The test can be carried out counting number of the
hole tracks because any spot, as already said, repres-
ents peak of high tension rectified wave.
For instance, operating a Si ngle-phase 50 Hz mains con-
nected generator, with the secondary half-wave circuit at
0,1 sec., the developped film will detect 5 dots when
the set exposure time is correct.
A four-valve rectification generator will obviously detect
10 dots.
A three-phase 50 Hz circuit, six valve rectification gen-
erator, will give out 30 spots in 0,1 sec ..
A twelve-valve generator will give out 60 spots in the
same time.
Care must be taken in chosing a suitable spinning ve-
locity versus the ckeck ing exposure time. In fact, if the
angular velocity is too low, the dots on the film will
appear too close to each other.
On the other hand , at too high angular velocities, the
138
-- - A
~
0 B
I
c
..
,.........
Fig. 44/3 (par. 3.5.4.2.) - Radiographic spinning top: typical
configurations.
The figure shows some typical con figurations detected with
the following H.V. rectification circuit (SO Hz mains supply
frequency) :
a) Self-rectified Circuit (5 dots in 0,1 sec.).
b) Four-valve rectification circuit (10 dots in 0,1 sec.).
c) Three-phase circuit. six-valve rectification circuit (30 dense
zones in 0,1 sec.).
d) Discharge-condenser circuit. which reveals the caractoris-
tic time-smoothed high tension,
Nota: In d) no spots are obviously detected. but only a con-
tinuous arc line.
Even in the case of a three-phase, twe!ve-valve rectification
circuit. it can be very difficult to distinguish the Interesting
dense zone.
In such cases the exposure time should be controlled, eva-
luating the spinning-top angular (constant) velocity with the
aid of the stroboscopic marks.
dots at the end of the test will overlap those at the
start.
Both situations cause countable difficulties.
It can be noticed that the time measurement with the
spinning top can still be used with condenser-discharge
apparatus.
In this case, instead of a dotted line, a continuous arc
track will appear, whose time-length can be easily eval-
uated observing the stroboscopic velocity during the ex-
posure, as explained above.
The rad iog raphic spinning-top method is very useful, in
practice, to check exposu re times which are shorter
than 0,1 sec.
3.5.4.3. TIme control using an oscUioscope on the prima-
ry circuit
Connecting a memory cathode-ray scope, conveniently
triggered, in parallel to a primary winding of the high
tension transformer at the output of the .. X-ray switch,
it is possible to display the voltage shape across the
transformer and to pick up information about the elec-
trical exposure times.
While executing the test, the oscilloscope must be mains
supplied through an insulating transformer, because its
ground terminal will have no ground contact.
Moreover, care must be taken in thouching the trans-
former case. The so carried out measure represents an
alternative and more sophisticated method than that ex-
plained in par. 3.5.4.1 .
GILARooN I. RAOIOlOGY ElECTIlOMEOICiNE
3.5.4.4. Time control with oscilloscope on the secondary
low tension mlillamperomelric circuit
This matter has already been dealt with par. 3.5.3.4.
pag. 137. See fig . 41 /3 pag. 136.
3.5.4.5. TIme control In high voltage, by means of vol-
tage divider units and cathode-ray osctlloscope
The method is described in par. 3.5.2.3. pag . 135. See
fig. 42/3 pag. 137.
3.5.4.6. Time control with dosimeter
It is also possible to check radiographic times with an
Integrati ng dosimeter, like the one represented in
fig. 84/2 page 94, which includes a 30 rnA full-scale
)Onization chamber and a 1 mm. calibrated copper filter
mounted In front of the X-ray tube window (see par.
2.8.5. page 1(0).
The operating procedure Is based on the step-by-step
multiple exposures method, as explained hereunder.
First of all. long time, e.g. 5 sec., must be checked on
control desk, using as reference a normal watch having
a seconds calibrated scale.
Thanks to such a long time, this first checking step is
easy to carry out and rather precise.
Then without altering the 5 sec. set on control desk, an
exposure producing 20 mA (213 on dial) on the dosime-
ter must be performed, setting appropriate kV and rnA
values.
At this paint the dosimeter can be reset and 5 expo-
sures, each of 1 sec .. must be lIashed.
The dosimeter pointer will still read 20 mA if the con-
trol desk timer is working correctly.
It is a good rule to repeat the procedure chang ing kV
and rnA or the dosimeter distance from the X-ray tube
focus.
The same operation will be applied to control shorter
exposure times; e.g. 0,1 sec. Presetting a time of 1 sec.
on a control table particularly checked for such time,
select an exposure (kV, mAl giving a dose of 20 mA.
Aesetting the dosimeter and flashing 10 X-ray exposures
at 0.1 sec ., the pointer will Indicate 20 mA again, if the
timer is working properly.
Eventually, if kV and mA are arranged to obtain a 20
mA dosimeter read ing at calibrated 0,1 sec. it is possi-
ble to shot ten X-ray lIashes with the time knob set at
0,01 sec., without changing kV and mAo
A total 20 mR dose can be obtained if the timer is co-
rectty calibrated at 1I100th of a sec.
Chapter 3.6. - FUNDAMENTAL ELECTRICAL DATA
FOR PHYSICISTS, DESIGNERS, MA-
NUFACTURERS AND ELECTRORA-
DIOLOGICAL TECHNICIANS
3.6.1. High voltage (HV). basis of X-ray generators
Table 1/3 page 116 gives circuit schemes. characteristics
and performances of the principal X-ray generators.
Also the following tables are fundamental for designers
and manufacturers.
GllAROONI . RAotOLOGY - ruCTROMEOICtl'lE
3.6.1.1. Electric field Intensity (kV/cm) for various elec-
trode shapes and distances (table 7/3 page 140).
3.6.1.2. Peak voltage (kVp) In function of spark distance
(table 8/3 page 1(1).
3.6.1.3. Characteristics of the most important Insulating
materials (table 9/3 page 142).
3.6.2. Tracing of the electric field graph and stress eva-
luation by means 01 the electric gradient (kY/cm
or mm).
The field graph Is Important because it allows to evalu-
ate the electric stress.
Fig. 45/3 shows how to trace the electric fi eld and how
to evaluate the electric stress (kV/cm or mm) .
Fig. 4513 (par. 3.6.2.) - Electric field graph between two
spheres having different dlems/e,.,.
The !leld tracing Is based on the rule: the lines of force are
always perpendicular to the electrodes surfaces and to the
equipotential surfaces.
With this rule. and having a little experience and imagi
nation,
I! Is possible to trace the graph of every electric field .
The field Intensity or voltage grad ient in kV/cm (or mm) Is
higher where the lines of force are more concentrated.
In the Illustrated case, the concentration of the lines of force
on the small sphere II about twice that on the targe one.
consequently, the voltage gradient and the electric Itress on
the small sphere Is about twice that on the large one.
3.6.3. Insulating material, choice In function of the vot-
tage gradient
Table 9/3 page 142 allows to make an appropriate cho-
ice.
Aeferring to perforation (dielectric strength in kV/ mm),
safety marg ins must be considered.
3.6.4. The most used Insulating materials
These materials are: mineral oil, highly pressed cellulose
paper (kraft paper), vacuum treated oil impregnated pa-
per, laminated plastics such as PVC, Makrolon, Oppanol ,
Teflon, Nylon, Mylar, etc. (see table 9/3 page 142).
The choice of Insulating materials must be made ac-
cording to the different working conditions and stresses.
139
 TABLE 7/3 (par. 3.6.1.1.) - Electric field in tensity (k Vl cm) fo r vario us electrode shapes and distances.
Example Max Field Intensity E - ~
em
for Vol t age U - kV

Elft(:ttod Flgur. Formula Eumple

"

H
U - 100 kV, d - 2 em
U
1 Two parallel planes E- - 100
d E - - - - 50 kV/em
2

~@d
U - 150 kV, r - 3 em, R - 5 cm
Two concentric U R
2 E- - -
spheres d , E-~ ' ~ - 125 kV/cm
R . 2

r01
U- 200kV. r - Scm. d -8cm
U N-d 9
3 Sphere and plane E- -
d
- ,- ' 1"0 200 5+8
E- - - -_. ,9 - 58.5 kV/cm
8 5 0
,
', 1 U - 200 kV, r - 5cm, d -12cm

4 Two spheres r~ U
E- -
d
r+ 'l.td
, ._-
9
10
E _ 200 5+ -- 9
. - - - 33 kV/cm
, I', 12 5 10

;-W
U - 100 kV, r - 5 cm, A - 12 cm
5
Two concentric
cylinders
E-
U
2.3 r lg t
, E-
100
12 - 23 kV/cm
2.3 ' 5Ig , -

6 Cylinder and plane

r@-(J E-
2.3 r Ig
U
.
,
-,-
._-
10
9
E-
U - 200 kV. r - 5 cm, d - 10 cm

200
2.3 . 519 ---r
5+10 . 10 -
9
32.7 kV/cm

7
Two parallel rL:)j. )
~V
E-
U
....., '10 9
U - 150 kV, r - 6 cm, d - 20 cm

75 9
eo ' 0 - 11.5 kVlcm
cylinders
l'J ",~ 2.3 r 10 E-
2.3 ' 619 T '

U - 200 kV, r - l 0cm. d - l 0cm

~ ..'"
Two crossed U 9
8 E- . --;0 E - 100 9
cylinders 2.3 r Ig , 2.3 . 10 Ig 10H,... .-
10
- 22.3 kV/cm

rto
U - 100 kV, 0 - 10 c m
E _ 3U
Hemisphere
9 d 300
and plane E - - - - 30 kVlcm
r(O("g. l) "d 10

to
U - 200 kV, d - 12 c m
E _ 2U
Hemlcylinder
10 d 400
and plane E - - 12- - 333
. kV/cm
r (lyl.~oO<) ~d

U - lookV, L' - 4,L I - I , d - l0cm

W~
r2 100
EI - E - - E - - - - l0kV/cm
11 Two dielectric
d l "d2 " 10
E, - 10 . -
4
1
- 40 kV/cm

U - 100 kV, L2 - 4, L, - I , d - ' 0 cm

~ ~ "
12 Two dielectric 1 E2- E -
r2
100
E - - - - l0kV/cm
10
d, " d ,
e, - 10 41 - 2.5 kVlcm

140 GILAAOONI. AAOIOt.OGY - ElEC"mOMEDtCINE


TABLE 8/3 (par. 3.5.2.2.) - Peak voltage (kVp) in
relation with spark-gap distance in air (2fJ'C and
760 Torr).
With insulating oil, the same spaf'i(-gaps can be
obtained with the kV 5 times larger. For insulating
oil the rules in force state that a spark voltage
must be ~ 50 kVp between two spheres 5 mm
diameter and spaced 2,5 mm, that is oil dielectric
strength must be ~ 200 kVp/ cm.
For other insulat ing materials see table 9/ 3
page 142.
lang l"
O. " m. ' ~ r 01 lpn,,, ..
spa. , Po,nl5
."_ _ _1 _5
ICm!
Thermo-shaped pieces or molded epoxy resins (Arald it,
etc.) having incorporated electrodes to regularize the
electric field are used, when possible, for complex shapes
of insulating materials such as cups, cable terminals,
bushings, etc.
3,6.4.1. Mineral or synthetic 011.
They are the most used liquid insulating materials.
Electric oil must be pure, clean and preferably treated
under-vacuum.
In this condition the dielectric strength is about 5 times
Lengll> O'D"' ~ I ~ r
more than that of air (see table 813).
'1>4' ~ Po,nl' 0ISpl>'''U

_10 _25
."
_ m _50
!c m!

_100 3.6.4.2. Kraft paper Impregnated with vacuum treated

011, one of the best Insulating materials

29 4 11 .5 11 8 120 - 20 19 63 - This materials is widely used to manufacture HV trans-

formers, condensers, bushings and in many other HV
4 5 14 8 150 152 - 25 24 75 76 components.
5 6 178 180 18 1 - 40 33 113 116 Transformers, condensers, etc. are placed in containers
vacuum trated and, when humidity and included gases
6 7 209 210 210 - 50 40 132 137 are evacuated, filled with other vacuum trated oil.
7 9 24 5 248 25 0 - 60 45 164 170

8 10 270 27 3 27 5 - 80 60 2 15 222 3.6.4.3. Tran. versal and longitudinal discharge In oil of

impregnated kraft paper
9 11 300 305 308 - 100 70 258 266
Under vacuum and oil Impregnated kraft paper may
10 12 32 0 33 2 338 34 2 120 80 298 310 support an electric gradient of 100 kVlmm by transver-
12 13 348 357 362 368 140 90 3SO 365 sal stress (lines of force perpendicular to the paper
Sheets); whilst by longitudinal stress (lines of force pa-
14 14 397 41 9 435 470 ISO 95 370 385 rallel to the paper sheets) . discharge may occur at only
0.5-1 kV/ mm.
16 15 420 451 473 S02 160 100 380 392
Practically, the paper insulating ratio: transversailiongi-
18 16 452 52 8 551 597 180 11 0 428 440 tudinal is 100/1.
20 19 47 5 550 591 6 1.3 200 11 5 46 1 500 Therefore, by drawing, it is important to place paper as
perpendicular to the lines of force of the electric field
22 20 - 60 4 620 637 220 120 49 1 525 as possible.
24 22 - 64 0 66 2 700 240 130 520 550
3.6.4.4. Transversal and longitudinal discharge with plas-
25 24 - 670 700 720 250 140 540 575 tics, mlns, etc.
30 27 - 780 82 90 260 150 560 590 Table 9/3 gives dielectric strength in kVlmm for the
35 30 - 850 89 97 280 160 590 635 most important insulating materials used in HV tech-
nique.
40 33 - 93 100 110 300 170 6 10 650 Plastics, resins, etc. support the longitudinal stress bet-
45 38 - 98 108 120 320 180 630 670 ter than oil Impregnated kraft paper, but they alter with
time and under strong electric stresses, therefore, higher
50 40 115 128 340 190 6SO 685 safety margins are recommended .
55 42 - 125 140 350 - 6 75 770
60 45
3.6.4.5. Compressed gas; suHur hexanuortde (SF, )
- 135 152 360 - 7 10 800
65 50 - 101 5 168 400 - 760 890 Sulfur hexafluoride gas (SF, ) compressed (3-6 bar) is
sometimes used as H.V. insulating material; in practice,
70 55 - 152 176 450 - 800 950 field gradients of 10-15 kV/ mm are used.
80 60 - 165 190 500 - 830 1000 Pre vacuum treatment of H.V. components is required.

90 65 - 180 210 700 - 1200

100 70 ~ 240
For example, with constant potential fields it is suitable
to use materials having a moderate resistivity to avoid
the local storage of migrating electric charges; these
may dangerously stress the insulating material.
3.6.5. High Voltage, a sophisticated technology
900 1350
The preceding paragraphs show that HV is a sophisti-
cated technology.
It requires good scientific-theoretic knowledges. deep
researches and many years of practical experience.
This is particularly true with X-ray generators where
compactness, lightness and high output are required (par-
ticularly in monobloc type equipment).

GIlAROONI. RADl()t.OGY - ELEC'mOMEOICINE 141

 TABLE 9/3 (par. 3.6.1.3.) - Characteristics of the most important Insulating matarials.
I
l,e l lO l l h elO' Ru l" ,."y O'.'.cu,e Modulus 01 WOrking " 'gll_
10'
M.,."",I ,e" -
~ H,
11
~H,
'" I MfU
0""" om
. ".n g l h
~II / m
.'U !lc" y 200c
Kg /e m'
11I.,moe I,"",
'C

Cellulose Acetato 3.5 -:- 7 t50..,..300 500 10" + ,0' 2 20 + .. 30000 90

Cellulose Acetate Butyrate

(fAIAFOl eN)
3.8- 4 I 70- 110 240-260 10 '~ 125- 130 33000 120

dlled 2 -:- 2.5 25 -:- 40 200 + 000 10 ' ~ 7+8 - -

Pa;"ler
oil impregnat e 3 + 4 30 + 100 - 10'~ 55 + 100 - 90

Silicon Rubber (SILQPAEN) 2.5- 5 5- 500 10'3-10 " 20- 30 > 500 - 150

Minerai Wa~ 2.1 + 2.5 - 9 10'~ 20 + 30 - -

Polyvinll Chlo ri des (PVC) 3.4-6 120-1500 SO- I 000 10'l- 10" 30 - 50 10000- 3000 80

Acetal ReSinS (DELRIN) 3.7 - 4 10 '~ 20 15000 100

Vul canized Rubber 3.5 + 5 - 50 + 150 10 'S + 10 " IS + 30 - 70

Mica 4 - - lO'l 17 - -
Transform er Oil 2+ 25 + 10 1 + 10 10" + 10" 10 + 25 - 90
r-Para II" , 2.0 -:- 2.3 < 2 < 2 10" + 10 '1 10 + 30 - -
Polyamide (UL TRAMID) 3.5- 4 300- 1000 230- 270 I ()&- IO" 30 (secco) 13000-28000 80- 100

Polycarbonate (MAKROl ON ) 3 7 110 10 '"- 10" 26- 27 21000 120

Polyc hiorotrilluoroethylene l 00- ISO

(HOSTAFLO N, KEl F) 2.5- 33 150- 3SO lO ll 25- 300 5000 180

POlyethylenes (LUPOLEN) 2.3 2-' 2- ' 16 " - 'A 2000 - 11000 68- 80

Polyisobutyl ene (OPPANOL) 23 , 2 > IO '~ 20- SO < 500 60

Acrylics (PLEXIGLAS) 35- 4.5 500- 600 150- 300 10" - 35 30000 90

Polypropylenes
(HOSTALEN PP)
23-2 .5 - 5- 6 10 " 75 10000- 33000 80-90

Plysl yrene 2.5 t 5-25 1.5-2.5 10'7 - 55 30000- 33000 80- 90

Polytetralluoroethylene < 2
(TEFLON) 20 < 2 10'1 - 25 5000 250

Polyvinilcarborole (LUVIKAN) 3 6- 10 6- 10 10'" - 50 35000 170

Porcelain 6 - SO + 120 10 " 35 - -

Epo lty Re sins
3.2-3,9 35-50 100-200 1 0 '~ -10" 120- 145 35000- 40000 8- 120
(AR ALOtTE. LEKUTERM)

Phenolic Resins 5-15 100-300 SO-7OO 1()9-10' 10-40 6OOOO- BOOOO 120- 150

Pol),ester Resins (LEGUVAl) 3-7 30-300 60-400 1 0 1 3-10 ' ~ 25-45 30000-40000 120-140

Sl eatile 6 - 3 + 20 1011 + 10,l 30 + 45 - -

Polyel hyJene Terephthalale
(HOSTAPH AN, MYLAR) 3.2 20 190 > 10 '~ 160 40000 130

Im pregnating paints 3+4 65 .;.- 200 300 + 400 - 10 + 15 - -

Gldss 3."5 + 9 - 5 + 100 10'3 10 + 40 - -

142 GllAAOONI. RADIOlOGV ElECTROMEOICINE

Chapter 3.7. - MOST tMPORTANT TEST INSTRU-
MENTS AND ACCESSORIES USED
TO EVALUATE PROTECTION, EQUIP-
MENT EFFICIENCY, IMAGE QUALI-
TY, ETC. (from Nuclear Associated)
3.7.1. Safety equipment. Prole xlmetry
This matter has already been dealt with in Chapter 2.8.
page 91.
Fig. 46/3 shows a digital exposure meter for flu oroscopy
and radiography.
Fig. 46/3 (par, 3.7. I.) - Direct-reading PBriMI XrlY 8ltposure
Indica/or 10 determine the lola/ eltp08ure during examina-
lions, msssurfld as Roentgen area product; R . cm2,
A flat, transparent Ionization chamber is mounted on diaph-
ragm and connected to the electronic meIer with digital dose
display In R . cm2.
3.7.2. Xray lest patterns for measuring Focal spot size,
Resolution, Modulation Transfer Function (MTF),
etc.
The patterns consists of 0,1 mm lead-foil screens (ras-
ters) that are sandwiched between two plastic plates.
Fig. 47/3 shows two important test patterns; many oth
ers are available for different specific applications, such
as measuring resolution of Image Amplifiers, Video Sys
terns, etc.
3.7.3. Solid atate Xray output detector lor measuring
Xray generator parameters
Figs. 48/3 and 49/3 show the detector and some exam
pies of its applications.
It allows the following measures:
Timer calibration (Single-phase, 3-phase or CP units).
Loading characteristics.
Rectifiers' malfunctions.
Contactors' problems.
Cables or connectors discharges.
Shutter calibration, etc.
GllARDONI . RAOIOLOGY ELECTROMEDICINE
Fig. 47/3 (par. 3.7.2.) - Xray test petterns.
For making precision mesurements of system resolution. fo-
cal Size al'ld MTF.
For measuring Focal Spot Size and Resolution (Mod. 510,
509. 542. 543).
Focal spot size can be delermlned by observing the regions
of blurring which occur when the panem is radiographed by
an X-my source of finite dimensions. Radiation lrom differenl
sreas 01 the local spot will cause a periodic blurring o f the
pattern due to penumbra ellects. Knowledge Of the geomet-
ric factors, and the distance from the center of the pattern to
the region where blurring occurs. will permll the calcutation
of the focal spot size with the same accuracy as measure-
ments made with a pinhole camera (see par. 2.1.8. page 38).
Model 07-510 is used to measure both uniform and nonuni-
form focal spots, and Ihe 07-2509 is used for uniform spots.
The laller can also measure non-uniform local spots by
means 01 an additional procedure: rOlallng Ille pallern 45",
preparing another radiogmph, and making an overlay of both
radiographs.
The minimum focal spot size measurable with Models 07-
1509 and 07510 Is 0.01 cm. For smaller foeal spots, use
10 star pattern (07-542) or 1.50 star pattern (07-543).
For measuring MOdulation Transfer Function (Mod. 553).
Pattern 07 -553 was developed especially for determining the
modulation tmnsler IUl'lCtlon. It ulilizes groups of 4 line pairs
with a very slight gradient between adjacent groups. For ex-
ample, the group with the highest resolution (10 LP/mm) is
followed by three groups with resolution of 8.5. 7 and 6
LP/ mm. The resolution of the individual groups of this type
can be taken from tile table.
Fig. 4813 (par. 3.7.3.) - Defector for measuring Xray genera
for paramefers (size t . 1/4" x , . 1/4" x 112") (see fig. 49/3).
It Is used with a slorage or camera oscilloscope to display
tile intensity-lime relationship 01 an X-ray beam. The detector
is simply placed In the X-ray beam, and the output cable is
connected to the oscilloscope input. The resulting wave-
shape patterns are used to calibrate andlor diagnose mal
functions in the X ray generator.
143

Fig. 49/3} (par. 3.7.3.) - Scope tracing examples of typical
X-ray diagnostics generator (see fig. 4813).
The detector supplies a crisp 200 mV signal at standard dia-
gnostic conditions (60 kVp, 100 mAl. Th is extremely high
outpu t permits the simple interpretation of oscilloscope dis-
plays. Since the detector rise tim e is better than 1 microse-
cond, no alteration of the true X-ray output pulse shape is
lOtJOduced.
The detector needs no power source.
17.4. Timing and mAs test kit for single-phase, three-
phase and CP equipment
F'9. 50/3 shows the kit.
Fig. SOl 3 (par. 3.7.4.) - Timing and mAs test kit.
For single-phase, 3-phase and CP equipment: it is cha racteri -
zed by the following features:
- Measures timer accuracy.
- Copper step wedge checks mAs uniformity.
This synch ronous rotating -Slit timer provides a simple means
of chec king X-ray timer accuracy and mAs uniformity. A
precision l -rps motor assures accurate timer phasing. Single-
phase measurements are performed by counting the -dot_
pattern generated. Three-phase timing is achieved by measur-
ing the included angle of the arc projected on the film by
th a rotatin g slit.
The unit is positioned on an 8" x 10" cassette. By masking
the blank cassette area, four e)(p08ures may be taken on one
film . E)(po sures are made at four technique values (1/5-sec
at 50 rnA, 1I10-sec at 100 rnA, 112Q--sec at 200 rn A and 1130-
sec at 300 rnA), and the film Is developed. The copper step
wedge ind icates the mAs uniformity while the 4 time values
are measured on the film . The timer accurately measures
sing le-phase machines to 1/120 of a second and 3-phase
machines to 1/150-sec.
3.7.5. Mammographic phantom simulating contrast con-
ditions normally found in mammography
Fig. 51 /3 reports the mammographic phantom.
144
oo
o
,
o
/
Fig. 5113 (par. 3.7.5.) - Mammographic Phantom.
Contains artifacts which simulate breast pathology.
- Embeddad screens permit measurement of sys tem resolu -
tion.
- Elimina tes necessity of repeated patient exposure.
The Mammog raphic Phantom allows the radio logist to de-
termine his radiography system's ability to resolve and define
small gradient changes in tissue density and artifact defini-
tion. It permits the determination of . proper kV, mAs and
film-scraan/no-screen co mbinations for high-resolution mam-
mography.
The best con trast levels and resolution limits are easily estab-
lished. The Phantom may be immersed in oil to reproduce
the scatter conditions found in mammography procedures.
Three l-cm-thlck plexiglass plates are supplied to simulate
various tissue thicknesses.
By establishing proper operating technique, the need for re-
peated exposures on the same patien t is eliminated. thereby
substan tially reducing the absorbed dose to the patient.
The arti facts embedded in the 5,1/2" diameter x 9/16" thick
plastic phantom Include:
SI)( stainless steel meshes (speci fic gravity 7.7)
Vinyl capillary tube impregnated with contrast medium.
Steel wool (speci fic gravity 7.8).
Nylon beads: diameter 1.5, 2, 3, 4. 6 and 6 mm (specific
gravity 1. t5) .
Aluminium step wedge. 0.2 mm (specific gravity 2.7/step).
Air step wedge, 1 mm/step.
Vinyl ch loride step wedge, 0.2 mm (specific gravity
1.3/step).
Ground and powdered chalk (calcium sulfate, specific
gra~ity 1.3).
3.7.6. TomographIc phantom
Fig. 5213 page 145 shows this phantom.
3.7.7. X-ray anatomIcal phantoms
Fig . 53/3 page 145 shows some principal anatomical
phantoms.
3.7.8. Gray-Mayo Clinic Patient Equivalent Phantom (PEP)
In an interesting Handbook: Quality Control in Dia-
gnostic Imaging by Joel E. Gray , Norlin T . Wink ler,
John Stear and Eugene D. Frank of Mayo Clinic, Ro-
chester, Ed. University Park Press, Baltimore. 1983 is
presented a very practical and useful Patient Eq uivalent
Phantom (PEP)>>.
By kind permission of the AA. whom we thank, we re-
produce the pages and figures describing the PEP, be-
ing sure that it will widely interest Radiologists, Engi-
neers and Technicians.
GILAR()(.)NI, f1AOIOLOGY - ELECTf10MEO ICINE

Fig. 5213 (par. 3.7.6.) Tomographic (!hantom.
Aperture plata al/ows eve/uatlon of fulcrum and bearing
conditions.
Lead numerals over a 12-mm depth check accuracy of
cuI.
Coppsr mesh measures In de(JIh resolution.
This test plate permits the determination of exposure unifor
mity, cut-Iellel accuracy and fulcrum stability (pillot-bearing
tolerances). It consists 01 a plastic phantom, a steel aperture
plate. and a set 01 metal space!'! 10 and 15 cm long respec-
tively. The spacer set provides precise and reproducible
placement of the phantom when ellaluatlng d ifferent X-ray
systems.
The phantom portion contains a helix 01 12 lead numbers
mounted from 1 to 12 mm above the base. and lour copper
mesh strips (1 .2 x 5 em each with 0.6, 1.2, 1.6 and 2.0 ho-
IesImm), all embedded in a 15 x 15 x 2.2 em plastic plale.
The aperture plale (15 x 15 x I mm) has a 3.Q-mm diameter
cen tral hole. May be used with a patient phantom (07-706)
or equivalent attenuating medium.
.
SK II I,I .
'
H~NII
PRI .YI~
\ 111''''''' IIII!':,,'"'
Fig. 5313 ((J8r. 3.7.7.) - Some phantoms usad in X-ray
diagnostics.
~OONI . RADIOLOGY . ELEC"TAOMEOICINE
",The Patient Equivalent Phantom (PEP) is based on a
design for a phantom by the American National Stand-
ards Institute (ANSI) for the testing of photosensitive
radiographic materials and photographic processing (Ame-
rican National Standards Institute, 1980). Its construction
is based on transmission measurements at various kVp
values, and has been modified so that the absolute
transmission as welf as the spectral transmission best
simulated that from an actual patient, using readly and
inexpens ive materials.
The PEP, its specific dimensions, and materials are
shown schematically in fig. 54/3. It consists of six slabs
of plastic (polymethyl methacrylate, also known as Plex-
iglas or Lucite) each 1 inch (2.5 cm) thick by 12 inches
(30.0 cm) square. The six slabs are arranged in pairs so
that the PEP actually is three phantoms in one:
1. SkUll, abdomen, and pelvis phantom-consists of the
chest phantom with an additional 2 inches (5.0 cm)
of plastic added in the air space of the chest phan-
tom (figs. 55/3 and 56/3).
2 Chest phantom-consists of a 7mm thick sheet of
aluminium sandwiched between two slabs of plastic
together with a second sandwich similar to the first
but with a 2-mm sheet of aluminium (fig. 57/3).
[Note: Type 11DO aluminium should be used]. When
this is arranged with a 2-inch (5.0 cm) air gap be-
tween the two sandwiches, as shown in fig. 57/3, a
typical chest is simulated for testing purposes.
3 Extremity phantom-consists of a 2-mm sheet of alu-
minium sandwiched between two slabs of plastic
lUg. 58/3).
As mentioned before, the PEP was chosen since It pro-
vided spectra l and absolute transmissions that closely
simulate patients. We have found, for example, that the
pelviS phantom simulates 8 21 -cm patient abdomen. In
addition, its simple construction and relatively low cost
maKe it available to most institutions. We should note
that it is necessary to obtain a phantom of these di-
mensions, especially the 12 x 12 Inch (30.0 x 30.0 em)
dimensions, to properly simulate the patient and the
scatter generated by the patient.
In addition to the PEP, we have developed a similar
phantom containing several test objects that allows us
to provide quantitative measurements of an imaging sys-
tem as welf as provide the clinical radiologist with ob-
jects to which he can relate (fig. 59/3). As can be seen
in fig . 59/3, It conta ins bone, catheters, simulated low-
contrast -stones.. in contrast media, steel wool, resolu-
tion targets, and a step wedge in a circular configura-
tion. These are placed at various levels, as shown in
fig. 60/3. Of particular importance is the construction.
type and placement of the resolution targets. These con-
tain frequency patterns to 5 cycles/mm since the large
majority of imaging systems are limited to this level in
the clinical situation, especially with the scatter produced
by the phantom. Two of these, 0.70 mm and 0.01 mm
thiCK, are placed on the bottom side of the phantom
and allow determination of the high and low contrast
resolution of the image recording system.
The third, 0.10 mm thick, is placed on the top of the
phantom and allows determination of the amount of un-
sharpness introduced by the focal spot and screen-film
system in combination ...
We made a PEP ourselves for our Research Laborato-
ries; it is very practical and useful.
145
 ._-
,--
I'_"OO!
"-"'"
:': : I~
Fig. 54/3 (par. 3.7.8.} - Patient Phimfom PEP.
Schematic drawing of the homogeneous pallent equivalent
phantom (PEP). The phantom and base, made of acrylic and
aluminium, are used extensively in a quality control program.
Fig. 5513 (par. 3.7.8.) - Pallent Phantom PEP.
Basic PEP, which Is used to simulate the abdomen, skull,
and pelvis.
Fig. 5613 (pal. 3.7.8.) - Patient Phantom PEP.
Base lor the PEP, wh ich Is used when dosimeter reedings
are to be made under the phantom.
Fig, 57/3 (par, 3.7.8.) - Patient Phantom PEP,
PEP for chests and extremities. The basic PEP can be modi-
lied 10 provide a phantom thaI Simulates Ihe chest and ex -
tremities. The chest phantom Is similar to the basic phantom.
but two slabs of acrylic [2 inches (5 cm)] are removed Irom
Ihe center. A 2-inch (5-cm) air gap is lett between Ihe re-
maining layers.
146
Fig. 5813 (par. 3.7.B.) Patient Phantom PEP.
The e.tremity consists of a 2-mm sheet of ty pe 1100 alumi
nium sandwiched between two '-Inch (2.5-<:m) sheels 01
acrylic.
Fig. 59/3 (par. 3.7.8.} Palient Phantom PEP.
Patient equivalent phantom containing special test objects. A
radiograph of the phantom containing test objects shows
that both quantitative and qualitative judgments can be maoe
about Image quality.
/----..." ~."" ...
1/ ...... 11 ....)
Fig. 6013 (par. 3.7.8.) - Pallent Phantom PEP.
The placement 01 the objects Is important. Objects are
placed in specific layers as follows:
Layer I: A O.lQ-mm lead resolution target (Ilem A) provides
information concerning the focal spot characteristic since this
Is closest to the X-ray source. This layer also contains
markers indicating the anode and cathode ends 01 the im-
age.
Layer 3: This layer contains: dilute contrast media in small
plastic vials with several plastic beads in the contrast media
(Item 8 ) to Simulate a gallbladder with Slones; a culout with
short pieces of catheter material (Item C); a cutout contain-
ing sleel wool (llem 0); a deeper cutout containing a portion
of a vertebral body (Item E) a culou t con taining various
sizes Of plastic beads (/tern F): and a slep wedge (Ilem G)
made by inserting aluminum rods 01 various lenghls 10 ob-
lain 111m densilies lighter than the surrounding malerial and
by drilling holes into the acrylic to obtain film densities
darker than the surrounding material.
Layer 6: On the undersioo 01 layer 6 there are two lead reso-
lution targets (llems H and I); one is 0.01 mm thick, provid-
ing a low-contrast image to assist in determining the effects
of quantum mottle. and Ihe other is 0.01 mm thick, providing
a measure of the resolution of the screen-lilm system,
GILAROONI. RAOIOLOGY ELECTROMEO ICINE
3.7.9. Chronogll, radiological wrist watch
Fig. 6113 shows the Chronogil (1950).
Fig. 61/3 (par. 3.7.8.) - Chronogl', professional, radiological
wrist-warch In actual $Ize.
The watch is; dater, automatic rewinding, waterprool. shock-
resistant and antimagnetic.
It allows:
\) Time measUf8S: seconds, minuteS, hoors, days.
2) Multiplication, division and other calculations like a clas-
sic rule with rotating logarithmic scale.
3) Fluoroscopic adaptometry by lIuorescent dial viewing.
4) Chronological programming by rotating dial.
5) Radiographic exposure (kV and mAs) In lunction of ana-
tomical parts thickness (em).
6) Radiographic exposure In lunctlon of F.F.D.
1) Devefopmeol lime in function 01 temperature.
8) Percen t radlalion transmission in tissues In deep therapy.
Chapter 3.S. - THE 10 FUNDAMENTAL PILLARS
OF X-DIAGNOSTICS
3.8.1. Generalities
Hereunder are synthetically described the 10 pillars of
X-Diagnostis, their references and applications.
3.8.2. High Voltage (HV)
HV and Coolidge tube are the basis of Xray produc
""n.
Ref.: par. 1.1 .1. page 29, par. 3.1.1. page 11 5, table 113
page 11 6.
3.8.3. CooUdge tube
t represents the heart of Radiology.
Coolidge tube has substantially remained the same from
tS invention (1913) . Its most important improvement is
represented by the introduction of the anode rotation.
Ref.: par. 1.1.1. page 29, par. 2.1. 1. page 36, chapter
3.3. page 120.
3.8.4. Radiographic Intensifying screens
They allow to reduce exposure times, patient dose and
rube load of 50-100 times and more in com parison with
radiographs made without screens.
3lAAOON I. RADIOlOGY El..ECTIlOMEDICINE
Radiology would not have developed as it has, without
them. It would have been limited to the extremity be-
cause the high overdose.
Ref.: par. 2.3.3. page 43 and following ones.
3.8.5. Fluorescent screens tor Fluoroscopy
They are the basis of dynamic investigations.
The fluorescent screens progress can be divided into
three steps: first: Barium platinum cyanide screens, se-
cond: zinc-cadmium sulphide screens and third: Image
Intensifier, still using zinc-cadmium sulphide and caesi-
um iodide as fluorescent material.
1.1. allowed the development of digital Radiology.
Ref.: 2.3.3. page 43.
3.8.6. Contrast media
Without contrast media, Radiology would have been li-
mited to skeleton. a very small part compared to the
possibilities offered to Radiology by contrast media.
Ref.: par. 2.4.1. page 45.
3.8.7. Antlscattered grids
Without grids, radiologic examinations would have been
limited to thin parts.
The latest progress In grids is represented by the 200
lines/inch invisible type for stationary use, which also
replaces the moving grids in Bucky.
Ref.: par. 2.5. 11 .1 . page 53 and following ones.
3.8.8. Image Intensifiers
It is the basis of modern Fluoroscopy, spot film, cine
and digital Radiology, etc.
Ref.: par. 2.7.3. page 77 and following ones.
3.S.9. Digital Fluoroscopy and recorded Radiography
They allow enhanced images technique, video subtrac-
tion angiography, image processing, film and dose sav-
ing, image storage and recall.
They offer good morphologiC, dynamic and analytical
information .
Ref.: chapter 4.8. page 166.
3.8.10. Examination auxiliaries
OrthoscOpes, tilting tables, Bucky tables, tomographs, etc.
are the basic part of a radiological installation.
Though they are called -auxiliaries, they are fundamen
tal for good investigation.
Computerized auxiliaries represent as well as a great
progress.
Ref.: par. 4.1. page 149 and chapter 4.9. page 167.
3.8.11 . "The RadlologisllO, the last mentioned but, " de
facto, the first
The Radiologist, obviously, is the fundamental pillar of
med ical Rad iology and great part of the radiological
progress is his merit.
147
 PART 4

DIAGNOSTICS . EQUIPMENT . TECHNIQUES APPLICATIONS

 PART 4 Chapler 4.2. - LOW AND MEDIUM POWER DIA-
X-DIAGNOSTICS - EQUIPMENT - GNOSTICS EQUIPMENT
TECHNIQUES - APPLICATIONS

4.2.1. X~GII : easy portable monobloc for emergency and

Chapter 4.1. - HIGH VOLTAGE (HV) GENERATORS
FOR X-DIAGNOSTICS
4.1.1. Some Gilerdonl HV generators and accessories
for dental and veterinary radiology
Figs. 1/ 4, 2/4, 3/4, 4/ 4 page 150, and 5/ 4, 6/ 4 , 7/4, 8/ 4
page 151 , show one of these units; it is very light and
can be used for various applications.

Table 1/4 summarizes characteristics, performance and

applications of different generators.
As specified in the ..Presentation" Gilardoni equipment
are often taken as an example.
Table 1a/4 summarizes the series of new Condensor-Gil
that in future may replace threephase 6-12 pulses gen-
erators. Table 3/4 page 154 lists some examination ac-
cessories.
4.2.2. Medium power monobloc tor Practical Medicine.
FigS. 9/4, 10/4, 11/4, 12/4, 13/4 page 151 , show MO
monobloc (see tab. 1/4 n. 7) and its uti lization.
MD monobloc can be replaced by the more powerful
MD-4R (see tab. 1/ 4 n. 6).

TABLE 1/4 (par. 4.1.) - Some Gllardonl high voltage generators for X-diagnoslics.
(See also table 3/ 4 page 154 and table 2/12 page 314) . (For electric and radiological power see par. 3.2.4.

-, -.
page 117)

N. GeneratOl" RectIfier
"~ Voltage ""
Cu,rent
TImer Weight
Appl;caliOl"lI
Range
.w mA
"
, , 3 , 7

, Dodecuilll( Threephase 200 2400 3 m, High power generator for: Chest,
'u"'" ""
"Xl ,000 '0
300

...
12 pulses 'SO Heart, Gastro-Intestine, Angio-
2 types
( fig . 813 po,. 119)
8 ...,. graphy, etc. Very shon time ex-
posures (ms)

2 5&181rll( Threephase 80 'SO '000 10 ms 280 As above

3 'u'"
types
6 pulses '0
8 ...,.
3 Pulse-Gil Threephase SOO 200 SOOO 0,1 ms 375 Cine x and pulsed digital radio-
wi th tetrode switching
(". fig . 3813 po,.
,33)
12 pulses
condenser
'0
8 ...,.
graphy

, 'ube
51111l Monophase
2 pulses
20 1SO 400 10 ms
'0
go Medium power generator
ganeml examinations
'0'
8 o>c.

, 'ube Conde",." 3 m, 17. Mobile medium power unit lor

CondenSOf-GfI
'" 'SO 350

...
mobile unit
( ' ~. "'. po,. '52)
diSCharge with low
powe,""
mains
'0
0,3 sec.

m,
g8fleral examinations and sped-
ally tor short time Chest Tele-
radiography

6 MD-4R
monobloc
Monop....
2 pulses
"" 7" SO
'0 " Mobile medium power units for
Surgery. Orthopedics. Emergen-
po,.
(see ligs. from 9/ 4 to 13/4 double locus 2 ...,. cy with Image Intens.-TV

.
151)
7 MD Monophase
'.' SO m, 15,5 Mobile units; applications
monobloc 1 pulse "" 25
'0...,. MD-4R (N. 6) "
po,.
(see figs. from 914 to 13/4
151)

8 X-GIL
monobloc
Monophase
, pulse
.' 7. 10 0,1 soc .
'0 V.,., light transportable units
tor emergency
po,..
(see figs. from 1/4 10 1<
150 and 151)
6 ...,.

COMMENT:
Columns 3, 4, 5:
Max electric power, max kV and max mA allow to trace the ..Generator Charge line-- see fig . 8/3 page 119.
1st example: Dodecasili)( (N 1) with 160 kW power allows an output of about: 1200 mA with 125 kVc, 1600 mA with
100 kVc, 2000 mA with 75 kVc, 2400 mA with 50 kVc: these values determ ine the straight ..Charge tine~ .
2nd example: MD-4R (N 6) with 4 kW power allows an output of about: 60 mA with 80 kVp and 100 mA with 50 kVp
(see fig . 713, page 118).

GII..AROONI. ~y - B.ECffiOMEDlClNE '49

 TABLE 1a/4 (par. 4.5.8.) - List of . Condensor-Gil.. 1SO kV; capacity: 1,2 and SpF with powerful rotating anode
tube; mains power only 2-4 kW.

N, Type and pertormarn::e Utilization

1 Condensor-Gil, 150 kV - lpF_ (par. 3.2.9. page 119, l ig. 16/4 Ali radiographies till lateral sacral spine at 1 m in 0,5 sec.
page 152) movable lor general and emergency use. 2 locus Chest at 1,5 m in lew msec.
low mains power (2 kW). Optional: battery motorization

2 Condensor-Gil, 150 kV - 3iJF-: lIuoroscopy and radiography Fluoroscopy and all radiographies till lateral sacral spine at
with table stand, Bucky Threegrids; lIuoroscopy with optical 1 m in 0,2 sec. Chest at I,SO m In lew msec. For general utili-
undertable devfCe; teleradiography zation also in poor countries because low power Is required
(2 kW).

3 Condensor-Gil, 150 kV - ~F.: fluoroscopy and radiography Fluoroscopy and all radiographies till lateral sacral spine at
(as N 2 with twice radiographic capacity) 2 m in 0,1 sec. Chest at 2 m in lew msec. Hard ray technique
and Total Body Radiography lor Check-up; Soft ray technique
(8efillium window tube, 2O-SO kV)

4 ..Condensor-Gil, ISO kV - 3 or 5,JF -: lIuoroscopy and radio- Specialized lor digestive system
graphy with tilting table

5 .Condensor-Gil, 150 kV - 3 or 5pF- with Totagil, Bucky Three-
grids, or mobile beds only.
6 Universal Condenser-Gil, 150 kV - SpF_ (<<Farad-Gilo) (par. 3.2,9.
page 119) with digitized, computerized ..Roentgen-Gil,. (lig. 2314
page 155). Mullilocus tube (par. 3.4.4. page 135). Optional: with
untlll 4 tubes
Specialized lor conventional exams with mobile radiographic
bOO,
The best equipment today. All the most sophisticated techn i-
ques: lIuoroscopy. rad iography, Serial, Cine X, digital angiology,
GTBR Hard and Soft ray technique etc.

CONSIDERATION:
A modern diagnostic department should be made up of the lollowlng equipment:
N 1 Universal _Condensor_Gil ISO kV - SpF. (- Farad-Gil,,) (N 6)
N 1 (or more) _Condensor_GiI 1SO kV - 3 or SpF" (fluoroscopy-radiography) (N 4)
N 1 (or more) _Condensor_GiI ISO kV - 3 o r SpF" (radiography) (N 5)
N 2 (or more) -Condensor-Gil 150 kV - lJ1F" (movable-radiography) (N 1).

Fig, 314 (par. 4.2, 1.) - XGI/.

The equipment during an
emergency leg lIuoroscopy.
The lead diaphragm on the
tube window reduces the
X-ray field to a uselul si:l:e

....
also lor pro'ective purpo-

Fig. 1/4 (par. 4.2. ,.) - X-Gil.

Ultralight. emergency monobloc: 5 kg ., 70 kVp, 10 rnA. It can
be led also by low powered domestic mains.

Fig. 2/4 (pClr. 4.2.1.) - X- Gil.

Fig. 4/4 (par, 4.2.1.) . XGiI Clnd accessories in the trensport
The equipment during an emergency chest fluoroscopy.
VerticCiI and horizontal exploration is sell-centered through case.
the coupling arm. The criptoscope is X-ray protected and its size is 24 X 30 em.

150

Fig. 5/4 (par. 4.2. 1.) . XGil in
transport trim.
The case with X-Gil and accesso-
ries weighs 15 kg., the criptoscope
4 kg.
Fig. 9/4 (par. 4.2.2.) - MD mono-
bloc, w ith tens ions adjustable
from 50 to 110 kVp. currenls till
25 rnA, power 1,5 kW.
Size 28 )( 19 )( 12 cm, weight
IS,S kg.
MD-4R is the version with 4 solid
stale rect ifiers (2 pulses).
Power 4 kW. 110 kVp, 70 rnA, size 28 )( 23 )( 12 cm weight
21 kg. Double focus.

Fig. 6/4 (par. 4.2. t.) Unigi/ MG.
The X-Gil monobloc generator and
the criptoscope are self centered.
lis spring balancing system allows
fluoroscopy aod radiography. Mo-
nobloc and criptoscope are easily
demoun table lor emergency use
(see preceding ligures).
~ .~
Fig. 10/4 (par. 4.2.2.) -
Un/gil MD (or MO-4R)
positioned lor horizontal
fluoroscopy aod radio-
graphy.

Fig. 11/4 (par. 4.2.2.) -

Unigll MO (or MD-4R)
Fig. 7/4 (par. 4.2. 1.) positioned for vertical
Un/gil lor veterinary lIuoroscopy and radio-
"".
A radiographic tun-
graphy. Both stand and
table are easily mova-
nel is placed under ble.
the crlplO8CQpe. Unl
gil stand l!i easily m0-
vable to allow the
exploration 01 all
parts. X-Gil, crlpto-
scope and table are
easily demountable

1
and transportable f~
va rious utilizations.

Fig. 12/4 (par. 4.2.2.) -

Un/gil MD (or MD-4R)
positioned for radiogra-
phy on the table.

Fig. 8/4 (par. 4.2.1.) Odon-

togH utilizes an X-Gil equip-
ment.
It has two techniques: soft
rays (45 kV) lor high con-
trast endoral radiographs
and hard fays (70 kV) IOf
extra -oral. cranial radio-
graphs, etc.

Fig .. 13/4 (par. 4.2.2.) - Ortogil

MD (or MD-4R) Teleradio-
graphs up to 150 cm.

GrtARDQNI, RAOIOI.OGY - ElECTROMEDlCINE 151

 TABLE 214 (par. 4.2.1.) - X-Gil exposure times for Fig. 17/4 (par. 4.3.) - Am-
normotype patient: 70 Kg., F.F.D. 100 cm., rare earth plisurgil 4R.
screens. For lIuoroscopy II-TV and
radiography . It Is equipped
with monobloc MD-4R (2
Thickness
Part (1',1'.0. 70 em) Grid Soo pulses. see tab. 314 n. 9
om. page 154), bllocal tube.
II . g"15~.
Hand 2-3 NO 0,1
All movements are molo-
Foot-Elbow-Humerus 5--7 NO 0,2 rized.

Shoulder-Knee-Femur 8-10 VES 0,5

Pelvis-A.P. Spine 20-22 VES 3
Lateral Spine 3<>-35 VES e Fig. 1814 (par. 4.3.) - Or-
A.P . Skull 20-22 VES 2,5 Ihopec1ix S lor lluoroscopy
/I- TV and radiography.
La teral Skull 15-17 VES 1,5
MO monobloc reduces the
20-22 NO 0,2 encumbrance. II Is easily
Lo""
used for orthOpedic bed. II
fiber optic, memory record-
Chapler 4.3. - SURGERY, ORTHOPEDY, CARDIO- Ing, etc.
LOGY, EMERGENCY, ETC.

Figs. 14/4, 1514, 16/4, 1714, 18/4, show the relevant

equipment. Chapter 4,4. - POWERFUL DIAGNOSTICS

Table 1/4 page 149 at point 1. 2, 3 and 4 gives exam-

ples of powerful diagnostics generators.

4.4.1. VoHa-GIl = Farad-Gil + Coolidge-Gil + Roentgen-

Gil today the best equipment for X-Diagnostics
(lig. 23/4 """" 155)

The "Farad-Gil .. , universal condenser generator, 150 kV,

~F is described in table 1a/4. point 6 page 150.
Fig. '4/4 (par. 4.3.) - Chlrurgi/
MD with MO monobloc (see The Farad-Git , the Multifocus-Git tube and the Roent-
llg. 9/4). gen-Gil equ ipment are described in par. 3.2.9. page 119,
3.4.4. page 135 and in chapter 4.9. page 167 figs. from
48/4 to 52/4 page 168.
Together these units represent . the best,. reached in X-
Diagnostics field to date.

4.4,2, Posslbkt future orientation of H,V. generators for

X-dlagnostlcs: powerful condenser generators and
mlddkt frequency generators.

We foresee that in the future the H.V. generators may

be:
Fig. 15/4 (par. 4.3.) - Chi- 1. High capacity condenser generators, as described In
rurgll 4R with MD-4A mOo the previous paragraphs.
nobloc (see fig. 9/4), 2. Middle frequency generators, working at 1000-2000 Hz.
composed as follows:
Powerful 3 phase supply - solid state rectifier - le-
velling condenser - frequency multiplier to 1(XX)-
2000 Hz - High voltage transformer - solid state
rectifier - levelling condenser - X-ray tube.
The middle frequency approach is a sophisticated me-
thod involving many complex sequential operations and
delicate electronic components.
Therefore, in the future, when the electronic components
will become more reliable and less expensive, the mid-
Fig. 16/4 (par. 4.3.) Con- dle frequency approach could become economically
densor-Gil 150 (see tab.
1/4 page 149 point n. 5). feasible.
It can optionall y be moto- In addition, a middle frequency generator always requires
rized . a powerful primary power supply if compared with a
H.V. condenser generator.

152 Gl lAAOON~ RADIOLOGV - ELECTROMEOICINE

Concluding , the high capacity condenser generator is 4.5.2. Bucky table
the ideal solution but it is more expensive; the medium
frequency system could be further developed and im- It is an examination accessory with patient in horizontal
proved in the future and then also become economical. position (fig. 20/4) .

Chapter 4.5. - EXAMINATION AUXILIARIES (ORlliO-

SCOPES, BUCKY TABLES, TILTING
TABLES, CEILING TUBE STANDS,
TOMOGRAPHS, ETC.)
Fig. 20/4 (par. 4.5.2.} -
Though called auxiliaries, they are essential elements of Buchy table.
radiodiagnostics equipment.
The Car1es1us Incorpora-
Their purpose is to support and poSition patient, tube tes a Bucky diaphragm
and viewing device during the radiographic examination. and allows the magnill-
cation technique.
Some Gilardoni equipment (radiological tables, tube Homothetlc tomographic
stands and accessories) are listed in table 3/4. device ..

4,5.1. Orthoscope
4.5.3. Tilting table
II is an examination accessory with patient in standing
It is an accessory for general diagnostics and is manu-
position (fig . 19/4)
factured in two versions: with overcouch tube (fig. 2114)
and with undercouch tube (fig. 22/4).
The former is always remota.controlled and nowadays it
represents the most used equipment for normal diagno-
stics.

4.5.4. All computerized, digitized, universal equipment:

Roentgen-Gil..
it is a universal radiological apparatus for routine and
Fig. 19/4 (par. 4.5. I.} - Or- specialistic examinations with 90/90 remota.controlled til-
thoscope. ling table, completely operated by computer.
Or1ogil Super: it Is illustra- The same computer co-ordinates the radiographic expo-
ted the model equippea Sures and ali the processings of digital images (fig. 23/4
with seriograph lor the ex- page 155).
amination 01 the digestive
apparatus. Mare details abou t these new techniques will be given
in chapter 4.9. page 167.

Fig. 22/4 (par. 4.5.3.) - Tilting lable with

undflrcouch tube.
Archimedes.: 00125 tilting table with eIec--
tromechanlcal serial-changer. Optionals:
laleral stand and II-TV chain.

4.5.5. Ceiling tube stand

Fig. 21/4 (par. 4.5.3.) Tilting table with oV6rcouch tube.
Cosmographlx: 90190 lilting table com pletely remote controlled wilh II-TV. It is equipped It replaces the column running on
with automatic serial-changer completely electronized, with a large subdivisions range. floor rails and gives complete free-
I! is a homOlhetic tomographic device. dom of access to the patient on all
sides (fig. 24/4 page 155).

GllAROONl. RADIOLOGY" - ELECTAOMEOICINE 153

 TABLE 3/ 4 (chapter 4.5.) Some GlIsrdoni equipment: radiological tables, tube stands and accessories (S88
also table 1/4 page 149. For guide line choice of equipment see table 2/12 page 314).

Eq",ipmen\
Radiological laDIes
I",be slands and '-
Inlensi!.
A",lOmatic
v_ Applications
"""""'~
N
R_ AOT
ExpoatJ,e

, , """"'"'" (II-TV)

, ,
1 Roentgen-Gil Dodecasilix
J

9O>19Q>. ceiling tube: mov.

Double Function

Fully T ill 31sec

All routine and speclall-
Universal Tele- 160 or 100 kW long. tranav, rotal. Film Field of density digitized ~x35cm Slic examinations with
con trolled Olg- Ihfeephase changer, tomograph. First Incofporat- very high quality require-
itized Cornp.Jte-
rized (UTDC)
12 pulses
3 m.
completely computerized
and digi tized equipment
ed in table ments. O~, fil ms
wo(\( saving. One 01 the .""
,
(page 155)
(Iig. 23/4)
(1962)
"" equipment today

Cosmograph/x as abOve or 90>/90> - 90"/45" - 90/30> as above as above as above as above All rout ine and anglogra-
Traditional TeIEt-
controlled (TT)
Seletfix SO kW
6 pulses
HOOf ,"be stand:
long, Ifansv. Film chan-
""", phlc examinations with
very high quality requ ire-
(pag. 153) ge', thomograph. ments.
(fig. 21/4)

3 Archimedes Seletri)( SO kW 90"/25" over table II-TV

111m changer: '0"
optional optional optional - For gastro-intesllnal wo(\(.
Economical version.
(pag. 153) 6 ptilses so"
(Iig. 22/4) tube 00 latera l stand
(optional)

4 Cartes/us Dodecaslll)( mov.: long\!. transv. Fitm - opUonal - - Fo, hOrizontal examina-
Bucky table or $eletrl)( changer. tomograph. rna lions and with chestspi-
(peg. 153) (see abOve) gnllicatlon technique os stand
(Iig. 2014)

5 Calling lube Dodecasilix

or Selelri)(
Telescopic stand. Optional
tomography with Arch!-
- - - - PoIitionable In any room
point lor using with d if-
(peg. 155)
(fig. 24/4) mod.. (N. 3) lerent accessories.

6 Arco-Gil Dodocasllix Telescopic stand with C- Double option al optional optional Fo' neu ro-card lologlcal
CfliHng lube or Seletrl)( shaped arm. field work .

7 Totagll Oodecasilix
or Seletri)(
Rotating tube-Bucky arm.
With Ihreegrid Invisible
- oplional - - Routine and emergency
WOfk; total spine Tefera-
(with Bucky)
(pag. 62) Of' Silix 20 kW lines ( ratio 6, 12, 20) dlograpny with cross grid
(fig. 38/2) Bucky. ratio 20,

6 StICky Stand
(pag. 155)
as above Tilting Bucky with three-
grid (Ratio 6, 12, 20)-
- oplional - - Routine lor Chest, Spine.
Skull etc. teteradlogra-
(fig. 25/4) system. phy

Amplisurgil
4R
(peg. 152)
MD-4R 4 kW
bi focal tu be
Mobil unit with C-slla-
pod "m so" II-TV
Double
field
optional optional - Surgery, traumatology e-
m......", etc.

(fig . 17/4)

As above but IIght6f" with ,- - above : movements

"
OrthoptJdlx
(pag. 152)
(fig . 1814)
MD, 1,5 kW
tiber optic II,
optional optional
"
sod
lod
positioning lacUlla-

11 Cond&fIISor-Gi/
(psg. 152)
condenser
d ischarge
Powerfutt mobile unit
tlonally motorized
OJ)- - optional - - Routine worll.: Chesl
short time radi ographs
(fig. 16/4) 40 kW

12 Gridgil Universal stationary, invisible grids, 1SO Iinesllnch. (61mm) and soft ray grids 200 Ii- Routine l or universal Ra-
(pag. 56) nesllnch (8Imm) lor Mammography. diography; 1hey ..",.,,,
(table 512) moving grids '0 Bucky
13 D/gital Image Every equipment with II-TV may be digitized l or sophisticated Image processlngs (sub- The luture 01 X-Dlagnos-
Processor traction enhancement. Integration, etc.) ti cs
(psg. 167)
(fig. 45/4)

4,5.6. Bucky .land 4,5,7,1. Chelt Changer

It is a tilting bucky lor teleradiography of chest, spine, Automatic serial Chest Changers are useful for heavy
skull, etc. (fig . 25/4). routine chest examinations and for Mass Screening.
4,5,7, T eleradiography Fig . 26a/4 shows the Gilardoni Chest Changer.

It is used for teleradiography and is equipped with cas- For other methods of Mass Screening see par. 4.5.10.
sette holder and automatically centering jaws (fig. 2614). and table 3a/4 page 156.

'54 GllARDONI. RAOIOI.OGY - ELECTROMEOICINE


Fig. 24/4 (par. 4.5.5.) Ceiling
tube stand.
Posillonable In any point 01 a
room. can be utilized with dil-
I&r&nt accessories. Optional: to-
mograph ic device.
Fig. 2514 (par. 4.5.6.) -
Bucky stand.
Tilting 8ucky. allows
three grid technique: In-
terchangeable. stationary
Invisible grid.
4.5.8 Different combinations of ..Condenser-Gil.. genera-
tors and examination accessories
Table 1a/4 page 150 describes the proposed combina-
tions.
4.5.9. Treatment of the Kidney stones with shock waves.
It is a new method to eliminate the Kidney stones with-
out surgery: the technique is to crush them with shock
waves transmitted th rough the body, in order to reduce
them in sand-like grains which can be washed out in
the urine.
The treatment, avoiding surgery, allows to reduce pa-
Glu.ROONl. RAOIOLOOY - ELECTROMEOIClNE
Fig. 2314 (par. 4.5.4.) - Roentgen-Gil first al/
computerized, digitized, unlll6fS81 equipment.
The !irst computer co-o rdinating all equip-
ment functions to be reallzed: tilting table
movements. radiographic exposure factors
and processing of digital Images. (Produced
by GIlardonl In (982) (see also par. 4.9.1.
page 167 and following) .
Fig. 26/4 (par. 4.5.7.) - Talara-
dlograph.
TeIeradiogl'll(i1ic device with cas-
sette holder (..mIl 70 x 120 em).
Ava ilable also with Buck-y dia-
phragm and stationary invi-
sible grid.
Fig. 26a/4 (par. 4.5.7. 1.) - GI-
lardonl Chest Changer: auto-
matic comp utarlzed unit for
cMst radiography.
The unit can be directly cou-
pled with an automatic film
developer. Inside the tunnel Is
placed the _film feeder- that
can store up to 40 films size
35 x 35 cm (14" x 14H) or
35 x 43 em (14" x lr) and
the . recelver- for the exposed
films. Available with automatic
exposure device Dosemat.
tient pain and hospitalization cost; every risk of compli-
cations or infection is also eliminated.
The Dornier made equipment is called _Kidney Lithotrip-
ter- (fig. 26b/4) and works in this way:
the patient is lowered in a bath of water because the
shock waves are not well transmitted in the air;
the stone position is centered by two X-ray devices
giving their images on two TV monitors;
in these conditions, the stone is exactly in the second
focus of an ellipsoidal reflector in whose first focus
the shock waves generating pOints is placed;
in this way. the pressure wave generated focuses its
energy on the stone which can be broken up.
The fig. 26c/4 show the Lithotripter operation principle.
155
 4,5.10. Mass Screening (military, schools, etc.), Hospital
General Acceptance, Pe riodical Rad iologic al
Check-up, etc.

Mass Screening (mi litary, schools, etc.) has always been

a felt need in Radiology.
Table 3a/4 gives the principal Mass screening techni-
ques.
The ..Gilardoni Total Body Radiog raphy. (GTBR) (see
par. 2.4.4. page 48) is the ideal system for this purpose.

Chapter 4.6. - TOMOGRAPHY

Fig. 260/4 (par. 4.5.9.) - The Kidney Litho/rlp/er (Oomier
system).
The equipment allows to eliminate kidney stones shattering
them by shock waves without surgery. The method reduces
patient pain and hospitalization cos\, avoiding also any risk
of complications or Infection.
4.6.1. Introduction
In a standard radiography. lhe shadows of anathomicaJ
parts lying at different levels in the patient, will overlay
each other. making sOrl)etimes difficult to separate the
details.
With the tomog raphic technique it is possible to obtain
a sharp image of a selected plane. whilst those upon or
under that plane give blurred images.
Practically. tomography is realized operating a co-ordi-
nated movement of both film and tube about a fixed
plane with in the patient (fig . 27/4) .

Fig. 27/4 (par. 4.5.1.) - Principle

of tomography.
1) X-ray Bucky tube; 2) lilm;

.~ 3) patient section: 4) pivot point

correspondent to the plane 01
sharpness; 5) lomographlc angle.
Tube and lilm perfOl"m arc-shaped
movements about a perpendicular
FlfJ. 2&/4 (par. 4.S.fJ.) - How the Lithotrip/er WOI"~s.
plane during tomography; only the
1) X-ray centering devices; 2) X-ray lube-heads; 3) TV moni- object lying on that plane gives
tors; 4) Ellipsoidal reflector; 5) Electrodes for shock waves frozen and sharp Images on the
emission: 6) Kidney. film; whereas the objects 01 other
The pressure wave Is focused by ellipsoidal reflector on the planes give moved and blurred
kidney stone which, In this way, can be broken up. Images on the film .

TABLE 3ai4 (par. 4.5.1 0.) - Methods for: Mass Screening. Hospit81 Gener81 Accept8nce, Radiologic81
Check-up. etc.

Image quality
Parts undor Residual Operating PeriOdical
Patlef1t F'urchaalng
N Ty,,"
examination Elements per
mmS
I Line pt.1,..
per mm
dillgnostic
000'. d~ ~, ~,
total bOOy
check-up

1 FIUOl"ography thorax POOR ,.. high medium k>w 00

2S I 2.'
2 Chest - Changer thorax GOOD 0O low medium high 0O

400
I 10

3 Large field image thorax POOR Y" low high medium 0O

inleosifier
49 I 3.'
4 Photodiode ' '''y thorax with
eventual
POOR ,.. low high low ,..
,
other par1S 4
I 1
. GTBRM thorax, skull, EXCELLENT 0O lOW high high yes optimal
(Healt-Passpor1) hear1. column. (homogeneized)
pelvis etc.
400 I 10

156 GllARDONI. fIAOlOLOGY - ElECTROMEOlCINE

4.6.2. Linear tomography: different methods The test shown in fig. 29/4 is used for this purpose; it
is realized according to the recommendations of the in-
The best operating tomographic method is the also ternational Commission on Radiological Units and Mea-
known "G rossman Method..: it describes a system where surements (Handbook 89) .
tube and film perform arc-shaped movements.
Magnification and blackening are constant during the
swing and then the tomographic image is at its best
(fig. 28/4) .

Fig. 29/4 (par. 4.6.4.) Test object used wilh linear and cur-
vilinear tomographs to determine the exposure angle and the
loca tion of the ob}ectlve plane. The lest object 01 X-ray
transparent malerlal Is marked with opaque wires al 0,25 cm.
Intervals up to a helgth 01 20-25 cm.
The scale portion Is al 45 degrees. The test object is set so
that a linear movement is at right engle 10 the length 01 the
scale. and a to mog raphic eKposure is made. These proce-
F/g. 2814 (par. 4.6.2.) - Tomograph/x. dures 818 operated IICCOfdlng to NBS recommendations (Hand-
U Is a tomographic equipment that operates aCCOfding to book 89).
.Full Grossman Method~: during the arc-shaped movement 01
the tube, bucky executes an arc whilst remaining parallel to
the plane 01 sharpness. Fig. 30/ 4 shows the tomogram obtained with this test
object.
Also par. 3.7.6. page 144 deals with this topic.
This method is also known as "Homothetic areal move-
ment...
A simplified system derived from the - Full Grossmann
Method,. does not perform arcal but linear movements
for both film and tube. This method is called - Homo-
thetic linear movement-.
Since a change in tu be to fi lm distance occurs throug-
hout the swing , the blackening per unit time on the film
changes.
On the contrary, the magnification is constant.
The last method performs an arcal movement of the
lube whilst bucky a linear one.
Unfortunately both magnification and blackening change
during the swing and the tomographic image is usually
not satisfactory.

4.6.3. Non linear tomography

The amount to which the image of an object is blurred

depends on the tomographic angle.
So, to increase the blurring path length without increas-
ing the angle of swing, different non linear tomographic
movements are applied . The most used movements are:
circular, elliptical, spiral and hypocycloidal.

4.6.4. Test procedures - Tomographk phantom

Different tests are used to check the accuracy of a to-
mographic equipment.
One of the most important controls is to measure the
exposure angle and the location of objective plane.
Fig. 30/4 (par. 4.6.4.) Tomogram obtained with test object
shown in l ig. 29/4. II indicates Ihe position 01 Ihe objective
plane at Ihe Intersection 01 the longitudinal wire images and
allows to detennine the real exposure angle.

GIl.AAOONI . IIAOIOI.OGY ELECTAOMEOICINE '57

Chapter 4.7. - COMPUTED TOMOGRAPHY
(From: Giampiero Tosi of Ospedale Magg iore - Milano
Many thanks for his collaboration) .
4.7.1. Hystorical noles. Prlnci~es 01 CT
Conventional prOCedures of radiography and fluoroscopy
are able to give a two-dImensional representation of a
body region due to the differential attenuation of a broad
beam of X-rays in a three-dimensional and inhomoge-
neous structure, namely the examined region itself.
Conventional radiological images take therefore thei r ori-
gin from the superposition of the attenuation images of
structures lying on different planes; for th is reason, in
order to clearly distinguish different objects placed along
the same ray, between the X-ray source and the plane
of the image, it is often necessary to employ particular
projection techniques, allowing to visualize separately the
objects themselves.
In 1922 the Dutch radiologist Zledses des Plantes, and
in the following years others - among which the Italian
radiologist A. Vallebona - demonst rated the possibility
of obtaining radiographic images of thin body sections,
lying on sagittal and frontal planes (X-ray tomography).
These procedures are based on the simultaneous mo-
tion - for instance a linear motion - along separate,
parallel and opposite d irections (but other, more sophis-
ticated types of motion are possible) of the X-ray tube
and of the rad iographic cassette (see Ch. 4.6. page 156).
The modern radiographic equipment for X-ray tomogra-
phy can produce . images of excellent quality; despite the
technological developments, however, these images can-
not give a perfect reproduction of fine details. because
it is impossible to get completely rid of the influence of
the body sections over - and underlying the one to be
imaged; the image of the structures contained in these
sections is only partially erased by the tomographic mo-
tion (thiS fact gives rise to the so called ..tomographic
blurring .. ).
Within the limits of conventional tomography. the image
of axial body sections is only obtainable with ..trans-
verse axial tomography". during which patient and radio-
graphic film simu ltaneously and sinchronously rotate
around vertical. parallel axes; in spite of the validity of
the theoretical assumptions. this tomographic procedure
has never gai ned a large diffusion. due both to the me-
chanical complexity of the equipment. and to the poor
quality of the images, characterized from very low spa-
tial and density resolution .
Conventional radiology was therefore substantially unable
to develop a tomograph ic technique able to visualize
images of thin axial body sections, characteriZed by
high spatial and density resolution and by the absence
of artifacts. This problem cannot in fact be solved only
by realizing particular motions of X-ray tUbe. patient
and film. however complex and sophisticated they are.
At the end of SO's the problem of getting - by employ-
ing X-ray - images of axial body sections was fased
out Independently by the english engineer G.N. Houns-
field - who was engaged in the study of pattern re-
cognition and computer storage techniques of the hand-
written word at the Research Laboratories of EMI - and
by the south-african physicist A.M. Cormack - who was
investigating the possibility of getting precise informa-
158
tions on axial body sections for purposes of radiothera-
py treatment planning. Both these scientists developed
and applied a principle - discovered in 1917 by the
austrian mathematician J . Radon - according to wh ich
the image of a two- or threedimensional object can be
reconstructed starting from a theoretically infinite number
of projections - taken from different directions - of
the object itself. In a second time, the "slice" approach
(that is the exploration of thin axial body slices) seemed
to be more convenient - from a practical point of view
- for a mathematical reconstruction and for a clinical
evaluation of the images.
Reconstruction techniques of this type. on the other
hand had already been developed and employed in 1956
by the Australian astronomer R.N . Bracewell, in order to
reconstruct the microwave emission pattern of the sun .
These reconstruction techniques need the employ of ma-
thematical calculations which are relatively simple from
a conceptual point of view, but extremely toilsome from
a practical one. The development of the equipment for
CT has been made possible by the availability o f large
and powertul digital computers.
For their contribution to the development of medical dia
gnostics, achieved through the invention and the diffu-
sion of computed tomography, Hounsfield and Cormack
received in 1979 the Nobel prize for medicine.
4.7.2. Data acquisition In CT and 1,st generation CT-
scanners
In principle, a system for computed tomography is can
stituted by:
1. an X-ray tube, eq uipped with a beam limiting device,
in order to select the slice thickness;
2. one or more radiation detectors;
3. a com puter, for data acquisition, Image reconstruction
and for the control of the whole system;
4. a control desk;
5. a TV-monitor, for the display of the Images.
The first CT-scanner. the so called " EM I Mark 1,. was
realized in 1971 by Hounsfield and was installed in the
Atkinson Morley Hospital, Wimbledon . where Dr. J .
Ambrose obtained the first axial image of the brain
(fig. 31 / 4) and developed the first clinical experimenta-
tion of computed tomography, by comparing it with
scintigraphy and with angiography and other radiologi-
cal procedures of neu rorad iology. This first CT-scanner
functioned according to the principle illustrated in
fig. 31a/4 (page 159).
Fig. 3114 (par. 4.7.2.) The
first CT-image of an axla!
brain section, obtained by
Or. J . Ambrose. at the At
klmon MOf1ey Hospital, Wim...
bledon, by employing the
lirst CTscanner, EMf Mark
1. deYeIoped by GN. Hour&
field at the EM I Research
Laboratories.
G llAROONi. RAOIOl.OGY . ElECTROMEDICINE

TRANSLATION
Fig. 31al 4 (par. 4.7.2.) - Principle 01 1.51 general lon CT-
scanner: an X-ray lube. Slrongly collimaled In order 10 emil a
pencil X-ray beam, and an X-ray delector (0) rOlale sinchro-
nously around the patient's head (HI: lor a delinite number
01 angular positions (180 or 360) carry out a linear transla-
tion, during which a discrete sel o t attenuallon measure-
ments is taken and stored into a computer. Each sel 01 atte-
nuation values Is named -density proilie-.
An X-ray tube, mounted on a yoke and operating at a
voltage of nearly 120 kV, produced a pencil beam of X-
rays, with a cross-sectional area of nearly 1 cm2; on the
same yoke, and opposite to the X-ray tube, was placed
a radiation detector, namely an NaJ scintillation crystal ,
of 2.5 x 5. The patient's head was put in a hole, of
nearly 20 cm diameter, between the tube and the detec~
tor, so that only the rays between the tube's focal spot
and the detector were allowed to pass through the head
itself.
The system constituted by the X-ray tube and the de-
tector is placed in correspondence of one particular an~
gular direction, with respect to the patient's head: at
this pOint, X-ray tube and detector are linearly translat-
ed, at constant speed, in order to obtain, from the radi-
ation beam emerging from the patient and revealed by
the detector, a set of attenuation measurements, at reg-
ular intervals within the pre-setted . view,,: this set of da~
ta, after having been digitalized, is stored in the compu-
ter's memory: the yoke is then rotated through a small
angle (for instance 1) around an axis perpendicular to
the slice to be examined, in its center, and a new trans-
lation is performed, so as to gain a new set of attenua-
tion data. This process of rotation and traslation is re-
peated through a total angle of 180" or 360", in order to
acquir~ all the data necessary for Image reconstruction.
Of course, the attenuation in each position strongly de-
pends on the diameter and on the internal structure of
the explored slice, with particular regard to its denSity.
For each angular poSition, a density profile- is there-
fore obtained. The whole exploration of the slice re-
quired, in this first CT-scanner, a . scanning time of 2-3
minutes, during which the patient's head stillness was
necessary.
The thickness of the explored slice was determined by
the beam's section in the direction perpendicular to the
slice itself, and was of the order of 1-1.5 cm. The im ~
age quality, as compared to that of the more recent
CT-scanners was very poor, due to the limited size of
the reconstruction matrix (see par. 4.7.5. page 162) -
only 64 x 64 - and to the great size of the detector.
GllNtOONl. RADIOLOGY - ElECTROMOICINE
The CT-scanners of the type described above, based on
the use of a pencil beam, on the exploration of the
head's axial section through a combined movement of
rotation and traslation and on the use of only one radia-
tion detector are known as . 1.st generation CT-scan-
nefS>o.
4,7,2.1 . 2.nd generation CT-scanners
The first CT-scanner - the EMI Mark 1 described in
the previous paragraph - which employed only one de-
tector, was able to produce images of low quality (par-
ticularly characterized by a low spatial resolution), whilst
the scanning lime (at least two minutes) was clearly too
large for the study of body regions containing moving
organs.
In a short time, therefore, many industries developed
new types of CT-scanners, much more sophisticated than
the first one, able to produce Images of excellent quali-
ty, with scan ning and image reconstruction times as low
as a few seconds.
The so called II generation CT-scanners, Instead of only
one radiation detector, employ a linear array of detec-
tors (up to 30-50) and, instead of employing a pencil
beam of X-rays, employ a . fan-beam.., with an aperture
angle of nearly 3()0, and thin in only one direction, the
one corresponding to the thickness of the slice to be
examined (2-10 mm) . In this way, du ring one translation
as many parallel views are taken and recorded as is the
number of detectors. As a result, more of the X-rays
emitted by the X-ray tube are utilized simu ltaneously,
and the angular increment after each translation is no
more a small angle (nearly 1), but is as large as the
angular aperture of the fan beam that encompasses the
detector array (nearly 3QO).
The scanning time of II-generation CT-scanners is stron-
gly reduced, and varies from 6 seconds, for the faster
scanners, to nearly 60 seconds, for slow, high resolution
scansions: a typical scanning time is 20 seconds. The
spatial resolution of these scanners can be very high
with a cut-off frequency of the MTF-curves as high as
up to 12 Ip/em.
In these CT-scanners the NaJ detector was substituted
by hig her efficiency detectors, generally Bi4Ge3012 (bys-
muth germanate).
4.7.2.2. 3.rd generation CT-lCIInners
In order to further reduce the scanning time and to in-
crease the number of attenuation measurements taken
during the scanSion, a completely new type of CT-
scan ner, where the translation motion was completely
eliminated and the fan angle widened, in order to in-
corporate the whole body cross-section, was realized
(1;9. 32/4) .
An array of a very great number of detectors (typically
nearly 500-600 detectors, and up to 1000 in the more
recent scanners) is mounted along a circumference arc,
opposite to the X-ray tube. The tube and the detector
array rotate contemporaneously around the patient: the
beam is pulsed at a high repetition rate and a great
number of attenuation measurements is taken during a
360" rotation. This rotation-only.. scanner is much faster
than the second generation one; the scanning time Is
very short and in the last models it may be as low as
1-2 s.
f59
A problem in the third generation scanners is that each
detector contributes mainly to the reconstruction of a
ring of image elements - whose radius depends on the
distance of each detector from the central one - so
that, if one or more detectors are out of calibration, a
- ring artifact,. appears on the reconstructed image. This
problem has QUickly and completely been solved by the
introduction of proper and frequent calibration proce-
dures and by the use of very stable and uniform rad ia-
tion detectors (such as Xe-ionization Chambers).
The third-generation CT-scanners are the most widely
employed fast CT-scanners and have even ousted the
4.th generation CT-scanners.

AX

, Fig. 33/4 (par. 4.7.2.3.) - Principle of 4.th generation CT-

scanner: an X-ray tube, emitting a very thin (2-10 mm) -Ian-
X-ray beam (. Ian angleoo nearty 4() rotates inside a circular
array 01 stationary detectors (up to 1000). Each degree. a sel
of attenuation measurements is taken and stored into a
computer. The scanning time may be as short as 1 second.

The scanning time can be very short (up to 1 s). whilst

Fig. 3214 (par. 4.7.2.2.) - Principle 01 3.rd QeOeratlon CT-
scanner: an X-ray tube, emllling II very th in (2-10 mm) . Ian_
X-ray beam (_fan angle. nearly 4() and lin array of some
hundreds 01 detectors (500 - 1000) rotate contemporaneously
around the patient (P). Eac h degree, a set 01 attenuation
measurements Is tllken and stored Into a computer. The
whole rolation 01 360> may take place in a very short lime,
t to 3 seconds.
4.7.2.3. 4.th generation CT-Icanners
In this type of scanner only the X-ray tube rotates in-
side a stationary circular array of detectors (fig. 33/4).
the image spatial resolution depends on the number 01
detectors and especially on their -angular density" (i.e.
number of detectors per degree) . Ring artifacts are com-
pletely eliminated, since the detectors can be continu-
ously calibrated; the spatial resolution is generally not
very high and may be compared with that of third-gen-
eration CT-scanners only if at least 1000 detectors are
available. Typical detectors are made 01 bysmuth ger-
manate or cadmium tungstate. Contrast resolution is high.
whilst the so called . dose efficiency.. is low, due also to
the need of a . post-collimation", In the form of small
bars of tungsten , placed between the patient and the
detectors, in order to absorb scattered and ",oblique,.
radiation) . The main advantage of such CT-scanners is
represented by the possibility of continuous calibration
of the detectors during the scanSion, which allows to
obtain a high degree of homogeneity and to avoid ma-
ny type of artifacts. The main features of the various
CT-scanners generations are listed and compared in ta-
ble 4/4.

TABLE 4/4 (par. 4.7.2.3.) - Main features of the various CT-scanner generations.

cr -.canner gen&rtll ion

PARAMETER
Th ,", Fourth

ScM motion
First

Translation - ROlatlon
""""
Translatio n - Rotation Rotation of X-ray Rotation of X-ray
tube and detectors tube alone
Sc," time 12O-150 s 5 - 150 s 2 10 S 1 + 6 s
Number 0 1 detec10fS 1 12 - 52 256 - 1024 600 - 1068
Type 01 detectors Scintillator + PM tube Scintillator + PM tube Scintillator + photodiode Scintillator + photodiode
or photodiode or high pressure
x..ionization chamber
angle - 12 - 26" 50 - go>
''"
Reconstruction matrix 64.64 128 x 128
30 - 45"

256 256 256 256

256 256 320 320 512 x 512
512 x 512 1024 x 1024
1024 x 1024

Reconstruction lime 120 , 20 - 1205 o - 20 5 - 30 s

160 G llAROONI . AAOIOl..OG V - ELECTAOMEOI CINE

4.7.3. The detectors In the CT-scanners
The main features of the rad iation detectors employed
in the CT-scanners are:
1. small dimensions, in order to increase the total num-
ber of detectors and to achieve a high spatial resolu-
tion;
2. high ",dose efficiency", in order to reduce both the
dose to the patient and the noise;
3. high uniformity of the response of the single detec-
tors, in order to reduce artifacts and to achieve ' a
high homogeneity of the image;
Essentially two types of detectors have been employed:
1. scintillation detectors, like sodium-iodide (only in the
1.st generation CT-scanners), cesium iodide and bis-
muth germanate, coupled with a photosensitive de-
vice (photomultiplier tube or photo diode) (these de-
tectors are employed in 2.nd, 3.rd and 4.th genera-
tion CT-scanners):
2. ionization chambers, filled at high pressure (2 to 3
atm) with a high Z gas (Xenon) and equipped with a
large number of electrodes (up to nearly 600) , in
such a way as to obtain an equal number of single
detectors. In these chambers (which are employed
only in 3.rd generation CT-scanners) the space be-
tween adjacent electrodes is in fact tully equivalent
to a single detector.
These ionization chambers have a lower dOS&-ellicien-
cy, as compared to solid state scintillation detectors,
but, with respect to these, are characterized by a
higher uniformity, due to the pressure and thermal
equilibrium reached inside the chamber. The CT-scan-
ners equipped with high pressure ionization chambers
are therefore less sensitive to ring artifacts than those
equipped with solid state detectors.
4.7.4. CT-Image reconstruction
In order to explain the principle of image reconstruction
in computed tomograhpy, It is possible to assume that,
in correspondence of every beam's incidence, the ob-
ject's section is constituted by a series of elementary
cubic or parallelepiped cells (which are called -voxels),
or volume elements of unknown density and of known
cross-sectional area (the so called -pixels, or picture
elements) (see fig . 34/ 4) . The X-ray beam's attenuation
in these ....oxels may be characterized by a linear atte-
nuation coefficient 11., so that, if we denote with 10 the
intensity of the beam incident on the voxel, with I the
intensity of the emerging radiation and with d the thick-
ness of the voxel, the following relation holds:
If one takes into consideration the whole of the n ....ox-
els, whose densities may be equal or not, the relation
between the intensities of the Incident and emerging ra-
diation becomes:
"
L:
I = 10 e--<l
, I 111
The values 01 the coefficients 111 depend both on the
energy of the radiation beam employed and on the
densities of the various types of tissues.
GllARDONI . RADIOLOGY - ELECTROMEOICINE
When working with an X-ray beam generated at a ten-
sion of nearty 120 kV, the linear attenuation coefficient
of water, I1H,O is equal to 0.19 cm-l, while the attenua-
tion coefficients of all the other tissues may be ex-.
pressed by a so-called CT-number. so defined:
CT"""",* = 1000
PH,O
In this way, the CT-number of air is nearly equal to
-1000 (Since. to a good approximation, the attenuation
coefficient of air may be put equal to zero) and the
CT-number of compact bone (which is the most dense
tissue in the human body) is nearly equal to + 1000. All
the other tissues are therefore cha racterized by a CT-
number comprised between - 1000 and + 1000.
The image reconstruction is a mathematical procedure
which has to be performed in order to produce a two-
dimensional distribution of attenuation coefficients - and
therefore of CT-number - starting from the attenuation
profiles obtained through the scansion of the patient's
section through a great, but yet limited , number of pro-
jections (these original data are called "raw data and
are temporarity stored into the computer's memory) .
Fig. 3414 (par. 4.7.4.) - Attenuation 01 an X-ray beam in a
voxel. 01 linear attenuation coellicient 11. and in a series. 01
voxels. of linear attenuation coefficients 11 112. .. . /oln and
thickness d.
In order to reconstruct the image starting from the raw
data, three mathematical procedures may be employed :
the direct and the ..-tiltered .. back-projection;
iterative algebraic procedures:
analytical methods of con ....olution and deconvolution
based on the use of Fourier transforms.
The method of direct back-projection is extremely sim-
ple from a mathematical point of view, and consists in
the direct superposition of density profites measured
along the different projections (see fig . 35/4) . It allows
to obtain very rough reconstructions, characterized by
the presence of the so called oestar artifacts-. In order to
eliminate these artifacts, the various density profiles, ba-
fore being back-projected , must be corrected through a
"convolution, consisting in the application of a correc-
tion function ("filtered back-projection). This method of
image reconstruction is, at the present time, employed
in the greatest part of commercially available CT-scan-
ners. It leads to the construction of a matrix, whose
elements correspond to the CT-number of each voxel.
In the fi rst CT -scanners three matricles had a size of
64 x 64 or 128 x 128 elements; in the modern scan-
ners the matrix's size has been increased to at least
256 x 256 and in some cases to 512 x 512 or even
161
1024 x 1024 elements. Of course, the image quality, and convert this matrix in a visual image, with characteristics
particularly spatial resolution strongly depend on matrix useful for the clinical evaluation. In order to reach this
size, and increases by increasing the number of ele- aim, one makes use of the so-called ..grey-scale", wh ich
ments. For instance, for an object of 25 cm diameter, allows to transform the CT-number of each pixel stored
each element of a 512 x 512 matrix corresponds to in the computer's memory into different grey levels, on
a pixel of nearly 0,5 x 0,5 mm2, whilst each element a television monitor. In practice, in order to visualize the
of a 128 x 128 matrix corresponds to a pixel of nearly . whole range of CT-numbers (from - 1000 to +3000)
2 x 2 mm2. one should have at disposal 4000 different levels of
grey. Th is is not possible for technical reasons: on the
other hand, the human eye can distinguish at the most
32-64 grey-tonalities: the visual display on the lV-moni-
tor is therefore simplified by allowing to correspond to
each grey-level, not a single CT-number, but a more or
less wide interval of CT-numbers. If, on the other hand,
one wishes to obtain high quality Images of regions, or
of a particulars, for which the interval of densities (and
I (
/ therefore of CT-numbers) is small, it is possible to em-
/ ploy the whole grey scale limitedly to such interval, in
such a way as to visualize in the best way also the
smallest differences of density. In order to reach this
,,I \\
last aim, all the systems of image display allow to se-
lect both the level of grey (and therefore of density)
around wh ich to operate, and a window, correponding
to the range of grey values (centered on the level) in-
side which to completely utilize the grey scale (see
Fig. 3514 (par. 4.7.4.) Principle of Image reconstruction lig . 36/4 page 163). This combination of level and win-
according to the method 01 direct backprojection; the dow is therefore regulated in such a way as to display
reconstruction profile 01 8 delta function Is characterized by as completely black the image of objects whose density
a -star artilact_ (Philips). is lower than the density corresponding to the lower
level of the window and as completely white the Image
of objects whose density is hig her than the density 01
4.7.5. CT-numbers the hig her level of the window: in particular, air will al-
As we have seen in the previous paragraph, the proce- ways be displayed as black , and the compact bone will
dure of computed tomography allows to reconstruct the always be displayed as white. The visual images 01
image of axial sections of the human body in form of a computed tomography, though of numerical nature, ac-
matrix of numbers, the so-called CT-numbers, each of quire in this way the same appearance of the usual ra-
which corresponds, In a conventional scale, to the atte- diographic images: they can be photographed with a
nuation of a volume element, the so-called "voxel, who- Polaroid camera or on a radiographic film, by employ
se height is determined by the thickness of the ex- Ing a device named multi-Imager, or multi-spot or vi-
plored slice and whose cross-sectional area - the so- deoimager (see fig 3714 page 163); on the same film
called "pixel .. - is determined by the size of the recon- (for instance 18 x 24 em) it is possible to photograph
struction matrix. The scale of CT-numbers ranges from one or more images, like in seriography.
- 1000 to + 1000 (or even to +3000, in order to charac-
terize also objects with an higher density than the bone,
like metal prosthesis or contrast media) and water has a TABLE 514 (par. 4.7.5.) - CT-numbers of human
CT-nu mber equal to zero. However, If one scans a ho- organs and tissues.
mogeneous cylindrical water phantom, one finds that
the CT-numbers corresponding to each pixel are not all Organ - 11_ CT-number
equal to zero, but are distributed in a more or less
large interval around zero. This distribution of CT-num- AI, - .000
bers is due above all to -quantum noise-, that is to the Lungs - 400 / - 800
statistica l fluctuation of the photons emitted by the X-
- 200 / - 30
ray tube and reaching the detectors after having been
attenuated by the object. The standard deviation of the
'" Breast - 110 / - SO
CT-numbers of a homogeneous water phantom is a Water 0
good measure 01 the image homogeneity; it depends on
the rad iation dose and decreases with increasing the
A,_ glands 10 I 25
dose. In the best CT-scanners the standard deviation of Salivar glands 15 I 35
the CT-numbers of a water phantom Is equal to 2,5-3
CT-numbers. White brain matter 20 / 35

The values of the CT-numbers of the human tissues are Gmy brain maner 35/SO
affected by a natural variability and also by a dispersion
due to the noise: the corresponding values and intervals
are listed in table 5/ 4.
S._Bowel 51 30
3O / SO
Kidneys 35 /SO
4.7.6. Grey scale. htv~ and window 25 /SO
H.."
As we have seen in the previous paragraphs, the ma- Liver 25 I 75
thematical treatment of the at1enuation profiles allows to
obta in a numerical image of the scanned slice, in the Blood 35 / 80
form of a square matrix of CT-numbers. Th is matrix Bladder 25 I 35
can obviously be printed, but, in this form, cannot be
Bone SO 1 1000
evaluated by the rad iologist. It is therefore necessary to

162 G1L-'ROONI. RAOIOI.OGV - El..ECTROMEOICINE


,~
.~
...,
. ~
.~
, l ....1
,,-
.~
- ~
~
,~
Wind ....
Fig. 36/4 (par. 4.7.6.) - Use of window and level for the dis-
play of CT -numbers. Left; window for soft tissues and mus-
cles: right: window lor lungs.
Fig. 3714 (par. 4.7.8.) - CT-image of the abdomen, alter
admnistration 01 8 contrast medium: liver, kidneys, spleen
and abdominal vessels are clearly represented by a proper
selection of the grey-scale.
.7.7. Image quality In CT
As in conventional radiology, also in CT the quality of
unage is as high as it better reproduces the physical
and geometrical characteristics of the object. In conven
tIOnal radiology the image quality is full y described by
optical density, contrast, noise and spatial resolution; in
order to determine these parameters it is necessary to
expose standard test objects, like step-wedges, grid pat-
terns or specially designed anatomical phantoms and to
measure the optical density distribution of the exposed
film; on the other hand, these parameters strongly de-
pend on exposu re conditions, mainly on the values of
voltage (wh ich, together with filtration determines the
beam quality), tube current and exposure time (mAs)
which, together with fiUration and distance determine
the radiation dose reaching the object first, and then
the film . In CT the evaluation of image quality is, to
some extent, easler, since the images, by their nature,
are discrete and numerical; moreover, the possibility of
modifying the technical conditions is much more limited
than in conventional radiology, since, in CT-scanners, at
the most two or three tube-voltages are available and
the other possibilities of varying the image quality are
bound only to the use of different numbers of projec-
tions (and therefore to the use of different values of
GIl....RDONI. RADIOLOGY ELECTROMEDICINE
mAs) and of different reconstruction algorithms. On the
1.000 other hand, only an exact knowledge of image quality
parameters allows the choice of aCT-scanner. and ' only
ro
W
the regular control of them allows to assure a hig h and
constant quality of the clinical examinations .
, The main image quality parameters of a CT-scanner,
w are the following:
ro 1. spatial resolution, as an index of the smallest objects
~ which can be discriminated;
.~ 2. contrast resolution, as an index of the smallest dif-
~ ferences of density which can be discriminated and
., which is strictly related to;
,~
3. noise, as a mesure of the statistical fluctuations of
the CT-numbers, in the Image of an homogeneous
object;
4. linearity, as an Index of the existence of a li near re-
lation between linear attenuation coefficients and CT-
numbers over the whole range of densities and CT-
numbers;
5. field uniformity, as a measu re of the ability of the
CT-scanner of calculating with the same accuracy
the CT-numbers of a homogeneous object in each
position of the field of view (for instance, in the cen-
ter and in the periphery of the field) .
In o~der to measure and to control these parameters,
specl8l phantoms have been developed: one type of
these phantoms is illustrated in fig . 38/4.
Fig. 38/4 (par. of.7.7.) Lelt: bar phantom lor the study of
Image quality In CT: right: CT Image of the same phantom.
The thinner bars are poorly distinguishable.
4.7.8. Spatial resolution In CT-scanners
Let us suppose to scan the bar phantom illustrated in
fi g. 38/4. The bars are made up of plexiglas (denSity =
1,19 g cm-3; approximated value of the CT-number =
130) and the space between each bar is filled with dis-
tilled water (density = 1 g cm--3: CT-number = 0) . If
the system were not degrading the information, the
graph of CT-numbers of the plexiglas bars, along an
axis perpendicular to their length would be a square
wave (fig. 39/4); contrarl y. due to various factors, both
of physical and technical nature, the contours of the
profile are more or less slightly blunted; the extent of
this blunting increases with diminishing the bars size,
that is by increasing thei r spatial frequency. Some fac-
tors which can influence the spatial resolution are the
pixel's size (depending on the matrix size) , the detec-
tor's size, the type of beam collimation, the reconstruc-
tion algorithm.
There are many ways to express the spatial resolution
of a CT-scanner; all of them are referred to high con-
trast particulars (like. for instance, plexiglass and water).
163

III III III
'. '0' ww w ..
Fig. 39/4 (par. 4.7.B.) - The square-wave pattern 01 the bars
Is blunted in the reconstruction and display process; the
blunting ellecl Increases with Increasing spatial frequency.
The ability of a CT-scanner of accurately reproducing a
high-contrast edge is mathematically expressed by the
..edge response function- (EAF); the ability of reproduc-
ing a thin split is expressed by the -line spread func-
tion. (LSF). which. from a mathematical point of view,
is the first derivative of the ERF (fig . 40/ 4) . The Fourier
transform of the LSF is the ~ned ..modulation transfer
function .. (MTF see par. 2.5.17. page ) which, in the
frequency domain , expresses the loss of information
when .the spatial frequency increases. The MTF is prob-
ably the best way to express the system's spatial resolu-
tion over the whole range of frequencies. The corres-
ponding curves (fig. 41 /4) are normalized to 1 (or 100%)
for a spatial frequency of a Ip/cm (no loss of informa-
tion) and are monotonically decreasing with increasing
frequency. Usually, in order to characterize the spatial
resolution of a CT-scanner one gives the value of the
spatial frequency for a value of 0,5 (50%) of the MTF-
curve; another indication is given by the cut-off fre-
quency, that is the frequency in correspondence of which
the MTF-curve falls to zero (no particular can be seen
for higher frequencies) . The higher these two values of
spatial frequency, the higher also the CT-scanners spa-
tial resolution.
Another way of easily determining the spatial resolution
of a CT-scanner is to employ a plastic phantom, in
wh ich some holes of different diameter, filled with air,
are present. The diameter of the smallest hole still reco-
gnizable on the image gives sufficiently accurate infor-
mation about the system's spatial resolution.
with a special reconstruction algorithm - HA) are also
I somewhat noisy. The noise reveals itself on the image
- ....... .,....
'f--_.J
Fig. 4014 (par. 4.7.8.) . The ERF (Edge Response Function)
(b) and the LSF (Line Spread Function) (a) characterize the
ability 01 the system 01 reproducing a sharp edge and a thin
split, respectively.
164
.,....
Fig. 4 114 (par. 4.7.8.) - MTF curves of a group 01 C T-
scanne s.
4.7.9. Noise and contrast resolution In CT-scanners
As we have already seen in the paragraph 4.7.5. page
162, If one scans a homogeneous object, like a cylindri-
cal water or plexiglass phantom, the CT-value of each
pixel would be equal to zero or nearl y 130, respectively.
The effective CT-numbers, on the contrary, are not all
equal, but show a gaussian distribution, with mean value
zero (for water) and whose standard deviation u Is tak-
en as an index of the noise. Its value depends on many
factors, namely:
1. the attenuation A produced by the object, depending
on kVp and filtration;
2. a constant K, describing the "dose efficiency" of the
system, and particularly of the detectors, and tak ing
also into account the reconstruction algorithm (a low
value of K corresponds to a high dose efficiency);
3. the pixel's width, w;
4. the slice's thickness, h;
5. the radiation dose Do incident on the explored slice.
The 6 value and is given by the formula of Brook and
Oi Chiro:
In the modern CT-scanners of Ill-generation, the stand-
ard deviation of the noise may be as low as 2-3 CT-
numbers, in the scansion cond itions characterized by a
high slice thickness and a high number of projections,
corresponding to a high incident radiation dose. Due to
the fact that spatial resolution increases with decreasing
the slice thickness the high resolution images (obtained
with a sort of granularity. The low noise systems give
rise (on the TV-monitor and on the photographic film)
to very uniform images, whereas the high noise systems
give rise to images altered by a rather uniform distribu-
tion of small spots and specks.
With the name of contrast resolution the ability of the
CT-scanner to distinguish between object differing in
composistion and density is designated, independently
of size and dimensions. Contrast resolution is particular-
ly important in the study of abdominal organs, where,
due to the small differences in density and in anatomic
number, the possibi lities of conventional radiology are
limited, and one has always to make use of contrast
media. Computed tomography can amplify the differen-
ces of attenuation and enables to image and study or
gans, like liver and pancreas (fig. 37/4) which cannot be
visualized with conventional radiology. In the practical
use of CT. in order to increase the contrast resolution it
is necessary to increase the radiation dose.
4.7.10. Mathematk:al fitters In CT
By modifying the convolution filter which is employed
for image reconstruction based on the filtered backpro--
jection technique, it is possible to change the character
istics of the image in a significant way. All the modern
CTscanners put at operator's disposal a series of re--
construction algorithms which can be selected depend
ing on the characteristics of the reg ion to be examined
and on the clinical requirements. For instance. in the
study of the middle ear It is necessary to achieve the
maximum spatial resolution : this can be obtained by
em ploying the socalled high-resolution (HR) reconstruc
tion algorithm which, at the cost of an increase in
nOise, allows to reduce the size of the particulars which
can be clearly distinguished . The standard convolution
fil ters, on the contrary, represent a compromise between
spatial and contrast resolution. and are the most widely
employed in the clinical use of CT.
4.7.11. Matttematk:al evaluation of CT-Images
The procedures of Image elaboration, through software,
may be subdivided into two main groups:
1. procedures of subjective elaboration, wh ich allow to
display the CTjmages In the more suitable form for
the clinical evaluation;
2. procedures of objective elaboration. in which mathe--
matical computations are performed on the reconstruc-
tion matrix, in order to allow quantitative evaluation
of some image parameters.
To the lirst group belong, among many others, the
following procedures:
1.1 . use of the level and of the window in order to
select (automatically or manually) the best range
of utilization of the grey scale (see also para-
graph 4.7.6. page 162);
1.2. use of more than one window on the same
image, in order to display regions with very dif-
ferent densities In the best way (for instance, in
the CT of the thorax, the use of a double win-
dow allows to display contemporaneously the
mediastinum, the spine and the ribs, on one
side, and the lungs on the other);
1.3. simUltaneous display of many images (4-12) . in
order to compare them contemporaneously;
1.4. display of images on coronal and sagittal pla-
nes. reconstructed by a software program start-
ing from a series of adjacent axial images, prev-
iously stored into the computer's memory;
1.5. image subtraction (for instance, subtraction of
the image acquired before the injection of a
contrast medium from the image of the same
slice acqu ired after the injection, in order to
display only the pattern of the distribution of
the contrast medium itself);
I.B. three-dimensional reconstruction and display of
internal structures, like tumours;
1.7. use of special mathematical filters (different from
convolution filters) which, operati ng on the ma-
thematical images, mOdify their appearance: a-
mong these filters, it is worthwhile to remember
the smooth ing filters (which increase the image
GllAROON l. RADIOLOGY ELECTROMEOICINE
uniformity, by mathematically smoothing the
noise). the edge enhancement filters (which im-
prove the recognizability of the contours of the
objects), the so-called .. bone correction filters
(wh ich take into account the beam's hardening
when it passes through the bone and apply the
necessary corrections, thus eliminating the cor-
responding artifacts) .
To the second group of procedures belong:
1.S. the display of the profile of CT-numbers, along
any vertical horizontal or oblique direction;
1.9. the measurement 01 distances and angles;
1.10. Ihe selection of the region of interest (ROI), or
circular or irregular shape, for wh ich it is pos-
sible to determine area, number of pixels, mean
value and standard deviation of CT-numbers;
1.11 . comparison of the parameters of two or more
ROI's:
1.12. display of the hyslogram of CT-numbers inside
the whole image or inside one or more ROI's;
These possibilities of mathematical treatment do not add
any new information to the image; anyhow, they allow
to obtain informations which. otherwise, would be com-
pletely lost and which may be very important for the
formulation of the diagnosis; they have opened a new
era in Radiology, the era of digital radiology. Probably,
in the future, new software programs will be developed,
allowing automatical pattern recognition and computer-
assisted diagnosis.
4.7.12. Computed tomography: system', general conflgu-
..'Ion
A CT-scanner is a rather complex radiological equ ip-
ment which has to be integrated in the radiological de-
partment and requ ires a certain number of separate
rooms, for housing both the CT-scanner and its acces-
sories, on one side, and the associated storage place
and sanitary facilities, on the other.
In general, a department for computed tomography
shOuld consist of (fig. 42/4) :
,. an examination room, where the scanning gantry (con-
taining the X-ray tube and the detectors) and the pa-
lient table are installed;
2. a small support room , adjacent to the examination
room , where the high voltage transformer, the high
voltage generator and the water cooling system are
installed;
3. an operator rooom, where the following system's com-
ponents are installed:
3.1. the operator's console. equipped with an alta-
numerical key-board and at least one (and gene--
rally two) TV-monitors, for, respectively, the dia-
logue between the operator and the computer
and the display of CT-images; the console may
contain also one or two floppy-disc drives, in
order to allow the long-term storage of CT-im-
ages on floppy discs and the display and elabo-
ration of the stored images (on a floppy-disc -
double side, double density - up to 30 CT-im-
ages, with a matrix 25B x 25B may be stored; of
course, if the image matrix has a larger size -
for instance 512 x 512 - a smaller number of
CT-images may be stored on the same disc);
3.2. a multiformat camera, directly connected with the
operator's console which - thanks to a TV-man
itor connected in parallel with the principal one
- allows to photograph the CTimages on radio-
graphic films;
165
 3.3. a second viewing console for the evaluation of
the CT-irTiages independently from the principal
one and connected in time-sharing with the sy-
stem's image computer; this second console may
be installed also far from the principal one. In
this case, a second computer is needed, to allow
the image display and evaluation;
4. a technical room (air conditioned according to com-
puter's req uirements for temperature and air humidi-
ty), where the following components are installed :
4.1. a minicomputer, for the general control of the
system (high voltage generator, scan sequences,
table and gantry movements, and so on):
4.2. a second mini-computer, eventually equipped with
an array processor, for the fast or real time im-
age reconstruction;
4.3. a large disk-drive, for temporary storage of CT-
image (at least 250 images - matrix 256 x 256
- may be stored on this disk):
4.4. a printer and/or a printer-plotter, for printing the
CT-numbers and the system's messages about
faults;
4.5. a tape unit, for long term storage of CT-images
(the storage on tape is alternative to the storage
on floppy discs).
Of course, a CT-department needs also a preparation
room (for the preparation of the patient and for the
administration and injection of contrast media) , toi lets
and dressing rooms; the total surface occupied by the
department should not be less than 100 m2.
Fig. 4214 (par. 4.7. 12.) Sysfem fOf compufed /omography
(Siemens Somafom DR).
Right: gantry. patlenfs table. principal console, with dialogue
and Image monitors; left separate evaluation console.
Chapter 4.8. - DIGITAL AND COMPUTERIZED RA-
DIOLOGY
(For Digital Radiology in clin ical practice, see Chapter
4.10. page 169).
4.8.1 . DIgltlzation princlpie
The term digitization means the conversion of an ana-
logic radiological image (coming from 1.1. tUbe) into digi-
tal form.
Fig. 43/4 shows how a digital image can be fully ex-
pressed in a numerical form and thus operated and
processed by a computer.
166
Fig. 4314 (par. 4.8.1.) Image digifiza/ion principle.
The analogic image Is split up In many pixels (512 x 512):
10 each 01 them a grey level in the range 01 a seleCted scale
Is given (Iotal range: 256 grey levels).
Thus the Image Is lully expressed with a sequence 01
numbers and can be taken and processed by computer.
4.8.2. Dlgltlzation benefits
The principal advantages of digitizatlon are:
image integ ration for noise reduction;
contrast enhancement;
post proceSSing faculty;
digital image subtraction, pa rticularl y in angiog raphic
field;
tomoscopic performance;
reviewing possibility, frame by frame, of dynamic ra-
diOlogical sequences, using digital memories.
4.8.3. How a digital Imaging . ystem for digital temporal
subtraction operates
The functional block diagram represented in fig. 44/4
page 167 shows, step by step, how Image dlgitization
and processing are performed in DMD Gilardoni equip-
ment (fig. 4514) .
Digital subtraction takes place in digital processor (6):
from the live image (contrast-filled) stored in digital ser-
vice memory (5), the mask image (taken before the
contrast intravenous injection) stored in digital mask me-
mory (5) is subtracted .
So, only the structures of interest injected with contrast
medium are displayed on the TV mon itor (figs. 46/4 and
47/4 page 167).
If live images are digitally stored in a video disc re-
corder, remasking procedures "off line.. are followed fOf
the best SUbtraction result.
4.8.4. Dual-energy and hybrid . ubtractlon, digital filtering
techniques
In par. 4.8.3. the featu res of digital temporal subtraction
are examined, where two images taken in successive
times are subtracted one from the other.
When the anatomical part does not require the use of
contrast medium the subtraction is operated between
two images taken with low and high X-ray energy; if
the two images are obtai ned almost at the same time.
even the artifacts caused by patient motion are reduced.
This technique is called "Dual-energy subtraction and,
if it is applied with the temporal one, is called "Hybrid
subtraction".
The purpose of reduci ng the motion artifacts is attemp-
GllAROONl. RAOIOLOGY ElECTROMEOIClNE
ted also with digital bandpass filtering techniques. These
subtraction methods involve digital recursive filtration of
the continuous fluoroscopic sequences.

.-~ . ---
. . .........

Fig. 44/4 (par. 4.8.3.) - Functional block diagram Of DMD

Gllardoni System for digital subtraction.
1) Radiological parameters control device: X-ray emission
is usually pulsating,
2) Logarithmic compressor and analog to digital (AlO) con-
verter: the video signal processing Is operated In such a
way that the subtraction does not take place between the
video signal intensities but between their logarithms.
So, the grey low-levels, which are very useful for the ra-
diological image formation , are enhanced.
3) Integration 12 bits memory: it integrates the Images to
Improve the signal to noise ratio (SNR) up to 24 dB.
4) VIdeo disc recOfd8f (Winchester type): 330 M byte - 1024
images capacity for digital Image storage and _oll_lln8oo
processing,
5) Digital service memories: matrix 512 x 512 pixels - 8 bits
(256 grey levels) , according to the following considera-
tions;
- 512 x 512 pixels: for a resolution power higher than Figs. 46/ 4 and 4714 (par. 4.8.3.) - Digital subtractiOn tesf.
TV standard one. In fig. 4614 the digital X-ray image 01 8 pelvis phantom, with
- 256 grey levels: for noise reduction, three superimposed catheters, is shown: if 8 digital Image 01
6) Digital processor, D/A converter: It realizes post-process- phantom without catheters Is SUbtracted, the Image showing
ing and: contrast enhancement, levels shifting, subtrac- only the cathet8ra Is obtained (Iig. 47/4).
tion, remasking, etc, The D/A, converter rebuilds the ana-
logic Image lor TV display.
7) Analog video tape: high speed (up to 50 frame/sec ,) and
high capacity (up to 1 h recording time): possibility 01 4.8.5 Fully computerized Radiology
reviewing the recorded Images frame by frame.
Computer is already used in Radiology; in particular
some special techniques, such as T AC. NMR, Nuclear
Medicine. etc, are heavily computerized.
Not much effort was made to introduce computer utili-
zation In Standard Radiology: therefore Gilardonl reali-
zed a fully computerized equipment named Roentgen
Gil : it is described in chapter 4.9.; according to its phi
losophy, the computer coordinates all equipment func
tions such as choosing parameters, mechanical move-
ments and image processing.

Chapter 4.9. - ROENTGEN-GIL: UNIVERSAL. FUL-

LY COMPUTERIZEO EQUIPMENT
(DIAGNOSTIC ROBOT)

4.9.1. A computer controlled equipment

Fig, 45/4 (par. 4.8.3.) - DMD Gilardon; Sys/am for Image digi-
/a/ subtraction.
In Radiology the benefits of computer utilization are un-
On the left: the keyboard for Imaging procedure program- til now limited to special techniques, such as TAC, NMR,
ming: on the right the alphanumeric keyboard for patient etc.
data entering.
Since a lot of time is usually spent by the Radiologist

GI ~OOI'II , RADIOt.OGY - ElECTROMEOlClNE 167

in standard Radiology practice, it is important to intro- 4.9.3. Computer aided, radiographic parameters choice
duce the computer aid in this field of application. on Roentgen-Gil
In particular, the computer is required to periorm the
following functions: The Radiologist can interact with the computer through
the control board shown in fig. 50/4 and a service
movements control of the radiological accessories monitor.
* automation of radiograph ic techniques,
- digitization and ptocessing of the images.
Such an equipment was realized before anyone else by
Gilardoni in the year 1982: its name is Roentgen*Gil
and is shown in fig. 48/4. (see also fig. 23/4 page 155).
This equipment was expressly devised to create a basic
hardware that can assume unlimited configurations for
different performances according to specific softwares.

Fig. SO/4 (par. 4.9.3.) Control board.

The operator can Interact with the compu ter, through the
represented keyboard, looking at a service monitor.

Consu lting a preliminary video displayed menu,.

(fig . 51 / 4) with a lot of stored automatic techniques, the
Radiologist can choose the techn ique of interest and
see the respective computer*suggested data on the vi-
deo screen (fig. 5214) .

FIfJ. 48/4 (par. 4.9.1.) * General view 01 RoentgenGII.

II 1$ a fully compulerlzed equipment where the computer
COOOfdlnates all functions:
1) Mechanical movements.
2) Radiologica l paramete~ choice: fully automatic technique!
are allowed.
3) Images digltizatlon and processing. (see also fig . 23/4
page 155).

4.9.2. Movements control operated by computer 01 Roent*

gen-GII
In fig . 49/4 it Is shOwn how the computer of Roentgen-
Git controls the mechanical movements optimizing equip-
ment performance also in tomography.
Fig. 51 /4 (par. 4.9.3.) Service monitor.
The video display represents the "preliminary menu"; the ope-
rator can choose the technique 01 Interest, operating on the
control board shown In fig . 50/4.
Some gulde notes>o give the suitable operation instructions,
wn lch are also available In synlhetil.e<I vocal output, to the
Radiotoglst.

Fig. 49/4 (par. 4.9.2.) How the movements control works.
There is no mecnanical connection between tube and patient
tilting table: all movements are directly and separately per
formed by tne computer.
These favourable conditions assure total play less move-
ments; even tne most refined techn iques. such as Tomo-
grapny, are perfectly perlormed.
Fig. 52/4 (par. 4.9.3.) Service monitor.
The video display shows the set of data suggested by the
computer for the selected tecnnique.
The operator can agree with the computer sU9gestion and
perform the automatic exposure, or intrOduce other data, or
modify the existing ones: all modifications can. if wanted. be
stored.

168 GILAAOONI. RADIOLOGY ELECTROMED ICINE

Other data can be introduced and, if wished, stored: the
computer checks their admissibility.
So, each radiological exam is performed in optimal con-
ditions and in total safety for tube and generator, with-
out particular trouble for the Radiolog ist.
The operation instructions are given by the computer
through some "guide noles on the video display. They
can also be expressed In synthetized vocal output.
4.9.4. Images dlgltlzation and processing
Roentgen-Gil computer is also en trusted to realize the
images digitization and their processing .
The task is carried oul according to the working modal-
Ities exposed in chapter 4.8. page 166.
The practical realization of the digital processor in Roent-
gen-Gil is shown In fig. 45/4 page 167.
Chaple, 4.10. - DIGITAL ANGIOGRAPHY IN CLI-
NICAL PRACTICE
(From: Rossi P., Passariello R., Simonotti G.. Pavone P.,
Tempesta P., Pesce B. of Rome University. Many thanks
for their collaboration).
(For Digitization technical principle see also chapter 4.8.)
(All figures of th is chapter are reported from page 172
to page 178).
4.10.1. Introduction
Digital Radiography, although potentially valuable in chest,
urography and gastrointestinal studies, has only found
practical utilization in the study of either card iovascular
pathology or other richly vascularized lesions. In these
fields commercially available Digital Subtraction Angio-
graphy (DSA) represents the more advanced technique.
Studies of arterial and venous districts by means of
sim ple IntraVenous (IV) .. bolus" injection of contrast me-
dium are made possible combined by recent develop-
ments in computer technology with increased efficiency
of image intensifiers and linked camera systems.
DSA employs methods which are well known in rad iol-
ogy and have been used up-to-now:
IV arteriography developed by Robb and Steinberg in
1939. It was never widely employed because of low
contrast resolution of conventional radiographic tech-
niques resulting in poor visualization of arterial dis-
tricts.
Digitization of fluoroscopic image, i.e., a conversion
from analog to digital of the gray scale values of the
radiologic image In a numerical matrix.
Radiological subtraction used with films in angiography,
mainly of the cerebral district, to avoid superposition
of bony structures over the opacified vessels.
Although only very recently clinically employed, DSA
has a wide spectrum of diagnostic possibilities and sub-
stitutes conventional angiography in some fields.
GllAIU)()NI. RADIOLOGY ELECTROME0IC1NE
The main advantages of the technique are represented
by the decreased:
a)wasiveness of the IV injection of contrast medium
which makes out-patient examinations poSSible,
b) cost, since radiographic films are not used,
c) dose of X-rays absorbed by the patient during the
examination.
DSA is particularly advantageous in vascular pathology
at the level of the supraaortic branches, intracranial cir-
culation , mediastinal vessels, abdominal aorta and renal
arteries, and peripheral districts.
The purpose of this chapter is to briefly summarize the
way DSA works and the diagnostic results obtainable in
the main fields of application.
4.10.2. Materials and methods
From a technical point of view, DSA basically employs
a normal angiographic suite with a computer linked to
the television system. The DSA zoom should comprise
an X-ray generator of at least 1000 mA, an angiogra-
phic shifting table, and a high resolution TV system
with the image intensifier mounted together with the X-
ray tube on a C arm unit, so that every projection can
be performed without moving the patient. The images
obtained are transmitted by the camera to the analog-
digital converter and from there to the computer.
The exam consists of a seriogram at the level of the
vascular district studied . After IV injection, some images
are taken immediately before the arrival of the Contrast
Medium (CM) , and the remaining images during the
passage of the CM to that level.
One of the previous images (mask) is then digitally sub-
tracted from all the later images (frames) thereby elimi-
nating all superposed structures and yielding an optimal
visualization of the vessels. It is imperative that the pa-
tient remains very still during the whole seriogram . Any
movement will result in an artifact after subtraction, since
each point of the matrix of the mask will not corre-
spond to that of the fram es.
The intravenous injection of CM is usually performed in
the Superior Vena Cava (SVC) with a 5-6 F pigtail
catheter introduced through an ante-cubital approach .
CM is Injected at a rate of 18-22 ml/sec, with 40-50 ml
for each bolus... Whenever no antecubital vein can be
catheterized, IVC injection is performed through a femo-
ral approach.
SVC injection has substituted the antecubital vein injec-
tion with short cannula. In the latter a too high inci-
dence of vein rupture was found and lower rates of in-
jection had to be used.
The degree of opacifi cation of vessels is in fact related
to the rate of injection and to the concentration of CM.
76% CM with 37 grams of iodine/UXXl ml is used, while
non ionic CM is employed in selected cases only.
The number of eM injections needed to complete an
examination of a vascular district varied from a mini-
mum of two injections for the abdominal aorta and re-
169
nal arteries to 4-5 injections for the study of supraaortic
branches and peripheral districts.
DSA can also be used with intraarterial injection of CM
(figs. 54/4, 57/4, 62/4). Intraarterial DSA has many ad-
vantages over both intravenous DSA and conventional
angiography:
The possibility of using lower amounts of CM be-
cause of higher contrast resolution of DSA, as com-
pared to conventional screen-film radiography. An
amount 3-5 times lower depend ing on the district stu-
dies can be used. Moreover, the eM can be diluted
with saline SO/50, reducing the osmolarity of the CM
and making the injection almost painless.
Injecting lower amounts of eM at lowest rates. It is
possible to use smaller catheters, thereb y reduci ng
the vascular trauma.
Lack of time interval between the injection of CM and
the passage of the bolus at the level of the arterial
segment studied, therefore, reducing the possibility of
movement artifacts.
Digital acquisition of radiological image, as with CT,
reduces the occurrence of technical mistakes and the
limitations due to over or under-exposure.
The association of all these factors allows to perform
even complex angiographic studies in uncooperative or
high risk patients.
4.10,3. Clinical applications
Clinical indications of intravenous DSA are mainly in
the field of actual vascular pathology, such as stenosis,
obstruction, embolization, aneursysm, malformation, and
post-operative control in vascular su rgery. Also vasculari-
zed neoplastic lesions can be studied with DSA, espe-
cially those involving the bones or the sku ll.
Intraarterial DSA, besides in the above mentioned fields,
can be used In all typical applications of conventional
angiog raphy, such as in parenchymal evaluation and stu-
dies of portal hypertension.
4.10.3.1. Neck vessels and intracranial circulation
The study of neck vessels represent the main applica-
tion of DSA in patients with symptoms related to steno-
sis or obstruction of the carotids or vertebral arteries.
The examination should be carried out as a screening
in patients with TIA, RIA, amaurosis fugax or complete
stroke, and should not be influenced by the results of
the Doppler examination since this exam is considered
just indicative in localization of stenosing lesions.
With different projections the origin of the supraaort ic
branches from the arch (fig. 55/4 - 5614) , the carotid bi-
forcations (fig. 53/4) and the intracranial circulation can
be studied. For a complete examination, at least 3-4 CM
injections in the different projections are needed to avoid
the superposition of vessels.
With proper technique DSA has an accuracy compara-
ble to conventional angiography. With only a little varia-
170
tion between institutions. the number of non diagnostic
examinations averages about 5% of the total cases.
These are mainly related to the presence of movement
artifacts which occur either voluntarily or are due to
swallowing, breatching, coughing, cardiac insufficency
determining an excessive dilution of CM in the arterial
phase, or finally due to the movement of a calcified
atheromatous plaques.
DSA can differentiate a simple atheromatus plaq ue from
an ulcerated one and show aneurysms or simple dilata-
tions and glomus tumour. Also the subclavian steal syn-
drome can be visualized .
DSA has now an accuracy definitely better than that of
Doppler examination, and allows to study all the bran-
ches from the arch to the intracranial level.
Even when previous Doppler exami nation has given a
negative result, it is still preferable to perform an intra-
cranial DSA with selective carotid injections in order to
visualize the small ulcerated plaques with distal em bo-
lisms, which are scarcely definable with intravenous
DSA
In the intracranial circulation DSA has also been widely
employed with different indications and results. In hy-
pervascularized cerebral tumors (meningiomas, etc.), DSA
shows the neoformed vessels and the drai ning veins
quite well, together with its relationship to the main
cerebral vessels. This information is very important in
pre-operative evaluation.
Even more information is obtained in cases of A-V mal-
formations and aneurysms. These lesions are identified
with DSA if they have a considerable size (greater than
0.5 cm) and if they present over an area free of move-
ment artifacts.
Also, stenosis or occlusion of main cerebral vessels can
be shown with DSA as well as the dislocation of intra-
cerebral vessels after cerebral hemorrhage.
Finally, in post-operative controls, the patency of intra-
and extra-c ranial anastomosis between superficial tem-
poral and middle cerebral arteries can be visualized des-
pite the small size of the vessels.
4.10.3.2. Mediastinal vessels
Thoracic aortic aneurysms do not usually present a dif-
ficult diagnostic problem . The presence of the lesions,
their extension, the involvement of supraaortic branches
and the status of the aorta proximal and distal to the
aneurys can be easi ly shown by DSA. The opacification
of the aneurysmal sac is decreased because of the slow
flow with dilution of the eM.
For this reason, it is sometimes difficult to visualize the
aorta distal to the leSion, especially that of the descend-
ing aorta in the diaphragmatic hiatus where homogenei-
zation of the field is often inadequate.
In aortic dissection, DSA can show the beginning and
the whole extension of the false lumen, recognizable
because of the different flow and the inti mal flap. The
distal end of the dissection and the presence of aortic
valve insufficiency is more difficult to show.
GILAFlOONI. RADIOLOGY ELECfflOMEDIC INE
In aortic coarctation and stenosis, DSA can provide a
useful screening , showing the lesion and its extension.
However, because of the slow distal blood flow and
subsequent dilution of the eM, the opacific ation of the
distal aorta and the collateral circulation is not always
valid for pre-operative purposes. The intraarterial study
is therefore needed. The presence of an aneurysm in an
intercostal branch could be missed with intravenous stu-
dy, thereby changing the operative approach.
The more common anomalies of the thoracic aorta and
branches, which usually do not need any therapy, can
be shown optimally with DSA. Only when there are
multiple or symptomatic anomalies, an intraarterial study
could be required in the pre-operative phase.
Differential diagnosis of some mediastinal masses can
sometimes require an angiographic study. With DSA it
is always possible to show the vascular nature of a le-
sion, or, when a solid mass has been found , the rela-
tionship with the main vascular mediastinal branches.
Pulmonary arteries pathology can not be studied as well
with DSA because of the limitations due to the pres-
ence of movement artifacts in the lung fields, which
does not permit a good study of the smaller alterations.
Alterations inVOlving the main branches can be seen
however with DSA. In the same way, A-V fistulas, be-
cause of high vascular flows, are easi ly visualized and
the feeding arteries and draining veins can be seen.
The study of pulmonary emboli with DSA can be limit-
ed to the trombi involving the main branches.
4,10.3.3. Abdominal aorta and branches
Use of large field image intensifier (35 cm , 16 inches)
has extended the indications of DSA to the abdominal
aorta, while initially limited to the study of isolated athe-
romatous lesions or of depistage of reno-vascular hyper-
tension.
At the moment, abdominal aortic aneurysms and dissec-
tions, Leriche syndrome, visceral embolisms and trauma
can also be studied with DSA.
The study of abdominal vessels is usually perlormed in
A-P projection with a large field image intensifier. To
avoid movement artifacts due to bowel gas, IV glucagon
(1 mg) and external abdominal compression are routine-
ly used . When superposition of mesenteric vessels is a
problem, a further oblique projection is needed.
In abdominal aortic aneurysms DSA shows the presence
of the lesion, its extension and the involvement of the
renal and iliac arteries (figs. 58/ 4, 59/ 4, 6Oa/4). The ex-
act external size of the aneurysm is not well defined
with DSA as well as with conventional angiography.
This is because of the frequent presence of parietal
thrombi. Therefore, better information can be obtained
with ultrasound and CT or angio-CT.
GI LAA DONI . RADIOLOGY - ELECTAOM EOICINE
The evaluation of renal arteries in the screening of hy-
pertensive patients is well done with DSA. Nowadays,
this procedure would substitute all other indicative diag-
nostic examinations (IV pyelogram with wash out or
nuclear medicine study) . DSA can show the morphology
of renal arteries and afterwards, a dynamic evaluation of
renal function as in the IV pyelogram with wash out
can be performed. In this way, time, amount of CM in-
jected and morey can be saved and, if the DSA is per-
formed th rough an IVC injection, with the same catheter
selective venous sampling from renal veins can be per-
formed.
The study of abdominal parenchymal organs cannot be
performed with IV DSA because of the superposition of
the vessels and the limited resolution of the technique.
However, intraarterial injection with DSA can avoid the
use of large amounts of CM when the study of various
vascular districts andlor parenchyma is needed (fig. 63/4).
The use of large field image intensifiers is required in
evaluating the portal system. In the late phases of celiac
trunk injection with limited amount of CM, a useful
opaCification of the portal vein is obtained with DSA in
order to evaluate the patency of the vein.
4.10.3.4. Peripheral vessels and post-operative controls
DSA equipment employing large field image intensifiers
can substitute conventional angiography in pre-operative
screening of peripheral vascular disease. Using equip-
ment with these technical characteristics, it is possible
to evaluate the peripheral district from the renal arteries
to the tibial vessels with 4 injections of CM (fig . 61/4) .
It can be foreseen that in the future, a system will be
developed that uses a shifting of the angiographic table
during peripheral studies, so that only one injection of
eM would be enough to complete the study.
For its safeness and low invasiveness, DSA can also be
routinely employed on asymptomatic patients at high
risk for such a disease.
Definitely DSA will represent the method of choice in
the evaluation of peripheral vascular disease to deter-
mine the better medical, surgical or transcatheter (angi-
oplasty) treatment, to follow-up asymptomatic post-oper-
ative patients (fig. 60/4 B ) showing complications of
surgical revascularization, and evaluating the whole run-
off which is not always obtainable with conventional
angiography because of the low concentration of eM
distal to obstructions.
SOME CASE OF DIGITAL ANGIOGRAPHY ARE REPORTED
FROM FIGS. 53/4 TO 63/4.
171
 SOME CASE OF DIGITAL ANGIOGRAPHY
(The ptinting remarkably reduces the inlormation power 01 images compared with the originals).

Fig. 5314 AS (par. 4. 10.3.1.) Two cases of atflerosclerotic lesions of internal carotid arteries.
(A) SUb-occlusive segmentary stenosis of the right Internal carotid artery is present (arrows). as well as a marginal lesion at the level
of the Internal carotid artery (large arrow).
(B) Tight cooceolric stenosis of the left internal carolid artery with good visualization 01 both vertebral arteries (V).

B
Fig. ( par. 4. 10.2.)
(A) Intracranial circulation in a case of cerebral vascular disease. The absence of the terminal part of the left Internal carotid artery
is well shown; the vascularization to the left hemisphere is guaranteed through collateral circulation by means of the anterior com-
municating vessels.
(B) Digital selective arteriogra m 01 the left vertebral artery. E.x.cellent visualization of the basilar artery and of the posterior fossa Cir-
culation.

172 OILARDONI. RAOIOLOGY - ELECTROMEOICINE

 /t\

Fig. 5514 A B (par. 4.10.3. 1.)
(A) Normal aortic arch. Evidence of the origin of the supraaortic branches with mild kinking of the bran chiocephalic artery. The ar-
rows show the dillicu lties found in obtaining a satisfying visualizetion of the aorte through the diaphragm due to different exposure
fields pertaining to the thorax and the abdomen.
(8 ) To rtuosity of the aonlc arch.

Fig. 56/4 (par. 4.10.3.1. ) - Isthmus coarctalion of the aorta

(arrows).
The intravenous digital angiography Is able to diagnose the
presence of the lesion, although it is sometimes not very
useful in visualizing the anatomical characteristics of the le-
sion. In these cases intraarterial digital angiography could be
used with many advantages.

GIl.AROONI. RADIOLOGY _ ELECTROMEOICINE 173

 A B
Fig. 57/4 A-B (par. 4.10.2.)
(A) Selective catheterization 01 the IeI1 subclavian artery in a case of thoracic outlet syndrome due to compression from the clavlcte
during abduction 01 the arm (8 ) (arrow).

Fig. 56/4 A-8 (par. 4.10.3.3.)

(A) Saccular aneurysm of the abdominal aorta without involvement 01 the renal and iliac arteries (arrow).
(8) 8ig aneurysm of the abdominal aorta with aneurysm 01 the right common lilac artery. Using external abdominal compression
and IV glucagon a better exam can be performed by pulling the bowel loops out of the region 01 interest

174 GII..AROONl. RAOIOt.OGY - ElECTAOMEOICIHE

 A
Fig. 59/4 A-8 (par. 4. 10.3.3.)
(A) Small aneurysm 01 the abdominal aorta. Good Yisualization 01 the renal vessels which appear to be normal.
(B) Same case 81 lilac level showing alherOSClerOlIc parietal lesions 01 the iliac vessels (arrows).

Fig. 6014 A (par. 4.10.3.3.); B (par. 4.10.3.4.)

(A) Bilateral aneurysmal dilatation of the common femoml arteries. (8) POSI-op control of aorto-bllemoral by-pass functioning well.

GILAAiJ()oNl. RAoOlOLOGY - ELECTROMEOICINe 175

 Fig. 6114 A-S-C-D-E (par. 4.10.3.4.} - Peripheral vascular dis-
ease.
(A) Good documentation of abdominal aorta from renal arter-
ies down to iliac vessels. There are parietal alterations and
stenosis at the origin of hypogastric artery.
(8, C, 0, E) Consecutive injections show every vascular dis-
trict of the limbs to the tibial level (E). In this case there is
a complete obstruction at the level of the right superliciaJ femo-
ral artery (0, arrow) with distal recanalization and good vi -
sualization of the popliteal artery (E, arrow).

"
',1
f

176 GllAADON I. RAOIOlOGV _ ELECTROMEOICINE

 Fig. 6214 A-B-C-D-E (par. 4.10.2.} - Intraarterial DSA in . a
case of peripheral vascular disease.
(A, B) Injection of limited amount of CM (20 ml) shows wi-
de-spread atherosclerotic lesions at the level of the abdomi -
nal aorta and lack of visualization of right kidney.
(C, D) At iliac and femoral level there are severe atheroscle-
rotic lesions of the common iliac arteries, obstruction Of right
eJlternal iliac artery, tight stenosis of both hypogastric arte-
ries, and complete obstruction of both superficial femoral ar~
teries.
(E) At the level of the knee. it has been possible to show
only a mild opacification of the popliteal artery (arrow).

. .-/

o
GI LARDONI. RADIO!..OGY - ELECTROMEDICINE 177
 Fig. 6314 A-S (par. 4.10.3.3.) - In-
fraarterial DSA In a case
hemangioma.
0'
hepallc I A
(A) In the arlerial phase the vascular
lakes filled wi th eM are evident in
the outer part of the lesion.

(8) In the venous phase those lakes

are beller visualized, charact9fistical
pattem of hemangiomas. There is al-
80 optimal visualization of the portal
system.

176 GIt...AAOONI. AADIOLOGY - ElECTFIOMEOIClNE

Chapler 4.11 . - DIGITAL IMAGE ARCHIVING 4.11.3. Digital Optical Recording (DOR)

The disadvantages of traditional archiving menagement
based on patient film jackets have become obvious in
diagnostic radiology departments.
The cost of films, personnel and storage space con-
tinues to increase rapidly and the extensive use of new
diagnostic systems that generate digital images suggests
the need for new image archiving and management stra-
tegies matched to computer based technologies.
4.11.1. Picture Archiving and Communication Systems
(PACS)
In simple term s, a PACS is an interconnected computer
network, that interfaces with the existing diagnostic im-
agi ng units to acquire, process, sto re and display digital
Images as an alternative to film.
The advantages offered by PACS are collected in three
major types: clinical, organizational and economic.
Clinical benefits include the possibility of digital image
processing like contrast windowing, computer aided pat
tern recognition and quantitative analysis.
Organizational benefits are in fa ster turn around on ra
diology reports, thereby shortening hospital stays, and
fewer missing or misfiled patient film jackets.
Economic benefits arise from lower film and film pro
cessing costs, plus related cost cuts in filmhandling
personnel, salaries and film storage space.
The only cost-effective storage media available today
with this large capacity are the Digital Optical Record-
ing Laser Discs (DaR): they offer a net data capacity
reaching about 2 Gbytes per face and a security stor-
age time exceeding 10 years.
A DaR disc has a diameter of about 30 cm. and is
made like a sandwich of two glass coats separated by
an air gap.
On the internal surfaces is engraved a spiral, equivalent
to 32.000 circular traces and are evaporated thin metal-
lic layers.
A light ray of a solid state laser drived on the spiral
writes digital bits on the substrates by means of mi-
croscopic holes (diameter = 1pm) obtained by locally
focusing the metallic layers.
4.11.4. Laser disc juke--boxes
It is clear that in a complete archiving system designed
for a time of several years there will be some thou-
sands of laser discs.
It is logical to think that there are at least two different
memory levels in the archive hierarchy.
The first one intended for the collection of most recent
examinations, implemented on a series of quick entry
sing le DaR readers.
The second one intended for older images not so Ire--
quently consulted which cou ld use juke-boxes of huge
capacity laser discs with linear organization or even bi-
dimensional .
At this level the latency could turn out in the order of
few tenth of seconds.

4.11.2. Storage capacity required for a PACS

Table 6/4 gives the data quantities corresponding to the

various types of digital images.
Statistical studies show that an active department serv
mg a 600 beds hospital generates today between 250 to
500 Megabytes of digital diagnostic Image data per day,
excluding standard radiograph y and fluoroscopy that ra--
present the remaining 60% to 70% of the department
volume.
Therefore a complete PACS encompassing all the imag
ing modalities will require between 1 to 2 Gigabytes
(1()9 bytes) per day.

TABLE 6/4 (par. 4.11 .2.) Storage capacity required

for 8 single image data set corresponding to the
va rious diagnostic applications.

Image type Format Dala quanlity

TAC 512 x 512 x 12 384 Kbytes

U.s. 512 x 512 x 6 192 Kbytes
Nuclear Medicine 256 , 256 x 6 48 Kbytes

Digital Angiography 512 x 512 x 8 256 Kbytes

High reso lution TV picture 1024 x 1024 x 8 1 Mbyte
Big format X-ray film 2048 x 2048 x 8 4 Mbyte

GllAROONl, RA,OIOLOGY ELECTROMEOIC INE 179

 PART 5

ULTRASOUND IN MEDICAL DIAGNOSTICS

 PART 5
ULTRASOUND IN MEDICAL DIAGNOSTICS
Chapter 5.1. - INTRODUCTION
Ultrasound is currently finding new values and applica-
tJOns in many fields of science, engineering and medi-
cine.
Basic physics of this discipline is easily extended to dia-
gnostic ultrasound.
Though ultrasound has already been used for therapy
and was proposed by $okolov for diagnostic use in
937, no successful attempts to apply the ultrasonic
pulse-echo principle to medical diagnostics were made
until the early 1950's. Recent developments in this field
em phasize the importance of scan converter technology,
computer implementation, gray scale improvements and
tissue classification analysis: now the use of ultrasound
10 medicine is a diagnostic field generally known as
~ hotomography ...
The greatest advantage of echotomography is the non-
..w asive and non-ionizing nature 01 the examination and
the relatively low cost of the equipment.
""'owadays, in several diagnostic fields, these ultrasonic
examinations are superior to other methods known so
far, this because better instruments have been developed
and a more clinical experience gained.
Nevertheless, certain physical and technological limita-
ttons remain, that restrict the use of echotomography:
strong reflections of the ultrasound beam from boundar-
teS between tissue and air or boundaries between tissue
and bone prohibit the scanning of lungs, intestines and
Wltracranial soft structures in adults.
Ultrasound is a mechanical vibration (like sound) of high
frequency, normally In the range from 1 to 10 MHz,
much over the bandwidth of human ear, that is, from
few Hz to 16 kHz.
These vibrations (or pressure train waves) are driven in-
to tissue by the molecules themselves and are charac-
terized by a very small wavelength, so that it is possible
to clearly detect and localize small - interfaces between
two tissues of different acoustic characteristics.
Chapter 5.2. - ULTRASOUND GENERATION
5.2.1 . Plezoetectnclty
Piezoelectricity is a property of certain crystals such as
quartz, Rochelle salt, tormoline, lithium sulphate. etc.
As the name implies, electricity is developed when pres-
sure is applied to the faces of these crystals.
The reverse effect is also present. When a voltage gra-
dient exists in the material , the crystal changes shape
(fig. 1/5).
The magnitude of the deformation is very small, of the
order of few Angstroms only, in medical applications.
Piezoelectric crystals are natural crystals: cutting slabs
from crystals with their faces normal to the crystal-
log raphic axes, piezoelectric elements are obtained
(';9. 2151.
GllAROONI. RADIOLOGY ElECTROMEDICINE
,.) Co,
Fig. 1/5 (par. 5.2.1.) Basic expander types of motion in rec
tangular crystals.
The type (a) corresponds to a thickness mode vibration lor
generation 01 longitudinal waves, while the type (b) cor-
responds to a lateral mode vibration lor generation 01
shear waves.
The crystals generally used by probe manulacturers are
thickness mode vibrating.
I
~
. ,
: -- -~--- y
Fig. 2/5 (par. 5.2. 1.) - Quartz pi&-
zoel&clric crystal.
I Positioning 0 1 crystallographic
axes In quartz crystal and rec-
tangular and circular elements
drawn Irom this c rystal. A volta-
ge applied to the surfaces nor-
mal to the allis II generates com-
pressional stra in.
5.2.2. Ferroelectrlclty
The ferroelectricity mechanism is shown in fig . 3/5.
Ferroelectric materials are composed of many domains
each including a large number of molecules and having
a net polarization vector or charge.
When no voltage gradient exists in the material, the
doma ins are randomly oriented. If a voltage is applied,
the domains are randomly oriented. If a voltage is app-
lied, the domains stend to line up in the direction of
the field and, since a domain is longer in the direction
of its polarization vector than in thickness, the block as
a whole expands; if the voltage gradient is developed in
the opposite direction, the block expands too.
To become piezoelectric a ferroelectric material must
undergo a polarizing treatment which consists in apply-
ing a strong d.c. field to orient all the domain vectors
in one direction .
If an oscillating voltage, small in relation to the polariz-
ing treatment, is applied to the faces of a polarized
material , the domains do not reverse themselves but
merely line up to a greater or lesser extent as the oscil-
lating voltage strengthens or weakens the polarizing field,
thus giving a linear response characteristic; in these
conditions, the polarized material begin to vibrate at a
frequency imposed by its thickness.
181
These materials, such as barium titanate, lead zirconatet- 5.2.3.1. Nature
itanate, lead metaniobate, are polycrystalline materials
and are known as piezoelectric ceramics. Piezoelectric materials may be crystals or ceramics (see
par. 5.2.1. and 5.2.2.).

5.2.3.2. Density

Density p is the ratio mass to volume.

5.2.3.3. Maximum operating temperature (Curle point)

, It is the temperature above which the material loses its
Fig. 315 (par. 5.2.2.) - FerroeleCfric effect.
Charge domains in a ferroelectric material are ran domly
orien ted in (a) with th eir polarization vectors pointing in
all directions because no electric l ield has been appli ed.
A voltage across the laces 01 the slab in (b) ca uses most
of the domains to line up with their polarization vectors
parallel to the field.
As domains are lon ger in the vector directi on than in
thickness, the slab expands.
5.2.3. Piezoelectric materials
Piezoelectric crystals are not widely used in probes ma-
nufacturi ng because, generally, they offer less magnitude
of deformation and consequently less sensitivity.
Quartz is now wholly abandoned; lithium sulphate is
sometimes used, mostly in the probes used as receivers.
Piezoelectric ceramics thus cover the large request by
probes manufacturers. The most used is lead-titanate-
zirconate, besides lead metaniobate and barium titanate.
In table 1/5 are listed the principal data of some mate-
rials used as piezoelectric transducers.
The meaning of some data is well known, for others it
is better to give explanations.
piezoelectric properties.
Obvi ously the operating temperature must be substan-
tially below the Curie point because the efficiency un-
dergoes a reduction with the loss of the piezoelectric
properties. In addition the element activity is reduced
for the aging process acceleration .
For these reasons the m8J(imum operating temperature
given by the manufacturer must be observed.
5.2.3.4. Velocity
Veloc ity "V" is the speedness of the ultrasonic waves
travelling in the piezoelectric material.
5.2.3.5. Acoustic Impedance
For the definition see par. 5.3.4. page 165. This parame-
ter is very important in the probe manufacture because
it condit ions the choice of the materials in contact with
the piezoelectric element.
5.2.3.6. Frequency constant
The frequency constant is the product of the piezoele-
ment thickness and the resonance frequency.

TABLE 1/ 5 (par. 5.2.3.) Characteristics of some piezoelectric materia ls.

I~
Denltl~ M.. ,mu m Souna ACOIl51' C F'equenc~ Couphng PlelOelee l"C PluoeleeHic Mec nan ,etl Rel . ". e
Ope" ' Ing . e loclly Impeoance con .. anl II Clo' cn.'Qe . on&ge OUlh ' y Ole le e Ule
le mp ...lu,e eoeUle,en l coe li,ele n' IIC lo' con. lanl
p V Z N" K, d" g" Q. t, - t33/t O

10 3 Kg/m 3 'C ml, 100~ M HZ ' mm I lO->'mlV 10-'~ I I

Ma le " ,1 m" s N
Quart z 2.65 550 57 40 15.2 2.87 0.1 23 58 10' 4.5
PI-SO
Zi rcon ate . 75 250 3 720 27.3 1.86 0.45 400 290 105 1600
Tit a nate

PZT5A
Zi rcon ate - 78 290 3 780 29.3 1.89 0 .4 8 344 248 75 1700
Tita na te

K 81
Le ad 5.8 500 2300 20.4 I.S5 0.4 85 32 15 300
Meta niobat e

Barium
Titanat e
5.7 70 .;- 90 5400 30.5 27 04 170 13 400 13 50

lith ium
Sulpha t e
2.06 75 5460 11 .2 2.73 0 .35 16 175 - 10

182 GllAROONI. RArn OlOGY - ELECTAOMEOICIN E

For the oscillators vibrating in thickness mode, the con-
dition of resonance is that the thickness is equal to M2
if A = v/f is the wavelength, "v" the sound velocity and
,.. the wave 'renquency:
A ,
s = - = -
2 2 f
According to this relation, the thickness is inversely pro-
portional to the frequency of the generated ultrasonic
wave. In table 1/5 (page 182) are listed the frequency
constants of some piezoelectric materials corresponding
to the piezoelement thickness referred to 1 MHz.
5.2.3.7. Piezoelectric con.tant.
The piezoelectric materials are anisotropic and their elec-
trical, mechanical and electromechanical properties differ
for each axis, for electrical or mechanical excitation and
according to whether the crystal is free or damped.
The principal piezoelectric constants are the electrome-
chanical constants. They are:
coupling or electromechanical factor Kt expressing the
abi lity of a piezoelectric material to transform electri-
cal energy into mechanical energy and viceversa;
strain constant or piezoelectric charge coefficient d
expressing the ratio of strain developed to the electric
field applied ;
stress constant or piezoelectric voltage coefficient g
expressing the ratio of field developed to stress ap-
plied.
Other piezoelectric constants are: the mechanical quality
factor am . identifying the rela tion between strain and
stress, and the relative dielectric constant c, identifying
the relation between dielectric displacement and electric
field.
Chap'er 5.3. ULTRASOUND PHYSICS
5.3.1. Ultrasonic wave.
Ultrasonic waves are mechanical waves, that is, they
transfer mechanical energy in contrast to light or X-ray
which are both electromagnetic waves.
The mechanical energy associated with the ultrasonic
wave is transferred across the material by molecules
which oscillate around their rest position.
They can travel in any elastic material and in a liquid
like sound does.
In each material, according to its elastic properties, they
travel with a characteristic velocity, are reflected and re-
fracted at boundary o f two materials with different acou-
stic properties, and they decrease in intensity by scatter-
ing imposed by inhomogeneous materials and by ab-
sorption.
The characteristic parameters of ultrasonic waves are:
velocity, (v) speed of sound propagation depending
on type of wave and material;
freq uency, (f) number of cycles in a period (time un-
it) depending on the thickness of the piezoelectric
element:
Wavelength , (A) in the material , the distance between
two planes in which the particles have the same mo-
tion condition. It is important to note that the wave-
length A is the ratio velocity/frequency;
GIl.ARtX)NI . RADIOlOGY ELECTROMEOIClNE
acoustic intensity, (I) is the average power through a
unit area normal to the d irection of propagation
(Wattlcm2) .
In fig . 4/ 5 are shown the longitud inal ultrasonic waves.
They generate alternate compression and rarefraction zo-
nes along the direction of motion of the wave in which
the particles in the medium support an oscillation back-
wards and forwards In the same direction as that in
which the waves are travelling. The - forward velocity of
propagation of the sound wave is caused by the elastic
interconnection between the particles wherein each par-
ticle.
...,....Jl
u
C!!,..ue. .... .., .....
............... C.~ :-:-:-:::! ....... .....
_...........................
.. ................................
..........
........ .. ........
........... ... ...... .
...............
_ .... .. ............. ...........
..........
.......... ........................
........................
..
.. ......
. .... . .......
'
Fig. 4/5 (PBr. 5.3.1.) Longitudinal waves.
The particle oscUlation Is parallel to the direction of pro-
pagation (compressional waves).
In the material there are pressure and rarefaction zones;
the distance between two consecutive zones of pressure
(Of rarefaction) Is A (one wavelength).
5.3.2. Wave propagation velocity
In the following paragraphs we propose the formulas
that allow to evaluate the velocity of ultrasonic waves
through the characteristic properties of the material such
as elasticity modulus and density.
Obviously these formulas have a theoretic meaning and
are truly reliable if the material is homogeneous.
In table 2/5 are listed the velocity values for longitud i-
nal, shear and surface waves for the most common
body parts.
The following formula allows to calculate the ultrasound
velocity in solids:
v={r
where E is the longitudinal elasticity modulus and S the
density.
The formula fo r liquid s is:
v=[r
where K is the Bu lk mod ulus.
5.3.3. Beam geometry
If we consider the emitter crystal as an oscillating sy-
stem in a continuous medium, according to Huyghens
principle, each poi nt of the system can be considered
as a single emitter with an associated wave front, evi-
dently spherical.
A zone near to the emitter surface will be characterized
by an irregu lar pressure behaviour since this zone is
that of composition of all the emitter points considered
before.
183
 TABLE 2/5 (par. 5.3.2.) Typical wave velocity
and acoustic impedance values for selected mate-
-
rials.

Biological materiel Density p

gmlc~
Loogjludi~1

V!llocity of Sound
wall'8
I\coustic Impedance
W = pV
N ----I
V (m/sec) Fig. 515 (par. 5.3.3.) - Schematic diagram Of the ultrasonic
(glcm' sec)
bema geometry.
Blood 1.<155 1.580 1.67 x 105
1) Pressure behaviour in N (near field) secllofl.
Bone r) Spread angle.
Skull (adult) 1738 2.240 ~ 3.89 x 105 8% For the evaluation of N value the following formula is used:
Skull (embalmed) 1.339 3,198 4% 4.28 x l Q5 4% DefP - A2
N=
Cerebellum 1034 1,470 4% 1.52 x l Q5
Generally being A "' Dell the A2 term can be omitted so
Eye the I()(mula in practice is:
Aqueous humor 1.00 1.500 1.50 x lQ5
1.14 1.85 x lQ5 Deft'
1.620 N =
"""
Muscle (adult)
Optic nerve (adult)
1.0212
1.0327
1,612 0 .8%
1,644 1.5%
1.65 x l OS
1.70 x lOS
O .~
1.5% For the evaluation of r value the formula Is the following:
Orbital '01
(adult)
Vilreous humor
0.9516
1.00
1,582 1.3'110
1,520
1.51 x 105
1.52 x
1.3'110
105 >
slnr - K - -
Deff
'01 0.952 1.450 1.38 x ")0 where K is in function of the considered dB drop value.
In both formulas Deff states the effective piez06lement
Kidney 1.04 1.560 1.62 x ")0 diameter.
liver 106 1,550 1.64 x ",.
Muscle 1.08 1.580 1.70 x ")0
Soft tissue (aver&gel 106 1.5<0 1.63 x I Q5
Spleen 1.04 1.566 1.63 x 105

In the next zone, for which the previous situation is

normalized, the wave front may be considered as a
plane wave front w ith regular pressure behaviour.
In other wo rd s, after the first zone with an irregular
pressure behaviour, for which the intensity is contained
in a cylindric volume, begins a second zone for which
the Ultrasonic beam spreads according to the type (dia-
meter and frequency) of the emitter and to the type
(velocity) of the medium according to fig. 5/5.
Fig . 6/5 illustrates the beam geometry by a polar dia-
gram.
The following formula states the pressure distribution
Fig. 6/5 (par. 5.3.3.) - Po/af diagram of compraMlon w.lle
along the emitter axis: probe propagating into a homogeneous medium.

p. = P, 2sin [(- : V~' + x' - x) J

The lobes geometry Is a function 01 fatlo D/A being D
the diameter of the emitter.

The formula is experimentally verified by making the ul-

being x the d istance from the emitter and Po a refe- trasonic beam collide w ith a point rellector moving away
rence pressure. from the emitter surface.
The exami nation of the above formula reveals that an Fig. 7/5 page 185 shows the graphic of the theoretic
Infinite succession of maximum and minimum is present behaviour of the pressure along the transducer axis.
along the axis.
The lower is the ratio reflector dimension to emitter di-
The last maximum occurs at a distance N (near field). menSion, the more the experimental behaviour approa-
from the emitter surface defined in practice by: ches the theoretic behaviour.
The section ",N,. defines the separation between two ul-
Deff 2 Deff2 . f trasonic zones: the first zone is named near field or
N = Fresnel zone, the second one is named far field or
4 A 4 , Fraunhofer zone.
The formula that states the beam spread is the fotl o-
where Deff is the effective crystal diameter oscillating in wing, referring to the fig . 515:
the medium.
The effective d iameter is less than the nominal diameter A
because a little part of the emitter surface. i.e. the part
sin r= k - -
Deff
near the boundary of the case. is not allowed to vi-
brate. where k is a coefficient that connects spread angle to

184 GILIVlOONI . flAOIOLOGY - ELECTflOMECIC INE

the choice of the minimum reference pressure value Referring to pressure, two coefficients can be stated: a
since the pressure reaches the 0 value asymptotically. reflection coefficient r:
K value is 1,22 if we refer to a level stated at 10% of
the maximum value. Z,
1
r ~
Z, Z, Z,
Z, + Z, Z,
1 +
Z,
and a transmission coefficient

t = 1

The values of r and must be squa red when we refer

to energy.
/- It is now evident that it is not possible to transmit ul-
trasonic energy in the air because the air has a very
low acoustic impedance (much lower than the acoustic
impedance of the crystal) so that the transmission coef-
ficient is negligible.
Fig. 7/5 (par. 5.3.3.) - Theoretic sound pressure distribution
along the Bl(is. The formula above does not hold valid for thin films
such as those used for coupling or crystal protection in
This distribution is the theoretical distribution determined which interterence effects take place.
according to th e formula
Table 3/5 shows the values of energy reflection coeffi-
p. = Po 2 sin [ ( ~ V~' + x' - x) J cients between two media normally met in ultrasonic in-
spection.
where: x is th e distance along the acoustic axis,
Po the reference pressure va lue.
D the c rystal diameter.
This distribution does not take into account the losses due TABLE 3/5 (par. 5.3.4.) - Reflection end transmis-
to absorption. sion ratios for selected material interfaces

utlo l. 1,11,. 0";00. 1";1"

5.3.4. Beam rellection Rellected
Ampli tude Ene~y Amplitude Ene~ y
Su rlace.
Rati o 0 1 Ratio 0 1 Ratio 0 1 Rat io 0 1
So far we have considered the propagation medium as Mat&rial 1 Reflected Rellected Transmitted TransmittllCl
homogeneous. "
Material 2
to Incident
w.~
to Incident
Wa~e
to Incident to Incld&nt
Wave Wave
let us examine now what happens when the beam im-
pinges perpendicularly on the interface between two Plexlglas-solt
med ia. tissue -0.317 0.100 0.682 0.900
It is important to define first of all the acoustic impe- Soft tissue-
dance ..z,. that is a characteristic of the material. plexiglas 0.3t 7 0.100 1.317 0.900
It expresses the opposite resistence of the medium to Cork - steel 0.995 0.989 1.995 0.011
ultrasound propagation and so the ratio between the Solt- tissu e blood 0.010 0.0001 1.01 0.9999
cause p (the sound pressure) and the effect v (the par-
Water muscle -0.07 0.005 1.07 0.995
ticles velocity).
E", (lens) glass -0.749 056 1.75 044
It can be calculated by the following:
E" (orbi tal lat)-
muscle 0.06 0.004 106 0.996
z = L, = p.v Alum inium
plexiglas -0.69 0.47 0.32 0.53
where p is the sound pressure, v the particles velocity, Fat- skull (adult) 0.48 0.23 1.5 0.77
p the specific mass density and V the ultrasound veloci- liver 0.089 0.008 1.089 0.992
F"
ty.
F" kidney 0.08 0006 108 0994
In energy, the beam that impinges on the intertace be-
tween two media with acoustic impedance Z, and Z2 is Soft tissue-
skull (adult) 0.41 0.17 1.4 0.83
reflected and transmitted in such a way that the sum of
these two last aliquots of acustic energy, equalizes, ac-
cording to the energy conservation principle, the inci- 5.3.5. Ultrasound energy aHenuation
dent energy:
The intensity of an ultrasonic beam after the ultrasonic
Ei= E,+ E, beam has passed through a certain medium results lower
than the intensity of transmitted beam.
In pressure, the amplitude of the transmitted and re-
flected pressure at a boundary between two media, with The causes of this decrease (attenuation) are of double
a normal angle of inCidence, is a function of the acou- origin . The first is related to the beam geometry; the
stic impedance of the two materials. according to the second is related to the absorption and scattering in the
formula: medium.
The influence of each factor changes every time depen-
Pi + P, = P, ding on acoustic and mechanical factors.

GILARDONI. RAOIOLOGY - ELECTAOMEDICINE 185

5.3.5.1. Scattering
Scattering of ultrasound is a variation of the physical
process that verifies when diffraction takes place.
Scattering occurs when small particles absorb part of
the ultrasonic energ y and reirrad iate it in all directions
as a spherical field .
This means that the receiving transducer can be positio-
ned at any angle to the ultrasonic beam and not just in
the path of the reflected beam from the structure of in-
terest.
Many biological interfaces have irreg ular surfaces, which
will tend to give scatter-like refl ections. This type of re-
fl ecting interface is quite useful , as it will give at least
some echoes when intercepted by the ultrasonic beam,
for different types 01 display, even though the ultrasonic
beam is not directly perpendicular to the reflecting tissue
interface.
5.3.5.2. Absorption
The friction in the medium will cause the ultrasound to
gradually die oul, an effect that becomes more and
more significant with Ihe increasing 0 1 frequency.
If 10 percent of the ultrasonic energy remains after
10 cm. of tissue to a totally rellecting su rface, only 10
percent of the 10 percent remaining energy (1 percent
of the original Intensity) is avai lable after a further
10 cm back to the transducer. This makes the use of a
logarithmic scale more practical than a linear one to
express the attenuation 0 1 an ultrasonic wave.
Absorption follows the exponential law:
being I. the beam intensity at ..x" section, 10 the referen-
ce intensity and k the specific absorption factor.
k is a function of frequency (increases with frequency),
density and propagation velOCity.
The liquids exhibit the smallest k factor.
Due to attenuation , the energy reflected at an interface.
can be very weak when reaching the probe for the
conversion in electrical signal. Therefore this signal must
be Increased before the visualization .
5.3.5.3. DlttracUon
The ultrasound beam that propagates In a homogene-
ous material Is considered as a coherent beam, because
all the particles of a plane parallel to the generation
plane have the same motion condition .
Little discontinuities, the dimensions of which are com-
parable to the wavelength, with irregular boundaries deter-
mine interference phenomena because the different por-
tions of the reflected beam have not the same phase.
Chapter 5.4. - ULTRASONIC PROBES
5.4.1. Ultrasonic probes
Fig . 815 shows the section of a normal probe.
The first step in the probe manufactu re is the ultrasonic
c leaning of the piezoelectric ceramic (crystal) ; the se-
cond step is the soldering of two copper wires on the
106
Fig. 815 (par, 5. 4.1.) - SOCfion of a
normal probe.
1) Piezo element; 2) wiring; 3) wear
prutection and acoustic coupling thick-
ness: 4) backing: 5) inductor lor elec-
trical coupl ing; 6) connector; 7) h0us-
ing (or case): 8) acoustical absorbing
ring.
For contact probes the protectio n
layer 3) is wear prool while lor im-
mersion probes the coup ling Is a
plastic layer of suitable impedance
and thickness (a quarte r wavelength)
to increase the probe quality.
metallized surfaces of the ceramIc; the th ird step con-
sists in making the backing (on the back side) and the
piezoelement protection (on the front side) by means of
special epoxy resins.
The protection layer also acts as acoustical matching
between piezoelement and body.
The last step is to connect the inductor for the electri-
cal matching between the ultrasonic equipment and the
probe (I.e. to maximize the energy transferred to each
other).
Every step requires great manual precision and a final
c heck, with auxiliary instruments, to state that the next
step can be performed.
The mechanical backing and the piezoelement protec-
tion have a great influen ce on the beam characteristics.
The backing layer must have an acoustic impedance as
close as possible to that of the plezoelement.
In addition , it must be capable of absorbing all the ra-
diation from the back of the crystal. Mixture of metal
powders in resin are generally used.
The most widely used crystal is the PZT, a solid solu-
lion of lead zl rconate and lead titanate with the addi-
tion of other compounds to increase the dielectric con-
stant with respect to pure solid solution (see table 1/5
page 182).
Other crystals sometimes used are barium titanate and
lead metaniobate.
5.4.2. Probes characterization
The characterization of a probe consists in attesting,
with photographS or graphics, its fundamental parame-
ters, electrical or geometrical, which are:
electrical sensitivity (real-time waveform)
central frequency
bandwidth
distance-amplitude curve
beam profile
focal spot
SQu int angle.
5.4.2.1. Electrical parameters
The sensitivity is drawn, as peak to peak voltage, from
the real time waveform, i.e. for a given amplitude emit-
ted signal, the signal at the receiver Input obtained from
a flat reflector positioned in the N section, as it appears
on the oscilloscope (see fig. 9/5).
GllARDONi. RADlOLOGV - ElECTROMEOICINE
 5.4.2.2. Geometrical parameters evaluation

The distance-amplitude curve can be drawn in an im-

mersion tank removing, along the beam axis, the probe
from a steel ball reflector (see fig . 715) and recording
the echo response by means ofaxy plotter. The maxi-
mum of the cu rve states the N section, i.e. the section
of separation between near field and far field.
In th is section moving the probe along an axis perpen-
dicular to the beam axis direction we can draw the
beam profile as it appears in fig. 11 /5.
This graphic technique allows the determination of the
focal spot dimension, that states the lateral resolution
power.

Fig. 9/5 (par. 5.4.2.1.) - Real time waveform.

X - scale: 0.5 IJS/div: Y - scale: 2 V/ div.
Probe under test: Gilardoni SBT 10/3.5 MF, an immersion
probe with 20 rnm crysta l diameter, 3.5 MHz nominal fre-
quency and medium locus. -
The sensitivity 01 a probe Is obtained as peak-ta-peak vol-
tage of the RF signal reflected by !lat rellector placed at
N distance.

,
The frequency spectrum (see fig. 10/5) that interprets the -
E
.mm
previous signal in the frequency domain permits to eva- <
luate the central frequency fo corresponding to the maxi-
mum of the spectrum and the bandwidth .6.f = f2 fl
where f2 and f, are the frequencies, evaluated at - 3
dB, below and over the central frequency.
The ratio fo / .6.f is the damping factor Q that is related
to the axial resolution power for the probe. The lower
the Q, the better the axial resolution power.
., -
,, , bl

Fig. 11/5 (psr. 5.4.2.2.) - Beam profilas for a straight beam

probe.
a) beam prolile in section NI2;
b) beam profile in section N.
X - scale: 5 mm/div: Y - scale: linear.
Probe under test: Gllardonl Ilat immersion probe BbN 2012
with 20 mm transducer diameter and 2 MHz nominal fre-
quency.
The beam profiles are evaluated with the Gilardoni immer-
sion tank of fig . 12/5, by means of a sleel bali reflector. The
beem width evaluated 81 -6 dB drop In section N gives
the dimension of the focal spot (for the probe under test:
5 mm).
According to Ihe Authors' experience, the focal spot dimen-
sion lor straight beam probe is about one fourth of the crys-
tal diameter.
The beam profile in section N/2 confirms the presence of
the last minimum in this region and the irregular diagram for
the pressure level.

Fig. 10/5 (par. 5.4.2.1.) - Spectrum analysis.

x - scale: I MHz/div; Y - scale: linear.
Probe under test: the same indicated in lig. 9/5.
Results: 10 = 3.4 MHz, .6.f = 1.12 MHz, a ill 3. 5.4.3. Immersion tank for probes' characterization
The spectrum analysis of the real time waveform (see
l ig. 9/5) gives the central Irequency fo the bandwidth .6.f and Fig. 1215 shows a photograph of the Gilardoni immer-
the damping lactor:
sion tank for cheking probe production and for probe
characterization when required.
The greater the .6.f value, the smalier the a
value, the great- Fig. 12a/5 shows the operating principle and ill ustrates
er the range resolution power. the detai ls.
The evaluation 01 the probe is made with the equipment of
fig. 12/5 (Gilardoni immersion tank). The probe can move along its axis and can rotate in a
vertical or horizontal plane.

GH.AI1DON I. RADIOLOGY - ELECTfIOMEOICINE 187

 Fig. 1215 (par. 5.4.3.) - Gilardonl lank for immersion conlro/s.

This tank Is manulactured with high mechanical precision

to make it suitable lor probe characterization and lor Im-
mersion controls.
The chassis is manulactured with steel sections and is
supported by lour vibration damping devices: the tank Is
made with glass.
The probe holder device has accuracy references lor all
the possible movements. The three main displacements
on II. y, z directions Bre automatic with programmable
velocity.
The probe holder device can be rOlaled by 360" on hori-
zontal plane and by 120" on vertical plane.
The same tank is also ready for ullrasound controls, with
rellection or through-transmission techn iques, with the aid
of suitable devices lor specimen rotation.
For the operating principle of the tank see fig. 128/S.

Fig. 12a/5 (par. 5.4.3.) - Operating

principle of Gilardonl Immaf!lon
lank of fig. 12/5.
1) Chassi s - 2) Device for sys-
tem positioning - 3) Glass tank -
4) Carriage - S) Slide guides -
6) Probe holding arm - 7) Han-
dle for manual scanning - 8) Motor
lor vertical movemenl - 9) Gradu-
ated bar - 10) Probe holding arm
- 11) Graduated bar - 12) Knob
lor vertical positioning - 13) Probe
~.

-. holder - 14) Graduated scale lor

horizontal rotation (360"')
IS) Knob lo r horizontat rOlatlon
- 16) Graduated scale lor vertical
rotation ( 120') - 17) Knob lor
vertical rotation - 18) Control pa-
nel - 19) Rods supporting the
face plane - 20) Face plane lor
specimen under tesl - 21) Motor
driver for specimen rOlation - 23),
24) Devices for specimen rota -
lion - 2S) Steel ball rellector -
26) lapped lIat rellector - 27) Ul-
trason ic equipmen t with a pro-
portional gated output - 28) x-v
recorder .

This system allows automatic movements along the allis and two angular positionings for the probe.
Transversal and longitudinal motions can be coupled in an . autometic scanning motion- for special contrOlS.
This scanning also allows the tracking of distance amplitude curve and the beam profiles in various sections of lhe ultrasonic field
(800 fig . 11/5).

168 GllARDONI. RAOIOLOGY - ELECTROMEOICI NE

5.4.4. Visualization of the ultrasonk: beam

The visualization of the ultrasonic beam is certainly a

very practical means for testing probe performances.
Some of the visualization techniques presently available
im pose costly installation.
Of these. the "Schlieren .. technique exploits the optic
diffraction properties of a medium crossed by an ultra-
sonic wave and enables a black and white visualization
to be made of the profile of the beam emitted by the
transducer.
The fig. 13/5 shows a characterization of ultrasonic probe
with Schlieren technique.
Another technique is based on thermotropic properties
01 cholesteric liquid crystals. This technique permits the
observation of cross section 01 the ultrason ic beam and
is based on the lact that thermal phenomena occurring
on a surface coated with a thin layer 01 these choleste-
ric liquid crystal is translated into a coloured image of Fig. 13a/5 (par. 5.4.4.) - Ultrasonic baam visualization of B
focused probe.
the tem perature distribution on this surface; the thermal
phenomena are created by the transformation of the The figure sho ws the comparison between cho lesteric
acoustic energy into thermal energy due to the absorp- liquid crystals and Schlieren technique.
tion of the acoustic waves. The visualization permits to oaline the local distance and
the focal zone.
There are other visualization techniques but presently (As the figure is not cotoured the visualization possibility
the technique using liq uid crystals is the most interest- 01 the cholesteric liquid crystals is not suitably shown).
ing one for the qualitative and quantitative information
obtained on the ultrasonic beam, when compared with
the cost of the visualization installation. Fig. 13a/5 shows
a characterization of a focused probe with chOlesteric
liquid crystals in comparison with Schlieren technique. f iii
." ....
J _

Fig. f415 (par. 5.4.5.) Gilardonl ultrasoniC probes for medi-

cal Inspection.
Generally medical probes are focused type for a higher late-
ral resolution tor the region Interest.

Chapter 5.5. - ULTRASOUND REPRESENTATION

TECHNIQUES

In any ultrasonic equipment for medical diagnostics, the

Fig. 1315 (par. 5.4.4.) - Ultrasonic baam visualization 01
normal probe with Schlieren technique.
This method allows the ultrasound beam analisys through
the visualization of the pressure behaviour when the beam
travelS in a transparent medium such as water.
The beam pressure is proportional to the picture intensity
collected on a suitable screen and recorded by a photogra-
phic equipment.
5.4.5. Gllardoni uttrasonk: probes for medical inspections
Most of the medical probes are of the focused type
with a wide range of frequencies, diameters and focus-
ings (see fig. 14/5).
According to the explanations of chapter 5.S. page 194
focused probes exhibit a high lateral resolution , which
is the most expressive factor of image quality.
a vital part is the transmitter/receiver system.
Electrical pulses from the transmitter are applied to the
probe for the conversion in pressure oscillations of short
duration.
Whenever the ultrasound hits a boundary between two
tissues some of the energy is reflected. The probe, now
In quiet condition, excited by this reflected energy part,
converts it in an electrical signal sent to a suitable cir-
cuit for visualization.
The visualization is realized in different ways, according
to the different representation techniques.
5.5.1. A-mode display
In the simple A-mode display, the detection and display
of the echoes are performed by horizzontally sweeping

GILAROONI. RAOIOLOGY ELECTROMEDICINE 189

a trace across an oscilloscope screen started at the The probe is mounted on a scanning arm and the echo
emission of ultrasonic pulses. dots are stored on a high perSistence osciltoscope or
The use of this old technique is limited to few cases, on a solid state memory to give a stable image.
where the interpretation of the display is easy, as In The display mode, allowing a simple and relatively easy
fig_ 1515, or can be used joined to 8mode techn ique viewing, has greatly contributed to the development and
(see par. 5.5.2.). diffusion of ultrasound in medical diagnostics.
The basic circuitry for the generation and detection of
electronic pulses is alike for more elaborate systems,
therefore the A-mode display is generally presented in
every equipment.
- c--
,
So
x..Y.. a E f4- G
'-----
f-- x(1I YlII

J"\J""L
E G

-T -
A

A Sc r- Vs ''1\7 \ \ I~
TV
, ,6::;; ',~ ) \
~~
KV)
l~
--- 5
,~
,
,~
, ,'
, "
.).

, , :C RT, ,
' 1
Fig. 1615 (par. 5.5.2.) - Prlnclpls of a manuel B-moda system,
The apparatus is composed 01:
- a section -G- that makes the pulse repetition Irequeocy:
- a section . e _ as emitter (or transmitter):
- a probe . 5 _ that Is moving on a l ixed plane;
,
I,' I
" : ,
," I , - a Xo. Yo. a coordinates detection system lor the delinitlon,
01 the acoustic beam axis position, time by time:

JUlJll
:~ '.M.
I~ i i i i i i i i i,! '
- I
Fig. ISIS (par. 5.5.1.) - A-modo equipment operation princi-
ple.
The equipment is composed 01:
- a section ~G- lhat generales the puise repetition frequency;
- a section .e.- as emiller (or transmitter):
- a probe -5. that generates and receives the ultrasonic
pulse:
- a secUon . R_, as receiver, that amplilles the reflected sig-
nals lor Ihe visualization on the CRT:
- a cathode ray tube (CRT) lor the echoes visualization:
- a section .Sc_. as time base, to drive the horizontal trace
on the CRT allowing the evaluation ot the re!leeting sur-
tace depth, according to the poslUon 01 the corresponding
echoes in the horizontal trace.
The echoes amplitude is stated by the geometrical (area,
liatness, orientation) and acoustic characteristics 01 the r~
fleeting surface.
5.5,2. Static 8-mode dl..,.ay
In fig. 16/5 the operation prinCiple of the static 8-mode
display is ill ustrated.
It is possible to convert the vertical deflection on the
A-mode into light dots on the time-base line (viewing
line), for a two-dimensional, so calted B-mode picture, if
the base line is ti lted and positioned according to the
position and direction of the selected crosssection probe
in the scanning pulse, so that the viewing line repre-
sents the beam axis,
- a section . R., as receiver, thai amplifies the rellected sig-
nals for the evaluation on the CRT;
- a section -Sc-, as time base, to detect the echoes position
(distance Irom the emiller surface) and to relate it to the
coord inates systems Xc" Yo:
- a Scan Converter Memory and a TV circuit unit (S,C.M.ITV)
lor the construction of lhe bidimensional Image.
The construction of the Image is achle'fflcl tilting the base
line (or viewing line) and positioning It according to the p0-
sition and direetlon of the acoustic beam axis.
In this way, the light dots on the base line generate the
Image.
5.5,3, Analogical Scan Conve rsion Tube (SCT)
It is the central unit of the B-mode manual equipment.
In an ordinary 8-scan instrument, the imaging informa-
tion is displaied on either the principal control tube or
on a bistable storage tube.
They are limited in resolution, display size, gray scale,
zoom capabilities, etc.
I! is well known that the above factors limit the poten-
tial values of diagnostic application.
Scan converter tubes have recently been introduced to
allow a wider use of B-scan information.
Together with TV monitor, they have recently been em
ploied to present high-quality images,
A SCT. as opposed to a CRT, is a non-viewing tube,
i.e, the information is stored in electronic form.
The main advantage is that information can be fu rther
processed to enhance the image quality or to perform
other analysis,
Now, it is also possible to store information at one rate
by one method and then to extract it at a different rate
by other scanning methods,

190 G'l./<ROON', FIAO'OLOGY - ElECTROMEOlC'NE

A "SCT, in short, is a device that takes the electronic
information produced in a form that is unsuitable for
the desired display and converts it into the suitable
form to provide a higher resolution and the rig ht di-
splay.
A lot of information can be recorded by a SCT. Quite
often, however, rapid scanning can miss some linear in-
formation and the high resolution of a SCT shows this
effect.
5.5.3.1. Construction and operation of a SCT
A basic Scan Conversion Tube is shown in fig. 17/5.
Fig. 1715 (par. 5.5.3.1.) A oasic Scan Conversion Tube
(SCT)
The only difference between a Cathode Ray Tube (CRT) and
a Scan Conversion Tube Is the target.
In a SCT, the target Is able to store a pattern of electrical
charge.
The electron beam emitted by the cathod e and locused by
suitable coils can store (or write), read or erase all or part 01
th e "electrical Imaga on tha target, according to its energy.
It consists of a cathode, a focusing system, a deflection
device and a target sealed into an evacuated glass tu be.
The only difference between CRT and SCT is the target
In a SCT the target is a small wafer of electrically con-
ducting material having a mesh of insu lator on one
side, being homogeneous on the other side and capable
of storing a pattern of electrical charge on its su rface.
The free electrons produced by the cathode are accele-
rated towards the target by a suitable electric field.
The beam is focused using a focusing coi l and can be
poSitioned at any point of the target. Dependi ng on the
electron beam energ y (electric applied field ), the beam
can store (write) , read or erase the whole or Just a part
of the image on the target
In "write mode, when an echo is received at the ca-
thode, high energy electrons are emitted and travel to-
wards the target.
The electron beam is swept across the storage target.
The direction of the sweep is provided by the poten-
tiometer ci rcuitry in the measuring frame of the US
scanner, to correspond to the direction of US beam in
the patient at any instant.
High energy electrons reach ing the target emit other
electrons from it A small positive charge is created at
the target spots from which the electrons have been
em itted.
In black areas no charge is stored, whereas in the
-white ones the maximum positive charge is stored .
In read" mode a lower energy beam is made to per-
form a raster scan on the target. All electrons reach the
-white areas (positively charged) allowing the maximum
current flow.
G!LAROON!. R.... OIOLOGV ELECTROMEO ICINE
At this time, a TV monitor is necessary. A simultaneous
raster scan is performed by the TV electron beam with
the SCT in order to present a visual image.
In "erase" mode a raster scan is performed on the
energy with such an arrangement of electron beam that
it cancels all the positive charge on the target and
brings it to the cathode potential.
Manufacturers have recently devised a sil icon/dioxide
target onto which the mesh is created using acquired
technology of integrated circuits.
This target has more advantages than the conventional
one: it is smaller, has higher resolution (2,000 x 2,000
matrix elements), req ui res low operating voltages, can
provide very high "zoom ratios and has a very long
life.
5.5.4. Digital Scan Converter
The analogical Scan Converter is now obsolete.
The SCT are very difficult to man ufacture and the ima-
ge can not be used for the next electronic treatments
(this equipment can not be managed by a computer).
All B-mode equipment now uses the dig ital Scan Con-
verter shown in fig. 18/5.
The image is formed on a certain number of matrices
with 512 x 512 elements as a logical signal: only in the
next step it is converted Into a bright image.
This digital image can be processed to find out the
whole diagnostic information.
Fig. 1815 (par. 5.5.4.) - Digital Scan Converter (Gilerdonl
made).
The Oigital Scan Converter uses electronic memories build
up, over 512 x 512 pixels electroniC matrices, with 32 gray
scale levels.
The pixel is the elementary component 01 the image; tha
brightness 01 every pixel is stated choosing one 01 the
32 grey scale levels, according to the amplitude raflection.
At present, all the ultrasound equipment use Oigi tal Scan
Converter.
5.5.4.1. Gray-scale
Whereas with the analogical fGCT an image formed by
innumerable gray shades is obtained, with the digital
SC, on each 512 x 512 elements matrix, the recorded
image is built up with logical signals (in each element
only a signal "BRIGHT or a signal "NOT BRIGHT" can
be present).
For this, the use is needed of some matrices of' 512 x 512
elements, each of these is driven by an ND converter,
which analyses the amplitude of the reflected echo and
chooses the digital combination corresponding to the
gray-level.
191
In this wayan image is obtained with many gray shades, 5.5.5.1 . Unear array and sector Scan
the more the gray shades number is, the more the dia-
gnostic information available in the image. There are two fundamental types of electronic scanning,
In practice, since the human eye can not read more namely linear and sector scanning.
than 15 gray shades, including the black and white The principle of linear scanning is illustrated in fig. 20/5;
ones, it seems right to use 16 gray shades. In reality in the same figure a transducer array, i.e. a multiele-
the differences that can not be detected by the human ment probe (64 or 128 elements) where every element
f1'je, can be clearly evaluated by a suitable digital circui- (about 1 mm width) is contiguous to the next, is shown
try and then increased for visualization. schematically.
It IS also evident that the enhancement of this differen-
tiation possibility is effective until all the information
available with this method is detected : beyond, the in-
crease looses every meaning.
Nowadays, many manufacturers in this field claim that
32 gray shades represent the best scale.
"..
".,
5..5.5, Real lime display

In the real time operation mode, instead of a si mple

probe mounted on a manual scanning arm, there is an
automatic system that scans the anatomic structure under
examination in rapid sequence (see fig . 19/ 5).

Fig. 20/5 (par. 5.5.5.1.) Schematic presantation of a linear

array.

M E
1
G
1, 2, .... n, n+ l , n+ 2, ... , N: N element of the array.
A: multiplexer c lrcuil.
8 : ultresonic beam Ihat shifts along the X-ax is.
The shift of ultresonic beam is got by disactivaling lhe first
element and by activating the .n+ l ~ element with the aid 0 1
a multiplexer circuit.

~ 9 Only the first "n" elements are simu ltaneously activated

and the acoustic beam is then made to scan in both
transmitting and receiving , disactivating the first element
and activating the (n + 1) element with the aid of a
multiplexer circuit.
In this way the acoustic beam performs a translatory
motion parallel to the x-axis.
s
Sector scan, on the other hand, is based on the opera-
tion principle shown In fig. 21/5.

( D 0

/ .. __." .".
Fig. 1915 (par. 5.5.5.) - Realtime (linear array) opera ting
prine/pie.
,
The equipment is composed of:
1) a multielement probe ..s-.
2) a multiplexer c ircuit . M~ that lransmits (and receives) the
exciting pulses 10 the Pfobe elements In successive times.
3) a section -G~ that makes lhe pulse repetition frequency.
4) a seclion _E. as emiller (or transmitter unit).
5) a section _R_, receiver unit, to place the echoes in the
position stated by the eltaetive depth and in the vertical
line stated by the excited element
6) a display . 0- for visuaJlzation. Fig. 21 /5 (par. 5.5.5.I.J Schematic presentation of a sec tor
At every scanning the produced image is replaced by the scan.
next, allowing a real lime examination.
' . 2, ..., n: probe elements
rp, .. " nrp: phase delay circu its
fJ: dellection angle.
In real time equipment image memory is used only Signals of identical amplitude are applied to all transducer
when a freezed picture Is necessary. elements but with a phase difference t:.rp from one element
to the next.
Real time equipment offer a dynamic image and are The wavefront will therefore be deflected through an angle fJ:
simpler to use, but give less definition and a smaller dia- the higher the t:.<p value, the greater the {J angle.
gnostic field.

192 GILAAOON(. RAOIOLOGY ElECTROMEDICINE

Signals of identical amplitude are applied to all tran-
sducer elements but with a phase difference of 6.(11
from one element to the next.
The wave front wlll therefore be deflected through an
angle /1 the greater the 1:J.(I1 value is, the greater the fJ
angle. fJ ang le increases also when the distance be-
tween one element and the next decreases.
5.5.5.2. Dynamic focusing
Dynamic focusing is used to improve the lateral resolu-
tion power at any depth, whereas state focusing can
improve lateral resolu tion only at a fixed depth.
The dynamic focu sing technique can be used with both
types of scan ni ng. It consists in applying a quadratic
phase distribution to each transducer element.
This has the same effect of an acoustic lens, but in this
case the phase factor is electrically varied, determining
a va riat ion in the radius of the "lens curvature on
transmission.
As soon as the sou nd pulse has been transmitted, the
-electronic lens (Comp lex made up by the array and
the variable delay line) gives the focal length corres-
ponding to the mi nimum depth Z min . to be explored.
The first echo arrives after a time equal to twice the
time taken by the sound to cover the distance and wi ll
be seen in the focus by the lens.
If the focal length is now increased at half the speed of
sound, all the subsequent echoes will likewise be seen
if\ locus.
Dynamic focusing has a certain degree of lack of preci-
sion, because the speed of sound in human body is not
a true constant.
For static focu sing the focal length is fixed and not
-modu lated by the sound speed.
G ration of the organs, only the manual equipment sup-
So ST
"'CI,.,
Fig. 22/5 (par. 5.5.6.) . Time Motion (TM) operation principle.
The equipment is composed 01:
1) a probe . S~ held in the position suitable lor the examina-
tion;
2) a section _G. that generates the pulse repetition Irequen-
cy;
3) a section .E_ as emitter (or transmitter unit):
4) a section "R_, receiver unit. that amplilies the reflected
signals;
5) a section -Se', time base unit. that detects the reflected
echoes depth;
6) a time ramp generator ST. for shifting the vertical line
on the monitor.
GlLAROON I. RADIOLOGY ELECTROMEDICINE
5.5.6. Time Motion display (TM-mode)
Time Motion operation principle is shown in fig. 22/5.
It is a method generally used in the cardiological field.
The echoes coming from moving anatomical structures,
for example cardiac walls or valves, are represented li ke
light dots moving on a vi rtual vertical line that is slowly
displaced on the monitor at a speed of some millime-
ters per second.
A number of curves can be stored indicati ng the move-
ments of the structures under study.
TM.. image can also be displayed on photosensitive
paper through an optic fibre recorder.
5.5.7. Computerized echotomography
,
The computerized echotomography refers to equipment
where the signals acquisition and the image generation
is managed by digital electronics.
An electronic memory treats and stores the image by
means of a high number of elementar cells" where it is
possible to store a Single logic state (O or 1).
For all pOints of the scanning plane, the equ ipment
supplies 3 binary numbers to identify horizontal and ver-
tical position and echo level.
The image is therefore built up and stored in a matrix
form .
Dig ital electronics makes possible the use of computer
procedures in eChotomography to enhance the diagnos-
tic information in a stored image.
5.5.8. Echotomographlc equipment selection
The wide diffu sion of echog raphic techniques caused a
large diversification in the required equipment.
Especially, the Real Time automatic equipment is now
proposed as the most polyvalent, economical and effi-
cient solution.
Instead, we think that if the examination is requested to
state pathologies by means of wide and accurate explo-
plies the suitable technical basis.
Real Time equipment is mostly valid for the examination
of morphology and dynamics of the interfaces such as
cardiac and phoetal structures.
The echotomog raphic equipment allows the image for-
mation by means of the representation of reflected or
backscattered echoes from discontinuities struck by sound
waves, on CRT screens.
As already seen in the previous chapters, these images
are built up with a certain number of view lines" (each
of them representing a ti me of flight of ultrasonic
waves in the body), the more the view lines are, the
best the image accu racy. A good image is built up with
thousands of view lines: therefore the formation time for
one single image Is of about some seconds (B-mode
manual equipment) .
A Real Time equi pment, instead, providing some images
for second (condition to show movements behaviour of
interfaces), requires formation times of less than one
second for a single image.
A single image is therefore built with a few hundreds of
view li nes.
Only in the images formed by high density view lines
the parenchima structures can be evaluated, such as in
liver, spleen, placenta, pancreas and in the kidneys.
The grain that the man ual equipment allows to point
out is a characteristic of the organ and is representati ve
of its pathological state.
193
The grain is strongly related to the frequency of ultra- Fig. 23/5 gives the pressure behaviour, in water, of a
sonic beam and therefore the possibility to operate wit h focused probe along the beam axis. The probe is a Gi-
different probes and different frequencies (possibility lardoni SBT 20/ 2, 25 MF, 20 mm emitter diameter and
easily provided by manual equipment) can increase the 2,25 nominal frequency, medium focus.
amount of the collected information .
Manual equipment is necessary in tissue characterization
(see par. 5.8. page 199), i.e. tissue analysis with ultra-
sound . ;',,':--_ _ _..llL'o%
In tab. 4/5 a layout of comparison between different
echotomograph ic equipment is shown.

Chapter 5.S. - IMAGE QUALITY

In this paragraph all the factors that affect the image
quality, are examined, starti ng from the fundamental one:
the probe parameters.
For their eval uation, electrical and geometrical probe r----c~.~'------~~O%
charact~ rization must be performed with the aid of an
immersion tank as that shown in figs. 12/5 and 12a/5
page 168.
It must be observed that in the med ical field, where re- ,
solution power has a great im portance, the probes used mmO 45 60 110 133
are generally focused at various depths.

5.6.1 . Probe performance checking
Probe characterization has been described in par. 5.4.2.
page 186.
For the focused probes, which are generally used in
medical field, the characteristics to be checked are:
sensitivity (real time waveform),
frequency analysis (axial resolution power),
distance-amplitude curve (focal length and depth ran-
ge).
beam profile (focal spot: lateral resolution power) .
For sensitivity, Le. the probe capability to convert
chanical into electrical energ y, see fig. 9/5 page
whereas for frequency analysis, i.e. the analysis of
time waveform in the frequency domain, see fig.
page 187.
Fig. 2315 (par. 5.6. 1.) - Pressure behaviour along the acousti-
cal allis for a focused probe.
The probe under test Is 8 Gil SST 2012,25 MF, a GllAR-
DONI probe with 20 mm diameter and 2.25 MHz lrequency.
The CUN e states the l ocal depth Fo and the depth range t.F
lor wh ich the sensitivity Is greater than hall the maximum
value.
The curve states the focal depth Fo and the depth range
.6F for which the sensitivity is greater than half the
maximum value. In other words .6F is the optimal depth
range for the probe.
me- A beam profile for a focused probe is shown in
187, fig . 24/5. The beam profil e states the probe "focal spot-,
real i.e. the beam width in the focal section : this values is
10/5 greatly less than for a flat probe of same frequency and
diameter.

TABLE 4/5 (par. 5.5.8.) - Echotomographic equipment: characterizing elements.

Manuel equipment (e-mode) Automatic eqUIpment (Real Time) Multitur>Ction equipment (B-mode + Reel Time)

1 ) Image build up with a large amount 01 1) Image with low amount of view lines:
view lines: macrostructures + micros-
tructures + tissue characterizatio n.
only macrostructures
mic.
00'
their dyna-

2) Easy probes changing: possibilities 2) Reduced possibil ities 01 operating with

locusings.
"
operating with different Irequencies and probes
"
focusings.
dillerent Irequencies
,,' All lunctions of manual equipment and dy-
3) Free choice 01 the scanning law. 3) Fixed choice 01 the scanning law. namic possibilities.
4) Small probes for access to th e acous- 4) Bulky probes: difficult operations
tic windows also critical anatomic critical anatomic lones. "
lOnes. " 5) Fixed and reduced lormats.
5) No lormat limitation: possibilties 01 ope-
rat ing according to the kind 01 exami-
nation.

COnClUSions Conclusions Conclusion ~

The equipment allows the analysis of the Th. equipment allows only 'h. examina- The equipment allOws both tissue charac-
tissue structure (tissue characterilation ).
Th. wide range 01 utilizations suitable
tion
"
namics.
macrostructures
,,' "
their 'y. terilation and analysis 01 organ dynam ics
due to the sector probe.
to General Diagnostics. " Th. "00 specialized and , therefore. li- Ih, m'~ complete equipment. able
mited. " "
to "carry out the true multifunction use In
General Diagnostics.

194 Gl lAROON I. RAO IOLOGY - ELECTAOMEOICIHE


100%
Fig. 24/5 (par. 5.6. 1.) - Beam pro-
file for a focused probe.
Probe under test: GIL S8T 2013.5
MF a GILAROONI probe with
- r- SO % 20 mm d iameter and 3,5 MHz
Ir9quency.
The l ocal spot l or this probe i.e.
the beam width in the focal sec-
tion, is about 1,7 mm.
Note thot the focal spot l or a tiat
probe having same d iameter and
Irequency. is about 5 mm (see
10%
fig. 11/5 page 187).
As an ultrasonic transducer is placed over the wire
targets shown. a series of RF waveforms are produced
on an A-mode display.
A rectified RF waveform, or a video display, is used to
obtain the peak-amplitude values that can subsequently
be used to obtain a 8-mode presentation.
Considering a particular recording threshold level,
Sl ightly set above zero, it is shown that a rather poor
B-mode display is produced, if the RF pulse duration is
long (in the frequency analysis o<long duration is rela
ted to an high value of damping factor a).
An excellent 8mode presentation is also shown in the
same figure.
In th is case the shortened pulse duration produces an
excellent 8-mode presentation, still conSidering a recor-
ding threshold level slightly above zero.
Lateral resolution, instead, is related to ultrasonic beam-
width and is defined as the capability of resolving two
point reflectors in a lateral direction.
Let us consider the series of pressure profiles illustrated
in lig. 26/5. In the sample problem , the transducer is
obviously focused at depth Z3 since Ihe minimum beam-
width is shown at Ihat point.

5.6.2. Probe resolution capability

Resolution improvement is a very important subject in

diagnostic ultrasound . Unfortunately, the image quality
depends on many items besides the more popular axial
and lateral resolutions.
Transducers problems are discussed in this chapter: in-
strumentation problems (registration, gain con trols, Ti- . """,
me-Gai n Compensation, dynam ic range and logarithmic
amplification) will be discussed in the next.
1"", .." . Pt ... ",.
,.,
...
Axial resolution is defined as the capability of resolving r'd l ~,

two point reflectors in an ax ial direction.

Let us consider the diagram presented in fig. 25/5, which I\ /\/\ A/-\
exam ines the subject of axial resolution in relation to a
bistable presentation for simplicity purposes.
'"
Fig. 26/5 (par. 5.6.2.) Sample Bscan recordings sho wing
lal8ral-resolutlon dill/cullles.

181 a) Axial direct ion (lour levels 01 gray scale).

- I -

--
I
b) Transverse direc1lon (bistable display) .
In the ~ deplh we get the best taterat resolution power.
La teral resotution power is the lirst responsible 01 the image
quality: therelore only locused probes are used In echota-
mograph y.

I I
Let us evaluate the projections to produce a B-mode
I I presentation from the pressure profiles shown in the
same figure .

. I Four threshold recording levels are shown in this sam-

., ...
ple problem in examining this gray-scale presentation .
"
Tof1Oll
hullol1l
The lirst level produces a very dark portion of the
" 8-mode display of width indicated by the intersection
points of the pressure profile.
This kind 01 analysiS continues as the gray-scale levels
are plotted accord ing to the intersection points of the
Fig. 25/5 (par. 5.6.2.) . A ray of informa lion on a B-Scan
various threshold recording levels.
Plesenlalion showing axial resolution difficull/es. Obviously the best image is produced at the focal point.
a) poor axial resolution. Excellent axial resolution quality is assumed for this
b) excellent axial resolution. sample problem.
The axial resolution capability is stated by the probes electri-
cal characteristics, such as Irequency and damping lactor.
The greater the lrequency and the lower the damping factor,
the better the axial resolution capa bility.

GIlAAOONI. R,\OtOl.OGV ElECTAOMEOICINE 195

Lateral resolution can also be evaluated in a transverse
direction as an ability to resolve the small reflectors in
a lateral direction.
For illustrative purposes a series of pressure profiles is
presented for the wire targets shown in fig. 26/5 (b).
It is important to remember that ultrasonic probes some
times exhibit a side--Iobe energy pressure component it
lustrated in a polar-coordinate type presentation of pres
sure vs. ang le at a fixed point on the probe surface.
The side-lobe component can greatly influence the la
teral resolution capability in the near zone of investiga
tion.
5.6.3. Probe selection
As already seen in the previous chapters, the probe is
characterized by the following parameters:
1) frequency
2) diameter
3) focusing
Choosing a probe means to look for the best combina
lion 01 these parameters with respect to the particular
use.
5.6.3.1. Frequency selection
The frequency increase gives a better resolution power
but a small penetration . Generally, high frequencies
(4,5 + 7,5 MHz) are used for subsurface examinations
(breast and thyroid), medium frequencies (2,25 -;- 4,5 MHz)
for abdominal scanning and low frequencies (2 MHz
and less) for abdominal scanning in large patients and
for A-mode examinations in neurolog ical field.
The frequency selection is joined also with the dead
zone amplitude (portion o f body below the probe, that
can not be presented).
The higher the frequency. the lower the dead zone am-
plitude.
For this reason the use of high frequencies for subsur-
face examination has a double justification .
5.6.3.2. Diameter selection
For focused probes, the greater the diameter, the great-
er the resolution power. according to the following for-
mula:
that states the beamwidth of a focused probe at the fo
cal depth , being ~ the wavelength , F the focal depth
and D the emitter diameter.
Large diameter probes have a greater penetration power;
on the other hand, a large diameter increases the cou-
pling difficulties (in pediatric and cardiological fields
small diameters are inevitable) and the dead zone.
5.6.3.3. Focusing selection
A focused probe concentrates the maximum sensitivity
and the minimum lateral resolution power at a well de-
fined depth . Therefore the use of a focused probe im-
plies the examination of a well defined zone.
The NF denomination refers to a flat probe.
196
The SF denomination (Short Focus) refers to a probe
having a focusing depth in the range of 2-3 cm.
The MF denomination (Medium Focus) refers to a fo-
cusing depth in the range of 4-6 cm.
The LF denomination (Long Focus) refers to a focusing
depth above 7 cm.
5.6.4. Time Gain Compensation (T.G.C.)
As described in par. 5.3.5. page 185 the greater the in
terface depth, the weaker the echoes reflected from it.
because of the energy losses during the ultrasonic path
In other words, two identical discontinuities placed al
different depths give different reflected echoes.
To allow the image of the two discontinuities to be
equal, a compensation is necessary to suitably reinforce
the far echo.
This adjustment, known as Time Gain Compensation
(T.G.C.), is provided by all the modern equipment and
greatly influences the quality and the diagnostic power
of the image.
An increase in gain. obviously, causes more echoes and
ultrasonic signals to appear above the recording thre-
shold level , hence generating significant variations in the
8-scan presentation.
Chapter 5.7. - ELECTRONIC PROCESSING OF THE
IMAGE
The best advantage of the Digital Scan Converter is to
allow the electronic processing of the image to lind out
the maximum diagnostic information.
5.7.1. Pre-processing operations
These operations are performed during the acquisition
of the image I.e. before the image is stored.
5.7.1.1. Prezoom
A magnification , based on the original image, is ob-
tained in the next scanning. as explained in fig . 27/5.
ZOOM
OA lm'N AL
Fig. 27/5 (par. 5.7.1.1.) - Differences between magnification in
write modfJ, ~~zoom. , and in read modfJ ..zoom-.
Note that the -pre-zoom- acts In write mode and the result
ing image has the same gralnes! of the not enlarged one;
the _zoomM operat ion, Instead, enlarges an image just stored
and consequently, also the grainess: therefore the informa-
tion power does not increase.
GIl.AAOONI. RAOIOLQGY El.ECTFIOtoIIEOICINE
5.7.1.2. Selecting the Time Gain Compensation curve
One of the most useful preprocessing operations con-
sists in replacing, the proportional law between the echo
amplitude and the corresponding point brightness, with
a law to enhance the contrast within some interesting
levels.
For example, when it is important to state if tissue modi-
fications are present inside the liver parenchyma, it can
be useful to impose a logarithmic type curve to en-
hance the contrast in the range of medium/low echoes.
It is possible to simply make this, modifying the control
law of the AID converter of the video signal at the
memory input.
Some explanations about pre-processing operation are
illustrated in fig . 28/5.
5.7.1.3. Reset operation
The useful signal to be visualized is inevitably coupled
with spurious echoes of various origins (noise).
If the useful signal is inc reased, the noise increases too,
reaching the low usefu l signals.
In modern equipment, it is possible to insert a suitable
filter to reduce the noise and make it lower to a certain
adjustable value.
5.7.2. Post-processing operation
These operations are made manipulating only the infor-
mation available In memory, allowing to put it in a
more meaningful form for the operator, enhancing the
original information power.
In the post-processing technique field, the chromatic
code conversion is the most important and innovative
processing, besides the differential window (that makes
grey levels very near to each other, distinguable to the
human eye) and the .. isorefl ec!ivity window (that puts
In evidence all the zones having the same echo ampli-
tude).
5.7.2.1. Colour Image: chromatic code conversion
According to the chromatic code conversion , the grey-
shades scale is replaced by a colour-shade scale.
The obtained image, composed of 32 different colour
shades, gives new and more advanced diagnostic oppor-
tunities than the grey-scale image, which, however, re-
tains the greatest importance.
The echotomographic system, in this case, is supplied
by two TV monitors, one for the grey-scale image and
the other for the colour image (8 different colours each
of them havi ng 4 different shades).
The new diagnostic possibilities in a colour image are:
1) Viewing with polych romatic contrast.
Human eye detects different colou rs (polychromatic
cont rast) better than different grey shades (mono-
chromatic contrast) .
2) Better evaluation of certain image details.
Because of the contrast enhancement provided by
the colour image, weak discontinuities appear with
different colou rings with respect to the adjacent zones,
so that they are more clearly detectable, without nee-
ding further elaborations.
GllAA OONI. RADIOLOGY ELECTAOMDIC INE
3) Quantitative differentiation of various echostructures.
Possibility to exactly quantify the various parts, that
compose the image, making reference to the stated
chromatic scale.
4) Optimization and enlargement of other post-process-
ing operations.
Enhancement power provided by differential and isore-
flectivity windows is further increased by the polych-
romatic contrast with the possibility of quantitative
differentiations.
5) Constant and direct check of the optimal use condi-
tions for the equipment.
From the colour image, there is immediate verification
whether the examination is carried out in optimal condi-
tions of gain, power, reject, etc.
On the other hand, if in a colour image the adjustment
of Time-Gain Compensation curve, power, or other fac -
tors, is mistakenly made, a complete change of the
chromatic scale occurs; this cannot be overlooked and
the operator can immediately revise the equipment pa-
rameters.
On the contrary, with a grey-shades image, the change
due to a wrong setting can go unnoticed .
For a reviewal colour images, see fig. 48/5 pag. 209.
5.7.3. Digital echotomography: research and develop-
ment
The developing computer techniques in echotomography
will now be explored.
The general feeling is that these methods wi ll find a
more widespread use and particularly, judging by recent
specialized reviews, they will replace. in some cases
fundamental equipment function s, unti ll now realized by
other methods, overcoming the present limitations.
For example, the possibility is quoted to use the ampli-
tude reconstruction technique of the analytic function
by means of the Hilbert transform for the detection of
echo signals, instead of the rectifying and suitable filter-
ing.
Hilbert transform goal is the considerable improvement
of the axial resolution power.
The same considerations can be made with regard to
the use of spatial filtration techniques, nowadays used
only in the research field .
The diagnostic potential of computer-aided tomography
has since long become a fact 01 general knowledge.
Nobody wi ll therefore be surprised to hear that great ef-
forts are being made nowadays to transfer this tech-
nique of image formation into the ultrasonic field, thus
avoiding the use of a ionizing radiation as dangerous as
X-ray.
The most frequen tly used type of algorithm for spatial
filtration is based on the Fast Fourier Transformer
(F.F.T.).
This technique is likely to have considerable impact on
medical diagnostics in the near future and its name is:
ultrasonic CAT. (Computed Acoustic Tomog raphy) .
Another important future application is the tissue char-
acterization described and analysed in the next para-
graph.
197
 A
z
~

"
ECHO AMPLITUDE

ECHO AMPLITUDE

ECHO AMPLI1UDE

ECHO AMPUl uoe

FifJ. 2815 (par, 5.7.1.2.) ElCplanation of dl//erenl TGC curves in pre-processing operating.
A) All echoes are amplified in Ihe same way: standard image.
8 ) The weak echoes are more amplified, whereas the high ones are damped.
The resulting Image enchances the little dishomogeneilies In soft tissues characterized by low amplitude echoes.
C) The weak echoes are damped, whereas the strong ones are Increased. In this way Ihe large discontinuities (blood vessels) and
the organs prol iles are beller enhanced.
0 ) The weak echoes are damped and Ihe strong ones too, whereas the interlaces characterized by reflection of medium amplitude
are enhanced.

198 GllARDON1, RADIOLOGY - ELECTROMEOICINE

Chapter 5.8. - TISSUE CHARACTERIZATION
The subject of tissue characterization is receiving much
attention nowadays.
Many tissue characterizations based on image pattern
recognition are already in use. They are based on new
eq uipment where the visualization is driven towards the
presentation of signals due to interfaces having very low
signals because of structures scattering.
Thanks to the introduction of non linear amplification. it
has been possible to modify the amplitude ratios in pre-
processing operation (see par. 5.7.1. page 196), so that
is possible to emphasize either reflected or scattered
energy.
The greatest part of the dynamic range is provided for
ef signals arising from internal structures, whereas
the amplitude response range is lim ited by the specular
mterfaces; on the other hand, the echo responses from
specular interfaces wholly depend on their orientation
with respect to the ultrasonic beam.
Such ultrasonic feature characteristics as wave velocity,
attenuation and reflection factor are being explored for
thei r usefulness in classifying various tissue structures,
Organs and other parts of the body are composed by
ssues that vary widely both metabolically and structu-
raJly.
When ultrasound passes through tissues, it interacts in
different ways depending on the acoustic properties of
the tissues.
The measurements of these interactions and their de-
pendence on temperature, time, ultrasonic frequency and
Ifltensity can provide the greatest Information about the
fundamental properties of tissues, such as density, and
modulus of elasticity, as well as microstructure, compo-
sition, motion and pathological state.
The simultaneous existence of so many different and
complex interactions makes it diflicult to isolate a par-
beular one with a high degree 01 accuracy.
The most important analysed lactor is the Internal ana-
tomy 01 the organs, their geometry and the intrinsic
properties of tissue itself.
These, and the characteristics of the surrounding tissue,
hel p to determine how much energy can enter the or-
gan, interacl with it and exit.
Research is now being directed towards the diagnosis
of many tissue abnormalities.
One of the more stressing problems is carcinomas clas-
sification.
Detection of breast cancer is a good starting point be-
cause large amounts of readily accessible data can be
obtained.
The questions, which are being adressed by ultrasound
researchers and clinicians, include:
1) Which are the prospects for measu ring ultrasonic ab-
sorption and velocity in tissue?
2) Can pulse echo images be made more quantitative?
3) Which other tissue parameters are amenable to mea-
surements?
Computerized ultrasonic tomography is now provided for
the determination of absorption and velocity. The trans-
mitllng and receiving probes are placed one in front of
the other outside the interested tissue, then absorption
and time-of-flight of the ultrasonic wave propagating be-
tween the two pOints are measured .
Many of these transmission measu rements along many
intersecting paths, are made to reconstruct cross sec-
tional images of absorption and velocity, using algorithms
identical to those used in X-ray,
Gll.AROONl. RADIOlOGY ELECTROMEOICINE
Most regions of body cannot be examined with such a
technique: extensive studies have been carried out only
on breast with a resulting image quality substantially in-
ferior to that achieved by pulse echo devices.
Chapter 5.9. - PHYSICAL CONCEPTS FOR ULTRA-
SOUNO OIAGNOSTICS
in the interaction between ultrasound and biological tis-
sues or organs some effects that can alter the B-mode
image are present, therefore it is very useful to know
them, in order to avoid wrong diagnosis.
5.9.1. Current clinical practice
(From : Sasic Phisics in Diagnostic Ultrasound by Rose
and Goldberg, Wiley and Sons publisher: with many
thanks).
The basic prinCiples of ultrasound have now been pre-
sented. However the application of this information to
actual diagnosis may not be so obvious. In the day-to-
day ultrasonic diagnostic facility, many principles of phy-
sics are utilized in an attemp to analyze the images that
are recorded, interpreted, and studied. It is obvious that
the electron ics involved, as well as the transducers used,
combine to make a picture that can be displayed and
recorded for interpretation by an ullrasonographer. It is
this final image that is viewed either on the screen as a
static image of film, or in real time on a video display,
or on a tape that must be fully analyzed for its anato-
my and echo characteristics. The anatomy presented , of
course, is related more to one's ability to understand
cross-sectional anatomy. But the echo characteristics,
resulting in various shades of gray proportional to the
strength of the echoes, depends directly on physical
and engineering prinCiples. Thus a strong reflector will
result in a strong echo, either a very black dot on a
white background or a very white dot on a very black
background, whereas weaker rellectlons at tissue inter-
faces within the bOdy will resutt in a variety of shades
of gray.
At this pOint, image-pattern recognition skills play an
important role in arriving at a successful diagnosis. A
variety of image features are stud ied , the features being
selected by either mathematical modelling and physics
of various tissue structures, or just by experience and
correlation with surgical results and pathology reports.
Popular image features include shape factors; wall tex-
tures; effects on image of using gain control settings;
variations in image with patient motion; and, obviously,
location features based on anatomic and medical expe-
rience. For example, ascites can usually be recog nized
because of the irregular outline of various fluid-filled
cavities. Cysts, in general, are recognized because of
their smooth wall texture and echo-free interior if they
are filled with lIuid. Hematomas can often be recognized
because of their rough wall texture. Many other simple
features can be used to diagnose numerous other pro-
blems in the medical field.
Other image features are olten used that are more com-
plex than those mentioned above. The characteristics
among tissues also play an important part; that is, fluids
will not reflect ultrasound unless there are some parti-
cles within it, and as a resu lt, echo-free areas often re-
present fluid .
This is particularly true when the distal-wall echoes are
strong (distal wall refers to the interface where the fluid
199
ends and solid, air, or bone begins) . This indicates that 5.9.4. Back reinforcement effect
the sound has been transmitted and the strength indi-
cates that there has been no significant attenuation . By It is a typical effect of liq uid collections. It is for this
the way, it should be noted that since there is very little reason that the Time Gain Compensation results exces-
attenuation of sound as it passes through fluid, and sive for the interval when the beam crosses the liquid
since in most all ultrasonic equipment there is a Time- (without absorption).
Gain Compensation control to amplify the echoes at A much higher signal appears from the tissues lying
deeper points within the body, the direct effect on a below the liquid collection, as shown in fig. 29/5.
cystic or fluid-filled area will be to transfer that sound
energy at an equal strength to a deeper level, therefore,
resulting in stronger echoes at points deeper in the
body. Thus, the image characteristics of a cystic mass
are quite different from that of a sol id mass: the cystic
mass was represented as an echo-free zone with distal
strong back walls, as opposed to the more attenuative
solid mass, having weaker back-wall than front-wall CYST
echoes.
Complex patterns with lIu id and solid components will
present various degrees of distal walls, although again,
rt
the more lIuid, the greater the tendency for the stronger
wall to be the back wall and for the more solid case to
have a weaker back wall and more attenuation. Of cour-
se, with solid masses, there will also be more internal
Ir }F
.L'\ BACK
interfaces. Echoes will appear within the mass, which REINFORCEMENT
will not be the case with a lIuid unless there are reflec-
ting tissues such as blood clots, debris, or septations.
Other image factors, of course, come into play. For in-
stance, In a cystic mass, the distal walls tend to be
very smooth and uniform, while the lateral walls, partIcu-
larly in a smooth-walled cyst, may not be as well de-
fined. Shadowing on eilher side of the strong central
distal echoes, due to the reflection of sound out of the
transducer pathway, can come about that are almost
like what one would expect with a lens-type effect. More
irregular borders tend to produce more scattering of the
sound; hence they are more likely to be recorded . The
attenualion 01 sound through solids, of course, results
in acoustic shadowing, with much lower echoes seen Fig. 2915 (par. 5.9.4.) - Back rein'orcement effect.
exciting the mass than through cystic or complex mas-
ses. Other characteristics of fluids can be seen in areas It is a typical ellect 01 liquid collection. When Time Gain
of ascites or In any fluid structure such as normal or- Compensation setting becomes excessive lor the interval
gans; for instance, the urinary bladder, gallbladder, etc. path where the beam crosses the liquid (as it sutlers no ab-
sorption), a higher aignal appears from the tissues lying
Of course, for fluids that are free due to gravity, shift- below the collection.
ing the patient and showing changes in fluid distribution
and also changes within masses due to the shifting of
clots or debris can often be used effectively in diagno- 5.9.5, Lateral cones of shade
sis.
When the ultrasonic beam passes from soft to liquid
5.9.2. Specular reflectors tissues, where the propagation velocity is lower, it is de-
flected because of the angled incidence, as happens in
They are characterized by a very high reflectivity but the lateral limits of the liquid collection.
strongly depend on incidence angle. The ultrasonic energy along the directions below the la-
The diaphragm is a typical specular reflector, because it teral limits does not arrive and is not reflected, therefore
is smooth, almost flat and exhibits a very high acoustic two cones of shade are formed as shown in fig . 30/5.
impedance change with respect to the surrounding or- This effect is strongly reduced if the cyst is small and
gans or tissues. placed outside the focal zone.
According to its characteristic of specular reflector, it
can arise some echoes due to structures which are late-
ral to the beam axis. 5.9.6, Rain.. Effect

5.9.3. Liquid collections
They are characterized by internal homogeneity and low
absorption but spurious echoes can arise within the
liquid collections because of the effects described in
par. 5.10,5. page 207.
Echo Signals arising from reflectors placed laterally to
the cyst can be dragged inside it; therefore, due to the
small beam width, it is possible to detect small cysts,
only if they are placed in the focal zone,
Rain Effect (RE.), shown in fig. 31/5, is due to the mul-
tiple reflections between the probe (T) and the interfa-
ces (SS) present in the ultrasonic path before the liquid
collection .
5.9.7. Comparison between liquid and solid formation
The differential characters between a cystic and a solid
formation are illustrated in tab. 5/5.

200 GIl.ARDONI. FV.DlexQGY ElECTROr.AEDIC INE

 TABLE 5/5 (par. 5.9.7.) -
Differential characters
between liquid and solid formations

Character Liquid (cyst) Solid

Internal echoes No yeo

Back detail Reinforcement Acoustic Shadow

Refraction elleets 00 009" yeo No

Contours Regular Irregular

Shape Spherical Uneven

Action of surrounding tissues Compression Expan sion

BACK REINFORCEMENT

CYST
L ,om", OF SHADES Chapter 5.10. - ULTRASOUND DIAGNOSTICS AP-
PLICATION FIELDS

" In this chapter the application range of ultrasound in

Fig. 30/5 (par.

"
5.9.5.) - A)
transversal scanning 01 8 breast
cyst (l,B em. diameter) and B) schematiC shade Information
layout of /ater8/ cones.
A) Cyst appears as an asonic area.
Beside the back reinforcement is evident th e presence of
lateral cones 01 shade.
8) The ultrasonic beam tangential to the cystic wall (R) is
deflected by refraction phenomena (R,) at the liquid/-
ti ssue Interface characterized by different propagati on ve-
loci ty.
Ra beam, instead, Is not deflected.
diagnostics is shown, starting from the fundamental field :
abdominal scanning.
5,10,1. Abdominal scanning
Abdominal scanning has become the main use of dia-
gnostic ultrasound , Fruitful ~ontributions to abdominal
diagnosis can be obtai ned with a variety of abnormali-
ties in liver, kidneys, gall bladder, urinary bladder, spleen
and pancreas.
Another important application of diagnostic ultrasound is
the detection of extra-organic abscesses, a field where
its capability of distinguishing between cystic and solid
structures represents the greatest advantage.

5.10.1.1. Liver
Liver is clearly defined on any B-mode display, like that
shown in fig. 3215.

RIGH T LOBE
LEFT LOBE

_ 7 _ ;. " '
.. - - .

,~i~1
A,

_RAI N EFFECT.

~ l
.... ... A) VEI N SOVRAHEPATIC
o
._e . ' -.s.
.- -'- ... ~-'-"-~: j ..
.. .....
: : :-'-:-'- "
----- ._-_._- ....... .
HOMOGENEOUS
LlOUID
COLLECTIO N

B)

Fig. 3115 (par. 5.9.6.) - A) longitudinal scanning of normal

bladder and B) schema tic layout of ~Rain Effecf,o.
A) In correspondence of the near wall, numerous stratified
rellections, at different levels, are present, they are known
as ~Rain Effect.
B) _Rain Effect" (RE) is due to Multiple Rellections (RM) be-
tween probe (T) and the interfaces (55'), present in the
ultrasonic path before the liquid collection.
OIAPHRAGM
Fig. 32/5 (par. 5.10.1.1,) - 8-mode displays of a normal liver.
In both images the diaphragm is well defined and visible. left
and right lobes are also visible.
Clearly evident are the vena cava and the sovrahepatic veins.

GllARDON I. RADIOI..OGY - ELECTROMEOICI NE 201

Multiple scattered echoes are visible resulting in a very
characteristic liver pattern.
The echo-producing structures in liver are interfaces be-
tween the parenchyma and the supporting structures,
such as connective tissue, intrahepatic arteries and bile
ducts.
Among the most important diagnostic uses is the detec-
tion of cysts, abscesses and solid masses, by means of
the characteristic deviations from the normal display of
the surrounding liver parenchyma.
5.10.1.2. Kidneys
The normal appearance of a kidney in a longitudinal
section is oval and smooth, as shown in fig. 33/5.
KI DNEY VEIN
AI
BI
Fig. 3315 (par. 5. 10.1.2.) - B-mode displays 01 8 normal kid-
ney.
A) Trans~ersa l scanning.
B) Same scanning but on a patient in left side decubitus.
Using the right hepatic lobe as acoustic window, il is possi-
ble 10 visualize the right kidnay, the correspond ing vein and
artery.
Both A) and B) scannlngs are particularly useful for the kid-
ney blood vessel analysis and as a complement of standard
scannings.
The kidney is well differentiated from the surround ing
muscles and abdominal organs.
Calices, pelvis and blood vessels are shown as an elon-
gated central group of high amplitude echoes.
In transverse sections the kidney is almost round. Cali-
ces are seen as a rounded group of echoes, nearly
central if the section goes through one of the renal
poles, or medially placed if the section goes through
the renal pelviS.
If the section is above or below the calices, the central
echoes group is not detected . The urethers cannot be
identified on a scan unless they are dilated.
Diagnostic ultrasound is especially useful for detection
of renal masses, where its ability in distinguishing be-
tween cystic and solid structures is of great importance.
202
Several other renal abnormalities, such as renal aplasia,
hydronephrosis and renal abscesses can be diagnosed
using ultrasound.
5.10.1.3. Urinary bladder, spleen and pancreas
On longitudinal and transverse scans, the full bladder is
clearly seen as a round, well delineated echo-free area
just beneath the abdominal wall.
In females, the uterus is visible just behind the dis-
tended bladder, often indenting it. When empty, the blad-
der is hidden behind the pubis symphysis and is not
accessible to abdominal- scanning.
Diagnostic use includes measurements of residual vo-
lume where benefit is drawn from the non-invasive charac-
ter of the method. Furthermore. bladder tumours, diver-
ticula and prostatic hypertrophia may be demonstrated.
Also the spleen is well delineated with diagnostic ultra-
sound equipment. It transmits the ultrasonic beam very
well and, thanks to its parenchymatous structure, it gives
a uniform weak echo distribution from inside the organ.
The main diagnostic uses are the detection of spleen
enlargement, splenic trauma and spleenic haematoma.
With regards to the pancreas, on oblique scans, its
body is seen in front of the aorta, the superior mesen-
teric artery and the splenic vein as a thin, well delineat-
ed structure, that contains scattered fine echO dots.
The head of the pancreas is seen to be localed in fronl
of the inferior vena cava. The tail of the pancreas is on-
ly seldom visible In supine position because hidden by
the interfering air-filled stomach.
Diagnostic ultrasound is used for the detection of in-
flammatory disorders, abscesses, cysts and malignant pan-
creatic tumours.
In fig. 34/5 is shown a 8-mode scan of a normal spleen .
Fig. 34/5 (par. 5.10.1.3.) - 8-mode Scan 01 a normal spleen.
Inside the spleen many echoes are clearly visible and on the
left side the diaphragm is viSible.
5.10.1.4. Extraorganlc abscesses
Pathological fluid collection may be located either in-
traperitoneally, preperitoneally or retroperitoneally.
Since the peritoneum is an effecti ....e biological barrier,
just one of these compartements will normally be in-
volved at the same time.
GILAROONI. RADIOLOGY ELECffiOMEDIC IN E
Free intraperitoneal fluid is most often due to ascites.
With large amounts of fluid, ec h o~free areas will be
seen between the intestines, that float in front.
Extreme amounts of fluid may compress the liver to
less than half its normal volume: th is will be regained
when the excessive fluid has been removed.
An abscess or haematoma appears as an echo-free or
echo-poor area, that may distort the shape and/or dis~
tort the position of abdominal organs.
Differentiation between an abscess and a haematoma
cannot be made with the ultrasound examination alone,
It must be based also on clinical findings or on ultra~
sonically driven puncture.
In fig. 35/5 is shown an ascite, located near the chole-
cystis, as it appears in longitudinal and transversal scan~
ning.
ASOTE FORMATION
.,
Fig. 35/5 (par. 5. 10. IA.) - Longitudinal A) and transversal 8)
scannings of an asclle formallon (carried oul on different pa-
I/ents).
Besides the presence ot ascitic liquid, the figure shows, an
hyperecogenic aspect 01 the cholecystis walls in correspon-
dence of the high ultrasonic contrast bet ween ascitic liquid
and the walls themselves.
5.1 0.2. Gynaecological and obstetrical scanning
The normal ovaries can frequently be visualized with dia~
gnostic ultrasound equipment, whereas the normal fallo-
pian tubes are too small to be seen .
The normal uterus is well circumscribed and contains
fine echoes relative to small amplitude dislribulion.
HEAO l
AI
GlLAROONI . RAOIOlOGV - ELECTROMEOICINE
Centrally, the slit~shaped cavity appears as a line of
stronger echoes especially at the time of the menstrua~
tion, as shown in fig. 36/5.
Fig. 3615 (par. 5. 10.2.) - 8-ScM display of a normal utarus in
longitudinal scanning: two eJCempJ&s 01 u /erus structure.
Uterus echostructuf(J is characterized by medium-low unilorm
echoes with small amplitude distribution.
The cephalad portion 01 vagi na is seen behind bladder.
To gain access 10 the genital organs located deep in
the pelvis and surrounded by the bowels, scanning must
be performed through a full bladder, that acts as an
acoustic window.
For this reason the start of the Time Gain Compensa-
tion curve must be adjusted further from the main echo
with lower compensation incidence.
5.10.2.1. Foetus
The pregnant uterus close to the abdominal wall suits
well to ultrasound examination.
In the early stage of pregnancy, scann ing is performed
through the full bladder. On a scan it is possible to
recognize the gestational sack from as early as the 5th
week and from the 7th week the characteristic move-
ments of the foetal heart may be seen.
In the case of twins, two gestational sacks are easily
visible, as shown in fig. 37/5.
Fig. 37/5 (par. 5.10.2. I.) -
B-mode display of a twin pre-
gnancy.
A) 8 -mode display.
B) Explaination.
Ultrasound diagnostics is very
uselul in gynaecological and
., obstetrics fields.
This Image 01 twin pregnancy
Is very clear.
203
5.10.2.2. Placenta

The placenta is easily accessible with diagnostic ultra-

sound. The echo pattern from the placenta depends on
several factors, amongst them: the amount of liquid in
the uterus and whether the trunk of foetus lays between
the placenta and the scanning probe.
The placenta echo-structure changes during pregnancy
time.
In the first three months it is characterized by a high
level of reflection with a wide amplitude distri bution:
these characteristics decrease in the following months.
A 38th week pregnancy placenta scanni ng is shown in
fig. 38/5.

SOLIO cc,"em,",
Fig. 3915 (par. 5. 10.2.3.) - Left dermoyd cyst viewed on longi-
tudinal A) and transversal 8) scannings.
The dermoyd cyst exhibits a cha racteristic aspect due to th e
presence of high level echoe zones: the back reinforcement
effect is also present.
Fig. 3815 (par: 5.10.2.2.) - 8 -mode display 01 a 38th week
pregnancy placenta.
The figure shows a homogeneous placentar area: some in-
ternal echoes are present In the amniotic liquid.

5.10.2.3. Gynaecological masses

The majority of gynaecological masses are easi ly reco-

gnizable and it is possible to state their natu re (liquid
or solid) and the originati ng organ.
Neoplasm of uterus will distort its shape. Very large
myomas may be experienced, or a modular appearance
can be visualized with multiple myomaS.
Benign ovarian cysts are often quite large and expand
into the abdomen.
A dermoyd cyst is shown in fig. 39/5, under the cyst
mass a back rein forcement effect is clearly detectable.
The cyst may be simple or multiloculated. If the cyst is
mu lti locular, echoes from the thin internal formations
are visible within the cysts, as seen in fig. 40/5.
Malignant ovarian tumours are often mixed solid/cystic
structures and may be suspected if t he internal texture
of tumour is irregular, with solid areas.
In advanced stages, ascites are often present and easily
visualizable. Fig. 40/5 (par. 5.10.2.3.) - B-mode display of a multilocular
cyst.
Molar pregnancies appear on an ultrasound scan with a
A) Transversal scanning.
characteristic structure, with small grapes-like cysts that B) Longitudinal scanning.
fill the uterus; they are larger than the expected ones. The internal echoes afe due to internal formations wh ich are
Fig. 41/5 shows a fibroma in uterus, with an echographic sometimes present inside the cyst.
When the cyst exhibits these typical internal echoes, it is
appearance of the pseudo-cystic type. called multilocular cyst~.

Anamnesis is often incorrect because of irregular men-

5.10.2.4. Estimation of gestational age
A good knowledge of the gestational age is very impor-
tant to correctly interpret diagnostic results and to take
the proper therapeutical measures, if necessary.
strual cycles or simply because the last date of the pe-
riod has been forgotten by the patient.
The best method of determining gestational age is the
ultrasou nd measurement of biparietal diameter of foetus,
by means of the electronic caliper.

204 GILAROONI. RAOIOlOGY - ELECTROMEO ICINE

 5.10.3. Cardk>loglcal scanning

Actual ultrasonic cardiac examinations can be divided

into two categories.
These are the real-time two-dimensional scanning of
heart and the time-motion registration of heart move-
ments along a simple transducer axis.
Both methods yield invaluable information and have
made echography one of the most often used non-Inva-
sive methods for the examination of heart movements.
However, since time-motion registration allows the dis-
play of heart movements as a function of time on a
simple photograph or on a sheet of registration paper
(as shown in fig. 43/5), and therefore does not require
special viewing devices, on ly this method will be dealt
with here.

Fig. 4115 (par. 5. 10.2.3.) - B-mode display or 8 Ilbromioma In ,............ ~

the uterus ( Ir8nSl/61'$e scsnn ing).

The flbromioma exhibits 8 characteristic aspect 0 1 pseudo-
cystic type.

This method makes it possible to study the progressive

growth of the foetal skull and relate this to conditions
that might affect the foetal growth , such as placental
insufficiency.
In fig . 42/5 gestational age has been plOlted as a func-
-
Fig. 4315 (par. 5.10.3.) - A typical scanning sequence for a
tion of the biparietal diameter. timemotlon exemlne/lon of the heart e8 displayed on physio-
logical recording paper.
Tne sequence shows tne dynamic behaviour of the aortic

---
and mllral valves and mitral leaflets during the heart move-
~1.
,- An electrocard iogram trace is also present.

,I II I III
w
Of the very large amount of clin ical experiences gained
I' I ' rf throughout the two decades in which echocardiography
. /or has been in cl inical use, only a few basic facts will be
stressed here.
~~-
, ~. Therefore, although it is possible to visualize all fou r
'" valves (i.e. mitral, tricuspid, aortic and pulmonary valve),
on ly the mitral and the aortic valves and the left atrium,
which are also the easiest to find and evaluate, will be

I I examined here.

I -
,
I 5.10.3.1. Mitral valve

r The echo from the posterior leaflet describes a mirror

image of the anterior leaflet movements in diastole, but
, it is of lower amplitude because the posterior leallet is
also smaller than the anterior one.
I , I I

-" As the ventricle fills rapidly with the blood coming from
the left atrium, the anterior leaflet is forced backwards
to a semi-closed position and stays so during the slow
filling phase.
Fig. 4215 (par. 5. 10.2.4.) - Ges/allonal age as a function of During the left atrial conctraction the mitral valve opens
tha biparietal diameter. and the echoes of the anterior leaflet go in an upward
For a foetus 0 1 30 weeks of gestational age, the biparietal direction. This is followed by a rapid down stroke pro-
diameter must be inside the interval from 68 mm to 87 mm. duced by the left ventricular contraction. thereby closi ng
the valve.

GILARDONI. RADIOLOGY ElECTROMEDIC INE 205

The shape of this movement on the echocardiogram,
outlined in fig, 44/5, is referred to as the systolic shape.
After this, a slow rise follows, produced by the forward
movement of the whole valve structure and the ring,
during the ventricular systole.
As the ventricles relax, the valve leaflets swing wide
open and the echOcardiogram trace rises steeply up-
wards to the maximum opening of the valve.
I ... ____ .~
---~~~~~--
Fig. 44/5 (psr. 5.10.3.1.) - Simplified diegram showing mitral
valve time-motion display build-up.
I) VentriCle lilting: 2) semiclosed position of the anterior lea-
flel; 3) mitral valve opening: 4) mitrat valve closing: S) ventri-
cles relax .
As the ventricle lills rapidly with blood Irom the left atrium
I , the anterior leallet is forced backwards to a semi-(:Iosed
position 2 . During the left atrial contraction, the echoes 01
the anterior leaflet traverse in an upward direction 3 . The
rapid downstroke, produced by lett ventricular contractio n.
closed the valve 4 .
The shape 01 th is movement on the echocardiogram is re-
lerred to a systolic one. The phase 5 is referred to ventricle
relaxation.
5.10.3.2. Aortic valve and left atrium
Ultrasonic examination of the aortic valve plays a signifi-
cant role In echocardiography. However, the aortic valve
is somehow more difficult to record than the mitra l
valve and recordings can only be obtained in most of
the patients after some training.
The anterior and posterior walls of the ascending aorta
move in parallel directions during the systole and back-
wards during the diastole. In systole the right coronary
leaflet moves anteriorly and the non-coronary leaflet
moves posteriorly.
Fluttering is a normal phenomenon in the systole.
When scanning the aortic valve, the left atrium is visible
behind the aortic root.
The wall of the left atrium moves posteriorly during
ventricular systole, when the left atrium is filling with
blood.
A steady phase occurs throughout ventricu lar diastole
with a slight anterior motion following atrial systole.
The detection of mitral stenosis was one of the first
uses of diagnostic ultrasound in echography.
In patients with mitral stenosis the steep down stroke of
diastolic closure, after the rapid filling phase, is very flat
or simply does not occur since the stenosis does not
allow rapid volume flows over the valve.
206
In mitral stenosis the closing velocity of Ihe anterior mi-
tral leaflet is less than 35 mm/s.
The prolapse of the mitral valve during the systole is
another slate that can be easily diagnosed with ultra-
sound on a time motion display as it gives a typicaJ
posterior displacement of the mitral leaflets during the
last half of the systole.
Aortic insufficiency may be detected indirectly, as mitral
valve motion may be altered significantly in patients
with this desease.
A typical sign of this will be a line fluttering of the mi-
tral valve during diastole.
5.10.3.3. DoppJer effect
Doppler effect instruments are used to measure the
speed -c- at which organs move in the human body,
the contraction of heart in the foetus being the case in
question, or to measure the velocity of blood flow.
As it is known, when a sound wave of frequency . f.
strikes a surface moving at a speed . c", the frequency
of the reflected wave undergoes a variation .6.f.. given
by the relation:
.6.f =
c2fcos8
where v" is the speed of the ultrasonic wave and 8 the
angle between the direction of propagation of the sound
wave and the velocity vector of the surface.
Fig. 45/5 illustrates the principle of a continuos wave
Doppler effect lIowmeter used to measure the velocity
of blood flow.
Fig. 45/5 (par. 5.10.3.3.) - Schemaflc layou! lIIustraling the
princ/pls of a continlJOUs wave dopplef effect flo wmeter.
T) Transmitting probe: A) receiving probe: 1) oscilla tor:
2) mhter; 3) detector; 4) recorder; S) loudspeaker; 6) lIow di-
rection.
Since the . t.f~ value, measured and recorded , is proportional
to the velocity _ 01 blood, the Instrument allows the mea-
sure and recording 01 flow velOCity.
Practically, through the transmitter .T~ the oscillator sends
out an ultrasonic beam that traverses the surlace tissues and
eventually strikes a blood vessel.
The return wave. reltected and scattered by the dishomoge-
neities contained in the blood. is received by the probe A.
Using a simple mixer and a detector, it is then possible to
obtain the Doppler frequency shift .6.I~, which can be either
recorded or monitored directly through a Ioodspeaker (since
it is normally within the audio band).
GllAAOONI . ""'OtOLOGY ELeC ~EOICINe
Through the transmitter _T. the oscillator sends out an
ultrasonic beam that traverses the surface tissues and
eventually strikes a blood vessel.
The return wave, reflected and scattered by the disho-
mogeneities contained in the blood, is received by the
probe R.
Usi ng a simple mixer and a detector, it is then possible
to obtain the Doppler frequency shift _6f., which can
be either recorded or monitored directly through a louds-
peaker (since it is normally within the audio band) .
The va riations of velocity KV in tissue allows to diag-
nose numerous vascular illnesses.
In obstetrics Doppler effect instruments are extensively
used for monitoring the heartbeat of foetu s.
It has become customary to perform spectral analysis of
the Doppler signal, since, in some cases th is is thought
to increase the information contact; but it is still opina-
ble whether this further processing really yields repeata-
ble and reliable results.
Using pulse-type Doppler techniques, it is also possible
10 measure the velocity profile of blood in a vessel and
thus, at least in general principle, to obtain the flow
rate, which is an even more useful parameter from the
cli nical point of view.
Today, flow rate measurements are possible only when
the probe can be directly applied to the vessel walls.
lesion and in some cases it will nol be possible to
demonstrate any shift at all.
Generally, abscesses and haematomas give midline dis-
placement more frequently than primary and secondary
malignant cerebral tumours do.
5.10.5. Thyrokt scanning
The inside of the thyroid gland is displayed with a
homogeneous distribution of the fine dot echoes being
the lobe and isthmus seen in close relation to the tra-
chea, the large neck vessel and the neck muscles.
The ai r inside the trachea gives a dense shadow in the
deep area.
Enlargement of the thyroid is easily detected using dia-
gnostic ultrasound.
it is also able to differentiate between cysts and solid
structures, which is not possible with isotopic scanning
techniques.
Volume determination can also be made with diagnostic
ultrasound.
A thyroid scanning display is shown in fig. 46/5%

;. , .
Although this limitation can be conceptually overcome,

.-g
It has so far been combined with the high costs of pul- . 1"","CHEA
se-type equipment (if compared to the continuous wave ...-Y.:;;i ~>rou,
-.- LEFT LOBE
'"""
Instruments). to prevent a widespread clinical use of this ~ :~= LONG !.IUSCLE
technique. _ CMlOlIO AATAY
It must be kept in mind that the Doppler effect tech- JUOUlAA VEIN
niques cannot give absolule values of the blood velocity
or the speed at which a particular structure is moving.
As can be noted from the above reported equation, the
Doppler signal depends also on the angle 8 and th is
can hardly be measured with sufficient accuracy in ev-
eryday clinical practice.

5.10.4. Neurology

Together with echocardiography. echoencephalography

Fig. 46/5 (par. S.fO.S.) Bf1'ICXN tryrold Jcannlng display.
IS one of the oldest disciplines in diagnostic ultrasound.
This is partly due to the fact that a great deal of dia- Tile inside 01 the thyroid glancl Is displayed as a homogene-
gnostic information in th is field could be achieved even ous dislribution 01 line dot echoes: bolh lobe and Islhmus
with the very primitive A-mode equipment available many are visible in close relallon 10 the trachea.
years ago.
S-mode ultrasound is also being used at the moment In
this field but. because of the necessary penetration of
skull bone, scannings are of inferior quality if compared
to those from entirely soft-tissues structure and the im-
portance of echoencephalography has decreased since
the introduction of CT scanning (chapter 4.7. page 158).
On a normal A-mode display, it is possible to display
echoes from the skull . the mid line and the ventricles of
brain .
The echoes from the skull are the so-called initial and
final echoes, and exactly half-way between these two
echoes, the echo from the midline structure should be
found.
One of the first diagnostic uses of ultrasound was the
detection of brain midline shift. The cause of this shift
may be one of several possibilities, such as tumours,
haematomas and abscesses.
The localization of the lesion will , of course, affect the
amount of midline shift obtained for a certain size of

GlLAROONI. RADIOlOGY El.ECTROMEOtCINE 207

Chapter 5.11. - GILARDONI B-MODE EQUIPMENT:
SONAGIL B
Sonagil, a multifunction echolomographic digital system,
is shown in fig. 47/5.
II allows the examinations according to the A-mode,
B-mode, M-mode and Real Time sector-scan techniques.
Its technical performances are hereunder described.
1. Multifunction is used in:
A-mode display with TGC behaviour viewing .
B-mode, with manual scanning, in a high defini-
tion display.
M-mode with fiber optic recorder (optional).
2. Digital Scan Converter provided with computer in-
terface.
3. Image with 32 grey levels.
4. Caliper for anatomic measurements (in any direc-
tion),
5. Alphanumeric keyboard run by microprocessor (free
writing on the stored image) with automatic date
recorder.
6. Possibility 01 storing two different images.
7. Zoom with two disposable magnifications.
8. Polaroid Camera.
9. Modular build up, provided for all the adjustements
in the computer field .
10. Four probes of different frequency, focusing and dia-
meter.
11 . ECG and photo-cardio units.
12. Survey technique (automatic erasing of the percent
image) .
Optionsls:
1. Pre-processing
zoom in written mode with preselection of the exa-
mination zone.
choose of the right dynamic gain curve.
2. Post-processing
cromatic code conversion (Color System).
- electronic window on the grey scale for contrast
enhancement.
3. Real time sector probe.
4. Manual device for seriographies on radiographic films
18 x 24 cm.
5. Recorders lor echocardiographlc traces on UV paper
or silver paper with 100-150 or 200 mm. formats.
6. Professional video-recorder.
7. Electronic device for automatic copy on radiographic
films (Mu lti- Imager).
8. Wide range 01 probes with different dimensions, 10-
cusings and frequencies (1,5 to 7,5 MHz) .
Some Gilardoni US probes are shown in fig . 14/5
page 189.
Chapter 5.12. - COLLECTION OF SIGNIFICAN T
US IMAGES
Fig . 48/5 reports a collection of both colour and grey
scale images to show the contrast enhancement due
to a cromatic scale.
Chapter 5.13. - EQUIPMENT PERFORMANCE CH E-
CKING
The procedu re of characterization for echotomographic
equipment is directed to state their effiCien cy, assu-
rance and operative security.

.............
1 ----,
,

u Fig. 47/ 5 (par. 5. /1 ,) - Sonagil-B,

,
~<
. ,~ Gilafdoni Multifunction echotomo-

,
I~ "
, . c- . graphic digital .system.

LEGENDA:
. .. . D( ~

! -- .. .----'" " , .~ ~ 1. Main display 8",

~
:
' .~ ~
.
~II. ,~:
*, ' , . "
.. 2. A-mode display.
3. Services panel.
4. RX and TX aettings.
5. Autocenler setting.
'-.-, 6. TG C setting.
7. Video memory setting .
8. T.M. settings.
9. Caliper.
10. Phono.
11. E.C.G.
12. Alphanumeric keyboard.
13. Colour display.
14. Polaroid Camera.
15. Film printing device.
16. Scanning arm.
17. DIgits fOf identificatiOn of scan-
ning plane.
18. Probe.
19. Writing pedal,
20. Erasing pedal.
21 . Zoom pedal.

208 GllAADON I. RADIOLOGY _ ElECTROMEDIClNE

Fig. 48/5 (par. 5.12.) - Collecrion of significant ultr8Sonic images.
This collection clear1y shows the advantages 01 chromatic convel'$lon post-processing operation.
The colour images exhibit greater contrast, better evaluation 01 certain image details and allows quantitative d ifferentiat ion 01 various
echostructures.

a) Cyst in the breast the image is ob- b) Cyst in a kidney (Image obtained with c) 31s1 week pregnancy (image obtained
tained with pre-zoom technique and with chromatic code conversion). with chromatic code conversion).
chromatic code conversion.

OIl.AROONI. RAOtOlOGY - ElECTROMEOICINE 209

The characterization is performed by the manufacturer
for the equipment trial; in the following times, the cus-
tomer himself will verify the characteristics, that more
directly influence the 8 -mode image.
These characterlstlcs are:
1. Resolution power.
2. Correct geometry of scanning arm.
3. Dynamic range.
4. Correct Time-Gain Compensation curve.
Some test objects, which set up an invariable reference,
have been developed to check these characteristics.
5.13.1. Test objects
The test objects are reference samples with reflectors
having suitable dimensions and acoustic impedance as
near as possible to a soft tissue (parenchyma).
T.he test object used to verify the correct geometry of
scanning arm is shown in fig . 49/5.
7
Fig. 4915 (par. 5. 13. I.) - TeS l Obj&cl lor check ing lhe corrocl
geomelry 0 1 the sCllnnlng arm lind the resolution powe,.
Inside the tester. the rellectors, nylon rods 01 0,8 mm. d iam~
tar, are assembled parallel to each olher in a trapezoidal grid
pallern.
The rod sets allow Ihe evaluation 01 Ihe r&solulion power al
variOus depth, whereas the live scanning surfaces allow the
evalualion 01 Ihe accuracy in the Image build-up.
The refl ectors, nylon rods of 0,8 mm diameter, are as-
sembled parallel to each other in a trapezoidal grid
pattern .
The test object supplies scanning surfaces to evaluate
the accuracy in the image build up.
The rod sets allow the evaluation of resolution power at
various surfaces.
In fig . SOlS is shown a display arising from a scanning
with a Gllardoni probe GIL SBT 2013,S medium focus-
ing. 20 mm diameter and 3,5 MHz frequency.
Fig. SOlS (par. 5. 13. '.J - Display arising from a scanning on
tha lesl ooj&et of fig. 4915.
The resolution power Is enough to clearly distinguish the
central set 01 rods very close to each other.
The detection 01 rods below Show a large segment due to
the beam spreading In th is section.
210
Gilardoni test object, shown in fig. 51/5, can prOYlOl!
correct calibration and depth range evaluation.
The object is built with a perspex container filled W ith ~
suitable gel having acoustic characteristics as close as
possible to soft tissue.
The reflectors are nylon rods of 0,8 mm in d i am~..er
assembled parallel to each other and gathered ~
three sets and three cilindrical discontinuities (cysts) w-.-
10 mm diameter.
Fig. 51/5 (par. 5. 13.1.) -
Gilardoni lesl object.
The reflectors inside the
test are:
- nylon rods of 0,8 mm
diameter.
- three cylindr ica l dis-
continuities 01 10 mm
diameter ( cysts-o).
- a cylindrical d iscontt-
nuity 01 20 mm dia"..
ter.
The perspeK container
Is filled with a suitable
gel with acoustic chao
racteristics as close as
possible to soft tissue.
Another cyst, having a 20 mm diameter, is present. The
capability of detecting the circular reflectors with de--
fined outlines is the primary cond ition to state a correct
equipment calibration, i.e. the optimal dosage of damp-
ing and power adjustment, compatibly to the Tissue
Gain Compensation curve utilized related to thai probe
The Gilardoni test object is a very useful tool in the
hands of an operator because an invariable reference
standard, wh ich provides an invariable B-mode display
picture, is a very important reference condition that ca/""l
always be verified, therefore assuring the optimal and
constant dosage of all fundamental settings.
In fig . 5215 a 8-mode display ariSing from a scanning
on the Gilardoni test object of fig . 51/5 is shown .
5.13,2, Safety aspects
Damaging biological effects of ultrasound, at the intensi-
ties currently used for diagnostic purposes, have not
been reported in the literature yet and it is commonly
believed that the use of low level ultrasound for diag-
nostics, even of such a delicate structure as the foetus,
is quite safe.
Fig. 5215 (par. 5. 13.1.) B mode arising (rom scanning rhe
Gllardonl rest object of fig. 51/5.
In this figure are clearly visible the nylon rods of small di-
ameter, besides the cylindrical hotes.
The probe used is a Gilardoni SST 20/3.5 MF wilh 20 mm
diameter. 3,5 MHz frequency and medium locus.
GllAROONI. AAOIOlOGY ELEC TlIOMEDICINE
 PART 6

NUCLEAR MAGNETIC RESONANCE IMAGING

 PART 6
NUCLEAR MAGNETIC RESONANCE IMAGING

Chapter 6.1. - INTRODUCTION

Biological tissue is relatively transparent to X-ray and

opaq ue to radiations with intermediate and long wave-
length (ultraviolet, visible, infrared rays and microwaves).
However, there is a window in tissue absorption through
which radiowaves can be used to probe deep inside the
human body. al
This possibility is given by a new revolutionary method,
formulated in 1973, by which a bidimensional represen- Bo
tation of the internal structure of a body is produced.
There is a noticeable characteristic of this new method,
known as Nuclear Magnetic Resonance (NMR): the "i r-
radiation" is sourced from the body itself.
One of the outstanding differential capabilities of NMR
is its potential to test body chemistry in vivo in such a
way as to provide information about the processes oc-
curring inside the cells.

Chapter 6.2. - PRINCIPLES OF NMR bl

Fig. 116 (par. 6.2.2.) - Nuclei's behaviour in a magnetic field.

The principles of NMR are not easy to understand. nor
a direct and si mple way to explain them exists.
For th is reason, in this chapter, great attention will be
paid to the properties of the materia.
a) In absence of a magnetic field . spins are randomly ori -
ented.
b) Dipped in a magnetic fi eld of strength Bo, each spin can
assume two dllferent orientations, denoted parallel~ (or
spine up) and "iIn tiparallel~ (or spin down).

6.2.1. Properties of atomic nuclei

As known , nuclei are the tiny cores of atoms, which

make up the elements of our universe.
Among them, certain species possess angular momen-
tum, or spin, Le. the nucleus can be imagined as be-
,?""
"'--_
--+-- /
--'I Precession
I _-,l Motion
having like a tiny magnetic bar or compass needle (a
magnetic dipole) .
---1-- !
The magnetic properties of nuclei are expressed by a
physical vector quantity n, called magnetic moment.

6.2.2. Nuclei in a magnetic field

Spinning
When immersed in a static magnetic field, the randomly
oriented magnetic dipoles respond to the force of the
Motion
field trying to line up with it.
For hydrogen proton, for example, quantum mechanics
conveys that there are two allowable basic states with
parallel (or spin up) and antiparallel (or spin down)
orientations corresponding to low and high energy states,
respectively, as shown in fig. 1/6. Gravitation
An exact analysis would show that the spins do not
align exactly with the magnetic field, but they are rather
tilted at an angle 8. Fig. 216 (par. 6.2.2.) - Spinning top.
The magnetic dipoles therefore begin to precess around Gravitation produces a torque and thus forces the top into a
precessional motion.
the direction of the field as a spinning top that tries to For magnetic nuclei, the torque is created by the interaction
orient itself in the earth gravitational field , as shown in of the magnetic moments with the external magnetic field.
fig. 2/6.

212 GllAADONI. RAOIOlOGY ElECTflOMEOICIN

 ~ the force of gravity were increased, the top preces- balance between the two basic energy states, function
SIOnal rate would increase, just as the proton preces- of magnetic field and temperature.
SIOnal frequency depends on the field strength. Furth-
ermore, the precessional frequency has been found out
., be related to the type of nucleus under study. /' ----- , , ..... ,....- --- - ......

~
'
""'rotons, for example, precess much faster than phos- /
I \ '\
Phorus nuclei.
I
\ /
1 1 e I

-- .-.;/
\ /
\~
5..2.3. Larmor relationship \
\
_//
I
//
\~ ....
-Larmor relationsh ip.. is fundamental in NMR.
\ I
\ I \ I
, I
states that the angular frequency Wo of the precession \ I \ I
s the product of the magnetic field Bo and the \ I \ I
so called magnetogy rlc ratio J (constant for each nu- \ I I
I I
clear species). For hydrogen nuclei (or protons) J is
2.675 x 1()8 s- ' . T- I and therefore in a magnetic field
01 1 Tesla (T) the proton resonance frequency is about Fig. 316 (par. 6.2.4.) Parallel spins precessing al random
.(2 MHz.
phase .

n tab. 1/6 the magnetogyrlc ratios, the relative detec- Note that the phase angle 8 for each spin vector is different
at a given lime point.
kln sensitivities and Isotopic abundances for some dia-
gnostically relevant nuclei are listed .

M
TABLE 1/6 (par. 6.2.3.) - Magnetic resonant pro-

..
perties of some diagnostically relevant nuclei.

AIl. abundance Magnetogyric Ratio

""'- "'I
SensitivIty
(MHz/TesIa)

'H 99.98 1 42.58

'H 0.015 9.65 1~ 6.53
"C 1. 11 1. . 10-3 10.71
"F 100 83 10-' 40.05

"N. 100 93 1(>-4 11 .26

"P 100 66 10 ' 17.23

5K 93.1 5.08 . 1()-' 1.99

n this table the abundance colu mn identifi es the per-

centage of the isotopes, present in nature, found in the
ndicated form .
:=or exam ple, in a sample containing phosphorus 31, the
~ti ve abundance is 100%, whereas, in a sample of
c:arbon, only 1,1% would be in the form 01 carbon 13.
Sensitivity figures are used to compare the signal strength
obtained from an equal number of nuclei using ' H as
Ile standard .
'kite the sensitivity difference between ' H and 3' P.
6.2.4. Magnetic resonance
n practice, as known , not a single n ucleus exists alone
and NMR would not be feasible without the observation
01 a collection of magnetic moments.
The phases of an ensem ble of precessing magnetic mo-
--tents are random i.e., the tips of the magnetic moment
f"eCtors have different locations on the precessional or-
0It, as shown in fig . 3/6.
The spin vecto rs, therefore, make up the surface of a
double cone and thei r alignement creates a macroscopic
magnetization or magnetic moment M , as described in
6g. 4/6.
It can further be shown that there exists a dynam ic
Fig. 416 (par. 6.2.4.) Macroscopic magnetlzellon vector.
The alignement of the single magnetic moments creates a
macroscopic magnetization pointing along the axis of the ex-
ternal field Bo.
Note that because of the random phases, the transverse
components 01 1he single spins cancel out.
Resonance is the condition in wh ich the transition be-
tween the two different energy states takes place.
The energy required to make this transition is the mag-
netic energy d ifference between the two basic energy
levels, whereas the frequency required is the Lanno r
frequency.
In these conditions the magnetic moments are moved
from their parallel to their anti parallel states.
6.2.5. The RF field
The Magnetic Resonance sig nal can only be detected if
a transverse magnetization, i.e. a magnetization perpen-
dicular to Bo is created, since the transverse component.
M. y , is time-dependent and th us, accordi ng to the Lenz
induction law, can induce a voltage in a receiver coil.
Tran sverse magnetization is created applying a small ra-
diofrequency field of amplitude B, rotating in resonance
with the precessing spins, as illustrated in fig . 5/6.

GIlARDONI. RAOIOlOGY ELECTROl.1EOICINE 213


M
.--
----
~
X'VP l a ne
B,
Fig. 516 (par. 6.2.5.) Transverse magnefizatlon.
Transverse magnetization 19 indUCed by a rotiotrequency field
B t , rolating synchronously with the precessing spins.
When this RF rad lalion pulse acts ina direction per-
pendicular to the ma in field 80, the effect is to pull the
magnetization away from its rest stale.
If the duration or strength of RF pulse is Increased, it is
possible to rotate the magnetization vec tor M at 90 de-
grees with respect to the Bo direction (xy plane).
6.2.6. Free precession
If the RF pulse. having enough strength or duration to
make the ang le (J equal to 90 degrees, is turned off, the
magnetic moment can induce a maximum signal In the
receiver coil placed in the transverse plane, as shown in
fig . 6/6. However, the transverse magnetization M.y , does
not persist.
Fig. 6/6 (par. 6.2.6.) - Receiving an R.F. signal 8t Larmor (re-
quency.
M ..... the transV(lfS(I component of the magnetization vector, is
time-dependent and thus, according to lenz Induction law.
can induce a voltage In a receiver coil.
It decays to zero with a characteristic time constant and
so does the amplitude of the detected voltage.
For this reason the signal, which is a damped oscilla-
tion , is called .. Free Induction Decay" (FID) .
As the initial signal amplitude is proportional to the
transverse magnetization, which is proportional to the
number of nuclei excited in particu lar parts of the body.
differences in hydrogen density become visible as NMR
images.
214
Chapter 6.3. IMAGING WITH NMR
NMR imaging is possible superi mposing linear field gra-
dients on the main static field Bo.
The term "'g radient" means that t he mag netic field is
modified along a selected direction, according to a li-
near function,
As seen earlier. the Larmor frequency is proportional to
the field magn itude thus, if the field is linearl y variecl,
for example along the x-<.:oordinate of ax,y,z cartesian
coordi nate system. then the resonance frequency obvious-
ly depends on the location of the vol ume element with
respect to x axis,
This can be shown with a simple phantom consisting of
a teflon block having two water-tilled holes aligned with
the x axis (static field axis).
In absence of a grad ient (oB. l ox = 0) the holes are in-
distinguishable; they resonate at the same frequ ency,
because they experience the same fi eld, therefo re the
Free Induction Decay (FlO) contains only one frequ en-
cy, as shown in fi g. 7/S.
However, as soon as the gradient is applied (oB.lox
the two holes will no longer experience the same mag-
0) , "*
netic field strength and the resulting Free Induction De-
cay will be the superposition of two different frequen cy
components (fig . 7/S).
.) bi
,...
Fig 7/6 (par. 6.3.) - Effect 01 I /leld gradient applied along
the x-Ixis.
a) In absence 01 a field gradient. both holes experience the
same lield: FlO. therelore, consists of a single Irequency.
b) In presence 01 a gradient, the twO holes experience dif-
ferent fields: it results in a FlO consisting 01 two Ireqoen-
cies.
In practice, signals are collected from a multitude of
spatial locations by means of a gradient in the three
spatial directions and the FlO contains many different
frequencies.
To select single frequencies, it is necessary to resort to
a mathematical analysis, called Fourier Transform, car-
ried out in a computer.
Besides the evaluation of sing le frequencies, the algo-
rithm allows the evaluation of their associated ampli-
tudes, which are proportional to the spin density at the
particular spatial location .
Fig. 8/S shows the Free Induction Decay and its Fourier
T ransform .
GllAROONJ, RAOIOlOGY - ElECTROME DlCI~E

'J
Tim. F' ......ncy
b)
" ton rich because of their elevated relaxation times, will
Fig, 816 (par. 6.3.) - Fourier transform or FID signals.
a) Single frequency.
b) Two d ifferent frequencies.
Fourier transform allows th e signal analysis in the frequency
domain.
Chapler 6.4. NMR IN TISSUE CHARACTERIZA-
TION
The greatest possibil ity offered by NMA is represented
by tissue characterization.
It has been found that relaxation processes show diffe--
ren t relaxation times among the various types of tissues
and, what is more important, specific differences have
been found between normal and diseased tissues.
In the next paragraph the relaxation processes will be
examined.
6.4.1. Relaxation process
During the precession period . the magnetization returns
to its original rest state through a process called "relaxa-
lion ...
Relaxation processes refer to the motional characteristic
of protons contributing to the NMR signals.
The signal collected by the receiver coil carries out in-
formation about the protons motional possibilities with
respect to the surroundings.
This is perhaps the crucial distinguishing feature of NMR
YS. X-ray tomography.
The motional characteristics are expressed by the so-
called relaxation times.
6.4.1.1. T,: The s~n- I8"k:e relaxation time
Spin-lattice relaxation is equivalent to the restoration
along the longitudinal magnetization: T" therefore, is al-
so called ..long itudinal relaxation time-.
T, represents the time required by the component of
the magnetization vector along z direction to return to
its initial value, after it has been perturbed by RF pulse.
This re-establishment depends on the energ y transferred
by nuclei to their envi ronment or "lattice". hence the
term spin-lattice relaxation".
In a pure liquid the return to equilibrium is exponential
and after 3 ",T," have elapsed, 95% of the original ma-
gnetization will have been restored.
GIVoROONI. RAOIOt.OGY - ElECmOMEOICINE
At this point, it should be mentioned that the signal-to-
noise ratio resulting from a single FlO is usually not
enough to afford acceptable image quality.
For this reason each projection is normally provided by
the result of several accumulated FlO, obtained under
the same operating conditions.
Depending on the spin-lattice relaxation times, the longi-
tudinal magnetization may be more or less restored at
the time the subsequent pulse is applied.
If excitation occurs at intervals appreciably shorter than
T h the signal will be greatly attenuated.
Since tissue and water have very different T 1 values, it
can be understood that the attenuation degree will be
very different. Cerebrospinal fluid or blood, though pro-
appear darker than the surrounding tissues, if the pul se
interval is shortened.
Hence the pixel values depend largely on the operating
conditions.
This is an important feature of NMR compared to other
tomographic systems.
The spin-lattice relaxation process is shown in fig. 9/6 .
Fig. 916 (par. 6.4. 1. 1.) - Re/allatlon behaviour of the magnetic
moment In the reference system (11 ', y ', z ) rotating at th e
Larmor frequency.
a) Atter AF pulse applicetion the magnetic moment vector
makes an angle 8 ; the vecto r then relaxes back to its
equilibrium position In T, S&C . (T, :: spin-lattice relaxation
time).
b) Immediately aiter RF pulse, the various nuclei precess In
phase. In short, for Internuclear magnetic Interactions and
lor Ileid Inhomogeneities, they begin to precess at diHe-
rent rates: RF waves lrom single nuclei dephase and can-
cel each other out. 50 that the sum 01 nuclear magnetiza-
tion vectors in the x'y' plane decays to zero.
The overall cieph8 slng time Is called ~ T2: spin-spin rela-
xatiOn time.
6.4.1.2. T2: The s pln-spln retaxatlon time
After a RF pulse has tipped the nuclear magnetization
vector towards the transverse plane, the components of
this vector all precess together (in phase) and therefore
appear to be stationary in a system rotating at the
Larmor frequency.
However. the precession does not remain in phase. Sub-
tle local alterations of the magnetic field strength cause
some nuclei to precess at rates different from the others:
RF waves from sing le nuclei dephase and cancel each
other out, so that the sum of nuclear magnetization vec-
tors in the transverse plane decays to zero, as shown in
figs. 9/6 and 10/6.
The overall time characterizing this dephasing or decay,
is called spin-spin Relaxation Time T 2".
215

Fig. 1016 (par. 6.4. 1.2.) True Ta measurement.
The measurement of true T a va lue is achieved applying
repeated 180" RF pulses after the 90" initial pulse.
The true Ta value is the time constan t of the envelope
decay.
It is, in fact, a composite relaxation time due both to
intrinsic interactions between neighbouring nuclei and to
heterogeneities in the applied magnetic field.
This parameter reflects the average magnitude of the in-
ternuclear magnetic interactions and is a result of energy
interchange between spi nning nuclei, hence spin-spin"
relaxation.
The free-induction sig nal from a sample in a real ma-
gnet, however, decays with a time consta nt T 2 ' , shorter
than T 2 as shown in fig . 10/6, because of the inevitable
inhomogeneities in the magnetic field.
Indeed, in a NMR imaging practice, T 2 ' is furth er re-
duced by the application of the magnetic field gradients.
6.4.1.3. True T 2 measurement
It was discovered that to determine the actual T2 value,
differentiated from the T 2" value due to the magnetic
field inhomogeneities, diffusion, etc, it was necessary to
apply repeated laC)<> pulses after the initial 90> pulse,
that turn M into the equatorial plane.
The capability of separating T2 from T 2 ' Is achieved be-
cause inhomogeneities are not a random process and,
therefore, can be reversed, whereas spin-spin interaction
is a random process and therefore cannot be reversed.
The sig nal decay seen after several echoes are formed,
is thus due to true spin-spin dephasing, as shown in
fig. 10/6.
6.4.2. Causes of relaxation time differences In various
tissues
Depending on the particular RF pulse sequence used,
the image intenSity may be a function of T , or T2 or
both.
T, and T2 are more sensitive to the degree of molecular
motion.
The ratio T 2 / T, is always less than unity, but it is close
to unity for liquids, whereas it is smaller for solids.
In NMR imaging, only the signal from liquid-like regions
is observed: rigidly bound nuclei give practically no si-
gnals.
Variations in T1 values among different tissues are often
related to free water content.
216
It is very important to state that the malig nant tissues
appear to have higher T, values than the normal o~
this mayor may not just be the result of the larger
amount of water present, as it has experimentally beer!
reported in a variety of human diseases.
Inherent NMR properties of tissues may therefore be
sufficient to distinguish among normal and malignanl
tissues.
With the introduction of paramagnetic ions, it is POSSI-
ble to markedly modify the relaxation behaviour.
At least, another possibility offered by NMR about tissue
investigation refers to the chemical sh ift" phenomena.
according to which the frequency spectrum of NMR
signal can be modified by shifts in resonant frequ ency.
because in chem ically complex samples the appl ied ma-
gnetic field is slightly altered around some nuclei.
Chemical shift evaluation gives useful information about
the molecular structures, where the nuclei exist and al-
lows investigation about biochemical processes in vivo.
Chapter 6.5. - IMAGING TECHNI QUES
There exist various approaches to the creation of a
NMR image.
All approaches have a common basis: the magnetic field
is mapped in such a way that it becomes position--de-
pendent, so that the nuclei placed in different locations
of specimen, resonate at different Larmor frequencies.
It is possible to classify imaging techniques accord ing
to the dimension of the excited and detected volume.
Assuming the total volume to be divided into n x , ny, n.
volume elements (voxels) along the th ree spatial coordi-
nates, nx . ny . nz signal elements are required to bu ild-
up all possible images within this volume.
In the simplest imaging experiment, each voxel signal is
independently acqui red. This method, therefore, has been
called sequential point method", unlike the "sequential
line method", where a row of voxels is simultaneously
detected.
In the "sequential plane method, instead, a whole plane
of voxels is detected at one time.
Finally, in three-dimensional imaging the signals of all
voxels are detected at the same time.
At present both sequential point and " line" methods
are obsolete due to their inherent inefficiency, since
signals are only gathered from a rather small number of
nucleI.
On the other hand " planar and volume imaging me-
thods need large computer capabi lities.
Nowadays, using these techniques, two different methods
have been developed:
1) Projection - reconstruction method.
2) Two (or three) dimensional Fou rier Transform ima 4
ging.
6.5.1. Projection reconstruction method
This method was proposed by Lauterbur and closely re-
sembles X-ray CT reconstruction.
In its two--dimensional version, a gradient rotates in small
angular displacements to produce a view projection, for
each angle increment.
Excitation is confined into a slice of predetermined thick-
ness in the previously described way.
GllAAOONI. RADIOLOGY El ECrnOMEDICINE
This method is rather simple to apply, but it is affected
by motion artifacts and field inhomogeneities.
The whole plane is stimulated by a RF pulse and a
NMR signal is stored.
Nuclei within the slice will emit NMR signals, which are
converted into a frequency spectrum: the frequencies
will be lower from the nuclei in the low strength portion
of the field and higher from those in the higher strength
portion.
In this way a frequency spectrum is yielded where it is
possi ble to evaluate how strong the signal at each fre-
quency is.
At this point, it is stilt not exactly known where nuclei
emitting Signals of a given frequency are, because they
may be anywhere along a line of identical field strength
within the plane; the spectrum relates to a monodimen-
sional projection of the plane being displayed.
A NMR scanner rotates the direction of the gradient to
produce a new signal which represen ts a new projec-
tion.
Computer manipulation of multiple projections allows
an image of the slice to be reconstructed, as shown in
fig. 11/6.
~ J\
Frequency V
Fig. I ' /6 (par. 6.5. I.) - Image r&eonslruction by projection.
This method requires a linear field gradient. i.e.: aB / ox =
coostant to be applied over the volume of Interest. to acquire
a . projectlon- of the nucleus concentration along the pre-
vious direction.
This projection is In the f()(m 01 the signal intensity distribu-
tion with respect to the frequency (frequency spectrum).
To obtain a com plete slice. the recording d irection (therefore
the gradient d irection) must be varied in xy plane.
In this figure. the proposed curves represent the actual spin
concentration distribution at 120' Intervals of the projection
direction.
Two plane selection techn iques are used : one employs
an oscillating magnetic field gradient and the other util-
izes a process known as ..selective irradia tion". described
in fig. 1216.
Sometimes, a magnetic field gradient is applied at an
angle of goo to the selected plane.
The gradient may be generated using two circular coils,
their currents being driven in opposite directions.
Th is produces an overall magnetic field which is equal
to the main field value Bo only at the midline, but
which differs elsewhere.
GllAROONI. RADIOI.OGY - ElECTAOMEOICINE
In the case of selective irradiation, the sample is irra-
diated by a specially shaped RF pulse whose frequen -
cies are tailored, so that only some of the nuclei are
stimulated.
The pulse contains a very narrow band of frequencies:
therefore, only those nuclei within a plane perpendicular
to the direction of the gradient. will be stimulated.
This is because, accord ing to the Larmor relationship.
only in this area the magnetic field corresponds to the
exact resonant frequency of the pulse (see fig. 12/6).
In the case of oscillating field , the currents in the gra-
dient coils are periodically reversed, thereby the direc-
tion of the gradient alternately reverses.
There is then just one plane between the coils within
which the magnetic field does not vary with time (see
fig. 1216) .
NMR signals from nuclei outside this plane vary rapidly
with time and do not contribute to the image.
-)
PI.ne.
]8~8~ ( ~ ""
,,,. I~
SI..-nQl h B" . ~ :~ PIMe
potllUon
AmPtlt"",1 ~P"'I"
F' eq ...... cy
b)
Plene.
1)8~8[
..:~'"+ffi ,,-
po.ltlon
Fig. 12/6 (par. 6.5,1.) - Plane selectiOn in NMR imaging.
a) Selective irradiation.
b) Oscillating gradient.
These layouts demonstrate selection of sagi ttal planes in the
head: the magnet and the gradient coils can be designed to
allow selection of transverse or coronal planes.
a) The pair 01 ci rcular gradient colis superimposes a linear
magnetic field gradient to the static field 80.
Planes at positions A. Band C will successively expe-
rience higher total magnetic field strength. A tailored RF
pulse with a narrow. rectengular frequency distribution
will then exci te only the nuclei within a single plane.
The tlckness or position of the plane may be electronical-
ly al tered changi ng width or frequen cy of the RF irradia-
tion spectrum.
b) In the OSCilla ting grad ient plane selection technique. the
currents In th e gradient coils are periodically reversed .
thereby they generate an alternating field grad ient.
Signals are collected only from the plane (8) where the
total magnetic field does not vary.
217
6.5.2. Two (or three) dimensional Fourier Transform During the readout period, a gradient Gy is operative. In
Imaging. this case the accumulated phase angle at the starting
time of data acquisition is a function of both coordi-
This method is based on three fundamental steps: pre- nates x and z.
paration, evolution and detection. With this imaging method, transverse, sagittal and coro-
Here is an example of the reconstruction of a cross- nal images across any point within the body can be
sectional image, whose pixels are characterized by x displayed.
and y coordinates. It is important to point out that new different methods
During the evolution period foll owing a RF pulse, one of NMR image reconstruction are predictable owing to
of the two perpendicular gradients, for example Go.. is great technological development in this field.
active.
This gradient is turned off after to. seconds and the oth-
er gradient Gy , which is turned off after t,. seconds, is Chapter 6.6. - NMR SYSTEM
activated. In this chapter the features of the components wilt be
During the time intervals Ix and ty. the magnetization briefly examined.
precesses at the freq uencies determined by the static
field acting within the sample: 6 .6.1. The magnet
The magnet is the heart and the most critical compo-
w. = J 18, + G . xl nent of a NMR system.
Wy = J (80 + Gy y) The signal-ta-noise ratio of a NMA image can be in-
creased by increasing Ihe strength of the applied ma-
When G y is actived, FID is collected (detection period) . gnetic fietd.
The frequency W y determines the location of the reson- However, there are limitations to the use of this rule in
ant spins with respect to y. clinical scanning, since higher magnetic fields require
higher RF signals, because the attenuation of signals
The information about x coordinate is got from the
due to tissue is greater at higher frequencies.
phase angle 9x that is related to the x coordinate ac-
cording to the following relationship: The performance of a magnet is characterized by the
following lour items:
9. = Wx tx = J . (80 + Gx xl t. 1) field strength;
2) temporal stability;
The image is obtained collecting n FID with to. increased
from Ix = 0 to t. =n . .6.t, being .6.t the time increase. 3) homogeneity;
The resulting n . n dala matrix is then Fourier trans- 4) bore size.
formed : first, according to Ix . Ihen accordi ng to I y. each NMA magnets, currently in use, can either be resistive
data point directly providing the pixel value, thus avoid- or superconductive depending on Ihelr field strength.
ing the need for reconstruction. Resistive magnet technology can produce fields up to
The prinCiple of 20 Fourier transform imaging is shown 0,2 Tesla, enough for proton imaging.
in fig. 13/6. For other biologically interesting nuclei (which have lower
values of gyromagnetlc ratio) higher magnetic fields are
requ ired: these are generated by superconducting ma-
_I bl gnets (superconductive wiring, cryogenically cooled: much
lower electrical power is required, but the utilized cryo-
genic fluids are very expensive).

V C o ord inate t The uniformity of the produced magnelic field is of critI-

cal importance: for proton Imaging the uniformity must
be within the range 50-100 ppm.
Superconducting magnets allow very high current densi-
ties enabling the generation of very high magnetic fiel ds
(for example, up to 2 Tesla at 100 cm bore diameter),
about ten times the field generated by the most power-
ful resistive aircore system.
FIg. 13/6 (psr. 6.5.2.) - Principle of two dimensional Fourier
fransfOfm imaging. A lour-coil resistive magnet design is shown in fig. 14/6.
a) Precession frequencies.
b) Signal phase.
The precession frequenc ies during Ihe periods I. and I, are
a function of lhe gradienlS G. and G, and lhe sample spatial
location.
Data sampling occurs during the ty period only.
Note that Ihe signal phase is relaled 10 the ... coord inate.
The signal phase shows the magnellzallon at the beginning
of the I, period (data acquisition) as a function of the y lO-
cation: the magnetization vectors are twisted in a spiral way.

Two dimensional Fourier transform imaging can be ex-

tended to a third dimension. Fig. 14/6 (par. 6.6.1.) A four coils resistive magnet design.
This is accomplished dividing the evolution period into Resistive magnet technology can produce a field up 10 0.2
two periods: t.. and t~, characterized, for example, by the Tesla. enough lor proton imaging.
gradients G x and G~.

2'8 GllAROONI. RAOIOlOGY . EUCTAOMEDICINE

6.6.2. Gradient system
The gradient system purpose is to produce the spatial
linear field gradients, crucial in NMR Imaging.
It generally consists of a set of three orthogonal d.c.
coils, generating the three principal linear gradients along
the x, y and z axis.
Tilted gradients, as required for projection-reconstruction
techniques, are implemented by suitably combining two
or more gradients.
The gradients' coils are driven by their own power sup-
plies and can be switched under computer control.
Both li nearity and stability are critical parameters affec-
ting image quality.
6.6.3. RF colis
imaging, and the data amount from a single slice could
easily exceed the computer memory capability.
Before processing, therefore, the raw data can be rout-
ed to a storage device i.e., a high-density disc.
The last step is the treatment of the image in terms of
the individual pixel values.
6.6.7. Display
As in X-ray CT, the image is displayed on a TV moni-
tor, either in grey-scale or in colour and photographed
on film for permanent storage.
In fig. 15/6 a simplified block diagram of a NMR equip-
ment is shown. Fig. 16/6 reports some examples 01
NMR images.

RF calls purpose is to generate the magnetic field re-

qui red for the excitation and pick up of the free induc-
~ -r::::-:;:::
tion decay signals. ~1
As most magnets provide a radially symmetrical field,
and the patient Is set with his axis aligned along the di-
rection of the Sa field, a pair of saddle-shaped AF coils
is mounted in a co-axial tube in such a way that their
magnetic field acts perpendicularly to the main magnetic
rleld. ,,
, ,
Designs with a single coil serving for both excitation '--------------
.... C\NIT
and detection, as well as those having separate ortho-
gonal transmitter and receiver coils, are currently in use.
As static field homogeneity is an important quality fac-
Fig. 15/B (par. B.B.7.) - Func tional block diagram of a typical
NMR imaging system.
tor for a magnet system, AF is a critical instrumental
parameter. 1) Transmitter.
Receiver.
2)
RF colis.
3)
Gradient coils.
4)
6.6.4. TransmlHer Magnet.
5)
Gradient ampli fier.
6)
The transmitter is the section of RF system that produ- 7) NO Convener.
ces the highly stable rad iofrequency and amplifies it to 8) Computer.
9) Oisplay.
a level, which is suitable for the pulse excitation. 10) Keyboard .
The power amplifier characteristics vary a great deal 11) Function buttons.
with the utilized imaging techniques. 12) Track ball.
13) Operating console.
The most used pulse sequences are: simple pulse tech- 14) Multllormat Camera.
niques", where the interval pulse T is the order of the 15) Magnetic Tape Unit.
average relaxation times of the sample, and steady state
free precessional techniques", where the interval pulse T
is compared with the average relaxation times. Chapter 6.7. - RISKS FOR THE PATIENTS

6.6.5. RecetYer
The few microvolts signal induced in the receiver coil is
amplified , first in a preamplifier, then is mixed down to
a band of audiofrequencies in one or two mixing stages,
each providing gain .
To increase the image quality it is necessary that on its
detection path , the signal-to-noise ratio Is not deteriora-
ted by Interferences with external noise sources.
6.6.6. Computer
Before processing, FlO is digitalized in the analog/digital
converter (AOe) and then stored in the computer me-
mory.
Typically a single FlO of 5 msec. duration consists, for
example, of 256 discrete amplitude values obtained by
means of a sampling technique.
Irrespective of the used imaging technique, a large num-
ber of FlO have to be collected, particularly in volume
Basically, three areas of risk associated with the applica-
tion of NMA technique to the field of human medicine
can be defined.
First of all, it should be appreciated that any changing
magnetic field, as resulting from the strong gradients
employed, will cause induced electrical currents.
11 is conceivable that induced currents might have a de-
leterious effect upon the heart or the nervous system.
The second possible source of risk is associated wilh
heating of body tissue by AF induction.
Extensive investigation has shown that medium strength
AF irradiation can be used, because it determines a tole-
rable rise in body temperature of about lOC. This condi-
tion is well within the limits set for irradiation in short-
wave therapy.
The third potential source of risk is the static magnetic
field that reaches very strong values (up to 2 Tesla).
From the foregOing, at present the NMR imaging me-
thod presents no risks for the patient or the operator,
when applied to the field of human medicine.

G/lAROONI. RADIOlOGY - ELECTROMEOICINE 219

Chapter 6.B. - FUTURE PERSPECTIVES
The rapid development and the very large capability of
NMR makes the comparison with the other techniques,
as X-ray CT and echography, difficult.
Over these years, since trials began, NMR produced a
large interest among radiologists and some of them pre-
dicted that NMR may eventually overcome X-ray CT.
NMR can supply three dimensional information of pa-
rameters that, besides giving an ..a,natomic,. image, allow
to know the organs' physiology and to probe body
chemistry in vivo, through the information provided on
the process occurring inside the cell.
For example, it has been shown that the NMR of phos-
phorus 31 allows to appreciate the concentrations 01 the
energy metabolites, such as ATP, ADP, phosphocreatine
and inorganic phosphate, which playa key role in ener-
gy production.
Fig. 1616 (par. 6.6.7.) - Some examples of NMR imagfls.
a) Head sagittal section; b) head coronal sectlon; c) cervical spine; lateral view; d) lumbar spine: lateral view.
220
Whether or not a cell is ischemic can be determined on
the basis of the concentrations of the high-energy phos-
phates.
Moreover, tumours are known to affect cell metabolism .
It appears, for example. that the concentration of the
various metabolites is tumour-specific; this may enable
the clinician to diagnose a tumour without resorting to
biopsy.
It has been only briefly mentioned that paramagnetic
ions. such as Mn (introduced as MnCI2 ) or O 2 can re-
markably reduce the T 1 relaxation time, assuring an
higher contrast in the image.
Furthermore. the introduction of radioactive ions, such
as 2H. UN or 19F in the body, will allow to get a mo-
lecular spettroscopy "in situ and .. in vivo.
On the other hand. the NMR method exhibits some
weaknesses: among them its inability of detecting calci-
fication, that makes this technique useless to study
bones. Moreover. the equipment and installation costs
are. at present. very high
GILAAOONI. RADiOlOGY - lECTROMEDICIN
 PART 7

NUCLEAR MEDICINE - ISOTOPE DIAGNOSTICS

 PART 7
NUCLEAR MEDICINE - ISOTOPE DIAGNOSTICS
(From: l. Conte and G. Pedroli of Ospedale di Circolo -
Varese [Ch. 7.1. - 7.2. - 7.3. - 7.5.1. G.l. Tarolo of
Ospedale S. Paolo - Milano [Ch. 7.4.1. Many thanks for
their collaboration).
Chapter 7.1 . - RADIOACTIVITY
7.1.1. Radioactive decay
Radioactive decay processes are a result of nuclear in-
stability. In order to understand them an elementary
knowledge of the properties of an atomic nucleus is
therefore necessary.
The atom consists of a small central nucleus surroun-
ded by a mostly empty space occupied by electrons. In
fact while the nuclear radius is about 10-1 m, the at-
mosphere,. of electrons extends about 10- 10 m outward
from the nucleus. The nucleus is a mass of protons
and neutrons held tightly packed together by cohesive
forces. Electrons ca rry a negative charge and appear to
be nebulous bodies somewhat larger than protons and
neutrons but much lighter in weight. Protons are Quite
different. They are small dense bodies carrying a posi-
tive charge that is equal to the electron negative charge.
Thei r mass is about 1830 times greater than the elec-
tron mass. Neutrons are very much like protons except
that they carry no charge and are slightty heavier than
protons. Because neutrons and protons make up the
atomic nucleus, they are called nucleons. The charge of
the nucleus is the sum of the charges of the protons.
Since each nuclear proton attracts one electron into the
atom, atoms have the same number of electrons as they
have protons.
Several hundreds of nuclides exist and each one Is
characterized by two numbers: the atomic number, Z,
and the mass number, A. While the number Z indicates
the number of protons present in the nucleus the mass
number, A, represents the number of nucleons making
up the nucleus I.e. the sum of the protons and the neu-
trons present In the nucleus. The atomic number, Z,
and the mass nu mber, A, specify a nuclide that can be
represented by the symbol ~X, where X is the symbol
of the element having atom ic number, Z (e.g.: ':C, '~ I ,
~U) . As Z also represents the number of orbital elec-
trons it specifies the chemical element unequivocally.
While the chemical properties of the atoms depend on
the element i.e.. on the atomic number, Z, the physical
properties depend on the mass of the atomic nuclei and
hence on the number of nucleons, A. There exist nu-
clides which have the same atomic number and differ-
ent mass numbers. These are known as isotopes of the
same element (e.g.: ' ~1 _ 1~ _ 1 ~1 _ '~1 ).
Each element therefore has a series of isotopes (from 2
or 3 up to 15); some of these are stable but the most
part are unstable. The unstable isotopes are subjected
to spontaneous transformations. The spontaneous trans-
formations of unstable nuclei are also known as radioac-
tive decay processes. Radioactivity is the general term
which denotes such physical phenomena.
There are various kinds of radioactive decays:
a) transformations which involve the spontaneous break-
ing up of the nucleus into two or more fragments (fis-
sion, alpha decay);
222
b) transformations which involve a change in the nu-
clear charge with the emission of an electron or a posi-
tron (/J or If decay) or with the capture of an atomic
electron by the nucleus (electronic capture);
c) transformations which involve an energy loss by the
nucleus in an excited state. In this case the nucleus
decays to the ground state and energ y is released by
means of secondary processes like the emission 01 pho-
tons (gamma-rays) or electrons (internal conversion).
7.1.1.1. Alpha decay
Some unstable nuclei (especially those with a high
atomic number) decay by emitting an a particle, which
consists of 2 protons and 2 neutrons, i.e. , a helium nu-
cleus. This decay has the effect of decreasing the num-
berAby4 andZby 2:
A A-4
X- Y +a (I )
Z Z- 2
7.1.1.2. {r decay
In effect, one 01 the neutrons in the nucleus is trans-
formed into a proton, a {r particle and an antineutrino,
1'. The {r particle is a negative electron. The antineutri-
no, 11 (as well as a neutrino, v), has no charge and es-
sentially zero rest mass. Since neutrinos do not easily
Interact with matter, the energ y they carry does nol
contribute to the radiation dose to the patient. The ener-
gy emitted from the nucleus is shared between the rr
particle and the anti neutrino; thus, the rr
energy spec-
trum is continuous from zero up to the full energy of
disintegration .
This decay has the effect of increasing Z by 1, and
leaving A unchanged:
A A
X- Y + rr +1' (2)
Z Z+ l
7.1.1.3. ~- decay
In effect, one on the protons in the nucleus is trans-
formed into a neutron, a {3. particle and a neutrino, v.
The fJ particle Is a positron, i.e., it has the same mass
as an electron and an equal, but opposite charge. As in
rr decay the If particle and the neutrino share the ki-
netic energy emitted from the nucleus. Positron emis-
sion occurs only if the excess energy in the nucleus
exceeds. 1.022 MeV, which is the energ y req ui red to
produce an electron and a positron . The positron is an
unstable particle. When a positron and an electron come
together, their OPPOSite charge add to zero and the
masses of both disappear or are annihilated. The annihi-
lation of the two masses leads to a creation in their
places of two annihilation photons, each having an
energy of 51 1 keV, i.e., the energ y equivalent of the
"rest mass.. 01 the electron and the pOSitron . The two
annihilation photons always leave the site of the coll i-
sion in diametrically opposite directions.
G!lAROON!. AADIOLOGY - ELECTROMEOIClNE
This decay has the effect of decreasing Z by 1, and
leaving A unchanged:
A A
x- y + ,tt + v (3)
Z Z-1
7.1.1.4. Electron capture
In effect, one of the orbital electrons (usually from the
II"Inermost shell, the K shell) is "captured,. by a proton
11"1 the nucleus to form a neutron and a neutrino. The
neutrino has discrete energy in this case. This decreases
Z by 1, and leaves A unchanged :
A A
X + e- - Y +, (4)
Z Z-1
This process competes with positron emission as a de
cay route to achieve a similar stable configuration of
protons and neutrons in the nucleus.
Following electron capture, a vacancy exists in an elec
tron shell, usually the K shell. Filling this vacancy by an
electron from a higher energy level may be accompan
led by the emission of a characteristic X ray with an
energy equal to the difference in the two levels. The
energy made avai lable by the electron transition may al
so be given to an orbital electron (Auger electron),
which is ejected from the atom with an energy equal to
the difference between that 01 the competing Xray and
the binding energy of the electron to lhe alom.
7.1.1.5. Isomeric transitions
Usually, the above decay processes leave the nucleus in
an excited state, with an excess of energy, which may
be dissipated by ray emission or internal conversion.
The numbers of protons and neutrons in the nucleus
are not altered by ray emission or internal conversion;
any such process is called an isomeric transition .
Like orbital electrons, nucleons can exist only al dis
crete energy levels. A given set of nucleons is said to
be in a ground state .when all of the lowest energy lev
els are filled , and excited when some of them occupy
higher energy levels. The transition of a nucleon from a
higher energy level to a lower vacant level may be ac
companied by the emission of a y-ray photon. In most
instances, the )'-ray is emitted promptly (usually within
about 10- ' s): if the emission is appreciably delayed,
however, the excited state is called a metastable- state,
signified by a lower case m, as in IltmTc.
The excess energy in the nucleus may also be emitted
foll owing another process. One of the orbital electrons
(usually from the K shell) may be given this energy and
thus be ejected from the atom with an energy equal to
the difference between the excess energy in Ihe nucleus
and the binding energy of the electron to Ihe atom.
This process is called "internal conversion. Clearly this
process can occur only if the excess energy exceeds
the binding energy of the electron. Unlike fJ particles,
conversion electrons have discrete energies.
As in the case of electron capture, following inlernal
conversion, a vacancy exists in an electron shell. Filling
this vacancy may be accompanied by Xray or Auger
electrons emission .
GltARDONI. RADIOLOGY E~ECTROMEDlCjNE
7.1.2. Natural and artificial radioactivity
In nature stable nuclei and radioactive nuclei with a
mean life of about 109 years or more are present. If the
latter constitute the first term of a radioactive series all
the radionuclides of which it is composed are present
too. Th is is in accordance with the hypothesis that the
age of the universe is about 3 x 1{)!1 years and that its
beginning is related to the binding of the nucleons to
constitute the various nuclei. The radioactive nuclei
which exist in nature are no other than the survivors of
a decay process that started about 3 x 109 years ago.
The other unstable nuclei are by now extinct as they
have a short mean life compared to the age of the uni
verse and can on ly be produced artificially. Of the ra
dioacl ive nuclei that exist in nature ..oK. having a half
life time of 1.3 x 1()9 years and the three natural ra
dioactive series should be remembered. These series are
generated by the following radionuclides: 238 U, Zl5U and
232Th, which have halHfa times of 4.5 x 1()9 years, 7.07
x 1()8 years and 1.39 x 10 10 years, respectively. The sar
les Include radlonuclides which are subject to alpha and
beta decay processes: each radionuclide transforms itself
into a subsequent unstable nucleus until a condition of
stability is reached . The ending stable nuclei of the
three natural series are: 2IlIl Pb, 201 Pb, 2IlIlPb.
The use of particle accelerating machines like the cycle--
tron or the linear accelerator and of nuclear reactors
permits the production of radlonuclides which are not
present in nature but which find an application in re--
search, industrial and medical fields. Radioactive isotopes
are oblalned by bombarding a ..Iarget- made up of sta
ble nuclei with neutrons, high energ y Charged particles
like protons, deutons, alpha particles and high energy
photons.
7.1.3. The law of radloacttve decay
Each unstable nucleus is characterized by a particular
process of rad ioactive decay among those listed in pa
ragraph 7.1.1. (e.g. alphadecay) or by a combination of
two or more processes (e.g. {J decay with emission of
'Yrays) .
In each case the process foll ows the statistical law:
dn = -~ nIt) dt (5)
where nIt) is the number of unstable nuclei at a time t,
dn the decrement of Ihat number in a lime interval be--
tween t and I + dt due to the decay, ~ the decay con
slant, characteristic of the radionucl ide's process of Irans
formation. The decay constant represents, at any time I,
the probability that an unstable nucleus may decay in a
unit of time. By integrating (5):
(6)
n(t) = no e-A1
where no is the number of stable nuclei present at I = O.
Equation (6) expresses in another way the principle of
radioactive decay represented graphically in fig. In. The
higher the value of " the more quickly the number da.
creases with exponential rule. The average life of unsta
ble nuclei is:
T = 1/~ (7)
223

No
'l;
"
~
.c
E ie (Ci) wh ich corresponds to an activity of 3,7 x 10'0
i o~~__~~~~~
o However, several years ago the un it of measurement of
T i me
Fig. 117 (par. 7. 1.3.) - Graphical r8pres8n18/ion Of the law 01
radioactive decay_
After a lime T the number of initial nuclei reduces to:
nIT) = note
as can be ded uced from (6), The time. Tl12 necessary
lo r the number of unstable nuclei to be reduced to one
half is known as half-life and it is given by:
Tll2 = In 2iA
Equations (5) and (6) are valid only when a radionu-
elide transforms itself into a stable nucleus or for the
first nucleus of a radioactive series. The number of nu-
clei of the second member of the series is at first zero
and subsequently grows until it reaches a maximum . II
then decreases. In th is case the law which expresses
the number of unstable nuclei of the second member of
the series is the foll owing:
n(l) = no
, \ (e- )." - e- AzI)
A2 - A,
where A 1 and A, represent the decay constants of the
firs t and second term of the series.
In this case the maximum of Ihe function n{l) occurs at
Generally for the itn term of the series the number of
nuclei present at time t is given by the equation:
n{t) = c ,e-A" + C~-AzI + ...... + c ,e-A~
where A" A2 ...... , "I
are the decay constants of each of
the terms of the series and c" c.z, ...... , C, are constants
wh ich depend on the decay constants and on the initial
conditions o r in other words depend on the quantities
of nuclei of each nuclear species present at the initial
instant.
When the first term of a rad ioactive series has a very
long half-l ife, it can be shown that, after a sufficiently
long lime I, secular equilibrium takes place for all the
members of the series, in other words:
n,", = 0 .02 = ...... = n,", = ......
224
7.1.4. Units of radioacHvlty
The number of nuclei that decay in a unit of time is
defined as the activity of a radioactive source. Since the
decay constant represents the fra ction of stable nuclei
n(l) wh ich decay in a unit of time, the activity of a ra-
dionuclide is expressed by the foll owing equation:
A(t) ~ , o(t) (t4)
Therefore the previous equations (5), (6), (10), and (12)
also describe the temporal law of the activity A(I).
The activity's traditional unit of measurement is the cur-
disintegrations per second. This unit of measurement
and its submullipliers (mCi, pCI) are still widely used.
the activity which goes under the name of bequerel
(Bq) and which corresponds to one disintegration per
second was introduced into the International System .
Th is un it and its multiples (kBq, MBq, GBq) are gradu-
ally replacing the old units of measurements. Taking in-
to account what has been said the conversion fa ctor
from Ci to Bq is 3,7 X 10'0 Bq/ Ci whereas the conver-
sion factor from pCi to MBq will be 3,7 x 10- 2 MBq/pCi.
(8)
7.1.5. Prlnclpel redlonuclides for medical ule
(9) Throughout the years use has been made of new ra-
dionuclides in Nuclear Medicine wh ilst others have fallen
inlo disuse. Generally speaking , as a result of the tech-
nological development of equipment for radioactive '
measurements .. in vivo.. and of machines for the pro-
duction of radioisotopes there has been a tendency to
make more use o f radionuclides which emit X-ray wilh
energy of about 100-200 keV and with a short physical
half-life. At present the most widely used radionuclides
are those reported in tab. 1/7 where the main character-
(10)
istics of the radioactive decay (type of decay, photon
energy, half-life time) are also shown. It can be noted
that many of the rad ionuclides reported in the table
have short (a few hours) or very short (a few minutes
or seconds) physical half-lives. The latter in particutar
are produced by a cyclotron and can be used only in
centres endowed with such equipment, in other words
where clinical and research activities are combined. Ne-
vertheless, even in centres wh ich do not posses a cyc-
(11 ) lotron, certain radionuclides, like I19mTc and 2IJ'T/ which
have a short half-life, can be used. These radionuclides
can be used by means of a generator which consists of
a parent nuclide that generates the radionuclide to be
used as it decays. 89mTc for example which is at pres-
(12) ent by far the most widely used radionuclide in Nuclear
Med ici ne is the product of the decay of INMo whose
half-life is 66.7 h. The I19mTc produced can be separated
from INMo by elution and used for clinical purposes.
The elution can be repea ted more than once until the
activily of the 99Mo is reduced to such low levels as to
be unable to generate Clinically useful e9mTc aClivities.
The main advantage offered by gamma-emitting radio-
nuclides with short or very short half-l ives used for "in
vivo" measurements is the possibility they give of reduc-
ing statistical error in measurements by administering
activities of the order of tens or hundreds of M8q to
the patient and maintaining the dose absorbed by the
(13) patient at acceptable levels.
GILARDONI. RADIOI.OGY - ElECTRD~EDIC I NE
 emitted during the decay process. If count measurements
TABLE 1/7 (par. 7.1.5.) - List of the most widely are repeated for a predetermined time in the presence
used radioisotopes in Nuclear Medicine. of a rad ioactive source whose activity can be consi-
dered constant during the measurements. it will be ob-
served that there are statistical fluctuations in the mea-
Rad io- Mode of Useful emittoo Half- sured counts which are expressions of the decay's sta-
isotope d~, radiation tife
tistical fluctuations. Precision in the measurements of
'H p- p , 5.71 keV 12.3 y activity is therefore influenced by counting statistics. If.
as is often the case, the counting time is negligeable
"c p' r: 511 keV 20.2 m compared to the physical half-life of the radionuclide.
"c p p-, 49.3 keV 5130 y the result of the measurement is expressed by the arith-
"N p' r: 511 keV 10m
metical average of the counts obtained during one or
more measurements. while the amplitude of the statisti-
"0 p' r: 511 keV 124 s cal fluctuations around the mean value is expressed by
"F p' and C.E. r: 511 keV 109 m the standard deviation. It is shown that under these
conditions. the standard deviation is well-approximated
"K p' r: 373: 617 keY 22.4 h
by the square-root of the average value. If a single
47Ca p- r: 159; 1297 keY 4.5 d measurement is carried out the result can be expressed
" Cr C.E. r: 320 keY 27.6 d in the form n ..ft1. where n is the number of counted
pulses and Vn the standard deviation . This means that
"F. /3' and C.E. r: 169; 511 keV 8.3 h the true average in 33_ cases out of 100 moves away
"F. p- r: 1100; 1292 keY 44.5 d from n by more than ,,;n.
'7CO C.E. r: 136 keV 272 d The count- rate r = nIt (t = the counting time) will take
on the fallowing form:
"G. C.E. r: 184; 296 keV 77.9 h
"G. p' r: 511 keV eam r u = nIt yn/t = r ...;r/t (15)
"s. C.E. r: 136: 265; 280 keY 120 d
The count-rate. r. is very important in the measurements
"B, C. E. r: 240; 510 keY 57h
carried out in Nuclear Medicine because it is directly
"mKr I.T. r: 190 keY 13 , proportional to the measured activity. It is usually ex-
8'Ab /3' 4.58 h pressed in counts per minute (cpm) or counts per se-
and C .E. r' 190; 450; 51 1 koV
cond (cps) . The statistical error associated with r is giv-
ORb C .E. r: 530 keV 83d en by standard deviation ..;r/t. In practice the errors as-
i S, C.E. r: 51 4 keY 64 .85 d sociated with n and with r are expressed as percenta-
- To LT. r: 140 keY 6 h ges of the standard deviations compared to the count
averages n and the count- rate r. In both cases the per-
Illml n C.E. r: 170; 250 keV 2.8 d centage error Is l00/vn % and therefore depends on ly
113Mln LT. r: 393 keY 100 m on the measured counts n. This means that a count of
m, C.E. r: 159 keV 13.3 h
100 pulses gives a percentage error of 10%. a count of
1000 pulses an error of 3% and so on.
,~,
C.E. r. X: 27-35 keY 60.2 d
In activity measurements, particu larly when low activities
'3 ' 1 p' r: 365 keY 8.06 d are concerned. the count due to the background must
I20Cs C .E. r: 385 keV 32.4 h be subtracted from the count obtained in the presence
of the source. The background generally deri ves from
l)3xe p- r: 80 keV 6.3 1 d natural radioactivity. from cosmic radiation or from ex-
1~lm lr I.T. r: 65; 189 keV 4.96 s ternal sources present during measurements.
' -Au LT. r: 261 keY 30.5 s
Il\eAu p- r: 411 keY 2.69 d 7.2.2. - Gas-filled detectors
,uHg C.E. r: 71 keV 65h Amongst nuclear detectors gas-fi lled detectors are of
~Hg p- r: 279 keV 46.5 d considerable importance. Nuclear radiation is detected
r.X: 70-80; 167 keV by means of the ionization of the gas that makes up
I ro lTI C.E. 73h
the sensitive volume of the detector. This ionization is
due to the interaction of the nuclear radiation with the
atoms constituting the gas and to the consequent re-
moval of a certain number of electrons. If an external
Chapter 7.2. - PRINCIPLES OF MEASUREMENT voltage is applied between the electrodes. two electrons
OF RADIOACTIVITY and the positive ions fl ow in opposite directions inside
the gas and are collected at the electrodes. Thus an
electric signal is generated. There are three types of
7.2.1. - CountIng statIstIcs and error predIctIon gas-filled detectors:
- the ionization chamber
The probabilistic nature of the decay of unstable nuclei - the proportional counter
causes statistical fluctuations in the number of disinte- - the Geiger-Muller counter
grations occurring in a radioactive source in a fixed
time interval. The measurements of the activity of a ra-
dioactive source are carried out by detecting the ioniz- 7.2.2.1. - Ionization chambers
Ing radiation emitted in the decay process. As the radia-
tion interacts with the detector it gives rise to electrical The operation of an ionization chamber is schematically
pulses that can be counted with a counting scale or described in fig. 217. It consists of two opposite parallel
other electronic apparatus. Each pulse corresponds to or coaxial electrodes with an external voltage applied to
the interaction with the detector of a particle or photon them. The gas contained in the chamber makes up the

GllAR DONI. RADIOLOGY - ELECTROMEDICI NE 225

sensitive volume of the chamber. As the charged parti-
cle passes through the gas a certain number of ion
pairs is created and migrate towards the electrodes be--
cause of the electric field. This device thus gives a di-
rect measurement of the total number of ion pairs pro--
duced in the enclosed volume of gas (primary ioniza-
tion).
Fig. 2/ 7 (p8r. 7.2.2. 1.) - Diagram of the principle of operation
of 8n ioniZ8tion chamber.
Ionization chambers may measure both electric pu lses
produced by single charged particles and electric cur-
rent i.e. the electric charge collected at the electrodes
per unit time.
Pulse ionization chambers are used for the measure-
ment of heavy charged particles, which create a number
of ion pairs sufficient for the formation of an electric
pulse that can be registered by electronic circuits.
In this case the height of the electric pulse induced on
the electrodes is proportional to the number of ion pairs
produced and hence to the energy released in the gas
by nuclear radiation. In this way energy spectra of char-
ged heavy particles can be measured, in particular those
of alpha particles.
Ionization c hambers that measure ionization current are
used in the field of radioprotection and clinical dosime-
try. They are of various shapes and sizes and permit
the measurement of X and gamma-rays exposure.
7.2.2.2. - Proportional counters
Since low energy beta particles and X-rays produce a
very low number of Ion pairs it is very dilficult to mea-
sure the primary ionization produced in the sensitive vo-
lume of the gas with an ionization chamber. In these
cases a proportional counter, that is to say a gaS-filled
detector In which the primary ionization undergoes a
multiplication process, can be used. This detector Is
generally cylindrical and a high voltage 01 about one
thousand volts Is applied between the electrodes which
are made up of a cylindrical cathode and a metal wire
placed along the IDCis of the cylinder which constitutes
the anode-collector (fig . 3n). The intensity of the elect-
ric field near the collector is such that the primary elec-
trons produced by the ionizing particle acquire sufficient
kinetic energy between each collision with the gas atoms
to ionize the atoms themselves, in other words to create
new Ion pairs. The initial number of ion pairs is there-
fore multiplied by a factor 1()3 to 10' depending on the
applied voltage and the detector geometry. The electric
pulses caused by the interaction of the radiation with
the gas can be easily measured. Their amplitudes are
also proportional to the energy released in each Single
event. Proportional counters may be classed either as
counting tubes or as flow counters. Counting tubes have
a sealed volume whereas the gas in fl ow counters is
continuously replaced. The most widely used gases are
mixtures of noble gases and vapors (organic gases) or
pure organic gases. For neutron detection boron trifluo-
ride (BF3 ) or 3He are used.
22fi
- , . . .,.- "_,_.
"'" " ..
c " , .. ",
"
P111
~' ''. I-
./" "
Fig. In (par. 7.2.2.2.) Diagram of 8 proportional counter.
7.2.2.3. - Geiger-MOIler counters
The Geiger-Muller (G-M) counter is similar to the pr~
portional counter but works at higher voltages. For this
reason Instead of the multiplication of the primary ions
there exists a real discharge in the sensitive volume of
the gas owing to a rather complicated chain of events..
This discharge may even be started by just one ion pail
produced In the gas. The electric pulse created on the
electrode collector (anode) is due to the motion of the
positive ions that migrate towards the cathode. However.
the space charge effect caused by the initial accumul ....
tion of positive ions around the col lector reduces the
electric field and "paralyses ~ the counter for about one
hundred microseconds. High count-rate measurements
are therefore impossible. The pulse amplitudes are also
independent of the energy deposited in the gas by an
ionizing particle. Thus, unlike the ion ization cham bef
and the proportional counter, it is not possible to mea-
sure energy spectra with a G-M counter. Most gas fil-
lings of G-M counters are mixtures of noble gases and
organic gases or mixtures of noble gases and halogens
lei, Br, I).
G-M tubes with thin walls or windows are suitable for
beta-ray detection, while G-M counters with thick walls
01 a high atomic number are used to measure X or
gamma-rays. In fact, in this case the electrons produced
by the interaction of the radiation with the wall, are de-
tected instead of the actual photons.
7.2.3. Solid state detectors
Solid state detectors are similar to the previously des-
cribed gasfilled detectors with the difference being that
the sentitive volume is made up of a solid crystalline
materiaL Because of the higher density of solids. sol id
state detectors present a greater stopping power and
can be made smaller. They are also comparatively rug-
ged.
In order to understand how a solid state detector works,
a brief deSCription of the characteristics of electrical
conduction in solids is necessary. The electrical proper-
ties of a solid can be explained by the so-called band
theory. In fact. the allowed energy levels for electrons
in a crystal are grouped together in bands separated
from each other by other bands of prohibited levels. In
Its ground state all the allowed inferior levels in the
crystal are occupied. As shown in fig. 4f7 the difference
between conductors, non-conductors and semi-conduc-
tors depends on the relative positions of their allowed
bands and in particular on whether the most external
band occupied by the electrons is completely filled or
not. In fact as the electrons that occupy a completely
filled band have no net motion since motion adds kinet-
ic energy which implies that an electron must ju mp to
a higher level, wh ich is not available in this case, con-
duction is not possible in a completely filled band.
GllARC()Nl. RAOIOlOGY - ELECTROMEOICINE

r - ------;;;-;-;;;:;;-;:;----co", .,'O" bo"'
ALLOW ED (empty I
FORBIDDEN "3-4.V
b)
, - - - -- - - - - - - - - C o n du<;tlon bend
ALLOW ED (empty)
c)
Fig. 4/7 (psr, 7.2.3.) Energy level diagram for 8 conductor
(a), 8 nonconductor (b), and 8 semiconductor (e),
In a metallic conductor the uppermost filled band (con-
duction band) contains electrons, but it is not com-
pletely filled and ord inary electric fi elds are sufficient to
make the electrons jump to empty levels within this al-
lowed region. T hese electrons are then free to carry a
charge through the conductor. If the uppermost fi lled
band is completely filled (valence band) and the next
one up is completely empty (conduction band) the only
possibility of conduction is if the electrons go up from
the valence band to the conduction band. In the case
of non-conductors, the cond uction band is so far above
the valence band that neither ord inary thermal energy
nor ordi nary electric field s can make electrons jump the
gap. In a semi conductor, on the other hand, the gap is
so small that ordinary thermal energies are sufficient to
raise at least a few electrons from the valence band to
the conduction band. The more electrons there are in
the conduction band , the better conductor the solid be-
comes.
Semi-conductors of commercial interest are ~ doped to
increase their conductivity. This is carried out by intro-
ducing either impurities (donors) with extra electrons
that can be easily raised to the conduction band (n-
type semi-conductors) or impurities (acceptors) where
one binding electron is missing (p-type conductors). In
this case with a small amount of energy other electrons
may move into the empty bond. As the electrons move
fill ing one bond but leavi ng another one em pty, the
em pty bond (called a hole) seems to move. This is
analogous to the motion of a bubble rising t hrough a
liquid.
The types of solid-state detectors normally used In the
nuclear field are crystal counters, surface-junction detec-
tors and lithi um drift detectors.
GlLARDONI. RADIOLOGY - ELECTAOMEDICINE
7.2.3.1. Crystal counters
Crystal counters are made of non-conductive (e.g . dia-
mond) or semi-conductive (e.g. germanium or si licon)
materials. In the latter case the semi-conductor material
is not doped and is used at such temperatu res that
thermal energy is not sufficient to make the electrons
ju mp from the valence into the conduction band. There-
fore, under normal conditions, no cu rrent flows through
the sol id. When radiation enters the crystal the electrons
are. knocked from the valence into the conduct ion band.
This means that the electrons are free to move and the
external electric field can now sweep out these charge
carriers, causing a current pulse.
7.2.3.2. Surface-junction detectors
Surface-junction detectors are constructed by facing a
p-type semi-conductor to an n-type semi-conductor.
Some of the donor electrons from the n-type material
near the junction diffuse across the junction and lodge
themselves in acceptor sites of the ad jacent p-type
material. The electrons neutraliz.e the positive holes, leav-
ing a layer depleted of carriers on both sides of the
junction. An applied external field (reverse bias) ampli-
fies the phenomena and increases the thickness of the
depletion layer. When radiation strikes the layer It crea-
tes electron-hole pairs which, li ke the ion pairs of the
gas, are swept out by the external field .
7.2.3.3. Lithium drift detectors
In the case of lithium drift detectors the sensitive region
is made by drifting lithi um into a p-type crystal. The
fabri cation process consists of two steps. Firstly lithium
Is diffused at a high temperature into a face of slab of
p-type silicon or germanium. Since lithium is a dono r
and the outer electrons are avai lable to fill acceptor
sites at the surtace of the p-type material, the surtace Is
converted to n-type material and a n-p junction is crea-
ted. Secondly an external field is applied and the posi-
tively charged lithiu m ions drift further into the bu lk
material, neutraliz.ing more acceptor ions along the way.
T he compensation of the acceptor sites with lithium
creates a region without carriers known as a depletion
o r drifted reg ion. This region is much wider than the
depletion layer of surface-junction detectors.
Since lithium has a tendency to diffuse further into the
crystal if the temperature is not low enough, the detec-
tor must always be kept at the temperature of liquid
nitrogen . During measurements this also reduces th e
noise caused by thermal agitation .
7.2.4. Scintillation detectors
Scintillation detectors are based on the property of cer-
tain materials to emit light when they are hit by radia-
tion . The quantity of em itted light is proportional to the
energy absorbed by the detector. So by coupling these
detectors with a photomultiplier tube which converts light
into an electric Sig nal , it is possible to obtain electric
pulses that are proportional to the energy released by
the radiation in the scintillator.
Scintillation detectors can be made up of inorganic sol-
id materials or both solid and liquid organiC material s.
The mechanisms that are responsible for the scintillation
phenomenon vary according to the scintillator type.
In the case of inorganic scintillators and in particular
alcaline iodides activated .wlth thall ium which are by far
227
the most widely used in Nuclear Medicine, the scintilla-
tion process can be briefl y described by using the band
theory already put forward in pa ragraph 7.2.3 .. Fig. 5fl
shows a schematic representation of luminescence in
the crystal. In alcaline iodide crystals the completely
empty conduction band is far above the completely filled
valence band . However the existence of impurity centres
like thall ium atoms for example in the crystalline lattice
leads to the presence of energy levels inside the prohi-
bited band below the conduction band. When radiation
enters the crystal it causes the formation of electrons in
the conduction band and holes in the valence band
wh ich are thus free to move inside the crystal. The
energy given up by the radiation can therefore be car-
ried into the various activator centres whic h in this way
are excited on one of their allowed levels. The excita-
tion energy is then released with the emission of a light
photon .
Cond uct ion band
Va lence band
FIg. 5/7 (pa r. 7.2.4.) Idealized represenlallOn of luminos
cenctt in a scin tillation crystal.
On the other hand, in the case of organic SCintilialors,
scintillation is caused by the electronic excitation of
molecules.
The intensity of the emitted light depends on tempera-
ture and follows an exponential type law:
I = 10 exp (-tiT)
where the constant T, the decay time, depends on the
temperature and on the chemical and physica l charac-
teristics of the scintillator.
Conversion efficiency or in other words the fraction of
energy absorbed by the scintillator and reamitted as
light photons varies from a few percent to 20-30 %. The
decay time, T, varies from 10- 8 s to 10-tl s. The wav&-
length of the emitted light also depends on the scintilla-
tor type.
7,2.4.1. Photomultiplier tubes
The photomultiplier tube is a light-sensitive device that
converts light into an electric Signal. It consists of a va-
cuum tube which contains three basic parts: the photo-
cathode, the amplification stage and the anode (fig . 6fT).
The photocathode permits photoelectric conversion since
it is coated with a thin fil m of a material whose outer
orbital elect rons are losely bound . The light photons
that hit the photocathode interact with these electrons
causing them to be ejected from thei r orbits. As the
num ber of light photons emitted per interaction is com-
228
paratively low and the number of electrons emitted by
the photocathode is therefore insufficient to form a de-
tectable electric pulse, it is necessary to amplify the
number of electrons that reach the anode by using an
amplification stage made up of a series of dynodes co-
ated with a material simi lar to that of the photocathode.
Fig. 617 (par. 7.2.4.1.) - Photomultiplier tube.
The electrons ejected from the photocathode are attrac
ted to the first dynode by the positive voltage difference
and eject secondary electrons from it which in turn are
attracted to the second dynode and so on. This results
in an overall gain rang ing from 105 to 1()8 electrons
produced per photoelectron depending on the num ber
of stages and the operating voltage. The electrons reach-
ing the anode are collected and flow through a load
resister to form a voltage pulse, which is the output
sig nal for the photomultiplier tUbe.
7.2.4.2. Inorganic solid sclntlllators
The most importan t inorganic solid scintillators are
Na l(lt), Nal, eSI(Tl), Cs t, UI(Eu), KI(Tt), CsF, ZnS(Ag ),
CdWO_ .
Owing to Its favourable properties Na l (Tt) is the most
widely used detector in Nuclear Medicine. The charac-
teristic of Nal (Tt) crystals can be summarized as fol-
lows:
the high crystal density (3.67 g/cm3 ) and the high
atomic number of iodine (Z = 53) lead to a high de-
tection efficiency for -y-rays of low and medium
energy;
(16) energy resolution is about , 0% and is therelore ac-
ceptable lor Nuclear Medicine examinations;
scintillation efficiency, that is to say the fraction of
absorbed energy which is transferred into light, is suf-
ficient (20-30 light photons for an energy loss of 1
keV) ;
the decay time is 0.25 jJS for 60% of the emitted
photons and 1.5 . for the remaining ones.
Sodium iodide is highly hygroscopic and, on exposure
to a humid atmosphere, it shows a yellow surface dis-
coloration. Since crystals used as scintillators should be
transparent, it is very important to prepare the crystal in
a moisture free atmosphere and also to keep it perman
ently in such an envi ronment during its use. For this
purpose the crystal is encased in a metal container
which is frequ ently made of 1I32-i nch thick alumin ium
and hermetically sealed by an optical window. The con-
tainer protects the' crystal also from ambient light.
The sodium iodide crystal is frequenlly mounted directly
on the photomultiplier tube. In this case the aluminium
container is extended from the crystal to the base of
the phototube.
Light collection efficiency is very much affected by the
nature of the crystal surface. Since diffuse reflection
GllAROONI. RADiOlOGY - ELECTROMEDICINE
Yields a greater and more uniform light output than
specular reflection. all surfaces of the crystal with the
exception of the light-exit face are roughened. As a re-
flector Ah03 or MgO powder is paked in a thin layer
between the crystal surface and the container. Finally, it
lS necessary to ensure good optical contact between the
rarious pol ished interfaces of crystal, container window,
and photomultiplier tube. A th in layer of a highly vis-
cx)us silicone between each interface minimizes light los-
ses by reflection.
7.2.4.3. Organic scintlIIators
Organic scintillators can be solid or liqu id.
Solid scintillators are made up of aromatic hydrocarbons
e anthracene and trans-stilbene. They have a decay
nme of about 10- 8 s - 10- ' s, a conversion efficiency
of a few percent and a density of about 1.2 g/cm 3.
They are much less efficient for the detection of y-rays
dlan Na l(Tl) scinti llators.
liqu id sci ntillators are solutions of organic scintillators
n an organ ic solvent. In this case the specimen emit-
nng {J-rays or low energy y-rays are dissolved or sus-
pended in the solution to permit the radiation to inte-
ract with the scintillator. The most widely used organic
scintillators are PPO" (2.5 difeniloxazole) and butyl-PBD
[2-(4-biphenyl)-5-(p-t-butylphenyl)-1.3.4 oxadiazolej .
They have a very short decay time (10-g s) and a con-
wrsion efficiency that is about hall that of anthracene,
a good liquid scintillator emits about 7 photons per keV
of absorbed energy. Plastic scintillators may also be used.
They are made up of organic scintillators dissolved in
polystyrene or polyvinyl toluene. The best concentration
lS of a few percent or less. Plastic scintillator detectors
can be made of any shape (disk, cylindrical , thin wire,
lOng bar, etc.) and size.
Their density is about 1 g/cm l and conversion efficiency
about a quarter of that 0 1 anthracene.
7.2.5. Electronic Instrumentation
The interaction between radiation and detector produces
a charge pu lse which is applied to the electronic cir-
cuits connected to the detector. The nature of the final
signal depends both on the characteristics of the detec-
tor and on those of the electronic circuit. The amount
of charge produCed by the detector for each pulse de-
pends on the detector type and on the natu re of the
radiation . It can vary from 10- 10 C (Geiger counters) to
10- 15 C (Solid State detectors) .
The lime necessary for the detector to supply the char-
ge to the electronic circuit varies Irom a few nanose-
conds to several microseconds. Gas counters are cha-
racterized by an initial rapidity in the collection of elec-
trons and a slower collection of positive ions. In fact
while it takes a few microseconds to collect electrons,
positive ions need a few milliseconds to be collected .
In the case of semi-conductor detectors the collection
times 01 electrons and holes are almost the same and
vary from 1()-3 to 10- 7 s. The duration of the pulse
produced by a scinti llation detector is determined on
the other hand by its decay constant which varies from
a few nanoseconds to several microseconds according
to the scintillator type.
In certain cases fl uctuations of the transit time of elec-
trons through the photomultiplier may influence pulse
du ration.
This however only happens if the decay constant is less
GIl.AAOONI . RAOIOlOGV - ELECTROMEOICINE
than 10-3 s. The electronic circuits con nected to the
detector have thefundamental task of forming amplifying
and analysing the electric pulses produced by the de-
tector. These are divided into circuits for the formation
and ampli lication 0 1 signals, circuits for data registration
and pulse-height analyzer circuits.
7.2.5.1. Pre-ampUflers and ampliliers
The initial stadium 01 lormation and ampl ification of the
electric signal produced by the delector has the funda-
mental task of making the pulse suitable for successive
analysis.
In particular, those pulses whose amplitude is too low
to be adequately treated by successive circu its have to
be amplilied. Pulse formation is also of great impor-
tance especially in so far as pulse duration is concerned .
In fact the shorter the duration the less likely it is that
more than one pulse will be present at the same time
(pile-up phenomena) causing distorsion in the analysed
pulse. Consequently the rate of pu lses that can be ana-
lysed will be greater. Whereas the rise time of the
pulses is due to the particular cha racteristics of the de-
tector, the decay time depends on the characteristics of
the pulse-forming ci rcuit. This circuit must therefore
form the pulses in such a way as to make their dura-
tion as brief as possible without however producing dis-
torsion in the rise phase that would invalidate subse-
quent analysis. When the pulse produced by the detec-
tor is of reduced amplitude or has to be transmitted to
the amplifier through a long coaxial cable, a pre-ampli-
fier must be used . This device provides impedance
matching between the detector head and the cable or
the amplifier thus making it possible to avoid attenua-
tion and distorsion of the signal.
7.2.5.2. Scalers and ratemeters
The output pulses produced by a radiation-detecting and
analyzing system are normally sent to an electronic de-
vice that enables one to count them . There are two
types of counters: the scaler and the count-rate meter.
A scaler Is a digital device that consists of an electronic
circuit to count pul ses, a clock or timer to measu re the
time interval during which the cou nts are collected and
a read out, that can be visual or printed . The scaler is
usually devised so that the operator has a choice be-
tween accepting a certain number of cou nts (preset
count) or a predetermined period of l ime over which
counts can be accumulated (preset time). Wh ile in the
first case the time interval necessary to reach the pre-
determined number of counts is measured, in the se-
cond one the number of counts collected during a cer-
tain time interval is determined.
A ratemeter on the other hand gives a continuous indi-
cation of the pulse rate. The term rateme ter is usually
associated with analog ratemeters. The analog rateme-
ters store a charge and provide an analog response (a
voltage) that is directly proportional to the input count-
rate. The ouput voltage directly controls the movement
01 the needle of a voltmeter or of a stripchart recorder.
Digita l ratemeters may also be used . The digital ratem&-
ter is an automatic reset scaling device in which the
number of cou nts per unit time is continuously recorded
on a visual display of numbers, printed or punched on
tape, or graphed on a stripchart recorder as in the
analog ratemeter.
7.2.5.3. Pulse-height analysis systems
The pulse-height analyzer is an electronic device that
enables the operator to select pu lses of a certai n heig ht.
229
Pulse-height analyzers can then also be used to mea-
sure the frequency distribution of the amplitudes of
pulses produced by a detector. If the amplitudes are
proportional to the energy imparted to the detector by
the incident radiation, the measured frequency distribu-
tion of pulse-heights may be used to analyse the energy
spectra of the radiation interactions with the detector.
The simplest pulse-height analyzer is the single-channel
analyzer, which permits the selection of pulses with an
amplitude between two predetermined values (window)
that is to say the circuit produces a signal only if the
input pulse has an amplitude included in the range of
the predetermined values.
The multi-channel analyzer or; the other hand is a more
sophisticated instrument that permits the classification of
the pulses com ing from a detector according to their
amplitude. The way in which this instrument works can
be briefly described as follows. The opportunely formed
and amplified pu lses coming from the detector are dig-
itized by means of an analo-to-digital converter which
transforms a pulse of a given amplitude V into a se-
quence of N standard pulses produced at a constant
rate by an osci llator, N being proportional to the ampli-
tude V of the signal. This pulse sequence is then sent
to a scaler that measures the number of pulses Nand
sends a pulse to a successive circuit which may access
a digital memory whose elementary cells or channels
correspond to a certain value Ni .6.N.
In this way the channel corresponding to the measured
value N increases its contents by one unit. At the end
of the measurements the contents of each memory cell
therefore contains the number of pulses that have an
amplitude included in the interval V /::,.V. The stored
data may be used for subsequent elaboration or dis-
played on the screen of a cathode-ray tube (CRT) where
the di fferential spectru m of the signal amplitudes may
be presented .
A mu lti-channel analyzer may also be used as a mUlti-
channel scaler. In this application all pulses in a given
time interval are directed to the same memory pOSition ,
and the channels are addressed in time sequence. The
add ress advance controls the dwell time in each chan-
nel. In this mode of operation the analyzer functions as
a fast digital ralemeter.
7.2.6. Gamma-ray spectroscopy
Due to their greater densily and consequently their grea-
ter efficiency the most suitable detectors for gamma ra-
diation detection are scintillation detectors and solid sta-
te detectors.
Since in this case the amplitude of the electric pulse is
proportional to the amount of energy imparted to the
detector by the radiation it is possible to analyse the
spectrum of the interaction process as of the radiation
with the detector by using a pulse-height analyzer. The
pulse-height spectrum is the result of the different types
of photon interactions with the detector. They can be
divided into four groups: totally absorbed primary pho-
tons, partially absorbed primary photons, scattered pho-
tons and background photons.
Totally absorbed primary photons produce one or more
prominent peaks corresponding to the characteristic pho-
ton energies of the radionuclide under observation.
These peaks are called photopeaks, since total absorp-
tion involves a photoelectric interaction in the crystal.
The photopeaks are bell-shaped (approximately Gaus-
sian) curves centered on pulse heights that correspond
to the primary photon energies. If the detector had per-
fect energy resolution, generating a pulse exactly pro-
230
portional to the energy transferred to the crystal, totally
absorbed photons of the same energy would give rise
to pulses of the same height, so that each photopeak
would be a narrow spike. It must be noted, however.
that photons transferring identical amounts of energy to
the crystal usually give rise to pulses of slightly different
heights, due to random variation at each step of the de-
tection process. This variation accounts for the broaden-
ing of the photopeaks. The energy resolution of a de-
tector is its ability to distinguish between photons of
similar energies, and depends on the shape of the pho-
topeak: the broader the photopeak, the poorer the
energy resolution. The most commonly used measure of
energy resolution is the full width at half maximum
(FWHM), which is simply the number of keV corres-
ponding to the width of a photopeak measured at half
its height and usually expressed as a percentage of the
energy of the photopeak.
The FWHM is energy-dependent, its percentage. value
decreasing with increasing energy of the photopeak.
therefore it is always necessary to know at what energy
it was measu red , The 662 keV peak of m Cs has been
adopted as the standard reference energy. Eight percent
is a typical value for the resolution of a NaJ(T>f:) crystal,
while semi-conductor detectors often have an energy
resolution below 1%, resulting in much narrower phOto-
peaks.
The partially absorbed primary photons are those that
transfer on ly a portion of their energy to the crystal , the
remainder usually escaping as Compton scattered pho-
tons. The maximum energy that a primary photon can
transfer to an electron in the crystal during a sing le
Compton interaction depends on its energy and it ap-
pears in the pulse height spectrum as the Compton
edge. When a primary photon undergoes a Compton in-
teraction in t he crystal, and the resulting scattered pho-
ton escapes from the crystal, a pulse is produced fall ing
at or below the Compton edge. When the scattered
photon undergoes additional Compton interactions and
then escapes from the crystal , a much less frequent oc-
currence, the resulting pulse usually falls between the
Compton edge and the photopeak. Finally, the scattered
phOton may undergo a photoelectric interaction and be
completely absorbed , in which case the entire energy of
the primary photon will have been transferred to the
crystal, and the corresponding pulse will be a part of a
photopeak. The larger the crystal, the greater the frac-
tion of totally absorbed primary photons.
Partial absorption may also take place as a result of a
photoelectric interaction. In fact if the y-ray followin g
the photoelectric interaction of the primary photon with
an inner shell electron escapes from the crystal, the
energy absorbed in the crystal is reduced by this
amount. In Nal(Tl) detectors this effect gives rise to an
iodine escape peak." which is 28.5 keV below the total
absorption peak. The 28.5 keV energy represents the
difference in the binding energies of K and L shell elec-
trons of iodine.
In the detection process photons scattered before they
reach the detector are also present. The number of
these photons depens on the size, shape and density of
the source and the structures separating it from the de-
tector. The spectrum of these photons usually includes
a backscatter peak, representing those photons that have
been scattered through angles that approach 180>. Final-
ly background photons depend on the presence of cos-
mic rays, of radionuclides within building materials and
of other radiation sources in the area. Background
photons may be reduced by adequately shielding the
detector.
Fig. tfi shows pulse height spectra made with a Nal(T)
detector and a semiconductor detector.
GILAROON I. RA.DIOLOGY ELECTROMED ICI NE

Soomicooducto. Scintil\lltion Detector
Detector
Fig. 7/7 (par. 7.2.6.) Typical pulse height spectra made with
8 semiconductor detector and a scintilla tion detector. The
hypothetical spectra due to the different components are also
shown: totally absorbed primary photons (horizontal cross-
hatch), partially absorbed primary photons (heavy diagonal
crosshatch), predetector scattered photons (light diagonal
cross-ha tch) and backgrOund photons (solid line at bottom).
Chapler 7.3. - INSTRUMENTATION IN NUCLEAR
MEDICINE
7.3.1. Generalities
uclear detectors described in the previ ous chapter are
the basic instrumentation used in Nuclear Medicine.
They are in fact able to detect the radiati on emitted by
radion uclides present in the patient's body or in sam-
pJes taken from him.
The special characteristics of these instruments depend
upon the types of measu rement and on the radioisotope
10 be detected .
In the case of in vivo measu rements, the radiation em-
tted by the radioisotope has to be able to penetrate the
tISSues and reach the detector situated outside the pa-
nt's body. For this reason isotopes emitting medium
10 high energy gamma rays and detectors which are
suitable for the detection of such rad iation have to be
used. By far the most widely used detector in the field
of .. in vivo" measurement is the Nal (Tt) solid scintilla-
lOr.
In the case of "i n vitro .. measurements, on the other
nd, since the geometry of the measurement set up
may enable the sam ple to be placed very near the de-
tector, isotopes emi tting beta particles or low energy X
and gamma rays may be used. The detectors used in
mis case are both solid and liquid sci ntillators.
The factors wh ich mainly influence measurements in
"!uelear Medicine are the geometry of measurement, the
absorption and the diffusion of the emitted radiation,
the detector efficiency, the background and the collima-
tion system.
The geometry of measurement, that is to say the di-
mensions and the shape of both the detector and the
source and their relative distance greatly influences the
measurements. In particu lar the inverse square law al-
though not strictly applicable in these cases has a con-
siderable effect on the measured count-rate,
Measu red count-rate can also be reduced by the diffu -
sion and by t he absorption of the radiation emitted due
10 the source itself (autoabsorption) or to the tissues or
materials interposed between source and detector.
Another parameter to be taken into consideration is the
detector efficiency, that is to say the fraction of the de-
tected rad iation in relation to that which reaches the
GrtAA DONI . RADIOLOGY - ElECTROMEOICI NE
detector. In some cases it is also necessary to know the
fraction of the detected radiation which is com pletely
absorbed (photofraction).
Since background radiation is always present in the en-
vi ronment due to cosmic rays, natural radioacti vity or
artificial sources situated near the detector it is also ne-
cessary for the detector to be appropriately shielded.
Fu rthermore, since background count-rate increases with
the volume of the detector, detector dimensions must
be kept as small as possible.
Finally the coll imator system must be taken into consi-
deration since it is a very important part of the detec-
tion system above all as regards i n vivo measurements.
The collimator is a device which permits the detection
only of the radiation of interest and the elimination of
radiation which is of no use for the measurement, as
for example the radiation emitted by the organs sur-
rounding the one of interest.
7.3.2. tnstruments for in vitro measurements of bio-
logical samples
The ways of measuring biological samples Kin vitro de-
pend on physical factors like the type and the energy
of the radiation em itted by the radioisotope use, and on
geometrical factors such as the shape and the dimen-
sions of the sample. Generally speaking "i n vitro mea-
surements can be divided into two catego ries: measure-
ments of beta-emitting samples and measurements of
gamma-emitting samples.
7.3.2.1. Beta-counters
The measurements of biological beta-emitting samples
are carried out main ly with liquid scintillation detector
systems. In this case the most frequently used isotopes
for labelling the biological sam ples are 3H and !4C wh ich
emit fJ- rays with an average energy of 5,6 keV and 50
keV respectively .
In liquid scintill ation cou nting the samples must be op-
portunely prepared so as to have a homogeneous solu-
tion of the material to be measu red and of the liquid
scintillator ensuring that the solution is as transparent
as possible to the light photons emitted by the sci ntilla-
tor. For this reason a solvent, a liquid scintillator and
sometimes an inert additive must be added to the mate-
rial to be measured in order to favour the prepa ration
of the sample. The choice of the solvent and of the
additive is conditioned by the chemicophysical charac-
teristics of the sample. A good scintillator shou ld have
the following characteristics:
1. It should have a good light efficiency and the light
output should be of a wavelenght wh ich matches the
response of the photomult iplier tube. A good liqu id
scintillator emits about 7 photons per keV of beta-
ray energy absorbed in the scintillator.
2. It shou ld be sufficiently soluble at the working tem-
perature of the system to permit incorporation of an
adequate quantity.
3. It shou ld be chem ically stable for reasonable time
periods.
4 . It shou ld be economical to use at the required con-
centration,
The most widely used liquid scintillators are PPO .
Other scintillator materials which can be useful in the
measurement of beta-emitting samples are the secon-
dary scintillators. Although these scintillators are not
particularly soluble they have the advantage of having
231
maximum fluorescence in the area 01 maximum response
of the photomultiplier tubes. They are therefore used
because they are able to absorb the photons of lower
wavelength. The bis-MSB IP-bis(o-methylstyryl)-benzene) ,
the POPOP and the dimethyl-PO POP are the most used
secondary scintillators.
As regards the solvent, it must be capable of efficiently
transferring the absorbed energy to the molecules of the
scintillator, must be transparent to the emitted photons
and must not solidify at normal working temperature.
Toluene is a good solvent which is generally used.
The inert additives which favour the solubilisation of
tissues, protein, blood, peptides and aminoacids in to-
luene and which are normally used are NCS, a mixed
dialkyl-dimethylammonium, and hyd roxide of Hyamine.
In preparing the samples care must be laken 10 avoid
the presence of quenching agents i.e. chemical subslan-
ces such as oxygen for example in the solution as they
absorb the light photons emitted by the scintillator and
thus reduce the light efficiency.
As far as concerns the measuring instrumenls they must
be designed in such a way to detect small quantities of
emitted light. It should be remembered that in the case
of tritium the mean number of light photons emitted per
disi ntegration is approximately 40 and that this value is
further reduced by the presence of quenching agents in
most samples.
Therefore the photomultipl ier tubes used for liquid scin-
tillation counting must have quantum efficiencies (num-
ber of electrons emitted per photon) of about 25-300/a
and high multipl ication factors. Moreover, in order to
minimize background noise the following procedures
may be adopted :
the counting camera and the photomultiplier tubes
must be perfectly light-proof and well shielded from
cosmic radiation and from other possible background
rad iation;
in order to reduce the phosphorescence induced in
the sample or in the sample vial by exposure to light.
undue exposure of the sample to ultraviolet light must
be avoided during preparation particularly when using
polyethylene vials which have a higher induced phos-
phorescence than glass vials;
to reduce the background noise caused by the ther-
moionic emission by the photocathode it is necessary
to operate at low temperatures, cooling the photomul-
tiplier tube and using coincidence syslems made of
two photomultiplier tubes with separate cou nt chan-
nels. This allows an event to be counted only if both
photomultiplier tubes observe the event, while a noise
event In one photomultiplier tube is not counted.
7.3.2.2. Gamma-counters
Nal(Te) scintillation detectors are the most widely used
lor the measurement of gamma-emitling samples as they
present the greatest efficiency in the measurement of
gamma radiation. The geometry of measurement de
pends ma inly on the dimension and on the shape of
the sample to be measured .
7.3.2.2.1 . Well-counters
When small volume samples are to be measured well-
counters are used as detectors. They are made of a
crystal of Nal(Te) with a small hole for positioning the
sample to be measured (fig. an). In this way the geo-
metry of measurement is almost 411" since the source is
almost completely surrounded by the crystal.
232
.
N. I (TI) "'''','' _&+;Lj
light guide
Photomultlpll., lube
Fig. 8f7 (par. 7.3.2.2. 1.) . A longitudmal section drawing of a
Iypical well delec tOl".
The standard well-detector is made up of a cylindrically
shaped crystal with a diameter of 13/4 inches and a
height of 2 inches containing a hole 3/4 inch in diame-
ter and 1112 inches deep. Thus the hole is surrounded
by 112 inch crystal on all sides. The total detection effi-
ciency will depend on the volume of the sample and on
the energy of the emitted gamma radiation.
As lar as regards the geometry it should be noted that
the fraction of ")'-rays which come out through the aper-
ture without passing through any section of the crystal
depends on the position of the sou rce, varying from
less than 2% for the ")'-rays emitted at the bottom of the
well up to 50% lor those emitted on top of the well.
Counting efficiency varies with sample volume ranging
from 100% for a hypotetical 0 ml volume to 94%, 82%>
and 58% for a 3 ml, 5 ml and 8 ml volume respectively.
With regard to the photon energy, measurements carried
out on samples with a 1 ml volume indicate that the ef
fective thickness of the walls is 1.5 em, that Is to say
greater than the actual thickness because most )'-rays
strike the walis at a certain angle. Photopeak efliciency
varies from about 100% lor an energy of approximately
50 keV to 31% and 5.5% for an energy of 364 keV and
1.27 MeV respectively. For energies lower than 50 keV
the absorption of the ),-rays in the sample must also be
taken into account.
Other frequently employed well-counters use crystals
with dimensions of 2" x 2" (diameter 2" and 2" height),
3" x 3", 5" x 5" and 9" x 9".
The 2" x 2" crystals with a hole P I e" x 1 ~/1" permit the
measurement of samples of greater volume (up to 20
mil but the wall thickness of only 5/ 16 inch leads to an
inferior efficiency of detection than that of the standard
well.
The 3" x 3" crystals are ideal for a great many uses as
they permit a wide choice in the dimensions of the
well. Three inch phototubes also ensure maximum effi-
ciency in the collection of emitted light. Finally the
weight of the material needed for background shielding
is not excessive.
Well-detectors of large dimensions permit the measure-
ment of samples emitting high energy -y-rays with ac-
ceptable efficiency (thick walls, small volumes) or sam-
ples of greater volume (thin walls, large volumes). They
do however require heavy, bulky shielding.
7.3,2.2.2. Counters for large sample volumes
For the measurement of large sample volumes the well-
counters must use crystals of large dimensions which
GILAflOONI. RADIOLOGY ELECTI'IOMEDiCINE
are either technically impracticable or else extremely ex-
pensive. For this reason it is preferable to use single or
coupled crystals even though they present a lower geo-
metrical efficiency.
Two crystals opposite each other with the sample to be
measured placed between them present a similar geo-
metry to that of a well-counter if the distance between
them is small in relation to their diameter. However, as
the dimensions of the sample increase, the distance be-
tween the crystals becomes large and a greater number
of y-rays go undetected.
Since large dimension crystals are very expensive, 3" x 3"
aystals are normally used. Although their geometrical
efficiency is low, these crystals have the advantage of
absorbing almost 100% of the emitted y-rays, even high
energy ones (including the y-rays of Co). So total effi-
ciency is determined almost solely by geometrical e11l-
aency. The latter can be roughly calculated if the effec-
tive distance is assumed to be equal to the distance be-
tween the centre of the sample and a plane at a depth
of 1" inside the crystal. In the case of sam ples with a
volume of 1000-2000 ml there Is a further count loss
due to the fact that the source diameter is larger than
the crystal diameter.
For a given separation of the two crystals the summed
output count-rate is more or less Independent of the vo-
lume of the sample. Th is Is very important if one has to
measure and compare samples which vary in volume.
A special counter for large volume measurements is the
Marinelli beaker shown In fig. sn. It is vi rtually the
SImplest and perhaps the most sensitive method for the
measurement of large samples (500-1000 ml) . It consists
of placing the sample around the detector (a 2 x 2-inch
Q( 3 x 3-inch crystal) . Such geometry is obtained by us-
U"IQ as sample holder a glass or plast ic beaker with a
hole in its base, in which the crystal may be inserted.
The sample holder and the crystal must be opportunely
shielded.
Fig. 917 (par. 7.3.2.2.2.) - Marinelli ooakor geometry for
counting large sample IIOlumes.
7,3.3. Instruments for ..In vivo>. measurements
- In vivo., measurements are mainly carried out by using
external detectors and radioactive Isotopes which emit
penetrating radiations such as y-emitters and ,8+-emitters.
In the latter case the 511 keV ' annihilation photons are
detected.
GllARlJ()Nl . RAOIOLOGV - ElECTROMEOICINE
Scintinator crystals, which have a high detection effi-
ciency for medium to high energy y-rays, are usually
employed.
The following measurements can be carried out "'in vi-
vo- :
1. measurement of radioactivity or radioactive concen-
tration in an organ by using stalic systems with
scintillation probes;
2. determination of planar distribution of radioactivity in
an organ with scanners or scintillation cameras;
3. determination of the distribution of radioactivity in
sectional maps within the body by using single pho-
ton emission tomography (SPEeT) or positron emis-
sion tomography (PET) systems.
The collimation system is of great importance in the "i n
vivo measurements. It is generally made of lead or sim-
ilar material and usually extends in front of the detec-
tor. The parameters which characterize a collimator are
the geometrical efficiency and the resolution. The geo-
metrical efficiency is given by the fraction of radiation
emitted by the source which passes through the collim-
ator and reaches the detector. The resolution, on the
other hand, is the collimator's capacity to distinguish
two pOint sources near each other. The c haracteristics
of a collimator can also be described by isocount lines
that is to say those lines which describe the geometrical
positions in which a point source is detected with the
same number of count, expressed in percentages of the
maximum count. For example. in fig . 10n the isocount
lines for different types of collimators are shown.
U
D
... .
t; ..
~
,
.,
Fig. 10/7 (par. 7.3.3.) - Isocount lines lor two kinds 01 col-
limators; l/at-!iBld colllm alor (a) and mullihole locusing
collimator (b).
7.3.3.1. Probes for "In vivo>. tracer studies
By using static systems with scinti llation probes it is
possible to measure radioactivity or radioactive concen-
tration in an organ and their variation over period of
time.
These systems are made up of one or more Nal(Tl)
scintillation detectors with appropriate collimation system
233
and shielding and of the relative electronics. The probes
are mounted on a mechanical system so as to permit
their positioning fig . 11n.
Fig. 11/ 7 (par. 7.3.3. I.) Scinfiliation probe system lor renal
blood flow measurement and kidney function determination.
From a clinical point of view these measurements may
be carried out lor the following reasons:
to measure central or peripheral blood flow by inte-
gration of the dilution curves lrom Injected tracer ma-
terials;
to determine organ blood flow by the clearance 01 a
radioactive tracer from circulating blood;
to determine organ function by the analysis of ac-
cumulation or disappearance of a radioactive tracer.
The collimation system for these measurements must be
designed in such a way as to detect the radiation emit-
ted by all parts of the organ under investigation and at
the same time eliminate or at least reduce to a min-
Imum both the background radiation and the radiation
emitted by the surrounding tissues and by the other
parts of the patient's body. For th is purpose cylindrical
collimators or ..flat-field- collimators are normally used.
Flat-field collimators are single taper slighlly diverging
collimators, whose isocount lines (Ilg. 10n) present a
lIat response in their central part, indicating a uniform
..vision .. through the organ under investigation.
As far as concerns the detector's dimensions, it shou ld
have a diameter which makes it possible to see the
whole organ to be examined, and a tickness which
permits a good detection efficiency of the gamma radia-
tion emitted by the rad ioactive tracer. On the other
hand , these dimensions must be kept as small as pos-
sible in order to reduce the detector volume and con-
sequently the measured background. The detectors that
are normally used have dimensions which vary from
11/2" x 1" to 3" x 3" depending on organ dimensions
and ,)--ray energy.
If the amount of radioactivi ty present in an organ has
to be determined accurately both in absolute terms or
in percentages 01 the administered radioactivity it is ne-
cessary to measure the radioactive dose before adminis-
tration in such a way as to reproduce as closely as
possible the in vivo measurement. Reference will then
be made to this initial measu rement.
This procedure is used, for example, in thyroid radioio-
dine uptake measurements. For the standardization of
the procedures for thyroid radioiodine uptake measure-
ments reference must be made to the IAEA recommen-
dations published in 1960.
On the other hand radioactive plasma concentration cur-
ves can be calibrated by measu ring a venous blood
sample taken a sufficiently long time after injection for
the concentration to be considered as costant over the
234
period of measurement. Concentration may be measured
in a well-counter and its value compared to the count-
rate value of the corresponding point in the dilution
curve. This method is used for exam ple for cardiac
output determination.
The electronics used with this type of detectors is usu-
ally not sophisticated, consisting of a single-<:hannel ana-
lyzer, a count-rate meter and a stripchart recorder.
Sometimes a multi-channel analyzer is used as a multi-
channel scaler. In this case each memory content 01
the multi-channel analyzer corresponds to the number
of pulses applied to the multi-channel input in a certain
period of time. The stored data then represent the time
variation of radioactivity during examination.
If automatic data processing has to be carried out, an
electronic computer is needed. The computer may be
on-line with the counting chains in such a way that da-
ta are stored directly in the computer memory during
acquisition or data may be acquired by means of a
mu lti-channel analyzer and then transferred to the com-
puter. Data transfer may be accomplished both on-line-
by means of a suitable interface or "off-line by using
intermediate storage of the data such as magnetic-tape
or paper-tape storage.
7.3.3.2. Linear scanners
The linear scan ner is an instrument which is able to
explore (by scanning) an organ or a body area and to
give a visual representation of the actual radioactive dis-
tribution. The block diagram of a linear scanner is
shown in fig. 12n .
-. ". .,,_.
..... ......
-"- ' -
"-"p
== - ....... -
~~-.
., ~J-"--. ..:".....
Fig. 12/7 (par, 7.3,3.2.) ,
-_-...-
Block diagram of , radioisotope
-.
scanner.
II consists of Nal (Tt) detector with suitable collimation
system mounted on a mechanical system wh ich perm its
its automatic movement along parallel lines of pre-fixa-
ble length and distance.
The electrical pu lses produced in the detector and trea-
ted by conventional electronics are applied to a read
out system which is synchronized with the position of
the detector and is able to present the processed in-
formation in a form suitable for visual interpretation.
The simplest method of scan presentation is the dot re-
cord . It consists of a stylus moving over a piece of
paper which stamps a dot or a bar for every fixed
number of input pulses. The resultant scan shows a dot
density variation proportional to the count-rate and con-
sequently to the radioactivity present in the organ. Back-
ground suppression may eliminate all information from
areas in the scan where the count-rate faUs below a
pre-selected value. Color scanning has the effect of
presenting on one scan contour levels of different co-
lour corresponding to different erase levels without loss
of any information. The photographic method consisting
of a light source moving over photographic film which
flashes once for a fixed number 01 input counts. The
collimation system is a very important part of a scanner
GlLAAOONI. RADIOlOGY - El ECTROMEOIClNE
and its main task is to limit the field of view of the de- Table 217 shows the geometrical efficiency, the resolu-
rector in o rder to reach the necessary spatial resolution. tion d istance and the response to a plane source for
Single-hole, cylindrical or taper collimators and multihole various types of collimators.
Iocusing colli mators are normally used . Multihole collima-
tors consists of a series of holes in a block of lead
angled in such a way as to all be d irected to one sin- TABLE 2n
(par. 7.3.3.2.) - Collimator efficiency
gle point known as the focal paint. and resolution 10' three different kinds 01 col-
The isocou nt lines for a multihole focusing collimator limator.
are shown in fig. 10/7.
The performance of a collimator can however be chara- Focal Plarnl source G. relative
Typo Reso lutiorl values
geometrica l geometrical
cterized on the basis of only two parameters i.e. geo-
-,etrical efficiency and resolution. In fact, since any dis-

collimator
eflicierlcy
distarlce
(0)
response
(G. = Qod' )
rlormalizoo
to equal d
("')
tribution of radioactivity can be considered as a collec-
bOn of point sources, collimator performance can be Cylinder ,; / 16 12 (0'{12 1
4 "
obtai ned from the response to a point source. The point Single taper r02/16 12 1.75 ro 0.19 (ro' {12 ) 5.15
source response curve for a focusing collimator in a
plane perpendicular to the collimator axis has a bell- Focus (in
shaped response, that can be well approximated by a apertures) nr02/16 12 1.75 ro 0.19n (ro'/12 ) 5.15n
Gaussian distribution in its central point. The collimator ) ;, length of co llimator and collimator to focal plane
response to a point source can therefore be analytically distance;
described by: is the radius of the cy lindrical collimator and radiu s
" of the large end of the taper in a single taper or fo-
g(x) = go exp(- 2.78 x2/d 2 ) (17) cus collimator.

and may be characterized completely by two parame-

ters, first, the peak sensitivity, go, and second, the full
width at half-maximum, d. In the focal plane, these two
parameters may be referred to as the focal geometrical
eHiciency, go, and the resolu tion distance d.
The resolution is oft en defined as the minimum distance
oetween two points which are barely disti nguishable. Al-
though the definition is qualitative the collimator res-
ponse to two point sources as the fun ct ion of thei r
separation distance can be exami ned assuming a Gaus-
Sian response curve for each source. Fig. 13n shows
the calcu lated patterns for the two point sources for dif-
ferent saparation distances in units of d, the resolution
distance. It is seen that the two sources can hard ly be
distinguished when the distance between them is equal
10 the resolution distance d, whereas they can be seen
dearly distinct when the separation distance is 2d.
2.
t.
~ t6
:;;.,.
"
'.0
7.3.3.3. Scintillation cameras
7.3.3.3.1. Operating principles
The scintillation camera introduced by Anger in 1959 is
at present the most widely used imaging device in Nu-
clear Medicine. The main advantage of the scinti llation
camera over the linear scanner is that it views all parts
of the fi eld continuously, so that it can take pictures 01
isotope distri bution in much shorter times.
T he scinti llation camera consists of a detector head with
its mechanical support and of a console containing the
electronic circuity, for the ela boration of the signals co-
ming from the detector head and for data read -ou t
(fig . 14/7) . The detector head contains a Nal(Te) scintil-
lator crystal, generally circular in shape, with a diameter
varying from 20 to 50 cm and a thickness of 1/ 4' to
1/2" , a hexagonal array of photomultiplier tubes varyi ng
in number from 37 to 91 placed above the crystal and
opportu nely coupled to it. A collimator is placed in
front of the crysta l in order to limit t he field of view of
the detector and to provide a one-to-one mapping of
radiation emanating from the organ of interest to the
detector.

'0
.6
0.'
02

Fig. 1317 (par. 7.3.3.2.) - Collimator response 10 IwO point

sources as a function of their separation S (In units 01 reso-
lution dis tanca). l ig ht deflecto,
1-.."....1 light g~ld<O
N. I (Til c rye tel
It can be shown for a focusing collimato r that the col-
limator response to a uniform plane sou rce, G. (z), does
not depend on the distance between the source and the pi>otons
collimator and that G. may be closely approximated by
g d 2 Since the source volume can most of the times
be approximated by series of uniform plane sources, the Fig. 14/ 7 (par. 7.3.3.3.1.) - Cut-away diagram of gamma-
collimator properties are fully desc ribed by G. and camera.
hence by g d2 .

G1LAROONI. RADIOLOGY _ ElECTf!OMEDICINE 235

The positioning of the scintillation event is obtained by
using an appropriate electronic ci rcuit for the elabora~
tion of the signals coming from the phototubes array. In
fact the scintillation event determines a partition of the
tight amongst the various photomultiplier lubes. The one
nearest the scintillation pOint will receive the maximum
amount of light and those further away will receive pro~
gressively less.
The block d iagram of the simple circuit for computing
the location of scintillations described by Anger in 1958
is shown in fig. 1Sn.
; ,
tub.
The X and Y signals are proportional to the x and y
coordinates of the scintillation. The origin of the coord i-
nate system is located at the centre of the crystal.
Obviously the most recent electronic circuits are much
more complex and also use non linear arithmetics in
the elaboration of the signals in order to give a better
reproduc tion of the position where the scinti llation event
occurred. In addition the more modern gamma-cameras
are endowed with microprocessor digital systems which
act during the analysis of the Z, X and Y signals taking
into account the different energy response of the var-
ious areas of the crystal and correcting for spatial d is-
torsions.
The X and Y deflection signals are then applied to a
cathode ray tube (CAT) display system and cause a

,\ f =;; =;; =;; , ;; II

fl ash of light (a dot) to appear at the appropriate (x. y)
location on the display screen. The phosphor of the
, ~

CAT screen has a low persistence, so dots are pro-

N.~~!~I,
::" r~~ duced on the screen almost instantaneously. It a film is
exposed to the flashed of light occurring on the CAT
screen for a certain period of time, a composite picture
corresponding to the distribution of radioactivity in the

::-" (\ J5~< ./ ' ,~

II
organ, is created. T he most commonly used record ing
systems are Polaroid cameras or multi-image format de-

::"
vices.

'- ~-
II

I cllo..
II.
"1-.../ II. 7,3,3.3.2, Con/mallon

I cllon "". , ;; =;; =;; ;; " The collimation system placed in front of the detector
head provides an intertace between the detector and the
f= II"

In pr
organ structure being imaged. II Is made up of a series
of holes which are geometrically arranged to permit on-
ly those photons travelling in an appropriate direction to
interact with the detector. The most widely used types
of collimator are the multichannel parallel-hole coll imator
,- j,- r j ,-
'-I I' and the pinhole collimator (fig . 1M).
DIII ..... U DIII f>C.. Adclllion
circul i cl' Cu ll cl .cu ll

1
'ul ~n."M
"'lOCto.

0 1 ' "'"
Im_,._,
" ou t
o.cillo_

Fig. 15/ 7 (par. 7.3.3.3. 1.) ~ Block diagram showing the princi
pie of operation 01 the scintillation camera described by
Anger in 1958.

Pulse signals from the phototubeS are fed to four out-

put leads (X~, X~ , y~ , Y- ) through electronic circuits
(capacitors or resistors in the most simple cases) which
transfer an amount of signal proportional to the dis-
tance of the phototubes from the crystal edge along
the X', X-, y' and Y- directions. T he four signals X', X-,
y. and Y- are then applied to an electronic circuit pro-
ducing three new signals:
Z = X' + X-+ Y'" + ' f
X ~ (X' - "I I Z
Y ~ (Y' - Y-)IZ
The Z signal is pro portional to the bri ghtness of the
scintillation and therefore to the energy transferred to
the scintillator crystal by the gamma radiation . This sig-
nal permits the discrimination between those events whe-
re all the energy of the incident radiation is absorbed
by the crystal and those corresponding to a partiat air
sorption of the incident energy (Compton effect) .
Fig. 16n (PBr. 7.3.3.3.2.) . Multichannel parallslho/e colllma
'or (a) and pinhole collimator (b).
The multichannel parallel-hole collimator consists of a
thick plate of high density material with thousands of
(18) uniformly distributed parallel holes. Each hole accepts
only vertically oriented gamma rays from a specific area.
The main characteristics of a parallel-hole collimator are:
the geometrical efficiency is maintained more or less
constant when the distance between the source and
the collimator face is increased;
resolution worsens in an almost linear way when the
distance between the source and the collimator face
is increased;

236 GllARDONI. RAOIOt.OGY - ElECTROMErIiCINE

 the dimensions of the image produced on the detec
tor do not become distorted and are not affected by
distance.
The pinhole collimator consists 01 a single small aper
nne at the end of a shield of high-clensity material. This
geometry creates an inverted image Irom photons travel
I ng in a straight line from an object to the detector.
When the distance of the object from the pinhole is
equal to that of the pinhole to the detector. a 1:1 rela
onship of size exists. When the object is moved further
rom the pinhole, a reduction in size occurs. and when
the object is moved closer magnification occurs.
The characteristics of the collimator are such that a
orog ressive worsening of the resolution and of the geo--
metrical efficiency is produced as the objecHo--aperture
d stance increases.
Besides this. geometrical efficiency is not constant for
all the points situated on a plane parallel to the detec
lO r but worsens as the lateral distance from the aper
rure increases. thus causing a distorslon of the image.
Pinhole coll imators provide the best combination of sen
s.tJvity and resolution for small organs that are positi
oned at a short distance from the aperture, such as the
thyroid gland.
7.3.3.3.3. Parameters characterising the response of a
gamma-.camera
The response of a gammacamera is characterised by
various parameters which depend both on the charac
teristics of the detector and on the characteristics of
the colli mation system .
The most Important are: sensitivity. spatial resolution.
spatial linearity. uniformity and countrate performance.
7.3.3.3.3.1. Sensitivity
Gammacamera sensitivity depends both on the efficien-
cy of the scintillator crystal and on the geometrical effi-
cency of the collimator.
Due to the reduced thickness of the scintillator crystal
detection efficiency is good for low-energy y-rays; such
as lor example those emitted by 'i9mTc (140 keV) whe-
reas it is considerably reduced for greater energies. Ty-
pical detection efficiency's values are shown in tab. 3fl.
TABLE 3n (par. 7.3.3.3.3.1.) - Theoretical intrinsic
crystal efficiency (%) 10' three different crystal
thicknesses and three different y-ray energies.
Crystat th ickness
y-r8y energy
1/ . " ~8 >lZ'
70 keV 99
99 '00
140 keY 76 87 93
I 360 keY 14 23 29
However the lactor which greatly limits the sensitivity of
a gamma-camera is the geometrical efficiency of the
collimator. In fact in order to faithfully reproduce the
distribution of radioactivity in an organ only the photons
which reach the collimator along opportune directions
(for example perpendicularly to the face of the collima-
tor in the case of a parallel-hole collimator) must inte-
ract with the crystal. Only very few (less than 0,01%) of
the emitted photons reach the crystal.
GIlAROONI . RADIOLOGY ELCTROMEDICINE
7.3.3.3.3.2. Spatial resolution
Spatial resolution is the gamma-camera's capacity to dis-
tinguish two point sources near each other. It is usually
defined as the full width half max imum (FWHM) of the
bell-shaped function representing the count distribution
along an axis passing through the centre of a point
source function (PSF) or along an axis at right angle to
a linear sou rce (LSF).
The spatial resolution of a gamma-camera depends on
the resolution of the detector (intrinsic resolution) and
on the resolution of the collimation system. The resolu-
tion of the detector is linked both to physical factors.
that is to the physical modalities of the y-rays' interac-
tion with the crystal, and to the technical characteristics
of the detector.
The interaction 01 the gamma radiation with the crystal
takes place either through photoelectric effect or through
Compton effect. In the former case all of the radiation's
energy is absorbed in a very limited area of the crystal
with a diameter of less than 1 mm . In the latter case, if
the diffuses photon leaves the crystal without interact-
ing. the scinti llation produced is much less lum inous
and so the event is eliminated by the discrimination cir-
cuit. If however the diffused photon interacts through
photoelectric effect two scintillation points are produced
belore the photon is able to leave the crystal. The total
light of the two points is the same as that produced by
a single photoelectric interaction so this event cannot
be eliminated by the discrimination ci rcuit. In this last
case the detected position is that of the centroid of the
two interactions and does not correspond to the entry
pOint of the y-ray into the crystal. The probability of
misplaced events becomes higher as the y-ray energy
or the crystal thickness increases.
As far as technological aspects are concerned the num
ber of photomultiplier tubes used an the dimensions of
the detector crystal influence the precision with which a
gamma-camera can reproduce the pOSition of interaction
01 the y-ray within the crystal.
However the limiting factor. especially at low energy is
the one linked to the statistics of the electrons pro--
duced In the photomultiplier tubes. In fact if a small
number of IIgth photons emitted by the scintillation
event is divided amongst the various photomultiplier
tubes involved in the event. there will be a considerable
statistical variation in the number of photons reachIng
each photomultiplier tube and there will also be an
electric signal produced by the photomultiplier tubes af-
fected by a very high noise. This will therefore result in
a relevant fluctuation of the scintillation coordinates.
In recent years many attempts have been made to re-
duce this effect:
collection efficiency of the light photons has been in-
creased by optimizing the shape and geometrical dis-
tribution of photomultiplier tubes and their optical
coupling to the crystal;
quantic efficiency of photocathodes has been In-
creased by the use of S-20 bialkali cathodes;
threshold preamplifiers have been used in order to
remove contribution from the furthest photomultiplier
tubes, wh ich give rise to low. noisy pulses. In lact
these signals greatly contribute to noise without ap-
preciably increasing precision in the positioning of the
scintillation event.
However this effect is still very important at low ener-
gies.
Table 4n shows typical intrinsic resolutions values for
two different fields of view and for various crystal thick-
nesses and y-ray energies.
237

TABLE 4f7 (par. 7.3.3.3.3.2.) - Typical intrinsic reso-
lution values (FWHM) of modern gamma-cameras.
Crystat thickness
yray energy
1/4"
"'-
Large.fleld-of
view cameras
70 keY
140 keY
5.5 mm
3.8 mm ,
6.5 mm
mm
61-13 pholotubes 360 keY - 3.3 mm
Small-lield-of
view cameras 140 keY 3.4 mm - 4.5 mm
37 phototubes 70 keY 5 mm - 6.5 mm
The resolution 01 the collimation system depends on the
collimator system and, as already said, on the source
distance from the collimator face.
In the case of a parallel-hole collimator it depends on
the number and on the dimensions of the holes as well
as on the collimator thickness. The resolution values for
y-rays emitted by WmTc at a distance of 10 cm from
the coll imator plane vary from 6 cm for a high resolu-
tion collimator to 12 cm for a high efficiency collimator.
To conclude, the total resolution of the detection sys-
tem (AT) is given by the following formula:
where RI is the intrinsic resolution and Ac is the resolu-
tion of the collimator system.
7.3.3.3.3.3. Spatial linearity
Spatial linearity is the parameter that defin es the gam-
ma-camera's capaci ty to reproduce the coordinates x
and y of the scintillation event exactly. It is inlluenced
by the arrangement and by the number of photom ultip-
liers used , by the characteristics of the optical light-
guide and above all by the arithmetic used lor the
analysis of the pulses produced by the photomultiplier
tubes. A great improvement in spatial linearity has been
obtained by usi ng microprocessor systems for the digital
correction of the x and y coordinate signals on the ba-
sis of a predefined experimental linearity map.
7.3.3.3.3.4. UnHormtty of response
An extremely important requisite for a gamma-camera is
its uniform response over the whole field of detection .
When a uniform fl ow of photons strikes the gamma-ca-
mera crystal, local variations in count density are in any
case present in the final image. These variations are
mainly due to variations in the sensitivity of the detector
from one point to another, to local variations in spatial
resolution and above all to local variations in the light
response and to phenomena of spatial distorsion.
The uniformity of response has also been considerably
Improved by the use 01 microprocessor for the digital
correction both of the energ y signal Z (which takes into
account the different light response of the various zones
of the crystal) and of the coordinate signals X and Y.
7.3.3.3.3.5. Count-rate performance
Since the light photons emitted as a result of the y in-
teraction with the crystal are not emitted instantaneously
the time duration of an electrical pulse cannot be fa-
238
duced below a certain value. Thus if the flow of inci-
dent photons on the detector is high, this leads to the
creation of incorrectly positioned signals due to the "pi-
le-up,. of coincident pulses and therefore to notable el-
fects on the fundamental parameters of the gamma-ca-
mera.
"T In fact if an event takes place before the earlier sig nal
has completely decayed, pulses whose energetic ampli-
8 mm
4.5 mm
tude would not normally enter into the analyzer window
5 mm may be accepted whilst on the other hand normally ac-
ceptable pulses may be rejected. The above-described
effect will also c reate on the X and Y pulses a dis-
placement of the pOSitions of the detected events with
respect to the real ones (fig . 17n) .
Z
I AZ
_1. ______ __
(19)
t
Fig. 17/7 (par. 7.3.3.3.3.5., - Typical high'fale pulse Iraln
generaled by a gammacamera.
Zo ls th e full-energy pulse-height and tJ.Z Is the pulse-height
wlndow. Wo and Ws are useful pul ses, but only Wo ls
recorded. while W, and W. glve ri se to mlsplaced events.
This inconven ience can be eliminated by introducing an
electronic device whereby a pulse is rejected if it occurs
when the residual am plitude of the previous signal is
greater than a predetermined threshold value. This of
course brings about count losses and an increase of
gamma-camera dead time. It Is also possible to reduce
pile-up by forming the electrical pulses in such a way
as to shorten its duration. This however leads to the
formation of very noisy signals with unreproducible am-
plitudes and therefore to a worsening of the characteris-
tic parameters in particular as regards spatial resolution.
On the basis of what has been said it is therefore ne-
cessary to find a suitable compromise in the design 01
electronic circuits taking into account diagnostic requi re-
ments in order to keep all the lundamental parameters
of a gamma-camera within an acceptable range.
The count-rate performance of gamma-camera may be
quantified by means of various parameters. Usually the
following operative parameters are given: maximum ob-
served cou nt-rate and input count-rate for a 20% count
toss.
Typically for y-rays emitted by a I19mTc source and for a
10% window maximum count-rate values vary from
200 to 350 kcps, while input count-rate for a 20% count
loss varies from 100 to 180 kcps.
For a more detailed analysis of the count-rate perfor-
mances of a scintillation camera the incident versus ob-
served count-rate curve has to be determined. Moreover
the fun damental parameters such as system spatial reso-
lution and intrinsic uniformity must be measured at high
count-rates, typically at 70 kcps.
GlLAROONI . IVoOIOt.OGY . ELECTAOMEOICINE
The gamma-camera characteristics described before may
be quantified by means of proper test methods. Many
mternational and national associations have adopted
standards for performance measurments of scintillation
cameras. Among them the Nuclear Section of the Na-
bonal Electrical Manufacturers Association has developed
a standard publication to provide a uniform criterion for
the measurement and reporting of scintillation camera
performance parameters by which a manufacturer may
specify its device. This standard has also been adopted
by many users for testing their scintillation cameras.
7.3.3.4. Emission tomography
In recent years many efforts have been made to im-
prove systems which are able to provide sectional maps
of activity distribution within the human body. The em-
ISSion tomography systems can be divided into two large
categories. The division is based on the type of radia-
bOn emitted by the radioisotopes used. The single pho-
ton emission computed tomography (SPECT) systems
make use of routi ne single photon gamma emitters such
as 99mTc, 131), 1231, 01Ga, 201Tt, etc. They are generally
designed to collect data from different angles about the
patient.
The pOSitron emission tomography (PET) systems detect
the 511 keV annihilation radiation from positron emitters
such as ll C, 13N, ISO, 18F, MGa, etc. They consist of two
or more opposed detectors which permit the detection
of the two 511 keV gamma emitted simultaneously and
., opposite directions in the annihilation process and
thus make it possible to determine the ray along which
the emission point is situated.
Smg le photon emission tomographic systems are in turn
classified according to the type 01 image produced : lon-
gitudinal section imaging devices, which produce images
of planes parallel to the long axis of the body and
transverse section imag ing devices wh ich produce cross-
sectional slices.
7.3.3.4.1. Single photon longitudinal-section Imaging
Longitudinal tomographic systems are based on the con-
cept of focal plane tomography where the information
coming from a particular plane is reinforced while blur-
nng out information from other planes. The images are
reconstructed and the poSition In which the gamma-ray
IS detected and the angle of incidence are determined
before back-projecting the information along the path in
this way.
The first device lor longitudinal tomography was develo-
ped by Anger and is known commercially as PHD/CON.
It consists of two scintillation cameras which are placed
above and below a fix ed bed and which scan in a rec-
tilinear raster.
They are endowed with multi-hole focused collimators
and the reconstruction of the images is carried out by
back-projecting each physical event at the point of in-
tersec tion with each of the six planes selected for each
detector.
Other more frequently used systems consist of gamma-
camera and special collimators which permit one to ob-
tain more views of the object to be vIsualized at differ-
ent angles. Special mathematical techniques are used to
enhance the reconstructed images. Seven pinhole col-
limators, time-coded multi-pinhole collimators, rotating
slant-hole collimators and four-quadrant slant ~hole col-
limators belong to this category.
GllAROONI. RAOIOt.OGY ELECTAOME01C1NE
Longitudinal tomography has severe limitations on quan-
titative imaging capabilities because of the limited angu-
lar range and sampling interval. In addition, as the mul-
ti-pinhole systems do not give constant enlargements
they can introduce evident distorsion especially when
large objects are to be visualized.
The seven-pinhole and four-quadrant slant-hote collima-
tors can however be used for carrying out dynamiC ex-
aminations.
7.3.3.4.2. Single photon transverse-section Imaging
The techn ique used In single photon transverse-section
imaging consists of obtaining multiple views of the ob-
ject through a 36()0 or 1SOO angle about the body. The
images are reconstructed by back-projecting each de-
tected event along the line of collection so that various
back projection rays are summed until the final image
is formed (fig. len). The process of back projection is
obviously a very simple., rough process which leads to
the formation of the so called star-effect artifacts. Much
more sofisticated techniques have been introduced .
Among them the most widely used is the convolution or
filtered back projection technique. With this method each
data profile is corrected before back prOjection by means
of a fill er function in order to enhance structures in the
profile and reduce statistical noise. Th is makes it possi-
ble to eliminate the star effect- artifacts.
.)
Fig, 18/ 7 (par. 7.3.3.4.2.) . Diagram of data collection at three
different angles (a) and of the re/atlve backpro/ection tech
nlque (b).
It Is also necessary for the appropriate corrections to be
introduced because of photon attenuation so that the
reconstructed images can provide quantitative informa-
tion .
Various equipment has been used for Iransverse-section
images. The most common , which is commercialized by
all gamma-camera manufacturers, consists of one or two
scintillation cameras mounted on a gantry with rotation-
al capability. These systems have the advantage of be-
ing able to detect data regarding more than one section
simultaneously and can also be used for the acquisition
of conventional not tomographic scintigraphic images.
7.3.3.4.3. Positron emission tomography
The positron emission tomography technique takes ad-
vantage of the fact that in the positron annihilation pro-
cess two 511 keV y- rays are emitted at an angle of
1eO" to each other. Thus if two opposed detectors si-
multaneously detect a 511 keV y-ray, then the origin of
the two y-rays lies somewhere along a line drawn be-
tween the two points where the y-rays were detected
(fig. 19n).
239

DETECTOR 1 DET ECTOR 2
COI NCIDENCE CIRCUIT
Fig. 1917 (par. 7.3.3.4.3.) Diagram of coincidanca counting
for positron clstflCtion.
Positron emission systems generally consist of a circle
of detectors placed around the patient or of two oppo-
sed positron-sensitive detectors, such as scintillation
cameras, which are made to rotate th rough 360 about
the centre 01 the imaging area (fig . 2On) .
",--00 ' ",
-
D o
~"...o.''''
Fig. 2017 (par. 7.3.3.4.3.) - Diagram 01 a cafTlf1f/J type sys tem
for positron emfssion tomography.
The combined electr onics permits the discrimination in
energy and the registration of the radiation coinciden-
ces. The mathematical technique for the reconstruction
of the images is bas ically the same as the one for the
single photon counting methods.
A particularly significant development in positron emis-
sion tomography is linked to the use of the flying
time method wh ich takes into account the temporal
distance of the two coincident events In order to deter-
mine the point of emission. By using CsF detectors
which have a temporal resolution of 0.5 ns, the point
of emission can be determined w ith an uncertitude of
7.5 cm. The reduction 01 the d imensions of the areas
where the baCk-projection of acquired profile s takes pla-
ce increases the signal to noise ratio In the reconstruc-
tion.
As the use of detectors with a high atomic number and
a high attenuation coefficient is necessary for 511 keV
photons, the most widely used detectors are BGO crys-
tals which have however a temporal resolution of 3.4 ns.
It is therefore probable that future generations of posi-
tron emission tomographs will use BGO crystals togeth-
er with CsF crystals which have a reduced coefficient of
attenuation. The main advantage offered by positron em-
Ission tomography by using coincidence detection tech-
niques are:
resolution does not depend on depth thus making it
possible to obtain a higher precision in the determi-
nation of radioactive distributions;
sensitivity Is about 100 times greater than the single-
photon technique with a rotating gamma-camera.
In addition, tracers which consent the examination of
very important physiological and metabol ic processes
can be used . Unfortunately however, as these positron-
emitting isotopes generally have a very short half-life
and therefore have to be produced on the spot, it is
necessary for a ciclotron and a suitably equipped radio-
chemistry laboratory to be available beside the positron
tomography equipment.
240
7.3.3.5. Computer systems
Electronic computers have become fundamentally impor-
tant in Nuclear Medicine since most of the instruments
used are endowed with computer systems.
Most of them are used on li ne with scintillation cameras
for the storage and elaboration of scintigraphic images.
They are extremely useful for dynamic examinations in
particular for storing the temporal sequences of the im-
ages and for subsequently analysing the recorded data.
The computer is also an essential part of tomographic
systems since the treatment of data for the reconstruc-
tion of tomog raphic Images requires complicated elabo-
ration. Recently integrated computer-gamma-camera sys-
tems have also been used. In this case the computer
system which generally consists 01 a series of micro-
processors each one dedicated to a given operation , al-
so carries out some operations wh ich are typical of the
detection system like the analysis and correction of the
signals coming from the detector head, internal calibra-
tion, data display, etc.
7.3.3.5.1. Hardware
A typical on line SCintigraphic data processor has the
following components: a central processor unit and rela-
tive mainframe memory, a mass image system, a control
console, a data acquisition interface and a display sys-
tem.
The first three components are standard computer items.
The central processor unit is a 16 bit processor (some-
times even 8 bit) which in certain cases superintends
the operations of a network of microprocessors, each of
which is dedicated to a particu lar operation. The central
memory varies from 128 kbytes to 1.2 Mbytes and some-
times an auxiliary memory known as .. Image memory is
combined with it. Image memories can reach 3-4 Mbytes.
They are used for storing images during acquisition or
for data display. Mass storage devices include magnetic
hard-d lsks (5-10 Mbytes) floppy-disks (200-1000 kbytes)
and magnetic tapes. The control console is usually a
keyboard operated unit .
The display unit system must be capable of handling
several different types of information, such as scintigra-
phic images. graphical data and text messages. A com-
monly used display device is the storage-type cathode
ray tube (CRT). Each image element is assigned to a
particular area on the screen and within that area a dot
or a number of dots are intensif ied according to the
count content of the image area. The display systems
in use at the moment are able to generate images con-
sisting of up to 512 x 512 locations with 256 grey Ia-
vels. Permanent copies from CRT displays are obtained
photographically using 35 mm , 70 mm or Polaroid ca-
mera systems. Multi-image format devices are also used.
The function of the acquisition interface is to convert
the X and Y analog signals coming from the gamma-
camera into digital values and to transfer these data to
the computer. The conversion is accomplished with ana-
log-to-digital converters (ADC) . The ADC converts the
analog X and Y pulse amplitudes into a range of n
discrete digital values, usually n is one of the binary
number sequence from 32 up to 512. Therefore the ca-
mera crystal is divided into a matrix whose dimensions
vary from 32 x 32 to 512 x 512 square elements. The
converters which are generally used are of the ramp
type (Wilkinson converters) with differential linearities of
1% and conversion times of 2-3 IJS. Normally the in-
terface is equipped with two ADC, one for the X signal
and one for the Y signal. These are activated only
GILAAOONI. A"'OIOlOGV ELECTAOMEOICINE
when a coincident Z signal corresponding to a useful
event is received, that is to say its amplitude comes
within the analyzer window.
In other cases an ADC is also present for the Z signal ,
which in turn is memorized in the computer. A further
converter may be used to sample the physiological ana-
log ic signals which are recorded at the same time as
the scintig raphic examination. Normally, however, it is
not necessary to sample the whole trend of a physio-
logical sig nal but just to memorize the 'temporal infor-
mation regard ing the most sign ificant phase of the phy-
siological event (physiolog ical marker). In the case of
an electrocardiographic signal for example, only the
presence of the QRS complex is usually detected and
memorized.
The interface is also su pplied with a clock which sends
a marker to the computer at predetermined time inter-
vals making it possible to time the acq uired images.
Since the conversion and transfer times of the gamma-
camera signals are rather long, special circuits known
as buffering ci rcuits have to be used. They are tempor-
ary storage devices that accept input at a faster rate
than it is transferred out. They serve as derandomizers,
accepting relatively short rapid bursts of signals, and
trans ferring them systematically and more slowly to the
next system component. In this way signals can be col-
iected during temporary periods of high count-rate and
digitized at a slower rate without count losses.
In a computer system, a very useful component for the
acquisition of scintigraphic images is the direct memory
access (OMA) facility. This gives an external device (in
this case the data acquisition interlace) direct access to
a selected memory location without the assistance of
the CPU . OMA is thus used to minimize count-rate
losses during acquisition.
The amount of information which can be memorized in
a memory location or rather the number of counts re-
corded in each element of image matrix depends on the
length of the word used. Normally the operator can
choose whether to memorize the content of an image
on one or two bytes. In the former case each channel,
that is to say each element of image matrix, will have a
maximum capacity of 255 counts whereas in the latter
case it can contain up to 65.535 counts. In some cases,
on the other hand, a fixed dimension of the word of 12
bit Is chosen and th is is generally more than sufficient
for carrying out all routine examinations in Nuclear
Med icine.
7.3.3.5.2. Acquisition lonnals
There are substantially two ways in which the computer
acquires scin tig raph ic images: frame mode and list
mode.
In frame mode the image data are collected and stored
directly in the form of square matrices. An individual
location in core memory or in image memory is as-
signed to a particular x, y add ress in the image matrix.
When an even t is detected at a particular position on
the crystal, the contents of the corresponding memory
location is incremented by one. Once the final image
has been formed it can be transferred to the mass me-
mory. In the case of a dynam ic sequence of images,
the matrices regarding the various images are stored in
a memory segment. When the memory segment is com-
pletely full the data are transferred onto hard disks
whilst in the meantime the subsequent images will go
on to occupy another memory sector and so on. If im-
age memories with a capacity of 3-4 Mbytes are availa-
ble then the last operation is unnecessary since this
GllAROONI. RAD IOLOGY ElECTROMEDICINE
memory capacity is sufficient to contain all the images
that are to be acquired during a dyna~c examination
(generally with dimensions of 64 x 64).
In list mode successive x, y data from the ADC are
stored in successive memory locations unti l a pre-de-
termined number of memory locations are occu pied. Just
like frame mode, data acquisition is then transferred to
another portion of the memory where the process con-
tinues while the segment of occupied memory is dumped
onto a hard-disk. Time markers and physiological mar-
kers are added within the data listing to permit subse-
quent reorganization of the data into temporal frames.
Whereas in frame mode the temporal resolution of re-
corded images is limited by the time necessary for the
transfer onto hard disk of the sectors into which the
memory is divided during acquisition in list mode the
temporal resolution is on ly limited by the rate at which
time markers can be inserted into the data listing by
the clock of the acquisition interface. List mode also
permits framing at rates that can be selected after the
study is completed . One disadvantage of list mode is
that bursts of data may fill an entire memory segment
before the previously recorded segment is dumped into
mass storage. Data accumulation is thereby temporarily
interrupted with uncorrectable count losses. List mode
acquisit ion also uses a large amount of mass storage
space and may requi re longer play-back times for fra -
mi ng or other analysis.
Another possible acquisition format is gated acquisition .
In this case a physiological trigger starts the acquisition
for a pre-set time and with a pre-set delay and these
acquisitions follow on one another for a pre-set number
of physiological events. The final image made up of the
sum of the series of acquired images is representative
of the distribution of radioactivity in a given phase of
the physiological event.
For example by using the ORS complex of an ECG
signal as physiological trigger and by su mming the rela-
tive images to a sufficient number of cardiac cycles it is
possible to obtain images which are representative of
the telediastolic or telesistolic phase of the cardiac cy-
cle.
The acquisition of various consecutive images in the in-
terval between one physiological trigger and the next
(mu lti-gated acquisition) permi ts one to obtain the ra-
dioactive distribution during the various phases of the
physiological event. In the case of an angiocard ioscinti-
graphic examination, a representative cardiac cycle made
up a series of between 16 and 32 images is normally
acquired.
7.3.3.5.3. Software
As far as software is concerned, the computer systems
normally used in Nuclear Med icine are equipped with a
series of programs wh ich are needed for carrying out
basic operations in addition to the com puter's own ope-
rating system. They are data acquisition prog rams, pro-
ceSSi ng programs, image display programs and utility
programs.
The acquisition programs carry out the previously des-
cribed operations in so far as the acquisit ion and stora-
ge of sci ntigraphic images is concerned. The data pro-
cessing programs perform all elementary operations such
as background suppressio n, cont rast enhancement,
smoothing, image arithmetic, reg ion of interest quantifi-
cation, curve generation and manipulation and also more
complex operations li ke the calculation of clinical pa-
rameters, creation of parametric images, etc.
'4'
Display programs are used to present images and other
data for intepretation . The images may be presented in
static form or in temporal sequence of cinematog raphic
type in the case of dynamic stud ies. Display manipulaM
tions are available and include image rotation, image
shifting, presentation of intensity profile slices and VOM
lumetric or contour displays. Programs for the represen M
talion of the images are also available in various scales
of grey, even nonMlinear, or in colour.
Utility programs are designed to assist the operator in
system utilization and record keeping. Among these can
also be found language programm ing, compilators and
interpreters such as FORTRAN , BASIC. PASCAL, etc.
which permit the operator to make his own programs
for personalized storage processing and calculation of
clin ical parameters for personalized calculations and for
every other special purpose.
Chapter 7.4. - EXEMPLES OF NUCLEAR MEDICI-
NE IN VIVO DIAGNOSTIC APPLI-
CATION. A SHORT OUTLINE
7.4.1. Introduction
Nuclear Medicine utilizes for diagnostic and therapeutic
aims the radiations emitted by not sealed radionuclides
introduced in the patient. Other methods which exploit
external radioactive sources, like the dual isotope bone
mineralometry, are so far much less dilfuse.
In this chapter only some diagnostic procedures among
the most common ones are described.
The most important features of Nuclear Medicine are
the following : it is not invasive; it doesn't modify the
physiology; it allows quantitative evaluation of function
and of metabolic processes; it allows Imag ing of organs
or apparatus thanks to functional mechan ism. It can be
considered peculiar of Nuclear Medicine the possibility
of detecting "change".
The radiocompounds for Nuclear Medicine procedures
should comply with the following requirements: detectaM
bllity of quantities In the range of micrograms: selective
localization in the organ under investigation; absence of
pharmacological or radiobiological effects.
Most of the radiocompounds which are nowadays utiM
lized are labelled with I19mTc. This radionuclide is ob-
tained from a generator of molibdermm 99 wich decays
to OBmTc with a half life of 66 hou rs. By eluting the
alumln containing at equilibrium the same activity of
" Mo and of 99mTc, only the latter outflows from the COM
lu mn .
In any department of Nuclear Medicine a generator of
ll9Mo I19mTc is always available and can be used for laM
belling a large number of compounds by means of inM
stant kits. The physical features 01 IMImTc are favourable
from a dosimetric point of view and optimal for the
standard crystal of gamma..camera Anger type.
Single or multi probes detectors are used for quantificaM
tion 01 organ uptake or lor registration 01 activityMtime
curves.
Whole body counters seldom are available for quantifi M
cation of body activity retention. that is useful for some
metabolic studies.
Imaging by gamma-camera is nowadays the most com M
man procedure in Nuclear Medicine.
Planar imaging is so far considered adequate although
some authors clai m a superior sensitivity of single photM
242
on em ission computed tomography (SPECT) especially
for some regional perfusion stud ies (brain, miocardium).
Positron emission tomog raphy (PET) is extensively valuM
able for regional metabolic studies, as most of metaboM
lic substrate can be labelled on ly with positron emitters
radionuclides ('3N, llC, 15(). 18F).
Unfortunately cyclotron for positron emitters production
is exceedingly expensive and a large diffusion is not
possible in the loreseeble future.
7.4.2. thyroid scanning and function
7.4.2.1. Physiologic Basis
The thyroid utilizes iodine to produce the principal thyM
raidal hormones: three-iodo-tironine (T3) and tetralodo-
tironine (T4).
In the thyroidal Iodine turnover we can recog nize the
following steps; trapping of inorganic iodine; organificaM
tion; iodination of tironi nes. The thyroid hormones are
stored in the colloid of the foll icules, bound to the
molecules 01 TG, and are mobilized according to the
phisiological need, to be dismitted in circulating blood,
almost completely bound to plasma proteins (TBG , PA,
albumin).
Radioactive tracers of Iodine behave like stable iodine
and make possi ble to study iodine thyroidal turnover
(R.!. uptake) and spatial distribution (Thyroid scanning).
7.4.2.2. Radioactive tracers
The on ly gamma emitting isotope of iodine commercial M
Iy avai lable are 131 and 123. The first one (physical half
life 8 days) gives a relatively hig h radiation dose to the
thyroid resulting from energetic beta radiations; so that
its use has to be restricted and possibly avoided ,espe-
cially in childhood and pregnancy.
Also, the 364 KeV principal photon energy is not op-
timal (too high) for Imaging with gamma cameras.
Nevertheless, with its advantages of low cost. relatively
long shelf life, and availability, 131J is still a very useful
tracer, and remains the tracer of choice for detection of
cancer metastasis.
123 1 has good physical features (monoenergetic gamma
rad iation of 159 KeV; half life of 13 hours) but is very
expensive and there are supply problems related to the
short half life.
When the only sci ntigraphy is requested 98mTc pertechM
netate can be used . This AN has very favourable physi
cal features (monoenergetic gamma emission of 140 KeV;
half life: 6 hours).
The pertechnetate ion is not organified or fixed in the
thyroid.
7.4.2.3. ..In vivo function studln
Many types of clin ical studies used to be carried on to
investigate the iodine thyroidal turnover, in order to evaM
luate thyroid function and to diagnose hyper and hypo
thyroidism. After the introduction of the in vitro studies
which allow a reliable and relatively simple determi naM
tion on blood samples of total T3, total T4, free T4 inM
dex, free T3 and free T4. TSH , almost all types of the
in vivo function studies fell into disuse because of their
higher complexity and lower diagnostic accuracy.
GllN'IOONI. RADIOlOGV - El..ECTROMEOIClNE
.... some conditions however there can still be the oppor-
lI,mity to study the radioiodine uptake curve. For in-
stance th is study is compulsory before radioiodine treat-
ment of hyperthyroidism .
7.4.2.3.1. R.I. uptake test
The percent thyroid uptake of admin istered dose is mea-
sured by means of a scintillation probe with standard
collimator at a fi xed skin-crystal distance. At least two
measures are requested: the earl y one (two hours after
oral administration) has the aim to eval uate the trapping
lunction; wh ile the late measure (24 hours) generally al-
lows to detect the maximum uptake, except when hy-
perthyroid subjects are considered where the maximum
can be reached earlier (4-6 hours) .
1herefore an Intermediate measu re 01 6 hours is advisa-
ble. The normal range of 24 hours percentage radioio-
cone uptake is 25 + 40%, but this value is influenced by
one dietary iodine intake and is generally lower in urban
population, and higher In mountain population.
To date the clinical applications of the test are the fol-
liCMIing:
1) in basal condition in treatment planning of hyperthy-
roidism
2) after administration of T3 (suppression test) for es-
tablishing thyroid autonomy in equivocal Graves dis-
ease, or in conjunction with imaging , to determine
autonomy in functioning nodules.
with administration of perchlorate (perchlorate dis-
charge test) to detect the dissociation between trap-
ping and organificatlon In the thyroid gland when
peroxidase enzyme deficiency is suspected, as in
Hashimoto thyroiditis.
7.4.2.4... In vltrOH function studies
Serum concentrat ion of total T4, total T3, free T4, free
i3, and of TSH can now be measured accurately by
radioimmunoassay. Free T4 and free T3 tests are more
.:curate in the evaluation of thyroid function than total
T 4 and T3 because serum concentration of the free
I'IOrmones are not influenced by plasma proteins levels.
When total hormones are determinated a T3 resin up-
take test is requested to measure the saturat ion of plas-
ma protein binding sites.
Serum TSH is elevated in hypothyroidism and low in
"l)'perthyroidism.
The thyrotropin releasing hormone (TRH) test is per-
form ed by administering TRH intravenously and obtain-
IIl9 blood samples at the baseline and at 20, 30, 40, 60
,.,in after injection for TSH assay.
.... normal subjects there is a sharp increase of serum
TSH and the response is exaggerated in hypothyroidism.
In patients with pituitary disease, or with thyrotoxicosis
there is subnormal response or no response.
7.4.2.5. Imaging
The thyroid scan is frequently used in the evaluation 01
palpable thyroid nodules. Rad ioiodine is concentrated
only in functioning nodules ("hot,,) that are benign in
99%. Solitary cold .. nodules are more suspect for ma-
lignancy (5-40%) and need further investigations.
With 99mTc pertechnetate some non functioning nodules
can appear .. hot" while they appear "cold .. with radioio-
dine. That is related to the difference of phisiologic
GLARDONI. RAOIOlOGI' - ELECTf'IOMEOICINE
mechanism : 99mTc pertechnetate scans reflect only the
trapping function; radioiodine scans reflect also organ if,
cation. It is advisable to rei mage pertechnetate hot no-
dules with radioiodine. Autonomy of functioning nodules
must be proved with previously described T3 suppres-
sion test or with TSH stimulation test. T3 administration
suppresses the rad ioiodine uptake only in pitUitary de-
pendent thyroid tissue. while exogenous TSH stimulate
the radioiodine uptake in normal gland tissue even if
this is inhibited by autonomous functioning nodule (tig.
21n). TSH test is seldom used owing to the hazard of
adverse immunologic reactions against the foreign pro-
tein.
Fig. 21/7 (par. 7.4.2.5.) - Autonomous functioning nodules.
Thyroid radioiodine Imaging belore (lett) and after suppres-
sion test. Only in the extrftnodular thyroid tissue the uptake
is inhibited by T3 administralion. (From Alias of Nuclear
Medicine by S. Baum, N. Vincenl. K. Lyons, S. Wu and
S. Gurkin, Appleton Century Crotta, New York, 1981).
The thyroid scan is also appl ied in the differential dia-
gnosis of mediastinum masses, in assessing the size of
goiters and in distinguishing diffuse from multinodular
goiter.
In primary hypothyroidism thyroid Imaging is useful to
vIsualize ectopic gland or tissue damage related to chro-
nic thyroiditis or previous irradiation.
7.4.3. Nuclear cardiology
7.4.3.1 . Introduction
The most extensively used radionuciide ca rdiac studies
can be subdivided in two groups:
1) methods which detect the blood activity contained in
the heart and vessels cavities.
2) methods which represent the myocardial distribution
of radiopharmaceuticals that are trapped by metabol-
ic mechanism either by the healthy myocardium ceUs
or by the necrotic ones.
With the first group haemodynamic parameters (cardiac
output; transit times) and ventricles function indices (ejec-
tion fraction (E.F.), peak fill ing rate (P.F.R.), peak ejec-
tion rate (P.E.R.) , regional wall motion, etc.) are eva-
luated.
With the second group myocardial bood flow distribu-
tion or AMI location and size are detected.
7.4.3.2. Non Imaging radlocardlography (ReG)
It is performed by means of a single probe with a col-
limator which includes in the field of view the whole
heart with minimal extraca rdiac contribution. A micro-
processor connected with the probe provides a time-ac-
tivity curve (TAC) which represents the cardiac activity
243
variations during the first transit of the impulsively in-
jected bolus (human Serumal bumine (HSA) or erith<r
cytes labelled with 99 m Tc).
The TAC shows two peaks which respectively represent
the bolus transit in the right and in the left heart cavi-
ties.
If the time resolution is adequate (at least 16 data per
second) we can recog nize also the count rate fast varia-
tions due to the cyc lical ventricles volume variations.
The RCG analysis provides the card iac output and the
pul monary transit time, and also allows the detection of
left-t<rright shunts.
The ventricular EF can be calculated from the systole-
dyaslole count rate variations.
The accuracy is lower than with camera studies where
a precise definition of ventricles edges is possible. At
the present time non imaging RCG is used for sequen-
tial evaluation of left ventricle function (follow-up; as-
sessment of response to drugs or tests) .
7.4.3.3. First Pass Nuclear Angiocardiography (FPNA)
It is performed by a single crystal or, less often, by a
multicrystal gamma.-camera. As each pulse coming from
the detector is coded with own values of coordinates x,
y a bidimensional display of activity space distribution is
obtained .
Therefore one can image through a Irames sequence
the variations of activity distribution inside the detector
field of view (heart, great vessels, lungs) during the first
transit of the tracer bolus (fig. 22n).
(' f f
(AI
.. '1..':"
~
T
.. (BI
;',-
lil~lJI
I I
t'f N
t !'~ I M\rrJ
AI. I;, ~,
11 '~"'~(\1,f
:'1 1
I,. ~, , 7.4.3.4.1. Left and right ventricles EF
Fig. 22f7 (par. 7.4.3.3.) - First pass anglocardioscinligraphy.
A: sequenllal Imaging, 1 Irame per second. B: lelt ventricle
time-activity curve with high Ireqoency variations due to
cyclic volume varialions (1 point per 40 millisec.).
Advantages vs. RX Angiocardiography: adsence of risks;
absence of functional modifications; availability of quan-
titative data. Drawback: poor image definition and lower
space resolution.
Informations: the direct inspection of the images sequen-
ce sometimes allows to diagnose the disease. That hap-
pens expecially in case of left-right shunt where it is
often possible also to localize the communication site.
Further informations: cardiac output: shunt quantitative
evaluation; global ventricle ejection fract ion (EF) ; ventri-
cle volumes; valvular regurgitation index; regional wall
motion (RWM) analysis.
7.4.3.3.1. E.F. determination
As the ventricle blood activity remains steady through
the systol ic phase. the count rate difference between
telediastole (TO) and telesystole (TS) images is related
244
to the stroke volume. So we can assess the ventricle EF
by the following formula:
EF = Stroke volume = TDC - TSC
TDV TOe
(TDV = telediastolic volume; TSC = telesistolic count).
7.4.3.3.2. R.W.M. Analysis
The RAO projection allows the wall motion analysis of
the anter<rlatera1. apical , inferior and posterior-basal seg-
ments during the selective left ventricle visualization. that
is especially advantageous because 01 the lack of over-
lapping of right ventricle activity.
7.4.3.4. Equilibrium Gates Blood Pool Angiocardiography
(EGBPA)
Data acquisition is performed in steady state activity
blood concentration. As we have simultaneously activity
in all the cardiovascular cavities we need the collection
of a high ventricular total count in order to obtain high
signal to noise ratio and acceptable statistical error of
ventricle function parameters. This aim is achieved by
collecting the counts for several consecutive heart cy-
cles and by reconstructing an average representative cy-
c le with as many matrix as many time intervals the cy-
cle is subdivide in.
In each matrix are sto red the counts of a single time
interval for all the acquired cycles.
'_ .., The R wave of the ECG triggers the counts setting in
the correct temporal sequence.
The most important advantages are the following:
1) repeatibility of imag ing in different conditions (pro-
jections, test) without further tracer injections;
2) possibility of obtaining a global and regional time-ac-
tivity curve (TAG)
I 3) possibility of parametric imaging with good quality
image definition.
Are determined with the previously cited formula using
the TO and TS images of the average representative
cycle. Peak ejection rate and peak filling rate are de-
terminated from the left ventricle TAC.
7.4.3.4.2. TO lett ventricle volume
Can be assessed on the basis of ventricle activity eva-
luation or by geometric method .
7.4.3.4.3. Parametric Imaging
Some TAC parameters can be calculated for each ma-
trix pixel by computerized analysis of each single pixel
T AC of average representative cycle. The absolute values
can be displayed in relative terms by means of a colour
or grey tones scale obtaining a map of the considered
parameter (fig. 2317).
The most diffuse parametriC maps are those of regional
ejection fraction, of amplitude and phase. The amplitude
value is an index of counts systolic stroke. The phase
image represents the synergy or regional dissynerg y of
ventricle contraction .
GILAROONI. RADIOt.OGY - ELECTAOMEOICINE

:,1
.',
;!
FRSE
Fig. 23/ 7 (par. 7.4.3. 4.3.) c.B.P.G. Angiocardioscintigraphy:
Parame tric Imaging In LAO pro/octlon.
On the left. regional E.F. and amplitude images show large
septal and inlera-apical a kinetic reg ion. On the right para-
(0)( and phase Images show apical diskinesis due to aneu-
rism (black area In left ventricle apical region).
1.4.3.5. Myocardium perfusion imaging
The fractional myocardial uptake of a potassium mimetic
radionuclide is assumed to be equivalent to the fraction
of cardiac output !l owing In the myocardial vascular
network.
1.4.3.5.1. Radlophann aceutlcal choice
~tassium radioisotope suitable for clinical Imaging are
not available. The most suitable potassium-mimetic rad-
Oluclide today available is Thallium 201 (physical half
fe: 73 hours; X rays 01 69 + 83 KeV, 135 and 167
.<eV). Free lally acids labelled with iodine 123 are used
., order to achieve myocardial metabolism besides per-
~ion information, but this method has not been exten-
SIVely applied, partly owi ng to the high cost of the ra-
dtopharmaceutical.
1.4.3.5.2. Technical procedure
Whenever there are no clinical controindications the stu-
dy must be perform ed with exercise test. The following
advantages are achieved:
the myocardial perfusion increase enhances the target
to non target ratio;
2} the Increase of blood flow difference between normal
and diseased coronary vessels increases the regional
difference of thallium uptake and consequently the
possibility to detect perfusion defects;
3} the exercise olten causes by itself the regional per-
fusion defect appearance.
The study is performed at least in 3 projections (ante-
nor, LAO 45, LAO TCP or left iateral) by means of a
gamma-camera, beginning soon after the thallium injec-
bOn.
7.4.3.5.3. Scintigraphic pattern
left ventricle wall is visualized as a horseshoe shaped
radioactive area, while the right ventricle wall is usually
faintly visible and indefined. except in case of right hy-
pertrophy when it is well evident.
3t.AAOONI. RADIOLOGY ELEC"ffiOMEOICINE
A regional hypoperfusion is shown as a relative uptake
defect, which appears sharper in case of acute infarct
or myocardial scar (fig. 24m .
An automatic Quantitative eval uation of regional activity
distribution is preferable in order to reduce interobserver
assessment variability.
II(C SIBIRACttD ,
ANT.
,
LAT
Fig. 2417 (par. 7.4.3.5.3.) Myocardium perfusion ThallilJm
Imaging (ellercIS9). Sharp docrease of ThallilJm uptake in
inferior and apical segments due to 911erclse ischemia.
7.4.3.6. Acute myocardial infarct Imaging
Damaged myocard ial cells show calcium intracellular de-
position. As the pyrophosphate binds calcium in a com-
plex molecule during . the intracellular depOSition , the in-
travenous administration of pyrophosphate 99mTc can
visualize the infarcted tissue.
The acute infarct pallern is represented by a ..hot area-
the size and shape of which expression 01 infarct size
and shape.
7.4.4. Renal procedures
7.4.4.1. Physiologic mechanism
Paraaminohippurate (PAH) is cleared for about 90% on
the first pass through the kidney and would be su itable
for evaluation of effective renal plasma flow (EAPF) .
As PAH cannot be labeled with any gamma-emitting
radionuclide, ortoiOdohlppurate (O IH ) labeled with io-
dine~ 1 31 has been used showing approximately the same
bahaviour (20% glomerular filtration, 80% tubular secre-
tion) .
The chelatlng agent s EDTA la beled with chromium-51
(ethylenediamine tetracetic acid) and DTPA labeled with
99mTc are used for evaluation of glomerular filtration rate
(GFA) as they are eliminated with this only mechan ism,
like inulin (wh ich cannot be labeled with any gam ma-
emilng radionuciide.
7.4.4.2. Non imaging procedure
The most important non imaging renal study is OIH
renogram.
A pair of scinti llation probes is placed posteriorly over
the renal area to detect the time-activity curve of OIH
in each kidney area. The renogram represents three
physiological steps: perfusion distribution, tubular secre-
tion and excretion . The normal curves show a good
separation of these sequential events, wh ile in many pa-
thol ogic condi tions there is a various degree of overlap--
ping.
In ch ronic disease impaired secretion results in slower
excretion while impaired excretion results in lower func-
tion. It is often impossible, therefore, to obtain diagnos-
245
tic information because the renogram assumes a flat-
tened shape.
The most useful clinical appl ications are the diagnosis
and evaluation of unilateral or asym metrical renal di-
sease: renal vascular hypertension ; acute impairment of
urinary drainage; pielonephritis.
7.4.4.3. Imaging procedures
Renal radionuclide studies cannot reach the high de-
gree of spatial resolution of X-rays and ultrasound.
However radionucl ide imagi ng provides reg ional func-
tion information and is preferable where func tional
rather than anatomical information is needed. The most
important advantages are the fallowing: renal physiol-
ogy is not altered by the tracer; renal tracer uptake
and excretion allow to calculate quantitative function
parameters.
Three basic types of radiopharmaceuticals can be used:
1) mainly trapped in the cortex, with very poor excre-
tion. The best known is dimercapto-succinic acid
(OMSA) which provides gOOd quality cortical mor-
phology.
The morphology imaging indications are the follow-
ing : renal position; cystic disease; renal or perineal
abscess; malignancy; traumatic lesions.
2) radioactive agents that represent a functional aspect
(G FA or tubular secretion) and allow sequential ima-
ging 01 cortex. collecting system. pelvis and ureters.
The radioiod inated OIH, elimi nated by GF and tubular
secretion, and DTPA labeled with I9mTc, elimi nated by
GF, are the most extensively used agents of this group.
Both provide separate informations on regional paren-
chi mal functi on and on renal drainage.
The labeling with IKImTc of DTPA gives the advantages
of a better kidneys and ureters visualization with gam-
ma-camera (Fig. 2Sn ).
Fig . 25/ 7 (par. 7.4.3.5.3.) - Renal sequential imaging with
- Tc DTPA.
A: Right ureter obstruction; B: Normal findings after urinary
stone elimination. (From Atlas of Nuclflar Medicine by
S. Baum, N. Vincent, K. Lyons, S. Wu and S. Gurkin, Appleton
Century Crofts, New York, 1981) .
246
OIH , usually labeled with 13 11, is to be preferred when
quantitative EAPF has to be evaluated.
Labeling with 123 1, more advantageous for gamma-came-
ra imaging, is too expensive and impractical for exten-
sive routine studies.
The most common funct ional imaging ind ications are
the following : assesment of symmetry of function, re ~
vascular hypertension evaluation; assessment of the func-
tional impairment due to urine drainage problems; renal
transplant evaluation.
When informations on renal blood perfusion distribution
are needed (suspected renal artery stenosis or embo-
lism; trauma; transplant perfusion adequacy), rapid se-
quential imaging during l irst bolus transit can be use-
ful. gijrnTc pertechnetate or OTPA are the agents 01 c h~
ice (Iig . 2Sn).
3) Agents for tumor an,d abscess localization .
Gallium 67 citrate is the most used especiall y in r~
nal pathology.
There Is focal renal uptake in malignant tumors or
abscess, whi le there is diffuse renal uptake in neph-
ritis or pyelonephritis, or acute tubula r necrosis.
Fig. 26n (par. 7.4.4.3.) - Right renal artery stenosis.
Blood perfusion study (upper left) shows lower activity in
right kydney, that Is also smaller than left.
Static delayed study (upper right) and X-ray angiography
(bottom) are also shown. (From Seminars in Nuclear Med/-
cine. 255, 1982).
7.4.5. Bone Imaging
7.4.5.1. Radio pharmaceuticals and Bone Physiology
The most commonly used bone scanning radiopharma-
ceutical Is 99mTc MDP. About one half of this agent is
deposited in the bone mineral and is incorporated by
the calcium-magnesium phosphate complex of hydroxy-
apatite crystals, while the remaining part is cleared by
the kidneys. Bone scann ing evaluates the regional me-
tabolic activity in normal bone and in skeletal diseases.
Abnormalities on bone scans almost always are seen
as areas of increased tracer uptake.
G1LARDON I. RAOIOl..OGY - ELECTROMEDICINE
7.4.5.2. Normal paHem
The highest tracer uptake in normal adults is seen in
the bones with high vascularity and high marrow con-
tent (vertebral column, sacrum and pelvis) and also in
certain epiphyseal centers (the shoulders, sternoclavicu-
lar and sacroiliac joints, hip joints). In the children in-
creased uptake is also seen al active epiphyseal bone
growth centers (knees, anckles, elbows and wrists).
Normally the kidneys and the bladder are visualized,
and the bladder must be voided before the imaging
procedure.
7.4.5.3. Abnormal paHem
Almost all bone diseases are seen on bone scan as
areas of increased radionuclide uptake (fig. 27(7). There-
tore a definitive diagnosis is rarely possible by imaging
aJone.
Fig. 2717 (par. 7.4.5.3.) Bone Imaging with POmTc MDP In
metastatic disease dua to lung cancer.
Cold spot with hot halo Is shown In parietal bone. Hot spots
are seen in pelviC bones.
Bone scans abnormalities related to metastatic diseases
or to stress fractures may be detected without asso-
ciated changes on X-rays. Metastasis may be detected
6-18 months before X-rays changes appear. In less than
3% of pat ients bone scanning will be normal in the
presence of X-ray evidence of metastasis.
Multiple myeloma bone lesions show variable rad ionu-
dide uptake and sometimes a decreased instead of in-
creased uptake (poor osteoblastic reaction).
SoN tissue uptake of 9IOmTc bone seeking compounds
can be detected in a num ber of malig nant and non
malignant diseases either calcified on X-ray or noncalci-
fied.
Some urinary tract abnormalities can be seen on bone
scans as the kidneys are usually visualized. Most com-
monly obstructive urinary tract lesions such as hydro-
nephrosis and hydroureter may be seen.
GIlAROONI. RADiOlOGY - ELECTAOMEOICINE
7.4.5.4. Benign diseases
Bone scanning is useful in the diagnosis and the fol-
lowup of many benign diseases:
1) Trauma
2) Infections
3) Metabolic Disorders
4) Paget disease
5) Arthritis
6) Joint prosthesis
When a fracture is suspected in a patients with normal
or equivocal X-ray examination, bone scan may dem-
onstrate a focal increased uptake at earl y stages. Serial
bone scanning can be useful in fallowing the cause of
a fracture (differentiation between delayed healing and
nonunion of fractures.
Bone scanning is more sensitive than X-ray examina-
tions in the detection of acute osteom ielitis. In Paget
disease bone scanning and X-ray exami nation are com-
plementary. Bone scan shows regional areas of highly
increased uptake In Pagetic bones, except than in case
of sclerotic non active lesions that can be seen only
on radiographs.
Bone scanning may be abnormal with normal radio-
graphs In the presence of joints prosthetic looseling
(screening procedure in patients with painful hip or
knee prosthesis).
7.4.5.5. Neoplasllc DlseaSH
Bone scanning can be applied in the evaluation and fot-
lowup of primary bone neoplasm, hematological bone
malignancies, metastatic diseases.
Staging of patients with a newly esthablished diagnosis
of breast or prostate cancer is one of the commonest
indication of bone scanni ng. Also in lung cancer is use-
ful as screeni ng procedure for metastatic disease.
Bone scanni ng is the procedure of choice in assessing
patients with suspected metastatic disease because it is
more sensitive than any other diagn ost ic procedure.
However an abnormal scan Is not conclusive.
Selected X-ra y examinations and sometimes bone biopsy
are needed to confirm the diagnosis.
7.4.6. Liver and hepatoblllary Imaging
7.4.6.1. Introduction
In the liver there are two types of cells: the hepatic
cells which produce the bite and perform several other
functions; the reticuloendothel ium cells (kuppfer cells)
which perform the function 01 phagocytosis.
The most common radiopharmaceutical for liver imaging
is l/9mTc sulfur colloid (II9mTc SC) which is rapidly cap-
tured by the kuppfer cells.
Several types of iminodiacetic (IDA) derivaters labelled
with I19mTc have been used for hepatobiliary imaging .
Nowadays the most commonly used are the following:
disopropil-IDA (DISIDA), dietil IDA, IGDIDA, Mebrofeni n.
These agents are all rapidly removed by the hepato-
cytes and excreted into the biliary tract.
247
7.4.6.2. Static Imaging
Liver is usually well visualized together with the spleen
by a large field of view gamma~camera 15 or more
minutes after intravenous injection of 99mTc SC. The
principal indications are the following: evaluation of liver
size, shape and position; diagnosis of abdominal masses,
focal hepatic space~occ upying lesions, subphrenic abs~
cess, evaluation of diffuse hepatic disease.
Most focal hepatic lesions appear on the liver scan as
-cold. defects, which are non specific.
Focal - hot areas may occur with focal nodular hyper~
plasia and with cirrhosis.
Further investigations of "cold defects are required to
distinguish primary and secondary malignancy from be-
nign disease of the tiver.
Gall ium 67 scintigraphy is suitable for detection of hep-
atoma, but one must be aware that radio~gallium ac~
cumulate also in the abscesses.
In lymphoma there is frequently hepato~splenomegaly
with or without focal defects.
In chronic hepatocellular disease the liver is usually en-
larged with decreased uptake and irregu lar distribution
of the radiocolloid.
Also there is often spleen en largement and increased
splenic and bone marrow uptake.
The liver scan has an overall accuracy for detecting
metastatic disease of about 80%. Lesions of size below
2 cm are usually non detectable.
7.4.6.3. Liver sclntlanglography
After a few second from the intravenous bolus injection
of .....Tc SC or pertechnetate a dynamic study of hepat-
ic blood perfusion can be done by rapid sequential im-
aging with gamma-camera.
Liver blood flow comes 30% from hepatic artery, 70%
from portal system.
Arterialization Is observed in malignancy and in cyrrho-
sis; therefore liver scintiangiography can be useful in dia-
gnosis of focal lesions which appear as cold .. areas on
colloid scan.
7.4.6.4. Blood Pool Imaging
After in vivo labelling of red cells with 99mTc a delayed
hepatic scan (2 hours) shows the distribution of blood
pool . Haemangiomas, which usually have slow blood
turnover, appear on delayed scan as hot areas. The me-
thod is highly sensitive and specific and has to be con~
sidered the method of' choice when hepatic haemangi~
omas are suspected (fig. 28/7).
Blood pool imaging shows increased activity in the same
area and provides a certain diagnosis of haemangioma.
248
7.4.6.5. Hepatobiliary Imaging
In 30 minutes from i.v. injection of DISIDA or similar
compound a sequential imaging can be obtained of liver
parenchima, hepatic and common bile duct, gallbladder.
Absence of gallbladder visualization in 90 min. means
cystic duct obstruction due to acute colecystis. Radioac-
tive bile passage in duodenum normally begins in 30
min., but it can be delayed even when no obstruction is
present. After sincalide or fat foot administration there is
gallbladder contraction and rapid bile drainage into duo-
denum.
If this fails to happen in 120 min. common bile duct
obstruction has to be suspected. Total extrahepatic ob-
struction usually shows the pattern of absent intestinal
activity in 24 hours with distinct liver visualization.
The major indications of hepatobi liary sequential study
are the following :
a) acute colecystitis: diagnostic sensitivity over 90%
b) patency of the biliary tract: when the ultrasounds
findings are not conclusive, and LV cholangiography
is not possible due to elevated serum bilirubin the
method can show the existence of obstruction , and
sometimes its level.
c) bile leakage detection in post-trauma or post~surgery
patients.
d) patency of surgical bilio-digestive anastomosis
e) enterogastric bile reflux detection and quantification
f) infants biliary arteria: differential diagnosis versus neo~
natal hepatitis.
The greatest advantages of the method are: its safety
and its feasibility even with serum bilirubin values over
20 mg%.
7.4.7, Patient dose In Nuclear Medicine procedures
The radiation dose received by the patient from a radio-
compound administered for diagnostic purpose depends
upon the radionuclide and upon the kinetics of the
compound.
The most extensively used radionuclide is technetium
99m which has two advantages:
a) It emits only gamma radiations with energy optimal
for gamma camera;
b) its half life of 6 hours is suitable for imaging proce~
dures even when they require delayed images, wh ile
the radiation rate is rapidly decreasing .
The kinetics and consequently the radiation dose in the
target organs is different for different compounds.
In table 5n are listed the most widely spread Nuclear
Medicine procedures. For each of them there is report-
ed the type of radiocompound , the average activity ad-
ministered for a single investigation , the radiation dose
received by the whole body (W.S.) and by the target
organs.
The table shows that the radiocompounds labelled with
99mTc which accumulate in the kidneys and are elim i-
nated with urine give the highest doses to the kidneys
and to the bladder, while those, labelled with the same
radionuctide, which accumulate in the liver and the are
eliminate through the biliary system give the highest
doses to the liver and to the colon .
Anyway the dose ranges with radiocompounds labelled
with 99mTc are within limits that can be considered al~
ways acceptable for clinical routine investigations.
Some caution has to be payed with 1311 for the dose
received by the thyroid or by the adrenal glands (if the
thyroid is blocked with stable iodine solution) in case of
cholesterol derivatives for adrenal imaging.
GILARDONI. RAD IOLOGY ELECTROMEDICINE
 TABLE 517 (par. 7.4.7.) - List of some Nuclear Medicine diagnostic procedures with average activity and aver-
age radiation dose for a single study.

!mag'roo Procedures Radiocompound

Average aclivily
(~ Bq) "..., Radialion dose
(mGy)

BRAIN - Tc pertechnetate 405 whole body 2.10

testis 1.60
ovary 2.55

BONE - Tc methylene diphosphonate 350 whole body 1.50

""""'
bladder
testis
7.50
18.60
0 .90
ovary 1.30

THYR OID 131 1 iodine 1 whole body 0.30

thyroid 604.00

THYROID IIOmTc pertechnetate 51 whole body 030

thyroid 7.40

LUNG PER FUSION ""'Tc macroaggregates (MAA) 54 whole body 0.30

lung 5.80

ANGIOCARDIOSCI NTIGRAPHY ""'Tc Red Blood Cells 540 whole body 3.30
testis 2.90
"""Y 3.90

MYOCARDIO PERFUSION XlI Thallium 45 whole body 1.20

liver 6.50
teslls 0.60
""."! 1.00

LlVEA-SPLEEN IIOmTc colloid 54 whole body 0.40

liver 6.90
HEPATOBILIARY ""'Tc IDA derivatives 94 whole body 1.05
small Intestine 11.50
,,"0 0 30.00

KIDNEY (STATIC) - Tc DMSA 72 ~id ney 16.70

bladder 4.50

KIDNEY (DYNAMI C) 1311 hlppuran 10 kidney 0 .50

bladder 14.40

KIDNEY (DYNAMIC) IIOmTc DTPA 89 kidney 0.50

bladder 11 .50

ADRENAL 131 1 lodomethil-l9-norcholesterol 27 whole body 11 .70

adrenal 2 13.70
testis 11 .80
ovary 12.90

The beta rad iation emitted by 131 ( and its relatively long
physical and biological half lives, contribute to increase
the radiation dose to the thyroid or to the adrenals)
over the level 01 3OOmGy.
That cannot induce any damage, but is considered a
risk for stochastic delayed effects. Therefore the nuclear
physician must accomplish a rigorous selection of the
mdications especially in pregnant women or in infants.
Chapter 7.5. - RADIATION PROTECTION IN A
NUCLEAR MEDICINE DEPARTMENT
7.5.1. Storage of radionuclides In a Nuclear Medicine
depar1ment
Radioactive sources in a Nuclear Medicine department
must be preserved in special rooms in such a way that
the sources are suitably sh ielded . The radioactive sub-
stances used in Nuclear Medicine may be in the form
of solids, liquids or gasses but in the majority of cases
they are liquid. The type of shielding required depends
on the radionuclide activity and on the radiation it em-
its. It should be borne in mind that gamma-emitling rad-
ionuciides are nearly always used so that shields are
usually made of lead.
If the activity of the source is inferior to 10-2 Bq, a few
millimeters of lead are enough to reduce the exposu re
around them to acceptable levels.
This is the case with vials, small bottles and syringes
containing radioactive substances that can be preserved
in lead containers of small dimensions and are conse-
quently easily transported .
If the energ y of the emitted photons does not exceed
tOO-15O keV even those sources with higher activity
(t oe - 1()8 Bq) can be shielded with a few millimeters of
lead, as in the case of WmTc which is at present the
most widely used radionuclide in Nuclear Medicine. Ot-
herwise radioactive sources must be stored in a sale
shielded with lead walls or in lead containers.
The walls in th is case are generally of few centimeters
thick.
Generators of radionuclides with a short physical half-
life actually have to be housed in containers shielded
with lead walls of considerable bulk and weight. Shielded

GItAROONI . RAOIOLOOY - ELECTROMEDICINE 249

safes and generators are placed in special store-rooms
to which access is checked and permitted only to the
personnel of the Nuclear Medicine department In order
to know at any time which radiopharmaceuticals are
available and what their activity is, a careful account
must be kept of the radioactive substances kept in these
rooms.
7.5.2. Exposure and contamination
The use of radioactive sources in Nuclear Medicine crea-
tes problems of external or internal radial ion in the in-
dividual. These problems concern above all the person-
nel assigned to activities in the Nuclear Medicine de-
partment and to a lesser degree those people who do
not belong to the department.
During operations with radiopharmaceuticals personnel
may find themselves up against gamma and beta emit-
ting radioactive sources. During handling operations (di-
lution, administra tion, etc.) these sources have little or
no shielding over varying time periods. Even if the sour-
ces do not come into direct contact with the operators
there is an external irradiation 01 parts 01 the body or
of the whole body with ensuring absorption 01 radiation
doses by the organs or body tissues.
Since the sources used in Nuclear Med icine are always
in a non-sealed form, contact with them Is possible dur-
ing handling operations and this results in the contami-
nation of clothing or parts of the body. Small quantities
of liquid radioactivity in particular may provoke external
contamination of the individual. This contamination can
be easily incorporated by the mouth or by small cuts
on the hands and in this case leads to internal contami-
nation too. Contact with contaminated objects like work
surfaces, syringes, pipettes and other laboratory equip-
ment can contaminate personnel both externally and in-
ternally since here there is once agai n external and in-
ternal body irradiation with consequent dose absorption.
The contam ination of work surfaces, fl ooring, walls, ob-
jects etc. can also cause the air to be con taminated by
flying radioactive substances or dust to which radioac-
tive contamination has become attached. Th is results in
possible internal contamination of the individual through
the respira tory tract.
External and internal doses can be reduced to very low
levels, that are in any case lower than the maximum
permitted values fixed by national and international rules
if the Nuclear Med icine department is correctly designed
if equipment and systems for reducing external irradia-
tion and contamination to a minimum are available, if
the working procedures are meticulously complied with
and if a regular monitoring 01 the rooms and people
who work there is carried out.
7.5.3. Room and surtace monitoring
Room and surface monitoring is essential for keeping
exposure and contamination within acceptable limits.
Measurements of exposure must be carried out in all
those places where high activity radioactive sources are
kept or used i.e. above aU in the rooms where the
sources and generators of 99mTc are stored and the
rooms where elution, dilution and, if necessary, marking
operations are effected . Continuous monitoring with a
fixed monitor should be placed in these rooms whilst in
others like those destined to administering radioactivity,
measu rement, waiting rooms for patients who are carri-
ers of rad ioactivity and adjoining rooms, monitoring of
exposure levels shOuld be carried out with a portable
250
monitor. These checks can be made weekly with a por-
table instrument made of an ionization chamber suitable
for measuring exposure or of a Geiger-Multer counter.
Monitoring of surface contamination must be carried out
in all rooms where operations involving handling trans--
port, the administering 01 radioactive substances and in
vivo" and in vitro measurements are effected. In fact in
these places it is possible that accidents may occur or
operations causing surface contamination may be car-
ried out more than once. In this case monitoring can
be carried out weekly with portable instruments like Gei-
ger or plastic scintillators that permit the detection 01
beta rad iation emitted by the radionuclide.
Contamination of the air is generally negligible in a
well-planned Nuclear Medicine department but can be
monitored weekly using fan devices with filters. The ra-
dioactivity present in the fillers can be measured later
with a scintillation counter for gamma or beta measure-
ments.
7,5.4 Principles of monitoring of workers
In a Nuclear Medicine department periodic ch~ks ot
the doses absorbed by the workers must be carried oul
These doses derive from external Irradiation of the body
or parts of the body during operations involving radioac-
tive sources. It should however be remembered that any
dose resulting from possible internal contamination due
to the introduction of radioactivity into the body should
be added to the dose external irradiation .
Internal irradiation may occur as a result of con tam ina~
tion due to the handling of sources and indirectly to
envi ronmental contamination. In order to be able to
check the dose due to external Irradiation the workers
in the Nuclear Medicine department are as a rule supp-
lied with a personal dosimeter. The individual external
dose is generally measured every month. For this pur-
pose badges containing dosimetric films of thermolumi-
nescent dosimeters are normally used. For the detection
of internal contamination the best solution lies in the
periodic measurement of the radioactivity present in the
body of workers with a whole body counter. This piece
of equipment is composed of one ore more suitably
screened scintillation detectors arranged in such a way
as to form a geometric set-up suitable for this purpose.
Anyhow the very same instruments used for the i n VI-
vo- measurements in the department (gamma-camera.
scanner, etc.) can be used for measuring internal con-
tamination, even if the limitations due to instrument
sensitivity must be taken into account.
Finally the problem of external contamination of the
workers should be considered. The contamination main-
ly concerns the hands, feet and clothing. A dai ly check
on this contamination is advisable and can be carried
out with a counter for hands, feet and clothing made of
a series of Geiger detectors or gas-flow detectors suita-
ble for beta and gamma measurements.
7.5.5. Safe handling of radlcHsotopeS
Radioisotopes must be used with care in Nuclear Medi-
cine so as to guarantee the safety of the operators.
Firstly, this safety depends on the characteristics of the
Nuclear Medicine departement. A rational distribution of
space and equipment in order to create a distinct sepa-
ration between the controlled areas where high risk ope-
rations are carried out and other working areas helps to
avoid undue exposure. It should also be borne in mind
that it is advisable to keep the moving of sources within
GILARDONI. RADIOLOGY ELECTROMEDlCINE
the department to a minimun. These problems should
be resolved du ring the planning phase of the depart-
ment.
Wans, fl oor and work surfaces should be covered with
tmpermeable easily washable materials in order to facili-
tate decontaminat ion of surface areas. The ventilation
system should be carefuny planned so as to guarantee
a sufficient change of air and keep to working areas
where air contamination is most likely under depression.
The use of an extractor hood above the work benches
where large quantities of radioactive substances are
handled is advisable.
Fixed shields should be placed on the work benches so
as to reduce the worker's external body irradiation to a
minimum. These shields made of lead or anti-gamma
glass are to be placed between the source and the ope-
rator and are a few centimeters thick. The use of for-
ceps, telemanlpulators, shielded syri nges and disposable
gloves avoids irradiation of the hands at high doses and
possible contamination. Finally it should be painted out
that it is Indispensable for operators to use correct ope-
rating proced ure If doses are to be kept as low as pos-
sible and absorption of undue doses Is to be avoided.
7.S.S. The disposal of radioactive wastes
Radioactive wastes in a Nuclear Medicine department
consists of residual radioisotopes contained in genera-
GILAflOONI. flAOIOt.OOY ElECTROMEDICINE
tors, small bottles and other containers, of contaminated
objects like syringes and laboratory equipment and of
the patient's physiological wastes. Most of the radioac-
tive wastes are in a tiquid or a solid form, while the
problem of the disposal of radiopharmaceuticals in a
gasseous form is less frequent but may be relevant in
those research centres where a cyclotron is used for
the production of radioisotopes with a very short life-
time.
While liquid wastes are usually discharged directly into
the drainage system, solid wastes can be discharged af-
ter a suitable period of storage when they have com-
pletely decayed. The d isposal of wastes from a Nuclear
Medicine department is normally considered acceptable
when the discharged radioactivity and radioactive con-
centrations do not exceed the values laid down by na-
tional norms. The discharged radioactivity and the ra-
dioactive concentrations may be estimated on the basis
of the consumption of radiopharmaceuticals and on the
fl ow of the drainage system . In order to make sure that
these limits are respected radioactivity may also be mea-
sured at the discharge points and outside the depart-
ment.
The physiological wastes of out-patients are not dischar-
ges within the Nuc lear Medicine department and it is
not usually considered necessary to hospitalize out-pa-
tients in order to check the discharge of physiological
wastes since drainage system generally bring about ex-
tremely low levels of environmental contamination.
25'
 PART 8

ANATOMY

,-
 PART 8
ANATOMY
(From .. Military Roentgenology" - U.S. Departments of
the Air Force, the Army, and the Navy, Technical
Manual; many thanks for the collaboration).
Chapter 8.1. - INTROOUCTION
8.1.1. Scope
Details of human anatomy and physiology are beyond
the scope of this text.
In this section emphasis will be placed on those as-
pects of anatomy that are 01 particular significance in
radiographic practice.
The skeleton will be discussed according to the regions
01 the body and since many special procedu res involve
the various body systems, emphasis wi ll be placed upon
the relative size and position of the component organs.
8.1.2. Anatomical terms
For descriptive purposes, the body is considered to be
In the erect position when the arms are hanging by the
sides and the palms of the hands are directed forward.
-"- -
-- I
J J
---
-
Fig. 1/8 (par. 8.1.2.J Analomlcal planes - anlerior and lalera'
views.
This is relerred to as the normal anatomical position
(see fig. 1/8):
Anterior is the front or ventral part of the body.
Posterior is the back or dorsal part of the body.
Medial pertains to nearness to the midline (midsagittal
plane).
Lateral pertains to a relationship of distance from the
midline.
Internal means situated or occu rring within or on the
inside- particularly with respect to a hollow viscus or
cavity.
External means the opposite of internal.
Proximal means nearness to a point under com pari-
son.
GllAACXlNI . RAOIOlOGV ELECTROMEOICINE
Distal is the oPPosite to proximal.
Superior refers to a pOint, part or region which is
higher, directed above or cephalad,..
Inferior is the opposite of superior. Rather than c&-
phalad it refers to a ..caudal" relationship.
In X-ray activities such terms as anteroposterior. post&-
roanterior, inferolateral. etc., are frequently used. In the
case of anteroposterior. the prefix antera indicates that
the principal ray enters the anterior aspect of the body
whereas the suffix posterior indicates the principal ray
emerges from the posterior aspect. In other words, the
anterior portion 01 the body laces the X-ray tube while
the posterior port ion is closer to the X-ray film. Many
combinations of the foregoing anatomical terms may be
employed in this manner to indicate the aspect of the
body through which the principal ray enters and emer-
ges.
8.1.3. Anatomical planes
Median plane. olten called the midsagittal plane, is an
imaginary plane passing In a vertical anteroposterior di-
rec tion which extends through the midline of the trunk
dividing the body into two exactly symmetrical parts.
Thus, there can be only one median plane.
Sagittal plane is an imaginary plane which is parallel to
the median plane. Hence, the body may be divided into
many sagittal planes, each passing in a vertical antero-
posterior relationship.
Coronal. or frontal plane. is any imag inary vertical plane
which passes at right angles to the median plane.
Tansverse plane is any plane which passes in a hori-
zontal direction at right angles to both the coronal and
median planes. It would divide the body into cross sec-
tions.
8.1.4. Anatomical postures
Supine-a horizontal position of the body lying lIat on
the back (see fig. 2/8).
Prone- a horizontal position 01 the body lying face and
trunk down (see fig. 2/8).
Laterally recumben t- the horizontal position of the body
lying on either the right or left side (see fig. 2/8).
Erect- t he normal posture of the body in either a silting
or standing position.
Fig. 218 (par. 8.1.4.) - Anatomical postures.
253
Chapler 8.2. - ORGAN IZATION OF THE HUMAN
BODY
8.2.1. General
The human body is composed 01 the head and neck,
thorax and abdomen, and the extremities, both upper
and kJwer. Due to the high deg ree of differentiation and
speciaJizatlOO. the body is composed 01 countless num-
bers of cef/s. These cells are arranged into tissues. Each
type of tissue performs intricate physiological reactions.
The organization of tissues to execute specific physio-
logical functions is known as an organ. The coordina-
tion of all the various organs in the performance of a
unified function is known as a system,.,
8.2.2. The cell
All cells, tissues, and organs of the body are developed
as a result of the fertilization of the egg or ovum (fe-
male germ cell) by the spermatozoon o r sperm (male
germ cell) , Each is a product of the gonads (sex
glands). The fertilized germ cell (zygote) divides into an
enormous number of cells which become greatly mod i-
fied by size shape, and function depending upon thei r
location within the body and upon the chemical, physi-
cal, and mechanical phenomena which they must inte-
grate.
The cell, as constituted , is composed of protoplasm.
The cell substance is a viscid, translucent, jellylike mat&-
rial composed mainly of proteins, fats, carbohydrates,
and Inorgan ic salts. Within the celf Is found a small
spherical body called the - nucleus. The small irregu lar
masses within the nucleus which take part in reproduc-
tion are chromosomes.
8.2.3. Functions of living cell
In order for a single cell to carry on all the processes
necessary for life it must be capable of the following:
Irritability- the property of responding to stimulation
received from its surroundi ngs.
Conductivity- the ability to conduct stimulation within
Itself and to other cells. Nerve cells are highly speciali-
zed for this function.
Contractility- the ability to react to stimulation by may
of motion. T his property reaches its highest degree of
specialization in muscle cells.
Melabolism- the Inherent property of all cells to take
in certain energy materials and bulld them up into
cell substance; then, to remove the waste materials
resulting from the cellular activities. T he building-up
phase is called anabolism"; the breaking-down phase
is catabolism. The cells of the digestive tract are
specialized for the complex processes of anabolism.
Reproduction-the property of developing new cells.
8.2.4. Reproduction of the Individual
The development of a new individual organism or hu-
man being is provided by the sex cells (ova of the f&-
male and spermatozoa of the male) . The female germ
cells leave the ovary at regular intervals and enters the
genital tract. The ova are nonmotile and they always
are large in comparison to the spermatozoa. The sper-
matozoa are extremely small and are very active. The
union of the femal e germ cell with the male germ cell
results in the formation of a new animal, namely, the
zygote- or fertilized egg .
254
During the entire period of growth within the mother
wh ich is about 9 months, the developing organism is 11\
a fluid medium called the "amniotic fluid and is sur-
rounded by the maternal and fetal membranes. The ex-
change of materials is accomplished by means of the
umbilical cord.
8.2.5. Periods of human development
Human life is divided into several stages. It commences
with the act of fertilization and terminates with death.
The period prior to birth is described as prenatal ..; thai
following birth, ~ postnata l . The development of the in-
dividual might be considered as follows:
Ovum period- begins at fertilization and terminates at
the end of the second week of prenatal liIe.
Embryonic period-extends from the end of the se-
cond week to the end of the second month .
Fetal period- the end of the secon d month to the
time of birth.
Newborn or neonatal period-birth to the end of the
second week of postnatal life.
Infancy-end of second week until time when the in-
fant assumes an erect position. This varies from the
end of the first year to the thirteenth month .
Childhood-end of the first year until about the thir-
teenth year In femal es and about the sixteenth year In
males. Puberty marks the end of childhood .
AdOlescence-puberty to the late teens in females and
to the earl y twenties in males.
Maturity-the end of the adolescent period to senility
or old age.
8.2.6. Concept of biological inheritance
In accordance with modern knowledge, structural, and
fun ctional characteristics o f each species, race and fami-
ly are inherited through chromosomes which are found
in Ihe nuclei of the celfs. At the time of fertilization an
equal num ber of chromosomes are contributed by the
female germ cell and the male germ so that the ferti-
lized cell has an equal amount from each. T he chromo-
somes carry genes which are the fa ctors by which the
transmission of inherited characteristics is accomplished.
A considerable number of racial, family, and ind ividual
differences are known to be inherited, but the mecha-
nism by which th is is accomplished is not exacliy
known. Body size and form , for an example, have a
genetic basis. Head and face, color of eyes, sk in, and
hair are other inherited characteristics.
8.2.7. Body types
Considerable variation of form and position is exhibited
by the organs of the same subject depending upon the
posture and other conditions. There is also a difference
of general body form and associated structures among
various ind ividuals. The normal type of individual is re-
ferred to as -sthenic. A short, broad stocky type is
known as - hypersthenic. The slender individual with a
long narrow trunk is called "hyposthenic-.
8.2.8. Regions of body
For the purposes of description, the abdomen is divided
into nine regions by means of two horizontal and two
GILAROONI. RADlot.OGY - ELCTROMEOICI NE
vertical lines (see fig. 3/8). The upper horizontal line
passes through the tenth costal cartilage inferiorly. The
lower line passes through the level of the anterior su-
perior iliac spines. Each vertical line passes through a
point midway the length of the inguinal ligament. The
regions above the upper horizontal line are the rig ht
and left hypochondriac and the epigastric. Between the
horizon tal lines are located the right and left lumbar
and umbilical. Below the lower horizontal line are loca-
ted the right and left iliac and hypogastric regions.
, ~~
\. --.:-
, ~
, body which function under control of the mind. This
., ., .. / / . 1.
~. RIG HT ...... .! ~. : 2 . .:(. .....
HIPOC~O~D l AC " !: . '"
6. RIGHT LUMBAR (61', ')$).. 4.
..
-'I "
9. RIG~lILIAC "'r'" ~( i/r.:.
I \ 'I
Fig. 3/8 (par. 8.2.8.) . Regions of abdomen.
8..2.9. Fundamental tissues ot the body
The cells in the different tissues of a highly developed
;ndividual are grouped into five general classes: epithe-
lal, connective, muscle, blood, and nervous.
Epithelial. These cells form the covering of the bOdy,
dle sec reting portion of glands, the channel of various
ducts and tubes, and the lining of the circulatory and
otgestive tracts.
Connective tissue serves as a binding and supporting
element. It includes ligaments, tendons. cartilage, bones,
and the supporting cells of all organs:
Ligaments- strong flexibl e bands of connective tissue
which usually serve to bind together bones that enter
into the formation of joints.
Tendons-dense white cords of connective tissue usu-
ally tubular in shape and of varying thickness. They
serve to fasten muscles to bones. Flattened tendons
consisting of thin, flat sheets of connective tissues are
called "aponeuroses. They serve to connect one
muscle with another or with the periosteum of bone.
Cartilage-sometimes referred to as gristle is a smooth,
firm and tough layer of cells frequently located at the
ends of bone in joint formations. It is covered and
nourished by a tissue layer called the ",perichondri-
um.
Bone- a form of connective tissue in which the inter-
cellular substance has been made extremely dense by
the deposition of calcium and other mineral salts. The
outer layer is hard and is known as compact while
the inner spongy portion is called cancellous. In
long bones, there is present a medullary cavity con-
tain ing red and yellow marrow. A thin vascular mem-
brane covers the outer layer of bone and is called
~ periosteum. The main function of periosteum is re-
generation of new bone in addition to nourishment of
normal growing bone. The quantity of mineral salts
present in bone determines the degree of opaqueness
and hence the amount of unabsorbed X-rays that will
sensitize the X-ray film. Since cartilage is usually less
dense than bone, differentiation can be made between
them. Consequently, the areas of high tissue density
will be recorded on the X- ray film as low roentgeno-
graphic densities.
GILAADONI . RADIOLOGY _ E~ E C TAOM~ O I CINE
Muscle cells possess to a high degree, the property of
contractility. In addition, muscle cells have two other
cospicuous properties-that of irritability and conduction
of stimu li. The movements of the body are not directly
produced by the contraction of the muscles. but through
the intermediary action of bones acting as levers. There
are three types of muscle cells:
Smooth muscle-functions involuntarily, that is, the
contractions are not under the control of the mind. It
is described as smooth because it lacks striations with-
in its structure. It is found mainly in the walls of the
viscera, the urinary bladder, the gall bladder, failopian
tubes, and the blood vessels.
Striated muscle-comprises the skeletal muscles of the
LEFT
HVPOCHONDRIAC
type is grouped as masses or bundles having definite
2 . EPIGASTR IC names.
4. LEFT LUMBAR Cardiac muscle- composed of cells which constitute
~. UM BILICAL the dynamic musculature of the heart. This type of
musculature shows striations as found in voluntary
.. 1. LEFT ILIAC
. a. H'rPOGolSTRIC muscles and to some extent resembles smooth mus-
cle. It possesses within itself the power to initiate
contractions of the heart muscle, but the rate is con-
trolled by the nervous system.
Blood cells-are not fixed to one location. They are
considered as tissue elements Circulating within a fluid
media known as "plasma". The average blood volume is
about 8.8 percent of the body weight. The blood is
composed of various types of cells:
Red blood cells (erythrocytes) are shaped li ke a disk.
White blood cells are colorless and extremely variable
in shape and number. Several varieties of white blood
cells are identified . With staining. the nucleus and
other constituents show up very conspicuously.
Lymphocytes resemble red cells in size but contain a
large spherical nucleus.
Transitional leucocytes are about the same size as
large lymphocytes with a nucleus in the shape of a
horseshoe.
Mononuclear leucocytes resem ble the large lympho-
cytes.
Polymorphonuclear leucocytes have a nucleus, irregu-
lar in shape. Three varieties are classified on the ba-
sis of their staining reactions: basophils, eos/nophlls,
and neutrophils.
Platelets are minute round bodies found in the fluid
medium of the blood . They appear as cell fragments.
They do not contain nuclei.
Nerve cells- high ly conductive cells such as found in
the brain , spinal cord, peripheral nerves, ganglia, and
plexuses.
Chapter 8.3. - ARTHROLOGY
8.3.1. General
Arthrology is the study of joints or articulations. There
are three general types: synarthrodial. amphiarthrodial,
and diarthrodial.
Synarthroses or the immovable type is that articulation
in which the surfaces of each bone are separated by a
thin layer of connective tissue or hyaline carti lage. The
bones of the skull are se'parated by this type of joi nt
which is referred to as a suture". In many cases the
interventing cartilage may be replaced by true bone and
then there is developed a "synostosis.
255
Amphiarthroses-slightly movable joi nts where the articu is the skeleton . II is composed of bones of various
IaDons are covered with an articular cartilage and se-. shapes supplemented by cartilage in certain regions (see

....
parated by a broad disk of fibrocartilage. This type may fig. 4/8).
be exemplified by the joints between the spinal verta- There is an axial portion, inc luding the bones of the
- neck. head and trunk, and, an appendicular portion
Diarthroses are freely movable joints. They are com including the bones of the extremiti es (upper and
posed of an articular cartilage connected by an articular lower).
capsule and ligaments to form a cavity between the ar- The adult human skeleton consists of approximately 206
tICUlating su rfaces of the ends of the articulating bone. bones.
ThIs type of joint might be further classified as follows:
HlOga.-joint-as exemplified by the elbow, knee and 8.4.2. Classification of bones
ankle joints.
There are four classes of bones: long. short, fl at, and ir-
Pivot-joint-such as found in the articulation of the regular:
odontoid process of the axis with the atlas in the
cervical vertebrae. long bones are found in the limbs where they act as
Ball and socket joint- such as the hip and shoulder levers. They consist of a body or shaft and two ends or
pnts. extremities. The body or shaft contains a central or
medullary cavity and walls which are composed of com-
Gliding joints- such as found between the bones of pact bone. Spongy bone extends into the cavity and
the wrist. towards the ends.
8.3..2. Types of joint movement:
Appendicular skeleton.
Flexion-the act of bending one part of the body up- Upper extremities 64
on the other. For example the bending of the lorearm Lower extremities 62
upon the arm , the leg against the thigh, or the lin-
gers onto the palm of the hand. Axial skeleton.
Extension-the method by which a part 01 the body Skull 22
IS placed in an outstretched or straightened condition. Auditory bones 6
Abduction-the movement of a part of the extremities Hyoid bone . 1
away from the median plane of the body. Vertebral column 26
Ribs and sternum 25
Adduction-the opposite of abduction and is therefore
a movement of the part towards the median plane. Short bones are composed of a spongy bony substance
Rotation-i nvolves the movement of a part around a surrounded by a th in crust of compact bone. They are
central axis. located in those parts where strength and compactness
Pronation- movement of a part such as the palm of are essential, as in the case of the metacarpals or pha-
the hand or ventral aspect of the body in a down langes.
ward position. Flat bones are composed of two thin layers of com pact
Supination-the act of turning the palm or body up. bone separated by a spongy substance. In the cranium
wards. the layers are known as the tables of the skull and the
interventing substance as -diploe...
Eversion- the movement of the part outward . In certain regions 01 the skull, absorption of bone oc-
Inversion- the movement of a part inward. curs between the tables with the result that ai r spaces
or sinuses are formed . In addition to the bones of the
Chapter 8_4_ - OSTEOLOGY cranium, other examples of flat bones include the scapu-
la, the ilium and the sternum.
8.4.1 General Irregular bones include all the bones which lack a uni-
The essential framework of the body upon which all form shape. The vertebrae, carpals and tarsals are good
soft tissues. organs. vessels are dependent for support examples.

...........,-'"-- _. ...
-
--
" '"
- --,-

-- --
---- - - --
,--
., ,~

......''''
- ~.

- -
-.- --- - ~

-
~
---
----
- .---""'-

Anterior view PosteriOr view Lateral view

Fig. 4/B (par. B.4.1) - Osteology - relationship 01 solt tissues to the skele/on.
Normotype person: 70 kg. 170 cm. Indicative scale 1:20 (1 mm _ 2 cm). For radiographic exposure data see tab. 10/2 page 73.

256 G1LAAOONI . AAOIOlOGY - ELECT~EOICIN

8.4.3. Descriptive terms of bone structure 8.4.6. Wrist

Various parts of the bone may be described in the fol- The carpal bones are eight in number and are arranged
lowing terms: in two rows. Those of the proximal row from the thumb
Condyle- a rounded eminence at the articular (joint) to the fifth finger side are named in the order as fol-
end of a bone. lows: navicular, lunate. triquetral, and pisiform bones;
Crest- a projecting ridge. those of the distal row, in order. are: greater multangu-
lar. lesser multangular. capitate, and hamate (see fig. 5/8).
Head- the expanded end particularly when situated
beyond a constricted or neck portion. Proximal row:
Process-a distinct projection. The navicular (scaphoid) is the largest of the proximal
group. Its name is derived from the fact that it re-
Spine-a sharp slender projection. sembles the outline of a boat. It is on the thumb side
Tubercle-a small eminence or elevation. of the proximal row.
Tuberosity- a relatively large elevation or eminence. The lunate (semilunar) is distinguished by its deep
Foramen-a hole or perforation through which may concavity and arch-shaped oulline. It is situated in the
pass such structures as nerves, arteries, and veins. middle of the proximal row, between the navicular
and the triquetral.
Fossa- a depression or hollow pit.
Groove- a shallow linear type of depression. The triquetral (cuneiform) is characterized by its py-
ramidal or three-cornered shape. II is situated on the
Fontanel- an unossified membranous portion in the ulnar aspect of the proximal row.
cranium of an infant.
The pisiform Is a pea-shaped bone situated in a ten-
Meatus-a relatively large opening. don in front of the triquetral.
Distal row:
8.4.4. Upper extremity The greater multangular (trapezium) as the name im-
plies. is one of the largest of the carpals.
The upper extremity is composed of the hand, the fore- Its shape is 01 many angles and it is situated on the
arm, arm and shou lder. Considering each of these parts, thumb side of the distal row.
the bones of each upper extremity include the lollowing: The lesser multangular (trapezoid) is the smallest bone
- Phalanges (fingers) 14 in the distal row. It is located Just to the side of the
- Metacarpals (palm 01 hand) 5 greater multangular.
- Carpals (wrist bones) 8 The capitate (as magnum) is the largest of the carpal
- Radius (small bone of forearm) 1 bones. It is localed in the distal row between the
- Ulna (elbOW bone of forearm) 1 lesser multangular and hamate.
- Humerus (arm bone) 1 The hamate (unciform) may be distinguished by its
- Clavicle (collar bone) 1 wedge-shaped, hooklike process. It is located in the
- Scapula (shoulder bone) 1 distal row superior to the fourth and fifth metacarpals.
32 Articulations of bones of hand and wrist. The phalanges
articulate with the metacarpal bones. The latter articulate
8.4.5. Hand also with the carpal bones. The carpal bones also articu-
late with the radius and ulna.
It consists of two segments: the metacarpals and the
phalanges (see fig . 5/8) . 8.4.7. Forearm
Metacarpal bones are five in number. They are identified
by enumeration from the thumb side. Each 01 these It is that part of the upper extremity located between
bones has a bOdy, a base or proximal end and a head the wrist and the arm.
or the distal end . It has two bones: the radius and the ulna (see fig. 6/8) .

UL~>'- __
~_"'D 'U S

LU Na' E . _~-_-:_ "a"eVl"

LATERA L EPICONDYLE ,
....'.~'<l
' ' OU l .l- lUV. SHAFT OF HUM ER US
"'S'" O. "
.. a" aTE -
. - -''1:;'"' " ~LU~'~L"
-.l>ur.
" UlI&'~,lU
CAP I TULUM __
-. _; CORONOID FOSSA

caPITAT [" -"(hC. ", ~

MEDIAL EPICONCY LE
HE AD OF RADIUS __ _
- ..... C" VOl
"HLn .
OLECRANON PROCESS
, '. ~ ~.,.~. RA DIAL CORONOIO PROCESS
. . . C'. 'UOl T UBEROSI T Y -
PHOla,.
"-"" "' DOlE .. .. Ol ....

UNGUal 'UIE.OS,,, SMAFT OF RADIUS - - - - SHAFT OF UL NA

Fig. 518 (par. 8.4.5) . Bones 01 the hand and wris,.

Phalanges are fourteen in number, three for each of the

fingers, and two for the thumb. The thumb is consi-
dered to be the first finger; the index finger. the se- ST VLOIO PROCESS STYLOID PROCESS
OF RADIUS _ - - . - ---.O F UL NA
cond, etc. Each phalanx has a body, a distal and a
proximal end. The terminal part of each distal phalanx Fig. 518 (par. 8.4.7.) Forearm an'eroposfarior view.
ends in the ungual tuberosity or tuft.

GllARDONI. RADIOlOGV ELECTROMEOICINE 257

The rad ius is situated on the lateral side. It is a long,
slightly curved bone having the following landmarks:
Head- a cup-shaped disk like structure situated at the
proximal end and adapted for articulation with the
capitulum of the humerus (bone of arm, proper).
Neck- the round, smooth constricted portion distal to
the head.
Radial tuberosity-located on the medial side of the
neck.
Body of shaft-the main portion, extending from the
neck to the region of the styloid process.
Styloid process- a downward, conical projection on
the lateral side of the distal portion.
Ul nar notch- a small depression on the medial side
of the distal end of the rad ius.
The ulna is situated in the medial portion of the fore-
arm and contributes prominently to the formation of the
elbow. It is composed of the following structures:
Olecranon process- a large, curved eminence on the
proximal end.
Coronoid process- a large, pyramidal projection from
the anterior surface of the proximal portion.
Semilunar notch- the arched depression extending be-
tween the olecranon and the coronoid processes.
Radial notch- the oblong depression on the lateral
side of the coronoid process.
Styloid process-a conical projection of bone on the
medial side.
Articulation of the forearm. The radius articulates with
the humerus at the capitu lum and the ulna, at the ra-
dial notch on the proximal end, and, with the ulna at
the ulnar notch and the lunate and navicular at the dis-
tal end (see figs. 5/6 and 6/6).
Proximally, the ulna articu lates with the humerus at the
semilu nar notch and with the radius at the radial notch
and distally, with the radius at the ulnar notCh . The el-
bow joint is the articulation of the radius and ulna with
the humerus. It is classified as a diarthrodial- hinge
joint (see fig. 7/6).
ACROMIA L.
PROC ESS OF ~~~~~____: CL.A VIC L. E
SCAPUL.A ._ . - - ~ - - - - CORA COIO PROC ESS
OF SC APUL.A
HEAD OF 'MOE'"
- - - - - - - SHAFT OF HUMER US
LATERA
HEAD OF
________ MEDIAL EPICONDYL. E
__ =:: --- -- T ROC HL.EA
--- --OL ECRANON ?ROCESS
SHAFT OF --- - -------SH AFT OF
RADIUS ULNA
Fig. 7/8 (par. 8.4.8.) - Articulations 01 the humerus - anterior
view.
8.4.8. Arm
The arm proper has one bone, the humerus (see
fig. 7/8). It is the longest and largest bone of the upper
extremity. It is that portion which extends between the
shoulder joint and the elbow jOint. It may be described
by the following landmarks:
258
Head- the rounded, proximal end.
Anatomical neck-that portion which is located between
the greater and lesser tuberosities and the head .
Surgical neck-the constricted portion below the tu be-
rosities. It is so named because it is frequentl y the
site of fracture.
Greater tuberosity-the larger eminence on the lateral
side of the proximal end .
Lesser tuberosity-the smaller eminence on the medial
side of the proximal end.
Intertubercular sulcus- a groove between the two tu-
berosities.
Shaft or body- the mai n portion extendi ng from the
neck to the condyles.
The musculospiral groove- a shallow, obl ique impres-
sion on the upper half of the shaft. It serves as the
pathway for the rad ial nerve.
The lateral and medial epicondyles- projections on
each side of the distal end.
Capitulum- the smooth, rounded eminence on the la-
teral surface of the articu lar area at the distal end.
Trochlea-the medial portion of the articu la r surface
on the distal end.
Radial fossa- a slight depression on the anterior as-
pect superior to the capitulum, for accommodating
the head of the radius during flexion of the forearm.
Olecranon fossa- a deep, triangu lar depression su per-
ior to the posterior aspect of the trochlea.
Coronoid fossa- a depression superior to the anterior
aspect of the trochlea, for accommodating the coro-
noid process of the ulna during flexion of the fore-
arm.
Articulations of the humerus. The humerus articulates
with the scapula at the proximal end and with the ulna
and radius, at the distal end. The articulation with the
scapula is a ball and socket type of a diarthrodial joint
(see fig. 7/ 8) .
8.4.9. Shoulder blade
The scapula is the shoulder blade. It is a large, flat
bone, roughly triang ular in shape. It lies against the
posterior aspect of the thorax and extends from the se-
cond to the eighth rib (see fig. 8/8). It may be des-
cribed by the following landmarks:
Subscapu la r fossa-the broad concavity on the costal
(ri b) aspect or anterior su rface.
Spine- a projecting plate of bone located on the pos-
terior surface dividing the scapula into the su praspi-
nous and infraspinous fossae.
Supraspinous fossa-the smaller of the two fossae and
it is located above the spine.
Infraspinous fossa- the concavity situated below the
spine.
Acromion-a triangular projection extending anteriorly.
at the lateral extremity of the spine.
Coracoid process-a thick, curved process attached
by a broad base to the upper part of the neck of the
scapula.
Glenoid fossa or glenoid cavity~the shallow concavity
located at the lateral angle of the scapula. It contrib-
utes to the formation of the shoulder jOint.
Lateral angle-that portion of the scapula where the
superior and axillary borders meet.
Medial angle-that part of the scapula where the su-
perior border meets the vertebral border.
G ILAADONI . Rl\OIOlOGY - ELECTAOMEOICINE
 Inferior angle- the rounded extremity at the junction
of the vertebral and axillary borders.
- - - - CA LC AN EU S

CO RA CO ICj PROCESS _' _ - TALUS

,
,, ; SCAP\JlAR NOTCH

"
- N o!.V ICU l o!. R
TIi IRO _ - - FIRST CUNEIFOR M
-. - - SECOND CUN ElrOR !.!
_ SPIN[ OF SCAPUL t.
_ METATARSALS
I NfRAGLE NOIO - - - - - -- PROXI MAL ~'''''''' I[]n
TUBE R OSITY ;',
1,''''
, \ , --- VERTEBRAL !.! IODL( Pti.t. L.t. NX
_ _ . ' PROX I MAL PH ALANX
"', ..... BOR DtR DISTAL PHALANX
.t. )(ILl AR Y BOIIOEII ' ... , \ -<",':
.:",' \.:;
-"
1\\' /"

""
_. DISTAL PHA LANX
,~
~~ ',", ' '" "''''
----- ANGL E
Fig. 918 (par. 8.4. 12.) - Bones of the foo t - anterior yiew.
Fl<}. 8/8 (par. 8.4.9.) Scapula - posterior view.

J"ticulation of the scapula. The scapula articu lates with

acromial extremity of the clavicle, at the acromion
;wocess, and with the head of the humerus at the gle-
!IOId fossa (see. fig. 7IS) . TIBIA-- _ __ _ _ --F I BULA

&.4.10. Collar bone

TALUS- - ___ __ _
~ clavicle, a long practically tubular bone, Shaped
D"Ilewhat like the italic letter .. t. It may be described
the following landmarks: CALC ANEUS - - - -

Sternal end- the medial portion. NAVI CULAR - -

Acromial end- the lateral portion of the clavicle.
CU,""FO"M" /~~7J~
- - -cu e olo
Coracoid tuberosity- a rough eminence located on the FIRST
posterior border of the lateral third of the bone. - - - -METAT ARSALS
Costal (rib) tuberosity- a rough area located on the
med ial aspect of medial third.
Nticulatlons of the coliar bone. The sternal end of the
- PHALANG ES
aavicie articu lates with the manubrium sterni while the
ICromial end articu lates with the acromion of the scapu-

~ clavicle and the scapu la, together are described as Fig. 1018 (par. 8.4. 14.) - BOllas of the fool - leteral IIlew.
shoulder girdle.

1..4.11. Lower extremity 8.4.13. Metatarsals

Commonly, the lower extremity is called the leg. Ana- They are the five bones forming the sale and lower in
lJmically, the leg is merely that part between the knee step of the foot and are numbered from the great toe
ald the ankle. The part between the knee and the hip side, laterally as 1st, 2d, 3d, 4th, and 5th. Each consists
.. referred to as the thigh , while below the ankle is the of a body, base and head . Union of these bones by
toot and the toes. The bones of each lower extrem ity means of Ilgaments constitutes the arch of the foot.
ndude the following:
Phalanges (toes) 14
8.4.14. Ankle
- Metatarsals (sole and lower instep) 5
- Tarsal (ankle) 7
The tarsal bones are seven in number and are referred
- Fibula (small bone of the calf) 1
to as the ankle bones (see fig. 10/S). They are des-
Tibia (shin bone) . 1
cribed as follows:
- Patella (knee cap) 1
- Femur (thigh bone) 1 Talus (astragalus),- second largest of the tarsal bones.
- Innominate (hip bone) 1 It supports the tibia and rests on the calcaneus.
Calcaneus (as calc is)- Iargest of the tarsal bones, is
31
&,4.12. Phalanges irregularly cuboidal in shape. 11 is situated beneath
the astragalus and provides the shape and support of
the heel.
Common ly called the toes of the foot. They are similar
fl number and arrangement to th ose of the hand. Each Navicular-situated at the medial side of the tarsus
s composed of a body, head, and base. The tip of the and Just anterior to the calcaneus.
:lIStal phalanges terminate as the ungual tuberosities (see First cuneiform- situated at the medial side of the
'igs. 9/8 and 10/S). foot and just anterior to the navicular.

a..AROONl. RADiOlOGY - ELECTlIO!.!EOICI NE 259

 Second cuneiform-wedgelike in form, is situated just Tibia (shin bone) is situated on the medial aspect of
lateral to the first cuneiform. the leg . It may be described in terms of the following
Thi rd cuneiform is situated just lateral to the second landmarks:
cu neiform. Medial and lateral condyles-the two eminences ex-
Cuboid- located lateral to the navicular and also lat- tending from the proximal articular surfaces of the II-
eral to the third cuneiform, anterior to the calcaneus bia.
and posterior to the fourth and fifth metatarsal bones. Intercondyloid eminences-two prominent tubercles pr~
Articulations of the ankle. The talus articulates with the jecting upward into the knee joint between the med ial
tibia, fibula, calcaneus, and navicular. The first, second, and lateral articular surfaces of the proximal end ex
and th ird cuneiforms articulate with the metatarsals. tremity.
Shaft- the main portion , extending between the upper
8.4.15. leg and lower extremities of the bone.
There are two bones in the leg: tibia and fibula (see Tibial tuberosity- the large, oblong elevation located
figs. 11 /8 and 1V 8). anteriorly and between the two condyles.
Medial malleous- a downward projection at the media
aspect of the distal extremity.
Fibula is a slender bone located on the lateral side of
the leg . It may be described in terms of the following
landmarks:
Head- a conical-shaped projection at the proximal ex-
tremity.
LATERAL EPICONDYLE ...
Styloid process- the pointed eminence on the head of
LII.TERAL CONDYLE-
OF FEMUR -- I~~~.I - -.'"",,,,_,,.o,, 1.'ARQI"'l the fibula .
LATERAL CONOYLE- EDIAL COr,OYL[ Lateral malleolus- a pyramidal-shaped process on the
OF TIBIA lateral side of the distal extremity.
;(EAO OF FIBULA- Patella (knee cap) is the largest sesamoid bone on
the body. It is lIat and triangular in shape and Is sit-
uated in front of the knee joint (see fig. 13/8).
SHAFT OF ''''''_, ---. SHAFT OF TISIA

- INTEROSSEOUS SPA CE
ME DIA L CO"lDVL~I
F EM1,I~

ME DI .lL COHDn
LATeRAL MALLEO LUS- - ~.iiiJ __ MEDI AL MALLEOLUS
-.J' -----D~ lle l.l

Fig. 11.8 (per. 8. 4. 15.} Bones of rhe leg end knee. "e LlL,---
A
--

~ --.",,- ,.

EMUR

MEDIAL CONDYLE
OF FEMUR--- -' ~---',
c __ """" CO NDYLE ..EDI .lL CONDVL [
OF FEMUR - - - OF l l t l .l
-LATERAL CONDYLE
MEDIAL CONOYL~_
OF TlS!A
OF TlBIA--
[ A D OF FIBULA F l eLoLA - __

Fig. 1318 (par. 8.4. 15.) Extension and flexion of the knee
;oinr .lateral view.

Articulations. The tibia articulates with the femur

(fig . 11 / 8) at the lateral and medial condyles and with
the fibula at its tateral condyle forming the knee joint.
MEDIAL ~'~~;~~~~:1~~~: _-LATERAL
TA LUS- - - -
MAL LE OLUS
ETATAR SAL B ONES
8.4.16. Thigh
C AL C ANE US - - - GES
The bony framework of the thigh is the fem ur. It is a
long strong bone with a shaft and two extremities. It
may be described by the following landmarks:
Fig. 1218 (par. 8.4.15.) - Bones of !he foot and leg. Head- a hemispherical-shaped prominence at its prox-
imal extremity.

260 GIIoAROONI. RADIOLOGY - ELClROMEOICI NE

 Neck-a constricted portion which connects the head
with the shaft.
Greater trochanter- a large, irregu lar tuberosity situat-
ed anterolaterally at the junction of the neck with the
upper part of the shaft.
lesser trochan ter-a smaller, irregular tuberosity which
projects posteromediaJly from the shaft below the ju nc-
tion of the neck.
lateral and med ial condyles-bony eminences at the
extreme distal extremity. They enter into articulation
with the articular surfaces of the tibia at the knee-
JOint.
lateral and medial epicondyles- tubercles projecting
from the condyles.
Patellar surface-the smooth, shallow depression be-
tween the condyles.
Intercondyloid fossa-the deep notch on the posterior
aspect between the condyles.
Alticulatlons of the femur. The head of the femur articu-
ng with the acetabu lum of the innominate bone forms
hip-;oint. It is classified as a diarthrodial articulation
1 the ball-and socket type. It is capable of engaging in
ion, extension, adduction, abduction, ci rcumduction,
.-ad rotation of the limb. At its distal end , the femur en-
I!r'S into the formation of the knee-joint (see fig. 14/8).
, FEMU R
__ PA TELLA
------ FIBULA
~ ..
Fig. 1418 (par. 8.4. 16.) Bones of the foot and leg - la/eral
1.4.17. Hlp bone
Wtomically, the hip bone is referred to as the .. innomi-
"'lilla. It is formed by the fusion of what was once
...tee distinct and separate bones; the ilium. ischium,
m pubis (see figs. 15/8 and 16/8).
AL.o. OF ILI UM...
"HEIIIOII
lNFE1l101I
ILI. C S"'NE ~~
,
:,
LESSEII , ,/
TIIOCHANT II / ISCHIAL TU8EIIOS ITY
Fig. 1518 (par. 8.4. 17.) - Pelvic bones - anterior view.
GlAROON I. AAOIOLOGV - ELECTROMEotCINE
. MEOIAL $ACIIAL
CIIEST
COCCYGEAL _ -
YEIITEBAAE
t
. -
' - - OBTUIIATOII
"( FOIIAM[N
Fig. 1618 (par. a4. 17.) - Pelvic bones - pos leriC)T vie w.
Ilium comprises the upper portion of the innominate
and represents the characteristic broad, wide-llaring por-
tions of the pelylc gi rdle. It may be described in terms
of the following bony landmarks:
Ala- the expanded part which bounds the pelyis later-
ally.
Iliac fossa- the anterior part of the interna l surface of
the ala.
Auricular surface-the rough surface located in the in-
ferior portion of the iliac fossa .
Iliac tuberosity- the elevated, rough, superior portion
of the iliac fossa .
Crest of the ilium- the uppermost portion.
Anterior superior iliac spine-a projection located at
the junction of the crest of the ilium and the anterior
border, at the superior aspect.
Anterior inferior iliac spine- a projection situated on
the inferior aspect of the anterior border.
Posterior superior iliac spine and the posterior inferior
iliac spi ne-similar prominences situated on the poste-
rior border.
Greater sciatic notch- located below the posterior in-
BONES ferior spine.
IschIum comprises the lower part of the innominate bo-
ne. It has a body, a superior, and an Inferior ramus. It
may be described in terms of the following landmarks:
Ischial spi ne- a pointed, triangular eminence extend-
ing from the medial border.
l esser sciatic nocth- Iocated below the sciatic spine.
Ischia l tuberosity- a large elevation on the posterior
su rfaces of the superior ramus.
Pubis forms the anterior portion of the innominate bone.
It has a body, a superior, and inferior ramus. It has the
following bony characteristics:
il iopectineal eminence- a rough em inence at the site
of fusion between the ilium and the body of the pu-
bis.
Pubic tubercle-a prominent tubercle on the upper
, 'SlCIIUM border of the superior ramus.
Obturator crest- the lower ridge which passes down-
ward on the superior ramus in front of the acetabular
notch.
Acetabulum of the hi p bone- the site where the three
bones of the innominate fuse. The il ium contributes
two-fifths to its formation, the isch ium . two-fifths and
the pubis, one-fifth.
Obturator foramen- a large. oval-shaped foramen lo-
cated between the ischium and pubis.
FE MUll Pubic symphysis- the ligamentous and cartilaginous
union of the anterior extremities of the two pubic
bones.
261
Articulations of the Innominate. The three bones of the
innominate, namely the pubis, ilium, and ischium articu- ---- ----------'.00.01.'
late at the acetabulum. This joint may be classified as
synarthroidal due to its lack of motion and complete fu -
sion . The acetabulum and head of the femur form the
hip-joint. The pubic symphysis is an amphiarthroidal ar-
ticu lation because slight motion is possible between the
junction of the pubic bones. The articulation of the au-
ricular surface of the sacrum with that of the ilium also
forms an amphiarthroidal jOint, referred to as the ..sa-
cro--iliac articulation...
Pelvic girdle. The pelvic girdle is composed of the two
innominate bones, the sacrum and the coccyx. The pel-
vis is divided into two portions by the pelvic brim. The
expanded part above the pelvic brim is referred to as
the .. major pelvis or the fal se pelvis,.. The part of the Fig. 191B (par. 8.4. lB.) . Catvanum superior view.
cavity which is below the pelvic brim is known as the
"true pelvis.
Frontal bone forms the forehead and enters into the
8.4.18. Skull formation of the orbits (eye sockets) and the nasal
caVity. Between the two tables of bone above this
The sku ll is supported by the vertebral column. It in- marg in are located the frontal aIr sinuses.
cludes the c ranial and the facial bones (see figs. 17/8 Parietal bones enter into the formation of the roof
through 21/8) . The cranial bones include: 1 frontal, 2 and sides of the cranial cavity. On the top of the
parietal, 1 occipital. 2 temporal . 1 sphenoid, and 1 eth- cran ium. the parietal bones are separated from each
moid. The facial bones include: 2 maxilla, 2 zygomatic, other by the sagittal suture, and passing laterally on
2 nasals, 2 lacrimal , 1 vomer, 2 inferior nasal concha, 2 each side, the coronal suture, anteriorly, separates the
palatines, and 1 mandible. parietal from the frontal bone. Laterally, the parietal
suture separates the parietal from the temporal bone.
Posteriorly, the occipital is separated from the parietal
by the parieto-occipital suture.
Occipital bone forms a large part of the base of the

----
._ ... """' -----
-, ----- --
cranium and is especially characterized by the large
foramen magnum which permits the spinal cord to
pass from the vertebral canal to the cranial cavity. On
each side of the foramen are the condyles that allow
.' .-- for articulation of the skull with the supporting member
of the cervical portion of the vertebral column- the
" )J..--------- arias. Externally, on the posterior surface, Is a distinct
projection known as the ..external occipital protuber-
-<---- ---------
ance. Internally the occipital bone contributes to the
formation 01 the cranial fossae and the walls are
marked by deep grooves for the passage of the cran-
--------- ial blood sinuses which drain the venous blood from
the brain.
Temporal bones are paired and each consists of squa-
Fig. 1718 (par. B.4. 18.) Rela tionshIp 0 1 so l/ tissues of head mous, mastoid, and petrous portions. Between the ta-
to Ihe skull - anterior view. bles of bone of the mastoid process are located the
mastoid ai, ce/ls. Within the petrous portion are situ-
The cranium is composed of a number of bones which ated the essential organs of hearing and equilibrium,
are united with each other by sutures (see fig. 19/ 8) . It and, opening internally, Is the internal auditory meatus
serves to support and prolect the brain: where an opening exists for accommodating the 7th
and Bth cranial nerves. Externally, an opening is pro-
$ Q U.U,IO~"~'-~~~~
,
sUTURE
------1 vided in the tympanic portion called the "external aud-
itory meatus- which allows sound waves to stimulate
the structures of the middle ear. Projecting downward
PAR IETAL
-, from the temporal bone is a slender spine known as
the ..styloid process- . Within the middle ear are situ-
l ENPORA L
ated the auditory ossic/es. These serve to conduct the
sPHENOID sound vibrations from the ear drum (tympanum) to
the inner ear.
O<:C IPI T,!,L - Sphenoid bone is located at the base of the skull.
The upper part of the body of the sphenoid presents
EX TERN AL a depression resembling a Turkish saddle called the
OCCIPITAL - - -
PR OTUOERlN CE -selia turcica- or ..hypophyseal fossa where rests the
WASTOID _ pituitary gland . Beneath this depression are the sphe-
PftOCESS noidal air-sinuses-<me of the paranasal sinuses.
, Ethmoid is an extremely light bone situated at the
SfYLOID PROCESS ' ' MENTAL f ORAM EN base of the cranium. It takes part in the formation of
Fig. 181B (pa'. B.4. 18.) - Relallonship 01 solt tISSueS of head the medial wall of the orbit, the septum of the nose
to Ihe skull - lateral ~/ew. and the roof and lateral wall of the nasal cavity. The
cribriform plate is a horizontal portion of bone perfo--

262 GIl.AROONI . RADIOlOGV Et.ECTROMEOIClNE

 rated for the passage of the olfactory nerves. It is lo- CO<CNOoO"<X I I \
cated in the midline between the orbital plates of the
Irontal bone. Extend ing from the midline of it, within
the anterior cranial fossa, is the crista galli to which
the meninges of the brain are attached . The upper
part of the nasal septum is composed of the perpen-
dicular plate of the ethmoid. The two lateral masses
of the ethmoid comprise the ethmoidal air cells, which
constitute one set of paranasal sinuses.
The auditory ossicles, incus, malleus, stapes, are lo- )
cated within the middle ear.
...HI .... IQl..t.MlN "'

The facial bones, by their union , assist in the formation

of the remaining portion of the skulL They serve as (OOOHOID .ooc:u~ -- - - -
---- /
\h
~
supporting framework for the upper portion of the di- CONO" o. D "ox."
~t ive and respiratory systems:
Maxi llae are the large bones contributing prominently
...... u ~ ,
in the formation of the upper jaw, roof of the mouth,
floor and lateral wall of the nose, and floor of the or-
bit. They serve as foundation for all the upper teeth. M''' '. ' ~'t'_':v~~ . _ . ,/' . ___ .
The sites of attachment of the teeth form Slight, bony -. '- ..0.1

eminences called alveolar process... The articulations ~,

,
of these processes form the a/veo/ar arch opening on Fig. 20/8 (paf. 8.4. 18.) - Ma ndible.
the outer surface of the maxilla. Below the orbit is
the infra-orb/tal foramen through which passes the in-
fra-orbital nerve carrying sensory impulses from the
e liNU<[ _ _ _ _ _ _ _ _ _ _ _ -~,- - - - - - ' INCISORS
adjacent facial area. Within the body of the bone is a
large cavity, extremely thin boned, known as the PRCMOLAR S _ _ _ _ _ _ 119':''''' __ ____~~L:T~;li~=ocSS
- maxillary air sinus_ or the _antrum of Highmore", - - ---ZVGO MATIC 80NE
another of the paranasal sinuses. It communicates by MOL AR S - - - - - - 1II. .AmI ---Pt. L ATI"I[ 80f< E
VOM[R ___ __ _
two small apertures with the middle meatus of the
nose.
.STY LOID PR OCES S
Zygomatic or malar bones form the promentories of
the cheek and lateral wall of the orbit. Together with
-
-t~
,~
. MASTOID PROC ESS
the zygomatic process 01 the temporal bone, they
, _ ~ I NrCRIOR NUCo-IA L
form the zygomatic arch. .... - -j LINE
Nasal bones are the small bones that comprise the ./
upper part of the bridge of the nose. The lower part
is formed by cartilage. - - - . ' SUPERIOR NU Ct1_L
lacrimals are the two small fragile bones situated at LINE

the medial wall 01 the orbit which assist in the forma-
tion of the nasolacrimal duct leading from the orbit to
the nasal cavity.
Vomer is a thin , flat, keel-like bone which forms the
lower part of the nasal septum.
Inferior nasal conchae are two, curved, shell-like struc-
tures lying horizontally In the lateral wall of the nasal
cavities.
Palatine bones are two, L-shaped bones which together
with the palatal process of the maxilla unite to form
the roof of the mouth. They also form the floor of
the orbit.
Mandible, the strongest and largest bone of the face,
is the horseshoe-shaped bone forming the lower jaw
(see fig. 20/8) . On the external surface 01 the body is
the mental protuberance; the upper border, called the
-alveolar process>-, supports the teeth. Extending up-
ward, posteriorly, at each side is a ramus which pro-
jects as a coronoid process (affording muscular at-
tachment) and a condyloid process (which enters into
the formation of the temporomandibular joint). On the
internal surface of the ramus is the mandibular fora-
men through which passes the dental nerve carrying
sensory impulses from the teeth of the lower jaw to
the sensory area of the brain.
Hyoid bone is a U-Shaped bone located Just above
the Adam's apple, serving as a point attachment for
the muscles associated with the tongue, pharynx, and
the anterior part of the neck.
Frg. 21 /8 (par. 8.4 . 18.) - S klill - inferior view.
8.4,19, Vertebral column
General, The vertebral column or spine is the central
part of the axial skeleton . It serves to support the head ,
the ribs, and the extrem ities. It assists the abdominal
muscles in supporting the viscera. There are seven cer-
vical, twelve thoracic, five lumbar, five sacral , and four
coccygeal vertebrae, totaling 33 in all.
General characteristics of a vertebra. A typical vertebra
consists of an anterior portion the body, and posterior
part, the vertebral arch. The vertebral arch consists of
two pedicles or roots and two lamina; it has seven pro-
cesses, four articular, two transverse and one spinous. It
encircles the vertebral foramen through which passes
the spinal cord. An in tervertebral disk , composed of fi-
brocartilage, forms an amphiarthrodial articulation bet-
ween the bod ies of the vertebrae. The notch of a lower
vertebra in apposition with thai of an upper vertebra
unites to form an in tervertebral foramen through which
pass the spinal nerves.
Features of the spinal column. In the cervical region
(fig. 22/8) the first vertebra is known as the ..atlas. It
serves as the articulating surface between Ihe rest of
the spinal column and the condyles of the skull. This
vertebra rotates upon the second vertebra, the axis. The
anterior portion of the axis is elongated by way of the
odontoid process.

GIl...o\flOONI. AAOIOI..OGV - LECTAO~ EOICI N 263

 _ __ _SAO<T TA l SUTUFl(
while the eleventh and twelfth ribs are free at their a n~
P.uU(tAl BOtH
terior extremities. The latter are therefore commonly cal~
,",AMBOOIOl
...... ,- SUTU RE led floating ribs". The junction of the osseous portion
of the ribs with their cartilages forms a synchOndrosis.
OCGI~ltO MA ST O I()
,SU T UR As age advances, the cartilaginous union is replaced by
J ' bone and is then known an synostoses. Each rib has
80N " , ...... STOI O PII()(:(SS a posterior and an anterior extremely connected by a
SOUAMOS.!, . '
body or shaft.
S U TUR ~ : ' " '~...':i~~~ :OR~';S~Al Sternum is the flat breast bone located anteriorly and
.', VEIITCBU
HfRNAl
OCCIPIT AL . -
P~ OTU8EHA N GE
r ---- ATLAS- 1ST CE RVICAL
VII T[ BRA
occupying the middle of the thoracic cage. It consists
of three parts, the manubrium. corpus sterni (gladiolus),
" _ _ __ 3~ D CERVIC AL

SP' NOUS PROCUS- VERT U R. and the xiphoid process.

OF A'tl S
_. ,TH CERVICAl The manubrium is the upper part. With the sternal end
~~:T~~:.ooe.o.: ~
V ER TEB RA
_,7TH CER VICAL
of the clavicle it forms the sternoclavicular articulation-
SP lti OVS PII OCUS VERTEBRA a diarthroidal joint. The articulation formed by the first
U HCEIIY' CH .-~ (C [ R VI CA l U rib and the manubrium Is a synarthrodial articulation of
,(IIIEB R. - PROMINtN S )
the type synchondrosis.
Ftg. 22/8 (par. 8.4. '9.) - Skull and cervical VfJrle/:Kae - pos'e- The corpus (glad iolus) is the middle section of the
rior view. sternum. It articulates with the costal cartilages of the
2d-4th ribs and forms with them dlarthrodial joints.
In the thoracic region. the vertebrae are all character- Xiphoid process is a thin variable structure in the lower
ized by the fact that they articulate with ribs and con- portion . It Is cartilaginous during the earlier ages but
tribute to the posterior wall of the thoracic cage. develOps into bone as age advances.
The lumbar vertebrae are the largest 01 the movable
vertebrae. They do not have cosfal facefs on the sides
of their bodies.
The sacrum is a fused, wedge-shaped bone inserted be-
tween the two innominate bones.
.-- - - IIVoNUBRIUM STUNI
The coccyx consists of a variable number of vertebral
segments which extend below the sacral and are the
rudiments of what was once a tail. - - - - SOOY Of STERNUM
When the vertebral column Is viewed laterally it shown
-- -- ~~~~W~,~i
four cu rves. The cervical and lumbar curves are con~
cave forward (lordosis) wh ile the thoracic and sacral
curves are convex forward (kyphosis) (see lig. 2318). - - - - XII'IiOID PROCESS

- - - - - - '*AC> O< "" .. ,,~

Fig. 2418 (psr. B.4 ,20. ) ThOracIC csge Inferior view.

-- - - -- - - - ... ~

Chapler 8,5, - DIGESTIVE SYSTEM

8.5.1. General
YflTUU!
The digestive system is composed of the digestive tube
(alimentary tract) and Its associated appendages or ac~
_ _ _ _ _ ..... ".IOIII<.ft.1OII
cessory organs situated in the abdomen (see fjg . 25/8) .

KI.UIC _E - - -
----- - HUC>Of f ........ _ -t:s.omo.GIIS

-- -- - --
/
[USU K I."O;: NOICH '" ___; : : ""1:X Of lEfT lUNG

cO(cu- - - - - ..- ..-_ __ iIUI'UIOII[OII!

1r1\;:l:,,- : Of IlI'l WNO
_ .......... ..-IN'UIOII IOIE
FIg. 23/8 (par. 8.4. '9.) Bones of the pecforal and pelvic
---
+

girdles - IMeral view. -- ~1

~: :: ~. _ c.o~DIA Of SIQM.to.CH
_~ _ _ _ _ _ _ _ _ stI U N

- - --- -- --'ANCau.5
8.4.20. Ribs and sternum - - - - - - I ....... ~V!IIlol COI.OH

- - - - - -SCH'OINO COlON
Ribs, twelve pairs, are located on each side of the tho-
_ _ _ _ __ COI.ON
racic cage (see fig. 24/8) . The first seven are connected ~ ~~O

by means of costal cartilages to the sternum and are - -- - -- - - - - - IECIUM

therefore called .. true ribs". In contradistinction the re~ Fig. 25/B (par. B.5. 1.) - Digestive system and associated or
maining five are called .,false ribs". The eighth, ninth, gans.
and tenth are joined to the cartilage of the seventh

264 GILA.RDONI . RAOIOLOGY - ELECTROMEOICI NE

Practically all of the food substances ingested by an in-
dividual requires some alteration before they can be ab-
sorbed into the blood and be conveyed to all parts of
the body. This process of conversion of food into assi-
milable substances constitutes otdigestion. . It is accomp-
hed with the assistance of enzymes which are secret-
ed by various glands along the tract. The functions of
the digestive system include:
Ingestion- accomplished by the mouth.
Mastication-accomplished by the teeth and rendering
the substances in a form so that they may be easily
acted upon by enzymes.
Insalivation- accomplished by the salivary glands where-
by the mass of food becomes lubricated for passage
down the tract and thus enables the initial stages of
enzyme action to being.
Propu lsion of the food along the tract- accomplished
by means of the muscles of deglutition or swallowing
In the esophagus and also by the complex move-
ments of the stomach and intesti nal tract.
Secretory-accomplished by the various digestive juice
of glands, either connected to the tract by ducts or
located directly within It. This permits the conversion
of the food into its final assimilable form .
Absorption of the final products of dIgestion-accomp-
lished by the cells of the mucous membrane of the
small Intestine, colon and the blood vessels.
Foods. Foods are classified as carbohydrates, proteins,
fats, and vitamins:
CarbOhydrates-substances consisting of carbon, hy-
drogen, and oxygen-as contained in starches and
sugars.
Proteins-complex substances which contain nitrogen
in addition to carbon, hydrogen, and oxygen-as con-
tained in meats, nuts, and certain vegetables.
Fats-a more concentrated form of energy food, con-
taining the same elements as carbohydrates but in
different combination.
Vitamins are complex organic substances. They are
not nutritious in themselves but are essential for nor-
mal health. Included are:
Vitamin A-promotes growth and increases resistan-
ce to Infections. Night blindness Is associated with
deficiency of this vitamin.
Vitamin B-promotes appetite and aids In the main-
tenance of the motility of the Intestinal tract. It pro-
vides for the proper functioning of the nervous sys-
tem. It is of a multiple nature and is referred to as
the ..Vitamin B Complex.
Vitamin C-stimulates the proper functioning, main-
tenance of growth of theet and bones.
Vitamin O- influences blood calcium and mineral me-
tabolism.
Vitamin E- essential for normal reproduction of the
germ cells in the male and for the development of
the placental membranes in the female.
Vitamin G- contains a growth factor.
Enzymes are chemical substances formed by living
cells. They are complex organic compounds capable
of producing , by their presence, a catalytic action in-
volving the transformation of some other compound
without themselves being affected.
The alimentary tract extends from the mouth to the
anus and is lined throughout its extent with mucous
membrane. It is about 28 feet long and is divided into
the following parts:
Mouth cavity (includes the: salivary glands, teeth,
tongue, and tonsils).
GIlAA DONI . RAOIOlOGY - ELECTROMEOICINE
Pharynx.
Esophagus.
Stomach.
Small intestine (includes the: duodenum , jejunum , and
ileum).
Large intesti ne (includes the: cecum, ascending colon,
transverse colon, descending colon, and Sigmoid ca-
Ion).
Rectum.
Anus.
The ' accessory organs wh ich contribute to the process
of digestion are: the liver, gall bladder, and pancreas.
8.5.2. Mouth cavity
The site of commencement of the digestive tube, where
the food is ingested . It Is composed of the mouth cavi-
ty proper and the vestibule. The vestibule is bounded
externally by the lips and cheeks, internally by the teeth
and gums.
8.5.3. Salivary glands
These include three pairs: the submaxillary, the sublin-
gual and the parotid together with numerous glands lo-
cated in the mucous membrane of the oral cavity. All of
these glands contribute to the formation of saliva:
Parotid gland is an irregular, lobated gland situated in
front of each ear. By means of Stensen 's ducl the
serous secretions of it are secreted through the mus-
cles of the cheek Into the mouth, through a small
papilla which is located adjacent to the second upper
molar tooth.
Submaxillary gland is rather Irregular in form, shaped
like a walnut, and lies close to the internal surface of
each half of the mandible. By means of Wharton's
duct, it conveys secretions into the mouth opening
through a small orifice at the side of the renulum of
the tongue.
Sublingual gland is the smallest of the three salivary
glandS. The pair are situated just anterior to the base
of the tongue. They empty directly into the oral cavity
by means of many ducts or Into the submaxillary
duel.
Function of the saliva. The quantity of saliva secreted
daily averages about 1500 cc. It contains an amylolytic
ferment (starch digesting) ptyaling and 'some maltase.
Its chief value is in the process of insalivation, that is,
to moisten food, bring taste components into solution
and lubricate the bolus or food mass for swallowing.
Excitation of salivary flow. The fl ow of saliva is activat-
ed by: the stimulation of the 5th and 7th cran ial nerves
by the presence of the food in the mouth; re flex stimu-
lation of the salivary glands by way of the autonomic
nervous system-exciting a thick secretion and direct
stimulation of these glands by the brain because of the
Sight, thought, or smell of food- producing an abundant
though thin secretion.
8.5.4. Teeth
There are two sets of teeth. The first, is the temporary
set which is referred to as the deciduous or milk teeth.
These appear during the first and second years. The
second set, called the permanent teeth, begin to replace
the deciduous set about the sixth year and are usually
completely developed about the twenty-fifth year.
265
There are 20 deciduous teeth, includ ing 4 incisors, 2
cuspids, and 4 molars in each jaw.
There are 32 permanent teeth, including 4 incisors, 2
cuspids, 4 bicuspids, and 6 molars in each jaw (see
fig. 26/8) .
TIl IRO r..OL A,R
SECONO MOLAR
--
SECO 'lO
LAHRAL I'ICIS OR -- -
=~ ___ L ATERAL 1'I5"OR
-- F IR ST BICUSPID
SECO'lU_- ~
BI1;1I5P10
TIlIRD 1oI0LAR--
Fig. 26/8 (par. 8.5.4.) - Arrangemenr of the teeth.
Characteristics of teeth. Each tooth consists of three
portions: the crown projecting beyond the gingiva; the
root which is embedded in the alveolus (bony ridges)
and the neck which is the constricted portion between
the crown and the root.
8.5.5. Tongue
It is a muscu lar organ intimately associated with the
functions of taste, speech, mastication, insalivation, and
deglutition. The varied movements of the tongue are
controlled by four pairs of muscles. The tongue is co-
vered with mucous membrane which contains secreting
cells and taste buds. There are three varieties of taste
buds: fungiform - located near the edges of the tongue;
filiform-which are widely distributed and circumvallate-
wh ich are largest and fewest and are located at the
posterior ridge of the tongue.
8.5.6. Tonsils
The common name, tonsil, is applied to any small mas-
ses of lymphoid tissue. The lingual tonsils are located
underneath the tongue; the pharyngeal tonsils (common-
ly called the adenoIds), and the palatine tonsils (the two
ordinarily considered in using the term tonsil,.) are lo-
cated on the lateral wall of the oral part of the pharynx
just above the palate.
8.5.7. Pharynx
It is the continuation of the digestive tube behind the
mounth and extending into the esophagus. It consists of
three parts: the nasopharynx- which lies behind the nose
and above the level of the soft palate- the adenoids of
childhood are located on its posterior wall; the ora/
pharynx- which continues from the soft palate to the
level of the hyoid bone and the laryngeal pharynx-is
the portion extending with the esophagus from the hyoid
bone to the lower border of the cricoid cartilage of the
larynx.
8.5.8. Esophagus
It is a musculomembranous tube, about 10 inches long
and 1/2 to 1 inch in diameter, extending from the end
of the pharynx to the cardiac orifice of the stomach.
266
8.5.9. Stomach
It is a pear-shaped organ situated between the end of
the esophagus and the beginning of the small intestine
(see fig. 27/8). It has an anterior and posterior surface.
The upper border is called the lesser curvature while
the lower border is known as the greater curvature. The
opening of the esophagus into the upper portion of the
stomach is known as the cardia and the opening into
BICII51' IO
the intestine is referred to as the pylorus. The fundus is
the expanded portion which bulges upward and to the
left.
;:-::- - - - - - FU NDUS
ESOPHAGUS __ ___ -- 2- ....
ENTERING THE \
STOMACH
LESSER CURVATUR E .. -
I,\,\
MOLAR
I' '-- - - GREATER
II CURVATUR E
,, /'
,, ':, \.
/- - - - - - - - - eODY
DUOOENUM
,
PYLORIC PORTION
Fig. 27/8 (par. 8.5.9.) - StomaCh.
Gastric secretion. Gastric juice, which is acid in reaction
and of sour taste, is secreted by the cells in the wall of
the stomach. It contains hydrOChloric acid. The enzyme
pepsin is a/so secreted by cells in the wall. It starts the
digestion of proteins after being activated by tha hy-
drochloric acid. A third enzyme which is secreted is
rennin which serves to coagu late mi lk.
8.5.10. Small Intestine
It is a tube, from 22 to 25 feet long, beginning at the
pylorus and ending at the ilea-ceca l junction. It consists
of the dUOdenum, jejunum, and ileum :
Duodenum-9 to 11 inches long and forms a C-shaped
curve, enci rcling the head of the pancreas. The pan-
creatic duct and the common bile duct open into it.
Jejunum-comprises the upper twofifths of the rest
of the small intestine and is thrown into numerous
curves.
Ileum- the remaining threefifths of the small intestine.
It opens into the ascending colon at the ilea-cecal
valve.
8.5.11 . Large Intestine
It is composed of the cecum, ascending colon, trans-
verse colon , descending colon , and the Sigmoid colon:
Cecum- a blind sac located in the right iliac fossa.
Extending from the cecum is the vermiform appendix.
Ascending colon-extends from the cecum to the trans-
verse colon. It is about 8 inches long and comes into
contact with the under surface of the liver. This por-
tion is called the hepatic flexure.
Transverse colon- variable in position, extending to
the under surface of the spleen. The curved portion
here is called the splenic flexure.
Descending colon-about 6 inches long, extending
down in front of the left kidney to the pelvis.
Sigmoid colon-extends as an S-shaped loop from
the descending colon to the rectum, passing over the
pelvic brim into the true pelvis.
GILARDON I. RAOlo\'OGY ELECH10MEDICINE
8.5.12. Rectum
It is about 6 to 8 inches long and passes downward in
the curve formed by the sacrum and coccyx. It termi-
nates in the lower end of the tract as the anus.
8.5.13. Movements of alimentary tract
In a greater mesu re, the extent of our knowledge of the
ali mentary tract is due to the application of contrast
media in roentgenographic studies.
The most common medium used is barium sulphate
which may be given by mouth (barium meal) or by rec-
tum (as a barium enema) . Much information might be
gained by these studies, such as: the rate of passage of
the barium, the position, condition and contour of the
organs and possibly, the presence of pathological condi-
tions.
Stomach. Normally, within a few seconds after the bari-
um meal reaches the stomach, it passes through the py-
lorus, After the first hour, the stomach is usually half
empty and by the sixth hour, none of the barium should
be left.
Small intestine. The barium should reach the ileo-cecal
valve within 2 hours. At the end of 6 hours, a large
part of it shOuld have passed into the cecum. In 12
hours, none of the barium shOu ld remain in the small
intestine.
Colon. At about 24 hOurs, the meal shou ld reach the
rectum. Usually, in normal health, the colon may be
em pty in 48 hOurs, thOugh it may sti ll be visualized for
more than 100 hours.
8.5.14. Liver
It is the largest gland in the human bOdy. It is located
an the right hypochondrium and upper epigastric regions
and extends for a short distance into the left hypo-
chondrium . It is held in place by ligaments. The falci-
form ligament attaches it to the anterior abdominal wall
and divides the liver into a right and left lobe. The left
portion of the right lobe is subdivided into two smaller
lobes the quadrate and caudate.
The excretory apparatus of the liver consists of:
The hepatic duct- which leaves the liver at the porta
hepatis . It is formed by the union of the Iwo main
ducts concerned with the right and left lobes.
The gall bladder- which serves as a reservoir for the
bile.
The common bile duct-which is formed by the he-
patic duct and the cystic duct (gall bladder duct) .
Functions of the liver:
Sec retion of bile- which serves to breack down fats.
This secretion is normally continuous; when not di-
rectly passed into the digestive Iracl, il accumulates in
the gall bladder where it is concentrated and stored
for future use.
Glycogenic function - wh ich involves the deposition of
glycogen (animal starch) within the liver cells. It is al-
so concerned with glycogenolysis- that is, breaking
the glycogen down into glucose again for the meta-
bolic requirements of the body.
Protein metabolism- the function concerned with ac-
tion on proteins; the formation of urea and the desc-
truction of uric acid. In this way the liver detoxifies
for if uric acid is allowed to accumulate, it becomes
toxic to the body.
Fat metabolism- a very complex biochemical process
concerned with fatty acids, glycerol, etc.
G1LAROON I. RADIOLOGY ~lECTfI O M~OICINE
8.5.15. Gall bladder
It is a pear-shaped sac situated in a fossa on the under
surface of the liver. It is composed of an expanded
end, the fundus, a body, and a neck which is constrict-
ed to form the cystic duct. Roentgenographically it can
be visualized by the administration of a dye such as te-
traiodophenolphthalein.
8.5.16. Pancreas
It is an elongated organ shaped like a pistol with the
muzzle pOinting toward the hilum of the spleen. It is
composed of a head, neck, body, and tail. It occupies a
position beneath the stomach. It furnished pancreatic
juice which is secreted by one or two ducts (Wirsung
and Santorini) .
Function of pancreas:
Produces a pancreatic secretion which is capable of
splitti ng all three classes of foodstuffs, that is, car-
bohydrates, fats, and proteins.
Produces a hormone, insulin, which is secreted into
the blood and acts to convert blood sugar into gly-
cogen.
Chapter 8.6. - RESPIRATORY SYSTEM
8.6.1. General
Respiration (breathing) is a process common to all forms
of animal life. It consists of supplying oxygen to the
cells of the body and relieving them of the carbon diox-
ide formed during the burning of foods.
Anatomically, the respiratory system is composed of: the
nose, paranasal air sinuses, mouth, pharynx, larynx, tra-
chea, bronchi, and lungs.
8.6.2. Nose
It is the organ of smell. It is composed of an outer or
external portion and an internal portion . The framework
of the external nose is composed of the nasal bone and
a greater amount of cartilage.
The nose has a dual function:
Olfactory function - which is accomplished by the fine
distibution of the branches of the first cranial nerve
which pass through the foramina of the cribriform
plate of the ethmoid and are distributed to the upper
portion of the nasal septum.
Respiratory function- which is carried out by means
of a mucous membrane, rich ly supplied with blood,
serving thereby to warm and moisten the inspi red air.
In this region also there are located many fine hairs
called cilia. When they are moist, they catch dust
particles in the inhaled air and thus serve as filters.
8.6.3. Paranasal sinuses
They are located in the skull and vary in form and size
in different individuals. The walls of each sinus are co-
vered with mucous membrane from which cilia extend.
These include the:
Frontal air-sinuses-two in number. They are situated
behind the superciliary arches. By means of the fron-
tonasal duct, they drain into the midUe meatus of the
nose.
267
 Ethmoidal air-Sinuses-which consist of many thin-waI-
led cavities, honeycomb in structure; they are frequen-
tly referred to as air-cells. They lie in the upper por-
tion of the nasal cavity and are separated from the
orbit by the thin plate of the ethmoid.
Sphenoidal air-sinuses- two In number, located behind
of the sphenoid bone beneath the sella turgica. They
drain into the posterior portion of the middle nasal
meatus.
Max illary air-sin uses-referred to as the antrum of
Highmore and are located within the body of the
maxillary bones. They, too, drain into the middle mea-
tus. The roots of the upper teeth extend up into the
fl oor of these sinuses.
Function of the paranasal sinuses incl udes: reg ulation of
temperatu re and moistu re of the inspired ai r, tiltering
foreign particles, acting as resonance chambers, affect-
ing voice tone and they lighten the weight of the skull.
8.6.4. Laryn x
It is the organ of voice and is situated in the upper an-
terior part of the neck above the trac hea. It is com-
posed of nine cartilages; thyroid, cricoid, epiglottis, two
arytenoids, two corniculate, and two cuneiform. With the
onset of puberty, the carti lages begin to ossify; as age
advances, they may be completely changed to bone.
8.6.5. Tracheas
It is a tube (the wind-pipe) which carries the air be-
tween the larynx and the bronchi. It is about 5 inches
long and lies partly in the neck, partl y in the thorax. It
begins where the larynx ends. Cartilaginous rings serve
for support of its walls.
8.6.6. Bronchi
They are the two tubes extending beyond the trachea.
Their structure is identical with that of the trachea. The
primary bronchi divide into secondary bronchi and with
further divisions they become smaller and smaller, even-
tually becoming bronchioles. The bronchioles divide into
the terminal bronchioles with in the lu ngs and then di-
vide further Into atria. Each of these atria then commun-
icate with air sacs into which the alveoli bpen. It is
here that the exchange of gases takes place.
8.6.7. lungs
They are composed of two pyramidal, spongy lobes
adapted to the function of oxygenating the blood. The
lungs are covered with a membrane known as the vi-
sceral pleura . There is a second layer of pleura adjacent
to the thoracic wall- the parietal pleura. Between the
layers of parietal and visceral pleura is the pleura cavity
which normally contains a small amount of serous fluid .
The pleural cavity is part of the thoracic cavity. The
lungs, heart, and associated structures lie in the thora-
cic cavity. The surfaces of the lungs are the diaphrag-
matic (base), costal (adjoining the ribs) and mediastinal
(medial aspects). The hilum of the lungs is the area
through which the essential structures enter the lung.
The apex of the lung is the rounded portion extending
up toward the neck. The right lung contai ns three lo-
bes, superior, middle, and Inferior partially divided by
two fissures. The left lung usually contains only two
lObes, inferior and superior.
268
8.6.8. Mechanics of respiration
The interchange of gases, that is, oxygen and carbon
dioxide, is accomplished by inspiration , expi ration , and
the rest phase of the respiratory cycle. The coordinated
movements of the lungs, diaphragm, abdomen , and as-
sociated muscles regulate the cycle. In a normal adult,
the respiratory cycle occurs about 14 to 18 times a
minute.
8.6.9. lung capacity
The amount of air in the lungs varies in accordance
with many fac tors. The volume of air which is inhaled
and exhaled du ring ordinary respiration is approximately
500 cc. This is called the ..tidal air. By tak ing a deep
breath, it is possible to inhale an additional 1500 cc. -
called "complimental ai,.... FOllowing a normal expiration
and inspiration, it is possible to exhale, by deep expira-
tion, about 1500 cc. in addition to the tidal ai r. This is
called .. supplemental air... The vital capaci ty of a normal
adult is therefore about 3500 cc. 01 air, includ ing tidal ,
complimental, and supplemental air. The air which re-
mains in the lungs after deep expiration is the .. residual
air" . It cannot be remove by voluntary effort ... Minimal
ai r is the air which is always present in the alveoli ev-
en after collapse of the lungs. The ai r present in the air
passages, such as the larynx, trachea, and bronchi is
called the .. dead space air and amounts to about
100 cc.
8.6.10. Control of respiration
Respiration is controlled by the nervous system and by
chemical factors. Nervous center for control of the ac-
tion of muscles coord inated in respiration is located in
the medulla oblongata of the brain. Th is is called the
respiratory center.
8.6.11 . Artificlal respiration
Prompt and intelligent application of the artificial means
of respiration will resu lt In saving the lives of many af-
lI icted by the cessation of respiration due to electrical
shock, drowning, asphyxiation, carbon monoxide poison-
ing, and many other causes. Resuscitation may be ac-
complished even when the heart has stopped; but in
order for it to be effective complete anemia or loss of
blood to the brain must not exceed 7 to 10 mi nutes.
Therefore in order to be effective, artificial respi ration
must be instituted promptly.
Chapter 8.7. - UROGENITAL SYSTEM
8.7.1. General
The urogenital system consists of the organs specialized
for secretion and discharge of urine and the genital or-
gans concerned with the process of reproduction (see
fig. 28/8).
The urinary organs include the: kidneys, ureters, urinary
bladder, and urethra.
The genital organs (male) include the: testes, epididy-
mis, ductus deferens, seminal vesicles, ejacu latory ducts,
prostate, and penis.
The genital organs (female) include the: ovaries, fallopi-
an tubes, uterus, vagina, and vulva.
G ILAROONI . RAD IOlOGV ELECTAOMEDICINE
r--:=-- _ . HILUM OF KI DN EY

~ ~ ~ ____ _ . PElVI S Of KIDNEY

UFIETEI'I - -- - - - -

.,,-UIITII Of
OPPOSI TE KI ON[Y

DUCTUS DE FERENS '

SEMINAL VESICL /

EJ ACU UTQRy DUC T" - - - URETHRA

EPIDID YM IS - - - -- - --
T EST[S -- - .- -" CLANS PEN IS
Fig. 28a/8 (par. 8.7.6.) - Lateral Cross Section of Male Re-
Fig. 2818 (par. 8.7. I.) - Urogenital system 01 the male. productive Organs.

Seminal vesicles are two saccu lated structures which lie

8.7.2. Kidney
There are two kidneys. Each has the shape of a bean.
They are located in the posterior part of abdomen, one
on each side of the vertebral column and beneath the
diaphragm. The right kidney is usually slightly lower
than the left. On the medial border of each kidney is
the hilum . This leads to the sinus of the kidney which
expands Inlo the renal pelves and calyces. The ureter
leaves the kidney at the hilum.
8.7.3. Ureter
It Is a tube which leads from the renal pelvis to the
urinary bladder. The urine secreted by the kidneys pas-
ses through it into the bladder.
8.7.4. Urinary bladder
It is a sac located in the pelvis which serves as a re-
servoi r for urine; its size varies with the amount of fluid
it contains. The capacity is from 120 cc. to 300 cc.
When empty, the bladder is shaped like a tetrahedron
presenting a fundus, vertex, superIor, and inferior surfa-
ces. Internally, there is a trigone which is a small trian-
gular area immediately behind ad above the internal ori-
fice of the urethra. The orifices of the ureters are situ-
ated at the posterolateral angles of the trigone.
behind the bladder. The union of the seminal duct and
the ductus deferens forms the ejaculatory duct. The
seminal vesicles produce a secretion which serves as an
optimum medium for motility of the spermatozoa.
Ejaculatory duct is formed by the union of the duct of
the seminal vesicles and ductus deferens. It enters the
prostate.
Prastate is a gland which surrounds the base of the
urethra and the ejaculatory duct. Prostate gland secre-
tion facilitates and stimulates the motility of spermato-
zoa.
Penis is composed of the urethra and the cavernous
bodies which form the erectile portion . The enlarged
conical structure at the end of the penis is the glans
penis, which is inclosed with a fold of skin- the pre-
puce. The penis and scrotum constitute the external
genitalia.
Semen is the fluid composed of spermatozoa and the
various secretions added to is along its passage. Ap-
proximately, two to five hund red million spermatozoa
are contained in each ejacu lation .
8.7.6.1. Genital organs (female)
The female reproductive system (fig. 28b/8) consists of
the gonads (ovaries), the fallopian tubes, (oviducts) the
uterus (womb) . the vagina , and the external genitalia
(vulva) .

8.7.5. Urethra

It serves to conduct the urine from the urinary bladder

to the exterior of the body and extends about 6 inches
in lenght.

8.7.S. Genital organs (male)

The testes, the reproductive glands in the male. are oval

in form and are suspended in the scrotum by the sper-
matic cords. The function of the testes is to produce
spermatozoa (the male germ cells). This function com-
mences at puberty and continues throughout life (see
fig. 28a/8).
Epididymis, attached to the posterior surface of the tes-
tes, receives all the ducts from the testes.
Ductus deferens together with the blOOd. lymphatic ves-
V~ g' na
sels, and nerves com prises the spermatic cord. It con- Fig. 28b/8 (par. 8.7.6.1.) . La reral Cross Section of Female
ducts the spermatozoa from the epididymis to the ejacu- Reproductive Organs_
latory duct.

GllAAOONI. 1VI0000OGV aEClllOMEOICINE 269

The mammary glands are sometimes considered to be a
part of the reprod uctive system:
The ovaries. The ovaries are a pair of flattened, oval
bodies about 3 cm long 1.5 cm wide, and 10 mm
thick . They are located in the ovarian fossa, a de-
pression on the lateral wall of the pelvis, one on each
side of the uterus. The ovaries are suspended from
the broad ligament of the uterus by a fold of perito-
neum called the mesovarium and attached to the ute-
rus by the ovarian ligament.
In the ovary, the germinal epithelium covers the sur-
face. The interior of the ovary, the stroma, consists of
a network of connective tissue which is abundantly
supplied with blood vessels. Embedded within the
meshes of this framework is an abundant supply of
vesicular foll icles in varying stages of growth, each of
which may form an egg cell or ovum. The follicles
also produce the fema le sex hormones that are essen-
tial in the development of the secondary sex charac-
teristics and the menstrual cycle, gestation and lacta-
tIon. However, their prod uction is regulated by other
hormones formed in the anterior lobe of the pituitary
gland.
The Fallopian Tubes. The pai red fallopian tubes are
flexible, muscular, trumpet-shaped tubes about 10 cm
in length and 1 to 8 mm In diameter. These tubes
are in contact with the ovaries but not continuous
WIth them. The larger, funnel-shaped end of each tube
has a fringed border which opens into the peritoneal
cavity near the lateral border of the ovary. The more
slender portion of the tube extends medially over the
ovary and opens into the superior latera l wall of the
uterus. The ovum (egg cell ) extruded from the ovary
is conveyed to the uterus through the fallopian tube.
Fertil ization of the ovum usually occurs in the tube,
after which the fertilized ovum Is generally passed on
to the uterus.
The Uterus. The uterus Is a hollow muscular, pear-
shaped organ wh ich varies considerably in size and
shape but averages 7 cm in length, 5 cm in maxi-
mum width, and 2.5 cm in thickness. Located in the
pelviC cavity between the rectum and urinary bladder,
it presents two regions.
The body or corpus uteri Is the main portion wh ich
provides protection, support. and nou rishment for the
developing embryo. The contractions of its thick. mus-
cular walls supply the expulsive force necessary for
partu rition (childbi rth).
The neck or cervix is the narrow lower third of the
uterus. It contains the cervical canal which is contin-
uous with the main cavity in the body of the uterus.
The Vagina. The vagina is a th inwalled tubular organ
extending from the cervix of the uterus to the vulva
where it opens to the exterior. It averages 8 cm in
lenght and lies dorsal to the bladder and urethra. and
ventral to the rectum . The vagina is also part of the
bi rth canal.
The Vulva. The vu lva or the external genitalia include
the mons pubis, labia major, labia minor, clitoris. ves-
tibule. and the greater vestibular glands.
The mons pubis is the rounded eminence anterior to
the symphysis pubis, consisting mainly of fibrous. and
adipose tissue. Extending downward from the mons
pubis and backwards toward the anus are two longi-
tudi nal cutaneous folds ca lled the labia major. Within
these two folds of skin are two smaller cutaneous
folds called the labia minor which meet anteriorl y and
form the prepuce of the clitoris.
The cleft between the labia minor is the vestibule
which contains the ciitoris. the urethral and vagi nal
270
orifices, and many vestibular glands. The clitoris, the
homologue of the male penis. is a small body of 81-
ectile tissue located at the point where the two labia
minor meet. The urethral orifice is located about 2..5
cm posterior to the clitoris and immediately antenor
to the vaginal orifice. The urethra has no connection
with the reproductive system. The urethra conveys
urine. The vagina orifice occu pies about two-thirds of
the posterior region of the vestibule. and is separated
from the cavity of the vestibule by a thin fold of mu-
cous membrane. the hymen. The hymen may com-
pletely cover the vaginal orifice (imperforate hymen).
or it may be absent enti rely.
8.7.7. Function of excretory system
The metabolic activity of the body results in the ac-
cumulation of waste products. In order for the proper
physiological functioning of the body, it is essential that
these substances be removed. Some of the products
formed In the process of digestion are absorbed into
the alimentary tract into the blood and are changed to
some extent by the liver. They do not, however. ~
come converted into tissue. This type of waste prod uct
is called exogenous>-. Other waste products are the re-
sull of the breaking down of general body tissue, mus-
cle, nervous tissue. glandular tissue, and blood pigment.
This type is referred to as endogenous".
8.7.8. Pathways of excretion
The principal pathways of excretion are:
Skin- the most primitive form of an excretory organ.
Two fluids are excreted by the skin namely sweBt
(perspiration) and sebum (oil excretion of the glands
attached to the hair roots) . Sweat is composed of
about 99 percent water, slight amount of sodium chlo-
ride (sail) and traces of organic material. Normally.
during ordinary weather, about 700 cc. of water leave
the skin per day. The ability of the skin to secrete
water frequently assists an over-worked or diseased
kidney. The main function. however, of perspi ration is
to assist in the regulation of the temperature of the
body.
Lungs elim inate chleffy carbon dioxide. Water is also
lost through the lungs. The amount exhaled may be
about 500 cc. per day if the respiration and tempera-
ture are normal. Volatile substances such as ether,
chloroform. alcohol, and acetone may also be elimi-
nated by the lungs.
Large intestine excretes residue of the food which
have escaped digestion . To this are added other sub-
sta nces such as calcium, magnesium, iron. phosphate,
which are excreted from the blood and cellular debris
and bacteria. This accumulated residue is referred to
as the leces.
Kidney is an im portant organ for exc retion and for
the maintenance of the blood composition.
8.7.9. Mk:turltion
The urine collected in the kidneys passes down through
the ureters into the urinary bladder. This is accomp-
lished by contraction waves in the wall of the ureter.
Accumulation of urine in the bladder occurs until the
pressure is such as to set up nervous impulses asso-
ciated with a desire to urinate or micturate. This desi re
results in the relaxation of the muscles controlling the
aperture and a contraction of the muscular wall of the
bladder. The effect is to expel urine from the bladder
into the urethra to the exterior.
GIVoROONI. RADIOI..OGY - ELCTROMEDICINE
8.7.1 O. Defecation
As the pelvic colon gradually fills with feces the mate-
rial passes into the rectum. With increase in pressure,
Impulses set up the desire to defecate. Th is is accomp-
lished by relaxation of the muscles of the anus and
contraction of the rectal wall. Normally, this act can be
prohibited or modified by voluntary control.
Exposure of the body to an excessive amount of X-rays
or radium emanations may cause destruction of these
cells.
The most outstand ing constituent of the red blood cell
is in its coloring matter or hemoglobin. The hemoglobi n
is a protein compound containing iron. The hemog lobi n
functions as the means of carrying oxygen from the
lungs to the tissues.

In the adult, the eryth rocytes are formed only in the red
Chapler S.S. - CIRCULATORY SYSTEM marrow of bones.

White blood cells (leukocytes) are colorless, nucleated

8.8.1. General cells extremely variable in shape and number. The aver-
age adult has from 7,000 to 9,000 per cubic millimeter
The circulatory system is composed of the blood-vascu- of blood. The life span is indefinite and it is estimated
lar system and the lymphatic system. It is through the that it may be in terms of weeks, days, or even hours.
blood-vascular system that the blood is pumped and by White blood cells are divided into two groups, non-
means of different vessels of varying diameter, the blood granular leukocytes, and granu lar leukocytes:
lS circu lated throughout the entire body (see fig. 29/8).
The lymphatic system consists of a network of vessel Nongranular leukocytes are of three types: Lymphocy-
and bodies which collect and transport lymph through- tes- which resemble red cells in size but contain a
out the tissue spaces in the body. large spherical nucleus, (they constitute about 20 per-
The blood vascu lar system includes the heart, aorta, ar- cent of the total white cells); transitional leukocytes-
teries, capi llaries, and veins. which are about the same size as large lymphocytes
The lymphatic system includes the lacteals of the intes- and have a nucleus in the shape of a horsehoe (they
lmal walls, the lymph capi llaries, the lymphatic vessels, number about 2 to 4 percent of the white blood
tymph nodes, and spleen. cells) ; mononuclear leukocytes- which resemble the
large lymphOcytes (they constitute about 2 to 4 per-
,, cent of the white cells).
'iEI NS ~ROM THE UPPER
EXTREMiTIES AND ""'O--J ARTERIE S TO THE
, , ' UPPER EXT REMITIE S
Granular leukocytes or polymorphonuclear leukocytes
.A.ND THE HE.A.O
comprise about 70 percent of the white cell s. The
CAP II.I. .A.RI ES IN
THE I.UNGS - - -
nucleus is irregular in shape and appears in three or
more lobulations. Three types are recognized by stain-
PUI.MONARY ARTERY
ing as: eosinophils- which take an acid stain and show
CARRYING VENOUS - -
9LOOO
"-'W'A'I.,"r red gran ulations, basophils- wh ich take a basic stain
and shOw blue granu lations, and neutrophils-whose
SUPE RIOR 'i ENA '"";';""I,.lftt'
granu lations respond to both acid and basic stai ns.
RIGHT .A.TR IU M ~

RIGHT
~i--.:::6~~~~ TO
/, ANOTHE
LOWEA
VE IN FROM '''E'-il\~..,,-:<""~I EXTREM IT I E S
I.I'o'ER -- __ __ ' SPLEEN
PO/HA l. VEIN __ _
- P.A.NCREAS
--- INTE S TINES
, ,
Fig. 2918 (par. 8.B.1.) . Circulation 01 lhe blood.
8.8.2. Blood-composition and function
Blood is composed of a fluid part, the plasma, and a
cellular part distinguished as red corpuscles (erythrocytes),
white corpuscles (leukocytes), and blood platelets (throm-
bocytes). The average blood volume is about 8.8 per-
cent of the body weight or about a gallon and a half
for the average adult.
Corpuscular elements of the blood. Red blood cells (ery-
th rocytes) are disklike in shape and lack a nucleus.
They number 4,700,000 to 6,500,000 for the male and
from 4,300,000 to 5,300,000 for the female per cubic mil-
li meter of blood in the average normal adult. The cells
exist in the ci rcu lation from 18 to 50 days. Estimates
Indicate that between 600 mi llion and 1.5 billion red
cells are destroyed daily dependent upon various chem-
ical, physical, or pathological conditions within the body.
Fu nction of the white cells is primari ly a protective one.
They possess the ability to enci rcle and eli mi nate for-
eign particles in the blood and tissue. In the execution
of this funclion, white cells are relerred to as phago-
cytes and the phenomenon is known as phagocytosis.
The ability of the cells to escape through the wall s of
the capillaries and enter tissue spaces renders them es-
pecially useful in combati ng infections. Any site of in-
fection is usually characterized by a great increase in
leukocytes which are attempting to destroy the bacteria.
Platelets are small (Qund bodies numbering aboul 300,000
per cubic millimeter of blood. Their c hief func tion is
concerned with the clotting of blood. The time between
the drawing of the blood and its change to a clot var-
ies and is usually from about 3 to 10 minutes and is
known as the coag ulation time.
Plasma is the fl uid portion of the blood and can be se-
parated from the cellular elements of the blood. It con-
tains over one hundred different constituents.
8.8.3. Heart
It is the main organ which forces the blood through the
vessels. It is a con ical , muscular organ situated in the
lower part of the thorac ic cavity. Inclosing the heart is
a sac called the pericardium. The position and size of
the heart may be determined by roentgenoscopy or by
making a roentgenogram (see figs." 30/8 and 31/8).

GlLARDONI. RAD IOLOGY ELECTROMED ICINE 271

 INNOM I NATE A~,,,,,fi';;".,---
,.'
~EFT COM MON CAROTID ARTERY
r ,TL" -LEFT SUBCLAVIAN ARTERY
FliGHT CORONAR Y
ARTERY - -
CORO~ARY
F'g
, A'.'UM
Fig. 3118 (par. 8.8.3.) Hear, sec tion.
Pericardium. It is a double-walled fibrous sac inclosing
the heart. The pericardium attached to the heart is the
visceral pericardium wh ile the ou ter layer is the parietal.
A slight space, therefore, exists between the two layers.
This is the pericardial cavity. It contains a small amount
of fluid called pericardial fluid. This fluid serves to re-
duce friction concerned with movement of the heart.
Walls of the heart. They are composed of th ree layers:
an epicardium (outer layer)- which is the visceral peri-
cardium, the myocardium (middle layerl- which is mus-
cular and the endocardium (inner lining)- which is con-
tinuous with the lining of the blood vessels. The endo-
cardium assists in the formation of the valves of the
heart.
Chamber of the heart, The heart is divided by septa in-
to rig ht and left halves and by a constriction, the coro-
nary su lcus into an upper cavity called the atrium and
a lower cavity called the ventricle. Thus the heart con-
sists of four chambers, namely. righ t and left atria. and
right and left ventricles:
Right atrium. It Is larger than the lett. Several vessels
carry blood to it. From the upper part of the body,
blood is returned by means of the superior vena cava
while the inferior vena cava returns the blood from
the lower portion of the body. Blood from the muscle
tissue of the heart or myocardium is returned into
this chamber via the coronary sinus. As the blood
accumulates in the rig ht atrium, it passes by way of a
la rge oval aperture, the right atrioventricular orifice, in-
to the right ventricle. This opening is guarded by a
tricuspid valve. The valve con sists of three segments
and permits the blood to flow from the atrium to the
ventricle but normally prevents its flow in the reverse
direction, during the contraction of the ventricle.
272
Right ventricle is the lower right cavity of the heart
extending from the right atrium to the apex. It is se-
parate from the left ventricle by the ventricular sep-
tum. The inner su rface of the ventricle is marked by
muscular projections (trabeculae carnae). From these,
extends slender fibers or cords (chordae tendlnae)
which may give rise to papillary muse/es which func-
tion with the heart valves. At the ventricle contracts.
the blood (venous) is expelled through the pulmonary
artery. Small cuplike valves in the walls of the pulmo-
nary artery (semilunar valves) prevent backflow of the
blood.
Left atrium . It is separated from the rig ht atrium by
the atrial septum. Entering into the atrium are four
pulmonary veins (carrying arterial blood). The blood is
forced into the lett ventricle through the left atrioven
tricular orifice. At this opening is located the bicuspid
or mitral valve consisting of two segments. This valve
allows the blood to flow into the left ventricle from
the left atrium but prevents a flow in the reverse di
rection du ring contraction of the ventricle.
Left ventricle. It Is longer and more conical in shape
than the right and forms the apex of the heart. The
walls are very thick. The blood (arterial) in the leN
ventricle is forced out into the systemic circulation of
the body through the aorta. Aortic semilunar valves
(three) allow the blood to flow through the aorta from
the left ventricle but prevent it from retu rning.
Blood supply of the heart. Since the heart is in contin-
ual action it must be supplIed with blood in order to
maintain its activities. The blood is supplied by the right
and left coronary arteries. Veins return the blood into
the coronary sinus and thence into the right atrium.
Nerve supply of the heart. The heart is under the con-
trol of the involuntary (autonomic) nervous system and
an intri nsic automatic nervous system of its own. The
vagus nerve (parasympathetic division of the autonomic
nervous system) Inhibits the activity of the heart; it may
slow the rate markedly or completely stop it. The sym
pathetic nerves (from sympathetic division of the auto-
nomic nervous system) increases the activity of the heart.
Cardiac muscular tissue possesses the power of myth
mic contractility. That is. even if the extrinsic or external
nerve supply were severed . the heart would continue to
beat.
Cardiac cycle. The phase of contraction in the heart is
called ..systole.. whi le the phase of relaxation is called
..diastole... Atrial systole lasts about 1/ 10 second while
diastole lasts about 5/10 second.
Action of the valves of the heart. The valves of the
heart keep the blood fl owi ng in one direction. At the
beginning of the contraction of the ventricles. the atrio-
ventricular valves close and prevent the passage of blood
from the ventricles back into the atria. The semilunar
valves are forced to open after contraction of the 'len
tricle and the blood thus fl ows into the pulmonary ar
tery and aorta. When the ventricular contraction (sys-
tole) is completed, the semilunar valves are closed by
the blood attempting to flow back . At the completion at
ventricular systole, the atrioventricular valves open.
Pulse rate. The pulse may be ascertained by placing
the index tinger on an artery. The radial artery located
on the anterior su rface of the distal end of the foream
is usually selected. Other sites may also be used: super-
ficial temporsl pulse. immediately in front of the ear at
the level of the ear; carotid pulse, at the level of the
lower margin of the thyroid cartilage. along the anterior
border of the sternomastoid muscle; femoral pulse, in
the groin; popliteal pulse, in the popliteal space. The
pulse rate varies in many individuals depending upon
the age, weight, sex, emotional disturbance. and amount
GllARDON I. RADIOLOGY ELECTROMEDICINE
of food ingested. Exercise increases the pulse rate tem-
porarily. The rate is faster in women, usually 70 to 80
beats per minute, while in men it is about 65 to 72 per
minute. The rate is faster in children than in adults but
decreases again as age advances.
Blood pressure. The arterial systolic pressure (that is,
during the phase of ventricular contraction) can be .de-
termined roughly by adding 100 to the age of the indi-
vidual. However, there are many groups of apparently
healthy individuals who do not fall within these limits.
During diastole (relaxation of the heart) the pressure
falls to about 70 to 90 mm. of mercury. The difference
between the arterial systolic and the diastolic pressure
is called the ",pulse pressure... For example, if the arte-
rial pressure is 120 mm. and the diastolic pressure is 80
mm., then the pulse pressure would be 40 mm. of mer-
cury. The rate and force of the heart beat, the elasticity
of the arteries, quantity of blood in the system, and vis-
cosity of the blood are the factors wh ich are involved in
the maintenance of blood pressure.
8.8.4. Arteries
They are the vessels which convey the blood away from
the heart (see fig . 32/8). As they divide into many bran-
ches, the size of each decreases. The aorta is the larg-
est artery in the body. It subdivides into many branches.
Arteries are composed of walls which are elastic and
extensible.
UO, .... - -.JI VI
C(),I ,oON ILIAC
\1,1:\1/- - POI'I.ITUl
_ _ uun
__ " T(nl'H"'~
&("!!II) _9
Fig. 32/8 (par. 8.8.4.) The principal arteries.
8.8.5. Veins
They are the vessels which convey the blood to the
heart (see fig. 33/8) . They are much thinner than the
arteries and are more flaccid (less elastic).
GI!.AROONI. RADiOlOGY eLECTf'Ot.IEOICINE
RlPUf lCLol T~Al
HT.,....1ol .lUGULA ~
loU&CLAYI ....
_ ..,a- ve .... CAYA
.. ED .....
tt:==~P"OPI.llfAL
!OOIolLs.o.,.,.,~
" ~"'
VENOUS A"Ot
- - IIJf'U f lCl~L VEIUS
_ OU~Y"$
_ _ TOLSTSH ..
Fig. 33/8 (par. 8.8.5., The principal veins.
8.8.6. CapUiaries
They are the vessels which convey the blood from the
arteries to the veins. Sinusoids are fine capillarylike ves-
sels located in the liver and spleen. They are either ar-
terial or venous.
8.8.7. Circulation of blood
The right side of heart Is venous because it contains
the waste products of metabolism and carbon dioxide
from the tissues. The venous blood, therefore, enters
the right atrium of the heart. From there it is pumped
into the right ventricle and leaves by means of the
pulmonary artery. The blood in the pulmonary artery is
therefore venous and it passes into the lungs. Here, by
means of a fine network of capillaries, the carbon diox-
ide is given off and oxygen is taken up. The pulmonary
capillaries give rise to the pulmonary veins which return
the oxygenated blood to the left atrium. The blood pas-
ses into the left ventricle and is pumped out of the
heart through the aorta and distributed by numerous
branches to all the tissues of the body (major branch)
except the lungs. In the tissues, the arterial blood gives
up its oxygen and picks up the carbon dioxide again
and carries the venous blood back to the right side of
the heart for another cycle.
Pulmonary ci rculation is the passage taken by the blood
as it leaves the right ventricle via the pulmonary artery
to the lungs and the return of the oxygenated blood to
the left atrium of the heart.
Systemic ci rculation is the course taken by the blood
from the left ventricle through the aorta and its branches
through the body and return ing to the right atrium.
8.B.B. lymphatic system
Lymph Is slightly yellOW or colorless. It resembles blood
plasma in composition. It contains less protein and coa-
gulates less slowly. Lymph is found in the tissue spaces
and contains some lymphocytes.
273
'1"" MOVeS tnroughout the body by means of a net-
WOf1t of capillaries and vessels under the influence 01
blood and tissue pressure. Chemical substances as well
as infections organisms and other material gain access
to the lymphatic system. By means of the lacleals , lo-
cated in the intestinal tract, it is believed that fats are
absorbed into the chyle or lymphatic vessels where they
may undergo a form of synthesis. A great portion of
the fat passes into the thoracic duct which is the main
lymphatic vessel. Commencing from the cisterna chyli it
passes up from the abdomen into the thoracic cavity
adjacent to the bodies of the vertebrae and em pties into
the lett subclavian vein.
Lymph nodes are small oval or bean-shaped bodies sit-
uated througoul the body in the course 01 the lymphat-
ic and lacteal vessels, lymph and chyle pass through
them on the way to the blood ,
8.8.9. Spleen
Ii is oblong and flallen ed in shape and is situated in
the left hyponchond riac region lying between the stom-
ach and the diaphragm .
Chapter 8.9. - NERVOUS SYSTEM AND ORGANS
OF SPECtAl SENSE
8.9.1. General
The nervous system is that mechanism wllhin the body
concerned with integrating the various processes of the
individual including the coordination of stimulation re-
ceived from the environ ment. The system is divisible in-
to two parts, central and peripheral. Contained within
each division are elements 01 the autonomic nervous
system. The organs of special sense such as the eye,
the receptors for smelling, for taste and for hearing are
considered to be constituents of the nervous system :
The central nervous system includes the brain and
spinal cord .
The peripheral nervous system includes the nerves
wh ich extend from the brain and spinal cord and also
the more or less detached sel, the autonomic nervous
system . T he autonomic nervous system includes the
sympathetic and the parasympathetic groups.
8.9.2. Composition of nervous tissue
It is composed of highly specialized tissue sensitive to
stimuli and it possesses to a high degree the property
of irritability and conductivity. The unit of structure is
the neuron wh ich consists of a cell body and its pro-
cesses. Supporting Ihe neuron are neuroglial cells and
fibers which comprise Ihe neural connective tissue..
Neurons are classified according to thei r fu nction. An
afferent neuron conveys impulses from the site in the
body where the stimulation is received to the central
nervous system . An efferent neuron conveys impulses
away from the central nervous system to a muscle or
organ,
8.9.3. Cerebrospinal fluid
Within the cerebral hemispheres are situated the lateral
ventricles. There is produced within them a colorless
viscid liquid called the cerebrospinal fluid. Each lateral
ventricle opens into the third ventricle by means of an
274
interventricular foramen (foramen of Monro) . Additiona
fl uid is added in the third ventricle and through the ac-
queduct of Sylvius. it passes into the fourth ventnc.
From this point. the fluid enters the subarachnoid space
through two openings (foramina of Luschka and Ma-
gendie). The cerebrospinal fluid then passes over the
spinal cord and may circulate over the surface of the
brain. Some absorption of the fluid may lake place by
means of small projections or vii/i. The fluid serves as a
protective medium for the narve cells and probably as a
means of exchange of metabolic substances. The ventn-
cles can be visualized roentgenographically by the injec-
tion of air, lipiodol, or thoratrast into the cavity and by
displacement of some of the fluid.
Surrounding the brain and spinal cord are three layers
of tissue known as the ...pia mate".. arachnoid.. and
-dura mate".; collectively, they are termed the - menin-
ges... The dura mater forms a tough lini ng closely at
tached to the skull. The middle layer, the arachnoid, is
fibrous while the inner layer, Ihe pia mater, is closely in
contact with the surface of the brain .
8.9.4. Cerebrum
II comprises the largest part of the forebrain and con-
sists of two cerebral hemispheres, The cortical or outer
layer of the cerebrum presents many convolutions (ele-
vations of brain tissue) or gyri, separated from each
other by furrows or fissures known as _sulci ...
8.9.5. Cerebellum
It lies behi nd the pons and medu lla oblongata. Its sur-
face is characterized by sulci, smaller than those of the
cerebrum . The fun ctions of the cerebellum incl ude: re-
gulating muscular tone and muscle balance and serving
as a reflex center: a delicate moderator of muscle tone
and a center for reflex action. The cerebellum exerts
considerable control over posture of the ind ividual. Re-
moval of the cerebellum from animals causes loss of
Ihe power of locomotion.
8.9.6. Medulla oblongata
It extends from the spinal cord to the pons. It is pyram-
idal in shape. It contains certai n groups of cells from
which the cranial nerves arise. It also serves as a means
of interconnection for the nerve tracts from the peri-
pheral nerves and the cerebellum. Vital centers within
the medulla control circulation of the blood, action of
the heart and lungs. The mechan ism for vomiting and
swallowing are also regulated by it.
8.9.7. Pons
It is the continual ion of brai n tissue from the med ulla
oblongata upward. II contains grou ps of nuclei giving
rise to some of the cranial nerves. Nerve tracts traverse
it conveying sensory impulSes to the cerebral cortex
and motor impulses away to other tissues.
8.9.8. Spinal cord
It is a continuation of the central nervous system within
the vertebral canal extending from the lower level of the
medulla oblongata to the level of the 1st and 2nd lum
bar vertebrae. If a cross section of the cord is exa-
mined , il will be noted that it is composed of white and
gray matter. The latter lies in the interior of the cord in
GIL..AAOONI. RADIOlOGV ELECTAOtIIEOIClI'E
trle snape of an H; within the horns of this matter are
lOcated the cell bodies. The posterior horn contains the
sensory cells while the anterior horn contains the motor
cells. The white matter surrounds the gray matter and it
s composed of bundles of nerve fibers, efferent and af-
'erent, constituting the so-called nerve tracts of the
cord.
&.9.9. Cranial nerves
The cranial nerves are sensory motor or of a mixed na-
iUre and some of the nerves are adapted to special
'unctions. The nerves are attached to the brain (fig.
34/8) and pass through specific foramina of the skull;
~ are paired and are listed as follows:
_ _ '1IC1o'l NUYf
_ IICOUSTIC NUV(
__ - IfYI'OO4.OSSM H( .....
-CUfIUIUM
- - MtDlALA OIlOrfOooT ..
- _ ' " ACctuOln' NUYf
FIf}. 3418 (par. B.9.9.) CrlJnlsl nerves.
The olfactory nerve (of smell) conveys the sensation
of smell from the mucous membrane in the nose to
the olfactory center in the cortex.
The optic nerve conveying the sensation of sight from
receptor cells in the retina of the eye to the visual
area of the brain.
The oculomotor nerve which Is concerned with the
movement of the eye muscles and to a lesser extent
with the iris of the eye.
The trochlear nerve which controls the su perior ob-
lique muscle to the eye.
The trigeminal nerve which arises from a collection of
cells known as a ganglion (semilunar) . It is divided in-
to the opthalmic, maxillary, and mandibular divisions.
The opthalmic nerve carries sensory stimuli from the
cornea of the eye and adjacent structures, the skin of
the eyelids, eyebrow, nose, and forehead to the gan-
glion of the 5th. The maxillary nerve conveys sensory
impulses from the teeth of the upper jaw, side of the
face, lower eyelid, and upper lip. The mandibular nerve
conveys sensation from the teeth and gingiva of the
lower jaw, the skin of Ihe head, the ear, lower lip,
lower part of the face, and mucous membrane of the
anterior two-thirds of Ihe longue. The motor portion
of the nerve controls the muscles of mastication.
The abducent nerve wh ich supplies the lateral rectus
muscle of the eye.
The facial nerve which supplies the muscles of ex-
pression of the face, scalp, and ear. Some special
type fibers are involved with the autonomic nervous
system concerned with secretion of the submaxillary
and sublingual glands and taste sensation from the
anterior two-thirds of the tongue.
The acoustic nerve composed of the cochlear root,
the nerve of hearing and the vestibular root, the nerve
of equilibration.
GIl.ARDONI. RADiOlOGY eLeCTROMEOlCINe
The glossopharyngeal nerve and as its name implies
it supplies the tongue and pharynx and conveys taste
sensation from the posterior one-third of the tongue.
It carries some motor fibers. Via the autonomic ner-
vous system, it supplies the parotid gland with secre-
tory fibers.
The vagus nerve composed of parasympathetic effer-
ent, motor and sensory fibers. II has an extensive dis-
tribution in the body and extends through the neck to
the pharynx, larynx, trachea, esophagus, and in gene-
ral the thoracic and abdominal viscera. It is frequently
referred to as the parasympathetic nerve of the body.
The spinal accessory nerve is essentially a motor nerve
supplying two muscles o f the neck (trapezius ans ste-
nomastoid).
The hypoglossal nerve controlling the musculature of
the tongue.
8.9.10. Spinal nerves
They arise from the spinal cord and pass through the
intervertebral foramina. There are 31 pairs in all and
they are divided into 8 cervical, 12 thOracic,S lumbar,S
sacral and 1 coccygeal. Each nerve is composed of two
roots, an anlerior and posterior. A spinal ganglion which
is a collection of nerve cells is located on the posterior
root. Sensory impulses enter the central nervous system
via fibers from the periphery of the body paSSing through
the posterior root. Motor impulses are conveyed out of
the cord through the anterior root and thence through
branches of the nerve. In certain regions of the body,
the anterior divisions of the spinal nerves form an inter-
lacing called "plexuses. These networks are termed the
"cervical plexus located In the neck: the . brachial plex-
us in the axilla supplying the upper extremity; the Ium-
bar-, "sacral. and -pudendal plexuses. associated with
the lower extremity. The sciatic nerve is the longest
nerve in the body (it supplies nearly all the skin of the
leg, muscles of the back of the thigh, leg, and foot).
8.9.11 , Autonomic nervous system
II is thaI part of the nervous system (fig. 35/8) which
controls Ihe activity of cardiac and smooth muscle, the
sweat and digestive glands, and certain of the endocrine
organs. In essence, the autonomic nervous system exer-
cises control over those reactions which are involuntary.
The system is divided into a sympathetic and a para-
sympathetic division.
The cells g ivi ng rise to the sympathetic division are sit-
uated in the lateral horns of the spinal cord arising
from the 1st thoracic to the 2d and 3d lumbar seg-
ments of the cord . These fibers are called "preganglio-
nic and leave the cord by means of the corresponding
anterior nerve root through the white ramus communi-
cans leading to the thoracic ganglion. Hence, sometimes
this part of the system is known as the ..thoracolumbar
outflow... The ganglia 01 the sympathetic chain are con-
nected with the spinal nerves which supply the extremi-
ties and trunck via the gray rami communicantes.
The fibers of the cranial outflow of the parasympathetic
division arise from cells located in the brain. These pre-
ganglionic fibers leave in the oculomotor, facial glosso-
pharyngeal, and vagus nerves. The sacral outflow arises
from the cells in the second, third and fourth sacral
segments of the spinal cord and are referred to collec-
tively as the "pelvic nerve" (nervi erigentes).
275
The function of the sympathetic division is directed to-
wards building up of the body against danger, attack,
fear, severe muscular exercise, and the hazards of the
surrounding environment; essentially, it is a spending
mechan ism. It causes acceleration of the heart, dilation
(openi ng) of the pupil of the eye, erection of the hair
of the skin (goose-pimples). secretion of sweat from the
sweat glands. dilatation of the bronchioles in the lungs
and coronary arteries to the heart; inhibition of the mus-
cular wall of the stomach, intestine and urinary bladder,
secretion of epinephrine from the medulla of suprarenal
gland, and release of glycogen from the liver to form
glucose for the blood. It has been found that an imals
may live indefinitely after complete removal of the chains
of ganglia. but they must live a sheltered existence.
The c raniosacral division has a limited action in contra-
distinction to that of the sympathetic. II is concerned
with a Saving or conservative,. reaction. Examples of
th is conservation are manifested by inhibition or slowing
down of the heart. constriction of the pupil of the eye
as a protection against intense light. activity of the di-
gestive di rected towards replenishing energy in the body,
relax ing of the sphincters and contraction of the wall of
the urinary bladder.
m bone filled with air and containing the auditory ossi-
LACRI........ l
P... ROTID
SU' UNGUAl GlAND
SU . ........JUllAn' GLANO
SWEAT GlAND
HEAlT
LA RYNX TR",CHEA
W NGS. ETC.
Ilooo VESSELS
STOMACH
I lOOO VE SSELS
INTESTINE
KIDNEY
"""".
GENIT..... OItGANS
RECTUM
Fig. 3518 (par. 8.9. fl .) AUTonomic nervous system.
8.9.12. Special senses
The specific adaption of certain structures in the body
permits reception of stimuli and thei r subsequent trans-
formation into sensation. II is in the designated areas of
the cerebral cortex that these stimuli are converted into
conscious processes. The skin and underlying connec-
tive tissue contain receptors for pain. temperature, and
touch. Other receptors are located in muscle, tendon.
tongue (taste buds) , nose (olfactory). retina of eye (vis-
ual). cochlea of ear (hearing), and labyrinth of ear (equi-
librium ). The components of a sensory mechanism con -
sist of the sense organ or receptor. the pathway by
which it is conducted into the central nervous system
276
and the sensory centers in the central cortex. The ~
cial senses more correctly include smell , taste sight, ana
hearing.
8.9.13. Eye
The eye is specialized for the recep tion of light. The
optic nerve conveys the impulses to the visual area of
the cerebral cortex where the sensation is made appar-
ent.
The eyeball is divided into an anterior chamber and a
posterior chamber. They are separated by the crystalline
lens. The anterior chamber contains the aqueous humOf
while the posterior chamber is filled with the vitreous
humor.
8.9.14. Ear
It is divisible into three parts: the external ear, the mid
dIe ear. and the internal ear.
The external ear is known as the ..auricle- or pin na.
It is composed of cartilage which is covered with
skin. It projects from the side of the head and serves
to collect sound vibrations of the ai r which are con-
ducted by means of the external auditory canal to the
middle ear.
The middle ear is the irr89ular space in the temporal
GLA ~ D
cles; the incus (anvil), ma/{eus (hammer). stapes (stir-
rups) . They serve to conduct vibrations from the tym-
Gl A~ D panic membrane to the in ternal ear. The middle ear is
also connected with the nasopharynx by means of the
auditory (Eustachian) tube wh ich serves to equalize
the air pressure in the middle ear with the exterior.
Another communication exists between the middle ear
and the mastoid air cells.
The internal ear contains the receptors for hearing
and equilibrium in relationship with the petrous por-
tion of the temporal bone. Sound waves which tra-
verse the external auditory canal to the tympanic mem
brane set up vibrations: these vibrations in turn cause
the auditory bones to vi brate. The waves are transmit-
ted to a fluid and thence to the fibers of the hair
cells of the organ of Corti. These in turn cause im-
pulses to travel In the auditory nerve to the auditory
center of the cerebral cortex.
The semic ircular canals. utricle. and saccule are con-
cerned with equilibrium. Change in position of the head
causes movement of a fluid within the canal and effects
the nerve endings in contact with the hair cells.
Chapter 8.10. - ENDOCRINE SYSTEM
8.10.1. General
Within the body, in various localities. are situated the
glands of internal secretion, sometimes referred to as
the -ductless glands. The substance secreted by the
glands into the blood is known as a hormone.. The
substances supplied by the endocrine glands are minute
in quantity since only a trace is necessary to produce
an effect. They reach different parts of the body in the
blood stream and influence the activity of one or another
organ or tissue. The glands which produce hormones
are: thyroid . parathyroid, adrenal, pituitary, sex glands,
pancreas (islet cells) . intestinal glands, pineal, and thy-
mus.
8.10.2. Thyroid gland
The thyroid gland lies in anterior region of the neck
below the lower border of the larynx. It consists of two
lobes connected by a strip of tissue called the .. isth-
mus.
G IL.AADONI . RADIOlOGY - ElECTROMEOICINE
The hormone secreted by the thyroid is thyroxin; its
mai n function is to regulate metabolism of the body.
Excess secretion of the hormone raises the metabolic
rate and is known as hyperthyroidism .. and may result
an exhaustion due to overstimulation . Hypothyroidism is
due to decreased secretion and causes cretinism whe-
rem growth is abnormal resulting in drawfism or dispro-
portionation of the body or both. Iodine is a major
constituent of thyroxin and lack of it results in glandu-
la( pathology (goiter) .
8.1 0.3. Parathyroid gland
The parathyroids are small round bodies, usually four in
'"1Umber, located in the posterior border of the lobes of
:ne thyroid gland.
"The hormone of the parathyroid gland is para/hormone.
t serves to regu late the calcium content of the blood
and hence is related to the general metabolic state of
calcium in the body. This is of particular importance
SInce it influences the amount of calcium in certain
tiSSues, bone formation, coag ulation of blOOd, mainte-
I"Iance of normal muscular excitability, and milk produc-
tIOn. Removal of the parathyroid glands will resu lt in
death characterized by tonic and spasmic contraction of
me muscles, convulsions, elevated temperatu re, rapid
"leart beat, and profuse salivation (tetanic state) .
&,10.4. Adrenal gland
Sometimes referred to as the suprarenal glands, are two
small bodies shaped like a cocked hat on top of each
<!dney. They consist of an outer portion called the cor-
tex_ and an inner portion called the medulla.
The hormone secreted by the medulla is called aepi-
1ephri ne" (adrenalin) . It causes an Increase in the heart
I'3te, increase in blood pressure, and rise in the sugar
content of the blood. It enables the individual to mobil-
..ze the resources 01 the body during emergency peri-
ods. The hormone of the cortex is essential for life;
'"8fT1oval of it will result in death.
&,10.5. Pituitary gland
Freq uently this gland is called the hypophysis. It is a
small oval mass about the size of a pea situated in a
oony depression of the middle cranial fossa known as
me sella turcica. It is composed 01 an anterior and a
posterior lobe.
The pituitary gland is frequently referred to as the Iea-
0E!f of the endocrine orchestra" in view of the fact that
has such a widespread effect upon the other glands
n the body and either modifies or controls their secre-
tIOns. The anterior lobe plays the master role and many
o flerent effects have been attributed to it due to the
action of the:
Growth hormone-which influences skeletal growth and
deficiency. Overproduction of this hormone may result
in abnormalities (giantism and acromegaly).
Thyrotropic hormone- which influences the thyroid
gland causing it to secrete.
Gonadotropic hormone-which stimUlates the gonads
(ovary and testes).
Adrenotropic hormone-which is related to growth of
the adrenal gland .
Lactogenic ho rmone- which is responsible for the
growth of the mammary glands during pregnancy and
for the production of milk.
Diabetogenic effect- which is the relationship produ-
ced by the influence of the pituitary upon the pan-
creas.
GIl.AAOONI. RAOIOI..OG Y ELECTROMEOICINE
Parathyrotropic effect-which has an influence upon
the function of the parathyroids.
Panc reatropic effect- which stimulates the production
of insulin from the pancreas.
A crude extract can be obtained from the posterior lobe
called "pilu itr!n ... The extract is divisible into two frac-
tions (pitressin and pitocin). Essentially, the extract of
the posterior lobe has an effect upon smooth muscle
causing it to contract.
8.10.6. Sex glands
The gonads (ovary in the female and testes in the
male) produce hormones which stimulate growth either
as a man or a woman. They also produce the cells
concerned with reproduction (ova in the case of the
female and spermatozoa in the case of the male).
8.10.7. Pancreas
The islet cells of the pancreas produce a hormone called
.. insulin which is essential for the oxidation of carbo-
hydrate in the tissue. Hypofunction of the cells results
in diabets mellitus. Injection of insulin relieves the con-
dition .
8.10.8. Intestinal glands
The duodenum supplies a hormone called "secretin"
wh ich causes the intestinal juices to flow whenever food
reaches the intestines. The liver and spleen are also be-
lieved to supply hormones to the blood.
8.10.9. Pineal gland
II is a small gland located near the roof of the third
ventricle of the brain. II is considered to exert and in-
fluence on the rate of growth of the entire body and
the commencement of puberty.
8.10.10. Thymus
It is a temporary organ located partly in the neck and
thorax. It is large in infancy and shrinks as the individ-
ual matures.
Chapler 8.11 . - SOME ANATOMICAL DRAWINGS
BY LEONARDO DA VINCI RELE-
TING GTBRII (GILARDONI TOTAL
BODY RADIOGRAPHY)
Leonardo da Vinci (1452- 1519) was one of the biggest
Geniuses. He was: painter, scultor, scientist, engineer,
physician, etc. Among other works he leaves many draw-
ings, with interesting notes, referring to the whole of
human activity and knowledge.
About 600 Leonardo drawings, belonging to Her Majesty
Queen El isabeth II, are conserved in the Royal Collec-
tion 01 Windsor. Among them, there are 50 anatomical
drawings with notes of great interest; we reproduce,
with original Leonardo notes, 6 of them (figs. from 36/8
to 41 / 8) in connection with .. GTBR.. (see par. 2.4.4.
page 48) and with special equipment Leonard Gil" (see
fig. 23bJ2 page 49) .
Leonard wrote left handed and backwards; therefore his
notes need to be read by means of a mi rror.
A very interesting, well reproduced collection of Windsor
Leonardo's anatomical drawings is sold by the Academy
of Arts - London .
277
 Fig. 36/8 (psr. 8. ft.) - .study of proportlorn and harmony In
natu,...
The studies for the research and development of _Gilardoni
Total Body Radiography - GTBR_ made us radiscover the
data that Leonardo da Vinci,S centuries before, had already
discovered and raported In his famous drawing of the Man
Inscribed in the circ le and the square for the . Studio di pro-
porzloni_, the basla of -GTBR-.
These data, which show the simplicity and harmony of Na-
ture referred 10 Man wh ich can be verified on Leonardo's
dfllwing and on d irect measurements taken on several Indl-
vlduals, are:
- Height of normotype Man '" t H -Gave vein, and arleries to trachN a. they were necessary lor it,
- Armpit height ,. 3/4 H
- Distance from hips 10 eKtremities = 112 H
- Distance from hips to armpits '" 1/3 H
- Distance hip-knee = 1/4 H
- Distance knee-ankle - 115 H
In his paintings, Leonardo used the proportionally for the
harmonic and correct figurative of men of different heights,
according 10 the depth 01 the ground where they were set.
The oG TBR. uses lhe same proportionally 10 compensate for
!he d ifferent pati8f1 t heights by moving the Homograph _,
anatomical-absorption facsimile of the various body parts, on
slider guide; In this way, in the radiographic projection, they
superimpose each other determining the harmonic homogeni-
zation of the whole structure on radiographs lor patients
With a height ranging from 1.20 to 2.20 metBfS.
The _Homographs- used lor GTBR- contain the teachings
0 1 Leonardo for Ihe anatomical proportlonalltles, of Mict1&-
Iaf199lo lor the bas-relief SCulpture 01 !he models, and 01 Cel-
hnl lor their final engraving, in addition to those of the Radio-
Iogisl and the Physicist lor the dosemetric anatomical-thick-
ness determinations of the -Homographs_ themselves.
Leonardo's constanl9 are also confirmed from recent sketches
and drawings by Ghyka j1931) and Le Courbusier (1946) In-
spired to Leonardo' s.
Leonardo da Vinci (1452-1519) was one of the greatest Ge-
niuses that Humanity ever had.
He was a painter. 8 scutptor, a scientist, an engineer, a phy-
sician, etc.
He has left a series of anatomical drawings with notes of
great interest. here are reproduced some 01 them In connec-
tion with the GTBA-: they come from the Aoyal Library of
Windsor.
It is known that Leonardo wrote lett handed and backwards,
a mirror is needed to facilitate the reading 01 Leonardo's
notes.
278
F,g. 37/8 (pal. 8. 11.) - 1/ CUOl"8 8 ,1 po/mon8 ( TtI& h8IJfI and
lung).
Pen and dark Ink (two tonalities) an blue paper (287x203 mm;
KIP 162 r: RL 19071 r) .
In Ihls peper the trachea with tM bronChial brenches can be
0bSefved ac<:ompenied by the bronchial .rlerles which originate from
the aorta.
Leonaroo describes !10th the bronc h~1 artene. end Ihe pulmonary
a.-. and d!8Cu_ why nature has provided two ways f(lf bIOOCI
Inflow to the lung:
life and nurllhment, and ITIOY8d IUrlher any Other large brlrlCheI
from the lr$CMa to nuri8l1 with more MIM the lung IWbetance- (here
-trachea_ 18 ute<! to Indicate the whole bronchlll tree).
AI righl of the prirlClpel drawing there are two minute figures. In
shape 01 dividers. of the _trachea minima. of bronchloiel , drawn
dilatee! and contracted, (luring inspiration end expiration.
The InlCr-. on the ""ht ITIIIrgin of the PfI{je, It drawn with pertk:ullr
emphasIS on the elasticIty of its ring .
At the bottom o' the lung Leonardo wrote the letter . n-, inscribed in
circle and connected by I line to the following note:
_Nature takes care of the breaking 01 the branches 01 Ihe trachea
hardening the IflIChea until it becomes I coat. I. il It were nut
Shell. which II cartilaginous. this hardening similar to I com repelrs
the ruptu .... and In. lOe will stop dust end water humours-.
With these word. Leonardo give. one 01 the IIrst description. 0 1 the
tubercular cavity 0 1 the lung.
In the long passage It the top leI! hand .ode, the artist emphasizee
once IfIOI1I the need o. I "';_1 .<lIItomk:f,1 representation, b8t1er
than the aimpte Y81ba1 description: !MIll original text on ltaliln Y8fIIon .
. Writer, with whit word. will you delcribe ttle enl i... figu ... with the
perfection thaI gives the drawing?
For your ignorance you write con fused and leave little knowledge 01
the true shipe of thing.; you 1001 beli6\l ing to fully satl.fy the
li' tener talking of something corporlll surrounded by surfaces.
But I remind you mull not use words other than 101" tal king to the
bjlnd ; and even It you Wlnt to demonstrate wilh WOfds 10 the ears
and not to ttle eyee. o. people. tIlen talk of things or sub6tancet or
natures Ind do not meddle with things penalnlng to the tyEIII Iince
you will be by far IUrpassed by the work of the painter.
With how ITIIIny worda will you describe thlt Ilea" if nol by filling I
book lind. ttle ITIOfe details you will write, the more you will confuse
the mind 01 the 113tener, Ind always you will need oommentators or
revert 10 eKperience. that in you is Y8ry 8110" and givet little
In tormation with respect to the whole subject 0 1 which you desire
tull knowledge-.
NOTE: The IlIdlologist II a modern -Leonard~ because he beses
his prolessiontillity on imaging.
GII.AAOONI. RADIOlOGY - ELECfflOMED\CINE
 Fig. 3818 (par. 8.11.) - _L/I spina dorsa/e- (The spina).
Pen and dark Ink (2 tonalities), waterpainted In brown, with
charcoal traces (286)(200 mm: KIP 139 v: RL 19(X)(l7 V) .
On the top part of the paper the articulations of
the spine appear in all the beauty of their natural
curvature, with the correct number of vertebras in
each section.
AI right. the drawing and the shading of the spine
achieve the superb effect of showing Its arching in
perspective.
Below, Leonardo shows it sideways, from the
inside.
In the notes he remarks that each part of the
column must be drawn ocseparata e poi congiunta..
(divided and then put together), not only in the
..tre aspetti. (th ree views: fronlal , lateral , and
posterior) , but also transversally, in the top part as
well as in Ihe bottom part. This Is expecially true
for the seven vertebras of the neck, at bottom left.
Fascinated by the unusual forms of the first three
cervical vertebras, Leonardo gives a blown-up sketch
of them with the articulations seen from the inside.
The note of the margin of the paper can be read:
.. You wi ll draw these three heck bones in three
views, first connected, then separated, thus you
will give the true image 01 their figure, as the
ancient and modern writers never could give
withOut ledious wasting of writing and time. But
this synthetic method of illustration in the different
aspects will give lull and true knowledge, and so
that this is to the benefit of the people, I teach
the way of reprinting it and prey you successors
that you will not grudge to have them printed
on ......
Here the writing becomes illegible and stops; it
reveals, however, Leonardo's hope to see his
drawings published .
Glt.AAOONI. Ri'OIOlOGY _ ELt:CTROMEOICINE
Fig. 3918 (par. 8.11.) - .Lo sche/efro del Ironco a delle
gamOO. (The skeleton of trunk and legs).
Pen and dark ink (three tonalities), waterpalnted in brown,
on charcoal traces
(268)(200 mm: KIP 142 r. 190012 r).
The drawings on this paper are the most complete
series of illustrations of the human sketeton that
leonardo has left us. The chest and the bones of
the arm and shou lder are shown In lateral view (top
rig hi) , posterior view (top left), and frontal view
(bottom left).
Near the first of these drawings Leonardo writes:
.. From the first rib (a) to the fourth under (b) II is
equal to the blade of the shoulder (scapula) (cd),
and It Is similar to the palm of the hand, and to the
foot from its pole to the lip, and each thing is similar
to the face lenght,..
Around the figure, at bottom lell (where Leonardo
repeats Ihe mislake of Mondino by reproducing the
sternum with seven segments), the artist wrote some
observations on the shoulder articulation.
The drawings of the leg and kneecap, at bottom
righi, are part of a series of separate drawings.
These clearly show Ihat Leonardo had understood
the dynamic importance of the kneecap and of the
sesamoid bone.
In the second figure from the right. he shows il bent
forward with the tendon suspended downwards and
further left, at the center of the paper, he draws it
separately.
The notes refer mainly to the shoulder articulation,
but the heading of the paper reads these two lines:
..where are the parts of the human body where Ihe
flesh never grows in any amount and where are Ihe
parts where flesh multiplies more than anywhere else,..
On the lower left hand corner of the paper there is
a list of Ihe bones of the head and of the jaw where
it is possible to read testa ' '', _mascella 2,., denti
32,. (Head 1, jaws 2, teeth 32).
279

Fig. 4018 (par. 8.11.) - . Due vf/dule del cra nlo_ (Two views 01
tn. skull).
Pen and brown Ink (2 tonalities) on charcoal (l88xl 34 mm:
KIP. 43 r; RL 19057 r) .
In these drawings of the skull Leonardo poured
all his mastery in perspectively reproducing the
real object. as it can be observed from the
delicate variations of the contour of the cranial
bones in the upper drawing.
The skull is seen laterally, with the roof in the
median sagittal section.
In the lower drawing the full section of the
skull is presented with the frontal and sphenoidal
si nus, the three cranial cavities and the nose
cavity.
The drawing is completed by an original repr&-
sentation of the upper vertebras.
For the lines superimposed to the lower drawing
and crossing to form squares there is not better
explanation than the one given by Leonardo
himself:
..where line a- m crosses with line c- b, there is
the combination of all the senses; and where
line r-n crosses with line h-f there is the pole
of skull at a third from head base, while c-b is
in the middle".
In another paragraph Leonardo stales:
..This soul of ours or common sense ... resides
in the middle of the head...
The strict relationship of the style and content
between this paper and another one in Windsor,
dated April 2. 1489, allows us to date this
drawing in the same year.
The lOP drawing of the skull was reproduced
by Wenceslaus Hollar in 1645, when the drawing
belonged to the collection of the Count of
Arundel.
280
"
.,j" iii;" .f
Fig. 4118 (par. 8.11.) - . Slomaco e Inteslln;_ (Stomach and
Intesllnes).
Pen and brown ink on charcoal scketches (l90xI39 mm:
KIP 73 v, AL 19031 v).
The central drawing represents the eso-
phagus (<<meri), descending towards the
stomach, with the intestines underneath it.
The various vertical segments of the small
intestine are indicated, starting from the
stomaCh, with these symbo ls explained in
the legenda at bottom right duodenum,
empty (empty because turned upwards) and
ileum, which crosses the blind intestine
(with attached appendix), reaches the final
ascending, transversal , and descending tract
of colon, and from here to the rectum.
The kidneys are drawn inside the colon
zone to the right and left.
This figure and the enlargement to the
right are the first illustration of the
append ix that we know of.
The notes which accompany the drawings
concern the force that pushes the co ntent
of the intestine.
Leonardo did few experiments of animal
vivisection and didn't have the possibi lity to
observe the peristalsis.
The figure at bottom center shows the
stomach with the worn out and contracted
liver, and enlarged spleen, organs of old
men used by Leon ardo in a great number
of anatomical disections within the period
1506-1508,
Gll.AROONI. RADIOlOGY - ELECTROMEOICINE
 PART 9

SOME SIGNIFICANT RADIOGRAPHS WITH ILLUSTRATED

PROJECTIONS AND EXPOSURE DATA
 PART 9
SOME RADIOG RAPHS WITH ILLUSTRATED
PROJECTIONS AND EXPOSURE DATA
(From Military Roentgenology"" - U.S. Departments of
the Air Force, the Army, and the Nayy, Technical
Manual : many thanks for the collaboration).
Thi rty cases of radiograph ic projections with exposure
indications, figurative anathomical- projectional positions,
anatomical sections and relevant radiographs are pre-
sented (figs. from 1/9 to 30/9) .
The exposure data (Focus Film Distance - Part Th ick-
ness, kV, mAs and X-ray grid) are derived from table
1012 page 73: it is necessary to refer to them also for
other body parts.
Table 10/2 and the above reported radiographic cases
consider tungstate screens: with rare earth screens the
mAs must be reduced to 112 or 1/5 in relation to their
speed.
Parts' thickness is referred to a normotype person
(70 kg): part thickness differences 1 cm. ;;;0,: 2 kV:
10 kV S!! about halving or doubling of mAs.
Over 14 cm part thickness, use stationary invisible Grid-
gil, Ratio 6, increasing by about 5 kV.

Fig. 1/9 - Shoulder.

ANATOMICAL: pro~lmal hume-
nJS and soft tissues.
FILM: 10 ~ 12 Inch. vertical.
POSITION: Pallent supine. su-
perior surface 01 shoulder and
upper arm in contact with cas-
selle. Tip 0 1 acromion 10 cen-
ler 01 film .
FOCAL SPOT: Principal ray di-
rected horizonlally 10 center of
axilla.
PflECAUTION: Shoulder eleva-
ted as necessary 10 allow cen-
ter o f image on 111m. Casselle
maintained in position by sand-
",.
ADDITIO NAL: Sandbag Immo-
bililaiion and support of arm.
Grid advisable In heavily mu-
scled individual.
NOTE: Useful In roentgenogra-
phy after application of airpla-
ne splint or ebduction cast.
k~ .. _ __
m" ___
grid OYef_ cm

Fig. 2/9 - Shoulder AMero-pos-

terior.
ANATOMICAL: Head 01 hume-
rus glenoid fosso. glenohume-
rei space and soft tissues.
FILM: 10 K 12 Inch, widthwi se.
POSITION: Patient supine. acro-
mion 5 cm . below midpoint
upper border 01 film . Unaffect-
ed side elevated 45'.
FOCAL SPOT: Central ray pro-
jected 15' caudally and 10" la-
terally (toward injured side) .
Align 2.5 cm. laterally and 2.5
cm. inferiorly to coracoid pro-
cess.
PRECAUTIONS: Forearm pro-
nated across abdomen. Hume-
rus aligned wi th Ion!;! center
aKis 01 lilm. Respiration sus-
pended.
ADDITIONAL: Grid advisable f .f.O._ . ~cm 100
lor part measuring 14 em. or
over. Thickness_ em t 1
kV _ _ "
m"' _ _ _ ~

grid OYe(,_ em 14

282 GILAROONI, RAD IOLOGY - ELECTROMED ICINE

 Fig. 3/9 - Scapula laterel.
ANATOMICAL.: Body of the sca-
pula, acromial process and
head of humerus.
FILM: 10 x 12 Inch. Ieflgth-
wise.
POSITION: Patient upright, an-
terior aspecl of shoulder aga-
inst cassette with hand grasp-
ing opposite shoulder. Blade
of scapula perpendicular 10
film.
FOCAL SPOT: Align focal SPOI
to pom l 2 cm. medial to mid
part of vertebral border of the
scapula ~IO center of film.
ADDITIONAL: Grid. Rasplrallon
suspended.

F.F.O. ~ 100

"'---
""' _ _ _ 100
grid ratIO 6

FIg. 4/9 - Clavicle, Posterer.n

tlrlor.
ANATOMICAL: Clavicle shoul-
der joint (or sternoclavicular,
JOint) and soft tissues.
FILM: 10 x 12 inch. widthwise.
POSI TION: Patient prone. arm
at $.ide and head rotated 10
opposite $.ide. Tip 01 acromion
5 em. below upper border and
5 cm. medial 10 laternl border
of lilm.
FOCAL SPOT; Align 10 center
of film .
PRECAUTION: Elevate oppcnl-
te shoulder to secure minimal
part-him distance. Suspend re-
spiration.

F.F.D.
Thlckness~cm

"
"'"
Fig. 5/9 Scapula coracoid
process.
ANATOMICAL. Coracoid prer
~.

FILM: 10 x 12 Inch, wldlhwise.

POSITION. Patient supine. np
of coracoid process 0Y'8f cen-
ter 01 film.
FOCAL SPOT: Emergent beam
direcIed 2S" oephalad: align prln-
Cipal ray to tip 01 coracoid.
PRECAUTION: Respiration su-
spended.
NOTE: PrOjection of particular
value In detection 01 Injuries
to coracoid proces.s, acromion
and la teral end ot clavicle.

ThiCkness _ em
kV _ _ _ _

""'---
grid OYef_ cm

GlLARDONI. RADI()t.OOY El.Ecn:wMEOICINE 283

 -
fig. IW - FOOf plsnfsr semi/Sf-

ANATOMICAL: Ptlslanges. me-

~, snd SOlt tissues.
ALM. to )t t2 irn:h, obllqued
10 long Dis 01 1001.
POSr11ON: Patient prone or $&-
mlp(ooe. dorsolstersl sunsce
of loot in contact with 111m,
plllniar sunace forming 4S"
angle with lilm.
FOCAL SPOT: Align to center
01 plan tar sunace 10 cenler 01
lilm.
PRECAUTION: Opposite leg
draWfl up 10 support and im-
mobilize pallen!.
ADDITIONAL: Cooe may be
used. sandbag immobilization
II needed.
VARIATIONS: TNe lateral of
1001 may be ob1alned by hav-
ing pallent lia on side wllh
lateral border of 1001 In con
tact with lilm (plantar surface Thlckr.ess _ Cfn
perpendicular to film), princi - kV _ __
pal ray aligned to center 01
tarsal region.
""---
w_.
Fig. 719 - Os cs/c~ In'8'0-

ANATOMICAL: Oe calcit. mol-

Il0l1 and soft tissues.
ALM: 8 x 10 inch, lengthwise.
POSITION: Patient sillino or
SUpine, center 01 heel 5 em.
distal to center of 111m.
FOCAL SPOT; Tube angled
AO"; .I~n 10 mldwidlh of 1001
~IOI"I of middle and poe-
1IInor !hlrds of plantar ItJrfaee
('lOll 01 fOOl).
PRECAUTION: TI8ClIon on fOOl
10 malntaln 90" anole l)etwoon
pfilntar surface and lilm.
ADDITIONAL: Immobl1izaUon
by sandbags 10 sides of 1001.
VARI ....TION: Os CIIlcls may ai-
110 be demonstrated with pa-
bent prone; Injured leg sup-
ported on sandbags 10 1hal
fool i. vertical, the principal
,.y dlrecled through posterior
IUnace 0 1 heel to strike film
placed ve rtically against the
plantar surface.

Fig. 819 - Knee Posfero-ant9-

"""
ANATOMICAL: llbiolemoral ar-
tieulalion, proximal IIbla ar'ld
fibula patella and soft tlsaues.
FILM: 8 )t 10 inch, lengthwise.
POSITION: Pa tient prone, 10-
_ border 01 patella to CSfltSf
of film. (SupportS above end
below knM, In case 01 Injury).
FOCAL SPOT: CentSf 01 pa-
pliteal fOS$ll (3 em. proximal
te level 01 head 01 fibula).
VARIATIONS: Satisfactory roen-
tgenograms can be secured in
the A.P. position by directing
the princlpel ray 5" cephalad,
aligning 10 point 1 em. distal
to lower borcler of the pal eUa.
Grid over 14 em. thickness.

ThlckllSSl_ Cfn
kV _ _ _ _
mAo _ __

~rkI fMJIf_ em

284 GILAROONI. RAOIOLOGY - ELECTflOMEDICINE

 Fig, 9/9 - Knee laterel.
ANATOMICAL: See preceding
position.
FILM: 10 x 12 inch. length-
wise.
POSI TION: Patient laterally re-
cu mbent. head of llbola 3 cm.
below the center Of the film:
knee in 45' lIexion.
FOCAL SPOT: Align to mid-
width UPpel' border 01 Internal
tibial condyle.
PRECAUTIONS: Plane of con-
dyles perpendicular to lhe film
(sandbag under heel). Opposi-
te leg thrown forward .

Fig. 1019 - Femur. neel! lateral.

ANATOMICAL: Femoral neck
and head. upper third 0 1 shafL
acetabUlum.
FILM' 10 x 12 inch, lengthwise
and Y8I1ical,
POSITION: Patient supine, groo-
ter trochanter to canter of 10-
WOl' half 01 111m, cassette paral-
lel to femur. leg In slight ab-
duction.
FOCAL SPOT: Principal ray di-
reeled 3Q'> cephalad and 25-
down ..... ard-through neck to
center of IiIm.
PRECAUTION: Oppoe~e Jag fI&-
xed and elevated to alford clea-
rane. of primary beam; affect-
ed hlp elevated on sar'ldbag.
ADDITIONAL. Grid and cone.

FJ.O.
ThiOHl8SI _ em

"
"'"
Fig. " 19 - Hip, necl! of ffH1lur.
oblique (frog posir/on).
ANATOMICAL: Pelvic bones.
acetabula. femoral heads and
neck and soft tiSsues.
FILM 14 x 17 inch, widthWise.
POStTION' PaUent supine. S0-
les of the feel 10Q8ther and
knees in flex ion and axtreme
abducllon of thighs.
FOCAL SPOT: Align to a point
about 5 em. above public sym-
physis, to center 0 1 film.
ADDITIONAl: Grid, Respiration
suspended or shallow.

FJ,O.
ThIckness_ em
,,---
grid rabo _ _ "

GILAROONI, RADIOLOGV - ELECTRO MEDIC INE 285

 Fig. 1219 - Sacrum An/ero-po-
s/erior.
ANATOMICAL.: Sacrum aod sa-
croiliac articulation.
FILM: 10 1\ 12 inch. length-
wise.
POSITION: Patient supine, ili-
ac crest 5 cm. below upper
border of fi lm.
FOCAL SPOT: Align principal
ray 10 poin t 2 cm. aboYe sym-
physis pubis, with 15 angula-
tion cephillao-to ce!1ter of fil m.
PRECAUTIONS: Pillow under
shoulder; $IIndbag under knees.
ADDITIONAL: Cone and grid.
VARIATtONS: Coccy1\ Is visua-
liZe<! by shifting tube cephalad
unlll principal ray IS projected
15" caudad toward pubic sym-
physis. Lumbosacral articula-
tion is visualized with 10 to
25" angulallon of principal ray
cephalad. Postero-anlerior View Thickness em
of sacrum and en tire pelvis is kV
made with patient prone. prin-
ci pat ray angled 10> caudad.
"'"
grid 111110

Fig. 1319 - Sicrum "!tUI/.

ANATOMICAL: Lateral view of
sacrum Bod coccyx.
FILM; 10 )( 12 Inch, length-
wise.
POSITION. Pllient lalerally re-
cumben l, Uppel border of film
5 cm. above iliac crest.
FOCAL SPOT: Align to point
5 cm anterior to silin surtace
over sacrum. midway between
,-,
greller Iroc hantor and iliac

PRECAUTION. Iliac crests must

be supenmpos.ed, thighs ,ligh-
tly flexed; shallow breathing.
AD DITIONAL: Grid. Cone.
VAAIATION Lalaral view of
5th lumbar and lSI sacral Wlr-
teOrM and lhe articulallon bel-
ween them Is visualiZed better
with .Iignmenl to 3 cm. below
illac CfflSt

FIf1. 1"/9 - Slcro-/II,c oblique.

ANATOMICAL: Sacro--illac artl-
culal!on.
FILM: 10 x 12 Inch. tength-
wise.
roStTtQN: Pallenl supine, With
side to be roeotgeoographed
elevated 30". Posterior iliac spi -
ne 10 center of film.
f OCAL SPOT Align 10 potnt
2 Ctn. cephalad and 2 cm. me-
dial 10 antelior superior spine
of elO\iated side.
PRECAUTION: supporl (alation
by sa odbags under loin and
thigh of side under study.
ADDITIONAL: Cone and grid.

.
VARIATION. Oblique view 01
bIaOder obtained with $lime po-
~

F.F.O
Thickness em
kV _ _

grid I1Itlo _ _ "

286 GllAAOClNI, RADIOLOGY - ELECTFtOMEDlCINE

 Fig. 15/9 - Sternum, posferr:r
anterior oblique.
ANATOMICAL: Sternum, sterno-
clavicular joints: costoslernal
al1iculatlOl1 s; oods of clavicles.
FILM : 10 )( 12 inch, length-
wise.
POSITION: Prone, arms at si-
des. Sternum and midwicllh 01
lilm. Upper border of manu -
brium " em. below upper bor-
der 01 cassella.
FOCAL SPOT: Displace lube 8
to 10 em. to the right of the
midline, and angle tube sulll-
cienl l), to have principal fay
strike 8 em. lateral to spine
and emerge through sternum.
PRECAUTION: Suspended res-
PIration or shaJtow respirHlion.
VARIATION. SImilar resuh3 may
be obtained by rotating patient
20 10 30", left side anterior,
local spot aligned liS above; ThK:llness_ cm
principa l ray d rrected vertically. kV _ __
lateral to the spine on Ihe sldo
elevated.
"""---
grid lM!II'_ cm

Fig. 16/9 Slernum, ISlfm,l.

ANATOM ICAL: Manubrium, b0-
d'! and xiphoid 01 sternum, re-
gIonal soli tissues,
FILM: 10 l( 12 inch. length-
wise.
POSITION: Patient laterally re-
cumbent. midsagittal plane pa-
raJtet to lilm. Manubrium 3 em.
below upper border 01 casset-
te, Ilemum at mldwldlh 01 111m
FOCAL SPOT. Align to point
3 cm. below the sterna! angle.
PRECAUTION: Arms thrown
back. Suspend respiration.
Head supported on sandbags.
ADDITIONAl: tmmobiUzatlon
by saodbag against bacf(. Gnd.

Thickness_ em
kV _ _

"""---
Fig. /7!9 Skull. po$l/Jro-ant&-
''''.
ANATOMICAL: Frontal bone,
or1)lts, frontal sinus and eth-
moidal cel ls. Secondarily, pe-
trous ridges.
FILM: 8 x 10 inch, lengthwise.
POsmON: Patient prone, 10-
rearms flexed beoeath chest,
r'IOSe arid forehead in conlacl
WIth film: nasion in center: pla-
ne through external auditory
meatl and ex ternal canthi per-
pendicular to lilm.
FOCAL SPOT: Al ign to point
6 to 7 cm. abo~e externat oc-
cI pital protuberance with prin-
Cipal ray angled 23" caudally,
emerging through nasion to
center of film.
PRECAUTION: Midsagittal pla-
ne perpendicular to film. Sus-
pended respiration.
ADDITIONAL: Immobittzatlon
grid.
VARIATIONS: Pelrous ridg es
may be soon clearly through
orbits by shifting oul caudally
and sngling 10 to ISO cepha-
.d. grid ralio _ _ "

GIlARDONI. AAOIOlOGY ELECTRQt..4EDlCINE 287

 -
Fig. 1819 - Skull, submenlo ver-

A NATOMICAL: Foramina at ba-

se 01 skull; spheooid and pas-
tenor ethmoid sinuses: lora-

-
men magnum, mandible, etc.
FILM: 10 It 12 inch, length-

POSITION: Patient supine, back

and ShOulders elevated, head
in 8l(lreme Il)(tenslon. ver'lIx
centered on film.
FOCAL SPOT: Align to point
between mandibular angles,
principal ray perpendicular to
plane through canthi and ex-
ternal auditOly meati, to center
of lilm.
PRECAUTION: Midsagittal pla-
ne pel'pendiculaf to li1m (ideal-
ly, plane through canthi and
external audi tory meati parallel
10 lilm).
AOOITIONAL: Gnd; cone (lor
10 It 12 inch coyerage).

. . ""' _ _ 12

Fig. f9/ Q - Skull, occipita Iron-

,oJ.
ANATOM ICAl: Frontal and 0c-
CIpital bones and foramen ma-

....
gnum.
FILM; 10 x 12 InCh, lenglh-

POSITION : Patient upright,

neck fleKed, frontal region <:en-
Wed to lower half of film .
FOCAL SPOT: Align 6 em. ~
bIN ooc:lpital pI'OIuberaoce. prio-
~I ray angled 10" cephalad
10 center of lHm.
PRECAUTION: Mldasg'"al pla-
ne pe!'p8OCIiCular to and In mid-

.""""'.
WMfth of film.
ADDITIONAL.; Grid. Respiration
-..pendOO. Immobllizatloo band

NOTE: Projection may be ml-

de with eilher posilloolng: lhe F.F.O.
pro,eclion may be made Iron-
IO-OOClpllaJIy. Instead 01 occipl-
IO-ironia ily.
-~
kV' _ __

mAo

Fig. 2019 - Mandible, later/ll,

ANATOMICAl: Bodr 01 man-
dible, angle, merila foramen:
secondarily, lower teeth.
fILM : 8 It 10 Inch. widthwise,
POSITION: Patien t prone. af-
fected sicIe in contact with cas-
sette. angle 0( mandible 10 cen-
tar of film ; lower border of
cassette el8\llltOO to 15"; head
rotated toward ~Ide under ~tu
<tv (to the extent of facial con-
lOur-approximately 15").
fOCAL SPOT: Align to point
5 cm. below the angle 01 the
mandible remote Irom Iilm:
principal ray directed 20' ce-
phalad to oeoter of lilm .

..........
PRECAUTION: Dentures. etc.,

ADDITIONAL: Cone.
VARIATIONS: Site of part icu-
lar interest (thoot, elc.) to cen-
lei" 01 lilm.

kV' _ __
mAo _ __

288 GtLAFlOONI. RADIOLOGY ELECTl'IOMEDICINE

 Fig. 21 /9 - Mandible, postero-
anterior (eftK;l-mouin closed).
ANATOMICAL: Symphysis of
mandible, rami, coronoid and
condylar processes. Seeondarj.-
tv, the lower inCISOfli and ca-
nine leeth.
FILM: 8 x 10 im.:h, lengthwise.
POSITION: Patient erect:
mouth closed; forearms res-
ting on thighs; nose and lore-
head In contact with film (spar~
ing Injured par1). Meotal sym-
physis to center 01 film .
FOCAL SPOT: Align principal
ray so that it emerges through
the mental symphysis.
PRECAUTION: MidSBjittal pla-
ne perpendicular \0 Ii m.
ADDITIONAL: Cone grid favo-
rable. Projection may be made
with pallen! prone.

,,---
mAo

Flp. 2219 - Mandible symphy-

sis.
ANATOMICAL: Symphysis of
mandible: lower inclSOB.
FILM: Occlusal tilm (individual
packel) placed in mouth pl"o-
lruding beyond lower lip 1 em.
POSITION: Patient, supine,
head slightly extended. midsa-
gitta l plane vertical.
FOCAL SPOT: Alipn 10 poin t
posterior aspect 0 symphysis
with principal ral perpendlcu-
lal to cefller 01 11m.
PRECAUTION: Respiration su-
spended.

FF O. em 100
Thlckr.esa em 6

" 70
""" ,.,
Fig. 231g - Skull. verlicOSUD-
nasal (modified).
ANATOM ICAL: Zygomatic ar-
ches. maxillae.
FILM: 10 )I 12 inch, length-
wise.
POSITION: Palienl upright re-
sting on thighs; nose and chin
in contact with cassette: upper
lip to 111 center.
FOCAL SPOT: Align to vertex,
Pl'1rn:ipal ray angled 23" cau-
dad, emerging through Ihe
middle of lhe upper tip.
PRECAUTION: Midsagittal pla-
ne perpendicular to casselle.
interpupillary line parallel to
cassetle. Respiration suspended.
ADDITIONAL.: Cone reconvnen-
dad; grid optional.

Thickr.esa_ tn'I

"'---
mAo
goo rllio _ __ '

lILAAOONI. flA,DIOLOGY - ELECTflOMEDICINE 289

 Fig. 2419 - Nose, $vperO-inf&-
riot".
ANATOMICAL: Nasal bones.
FILM: Occlusal lilm (Individual
packet).
POSITION: Patient slnlng. 0c-
clusal 111m in mouth--3 cm. 01
film projecting beyond teeth.
FOCAL SPOT: Align so thaI
principal ray passes just ante-
rior to the fOf"ehead and per-
pendicular to coote!" of lilm.
PRECAUTION: Midsagittal pla-
ne vertical. respiratIon suspen-
"".

Fig 25/9 - Nose, laler/l/.

ANATOMICAL: Nasal bones.
FILM Occlusal film (or dental
film In Individual packet).
POSITION: Patient may be pro-
ne or sitting erect. holding film
agalNt lateral aurlace of noee,
ex1IIInding well Into the intemal
canthua of the eye, 111m being
In sagittal plane
FOCAL SPOT: Align to cooter
of 11..., surlace o' nose.
PRECAUTION Principal ray
peopeilclicula1 to midsaQittal pla-
ne and to center of him. Film
WI cIoee appoaltlon and sup-
porI8d beneath noee and hand.
A.DDITIONAL: 1/ above films
are no! available. 8 x 10 Inch
CIIrdboard holoor placed ben-
88th head may be used. being
adjuated as lor position 01 lat-
eral "'ull and cen terlnp llbout
1 em. anterior to tip 0 nose.
NOTE. Both sides advisable.

Fig. 26/9 - Par,n/J!Jal $Inu$es.-

fIOS6-(;hin position (er&c r).
Jo.NA.TOMICAL: Same ItruClu-
res 8$ Indicated In preceding
posJlioo.
FILM: 8 x 10 Inch, lengthwise.
POSITION: Patient. Sitling. chin
resling agamSl casselle; tip 01
nose 2 cm. 'rom casselle.
FOCAL SPOT: Align to vertex.
principal ray to emerge through
nuolllbial junction to coote!" of
film.
PRECAUTION: Dentures, hair-
pins. etc.. removed. Midsagillal
plane verticil!. Suspencled respi-
ration.
ADDITIONAL: Cone; grid 0p-
tionaL Immobilization blind with
ve rtical casselle holder edvisa-
ble.
VARIATION: Fluid level may
be demonstrated by flHIxami-
nation with head ti lted 45 to
either side, other lactors remai-
ning the same.

290 GU.AROONI. RADlOl.OGY UECTROMEDICINE

 Fig. 2719 - SjnlJ8e8. mastoid
an/ero-pos terior.
ANATOMICAL: Mastoid tip. pe-
trous ridge.
FILM: 8 )( 10 il'lCh, widthwise.
one-half covered with lead
~k. ",:;i,
POSITION: Patient supine.
head rolaled 30 to 40"; side
under s iudy up from film. rl"I8--
stoid tip to center 01 e)(posed
han of film.
FOCAL SPOT: Align 10 point
1 em. above e)(temal auditory
meatus, principal ray passing
through base of mastoid pro-
cess. Ang le tube so es to di-
rect principal rey 17" caudad.
PRECAUTION: Rotation should
be sufficient to remove mas-
lOKI tip from behind angle of
mandible.
ADD ITION AL: Cone: grid mey
be used. f .f .D.
NOTE: Recommended similar ThlCkneM_ cm 17
Pfojection of opposite side.
"'---
Fig. 2819 - Cnest, postero-an-
twnx.
ANATOMICAL: Lungs, heart,
8OI1a: secondarily, ribs, lhora-

-.
Cic spine IIIld solt tissues.
FILM. 14 )( 17 Inch, length-

POSITION: Patien t M8Ct lean-

~ 1000ard a' an angle 0 1 SO:
aM resllng on upper border
of casselle: neck stretched.
With plane 01 acromial prOCM-
__ 5 to 7 cm. below upper
boIcIef of 111m: mldsaglnal pla-
,.. ' 0 midwidlh of him and
p8fpendlcular 10 II; dorsum oj
hand on hips with shoulders
rotated forward.
FOCAL SPOT: Align to Cellier
of film.
PRECAUTION: RespimtiOn sus-
pended in normal full Insplra-
""'. F.F.D.
~ '"
ADDITIONAL: Verllcal casselle
holder advisable.
NOTE: For cardiac study, can-
''''-
kV
~ 23
eo
lei" to 9th thoracic ve rtebra.
"'"
grid ratio ,
2S

Fig. 29/9 - Chest, laler,l.

AN ATOMICAL. As previously
described. In particular Int&no-
bar fissures; anterior and su-
perior mediastinum.
FILM: 14 ~ 17 Inch, length-
WISe, vertical.
POSITION: Patient erec!, la te- ,
ral CheSt wall oj side under
study In contact with cassette;
ptane 01 acromial processes 7

10 9 cm. below upper borde!'
of cassette; arms Ioided above
head. Midaxillary plane 10 mid-
=i-~.
width of l ilm.
FOCAL SPOT: Align '0 cent6f 1
of film.
PRECAU TI ON: Respiration
suspended in normal lull inspi-
ration.
ADDITIONAL: Sta,ionary casset-
te holder advisable.
VARIATIONS: Greater local film ThlCkne5l_ C/!1
dislance recommended (chan-
ge technical factors In accor- kV _ __
dance with inV(lf"SG square law).
""'---
grid r.IIO ___ '
,
:.:

GlLAADONI. RAOIOLOGY EI.ECTRO.... EOICINE 291

 Fig. J()/9 - Gall bJBdd6r, poste-
ro-anter;o,.

ANATOMICAL : Gall bladder.

right lobe of liver.

FILM: to ~ t 2 inch, lefJgth-

Wise.

POSITION: Patient prone. head

resting on outstretched right
Iorearm; left arm 10 side (Slight
rolalloo to the lell); mldscapu-
lar crossing of t1th rib to cen-
ter of film. Preliminary 1Wbse-
Quenlly, chenge to Iocalilatioo
of gall bladOOf.

FOCAL SPOT : Align to cen ter

o f film .

PRECAUTION: Suspended re-

spiration, trunk straight.
ADDITIONAL : Grid; cone or
elC tension cylinder.

VARIATIONS: Occasionally, up-

~.ht position may be Indical-

F.F 0 _em 100

Thckoess em 20

" ~
"'" 200
grid ratio 12

292 OllARDONI . RADIOLOGY. ELECTROMEDICINE

 PART 10

RADIOTHERAPY - APPLICATIONS - TECHNIOUES EQUIPMENT

 PART 10
RADIOTHERAPY - APPLICATIONS
TECHNIQUES - EQUIPMENT

Chapter 10.1. - GENERALITIES AND REFERENCES

In part 2, chapter 9, page 104 Physics and Biology of

Radiotherapy have been treated and it is usefull to con
suit that chapter before reading the following.

Chapter 10.2. - ISODOSE CURVES' APPLICATIONS

Isodose curves give the dose distribution value in the ir-

radiated tissues; they represent the key of radiotherapic
planning.
Fig. 1110 shows an Album of n. 24 isodose curves for
static and kinetic deep therapy, very usefull for treate
ment planning. (For equipment see tab. 21/2 page 105).
Fig. 3110 (par. 10.3.2.) . Neodermo Be app8rtJtus, BerllUum
window tube, rapid dose decay (see fig. 2/ 10).
kV 5-80, rnA 5, THVL 0.310 mm, 400 R/min. at 50 cm . (see
also tab. 21/2 page 104) . It allows the following therapies:
Grenz-Ray (5-15 kVp). Roentgencaust lc (15-40 kVp), Cutane-
ous (40-70 kVp) and Sub-cutaneous (70-80 kVp).
It also allows biological and m icrobiological samples irradla
lions with output 01 the order 01 too.ooo Almin. at ahort dis-
tance, microradiography with solt rays, elc.
For practical therapeutical application see isodose curves In
fig. 2/10.

Fig. '''0 (par. 10.2.) - Gllardoni album of 24 I!odose curves,

In &Crual size on transparent films, for static and kine ric dHp ,
lumour rherapy usable by superimposing them to the ana
tom/cal figure with localized tumour.
These isodose curves usable in the el)Qrgy range 400-600 kV,
-.r,o:
THVL ca. 8.5 cm . allows easy. quick and accurate treatment
planning.
For the equipment 588 tab. 2112 page 105. ,.
Fig. 2/10 shows the isodose curves obtained with an
equipment with Beri ll ium window tube for rapid dose
decay (Neodermo Be, fig. 3/10 and fig. 4110) .
.

~.
Chapter 10.3. - EQUIPMENT
, lOeo!lO~
10.3.1. Fundamental equipment for Radiotherapy

Table 21/2 page 105 summarizes the fundamental radio
therapic equipment referred - for simplicity - to Gi
lardoni production . Other equipment, obviously, may be
considered.
10.3.2. Dermotherapy equipment
Fig. 3/10 shows an equipment with Berillium window
tube (Neodermo Be) for dermotherapy and rapid dose
decay therapy. Fig . 2/' 0 shows relevant isodose curves
for practical applications and fig . 4/10 other characteris
tics of Neodermo Be. For further information see also
lab. 21/2 page 105.
Fig. 4/10 (par. 10.3.2.) . Oufput and absorption curves of
N9Odermo Ba. Focus-Chamoor Dis tance 10 cm., mA 5, Baril-
lium window 0,3 mm thick.
A curve: Outpu t (A/min.) in function 01 kV and AI. Iiller.
a curve: AI. Hall Value Layer (S.E.V. mm AI.) in function of
kV snd AI. Iilter.
C curve: Output (Rlmin.) in function of kV and Plexiglas Iil
ter.
o curve: Plexlgtas Hall Value Layer (S.E.V. mm Plex.) in
function of kV and AI. filter.
Plexiglas has an absorption similar to that of human tissue,
therefore curve C may represent the dose decay In human
tissue: curve 0 gives the HVL (S.E.V. mm Plex.) for different
kilovoltages snd filtrations: it may also represent the THVL.

294 GII..AAOONI. RAOtOlOGY - ElECTROMEOICINE

 Fig, 2/10 (par. 10.2.) - Isodose curves of "N9Odermo Be~ apparatus, 8erillium window tube, 5-80 kV, lIIustra t/KI In fig. 3/10.
The thick isodou line represents the Tissue Half Value Layer ( THVL), that i$ lhe 50'10 of skin dose. THVL gives an Immediate idea
of the dose decay.
i
I Technique n. 1: Grenz-Ray. Technique n. 2: Dermotherapy.
kVp 10 - rnA 5 - filter 0 - Rlmin. about 250 at 10 cm, kVp 10 - mA 5 - filter 0 - Rlmin. about 30 at 30 cm.
Treatment field: 0 1-3 em. T reatment fiel d: 0 12 em,

~ 120 I
10e30 ~ mm.
0
50
0
mm. 20 , 20
1 10
5 2
5
2
20 10 0 '0 20 3
mm. 70 60 50 40 30 20 0
'0
mm.

Technique n. 3: Aoentgeneaustie. Technique n. 4: Intensive Oermolherapy.

kVp 80 - rnA 5 - filter 0,1 AI. - Almin. about 1250 at 20 em, kVp 80 - rnA 5 - filter 0,1 AI, - Rlmin. about 550 at 30 crn,
Treatment lIeld: 2l 1-3 cm. Treatment Ileld: 0 12 em.

t 120
~ ~e30 ~
0
0 mm. 50
mm. '0 20
20
1 10
'0
5 20
5
20
20 '0 0 '0 20 30
mm. 70 60 50 40 30 20 '0 0
mm.
II
Technique n, 5: Rapid Dose Decay Therapy. Technique n. 6: Temporary Oepilatlon-Tinea-Sicosis.
kVp 80 - rnA 5 - liller 0,3 AI. - Almln. about 400 at 20 em. t.:Vp 80 - rnA 5 - lilter 0,3 AI, - Rlmin. about 200 at 30 cm.
Trealment field: 0 1-3 em. Treatment field : 12) 12 em.

0
10 e30 ;1
- 7 0
~ 120
mm. 50 mm. 75

'0 30 '0 50
30
20 20 20

10 ,20
30 30
10
40 5
40
20 10 0 '0 20 70 60 50 40 30 20 '0 0
mm. mm.

GlLAROONI, RIoOIOt.OOV - ELECTfIOMEDICINE 295

10.3.3. Medium deep therapy equipment
This therapy works in the range 70 - 250 kV. Fig. 5/ 10
shows an equipment for medium-deep therapy. See also
tab. 21/2, n. 2 page 105.
Fig. 5110 (par. 10.3.3.) T 250/ 12.
Equipment for superf icial and medium the rapy: 7()"'250 kV,
mA 12. THVL 1()...70 mm, build-up 0,5 mm. muscle/bone ab-
sorpti on 0,56; R/min. 30 at 50 cm. with lilter 1.5 mm Cu (see
also tab. 21/2 page 105) .
10.3.4. Deep tumour therapy equipment
In chapter 2.9, page 104 characteristics and periorman-
ces required by deep tumour therapy equ ipment have
been treated , Fig , 6/10 and 7/10 show two equ ipment
for deep tumour X-therapy.
One of the best equipment for this X-therapy is nowa-
days represented by "Centered T h e rapix ~ , illustrated in
fig , 115/2 page 112,
Fig. 6110 (pa r. 10.3.4.) - Monogil 400.
Equipment for superficial, medium and deep therapy. Mono-
bloc (without HV cables), 100-400 kVp. 6 mAo THVl I ()...SO
mm, build-up 1 mm. muscle/bone absorption 0,9. 20 RJmin.
at 50 cm. with 3 mm Cu l ilter (see also tab. 21/2 page 105).
296
.;
Fig. 7110 (par. 10.3.4.) - Trimegagil.
Equipment lor superiicial. medium and deep tu mour therapy.
Constant potential 100-500 kVc. 10 rnA. THVl 1()"'85 mm,
bu ild-up 1.5 mm. musclefbone absorption 1.0; 130 R/min. at
50 cm with 3 Cu filter.
See also table 21/2 page 105.
10.3.5. Cobalt Bomb
Fig. 8/10 shows a Cobalt Bomb for sources till 3000
Curies and fig. 9/10 its head section .
Figs. 108, 109, 110/2 show the comparison among typi-
qll isodose curves of Cobalt Bomb and 400 kV equip-
ment.
Cobalt Bombs are today used in deep therapy with
Linear Accelerators and 400-600 kV equipment (see
par. 10.4. page 298) .
Fig. 8/ 10 (par. 10.3.5.) - Gilatron 3000 (Gilardoni made).
Cobalt Bomb for static and kinetic therapy lor source till
3000 Curies (about 3000 RJh/ meter); THVl = 9,5 cm.
GILAROONI, RADiOlOGY - ELECTROI.4EOICINE

Fig. 9/10 (par. 10.3.5.) - Head section of Gilalron 3000 (see
fig. 8110).
1) Cobalt source tHl 3000 Curies; 2) lead protection; 3) tung-
sten pneumatk;: transla tion shuller; 4) tungsten Ilelds colli-
mator.
10.3.6. Betatron
Betatron till 40 MV has been used years ago for deep
Fig. 11/10 (par. 10.3.6.) Gi/belron 35 MV during assembling
(GI/ardonl).
t) Magnet co re: 2), 3) magnetization coils; 4), 5) magnetic
poles: 6) doughnut.
Lett., condensors for electromagnet. Right, control unit during
assembling. Weight 5S(X) kg; dimensions 9Ox95xl30 cm .
10.3.7. Linear Acceferator
Nowadays, the 2-6 MV linear Accelerator is the most
used equipment for deep tumour therapy, It still is a
sophisticated and expensive equipment. New equipment
400-600 kV, with incorporated t!MTV Centeri ng device in
replacemen t of separate Simulator, are favourably consi-
dered too.
Fig . 12/10 shows the operating principles of linear AC M

tumour therapy. Nowadays it si obsolete and has been celerator and fig . 13/10 a Linac for deep tumour the-
replaced by Linear Accelerators, Cobalt Bombs, or 400- rapy.
600 kV equipment (see par. 10.4. page 298) .
Fig. 10/ 10 shows the operating principles of Betatron
and fig. 11 / 10 the assembling 01 Gitardoni Betatron
35 MV.

~ 'UI1''''
~--fr
.-.... II ....

.....

...". 'fl" 1.11

Fig. 10/10 (par. 10.3.6.) - OpefBtlon principle 01 Belalron.

The Betatron operates like a transformer in wh ich the prim-
Fig. 12/10 (par. 10.3.7.) - Operating principle of Unac.
ary coil produces in the core a slnusoidal magnetic field; the
secondary Is the electronic equilibrium orbit In the doughnut The injeCted electrons are accelerated in tu be (6) by the
in which the electron rotates accelerating. high frequency oscillating field (about 3000 MHz) and in-
The electrons are infected at lime lero of sinusoidal magne- c rease their speed as the ooSurt-rldersoo on the wave crest.
tic field and accelerated in the ascendent quarter of the flux ;
then they are launched on the target thus producing X-rays. 1) High voltage generator.
During this time (11200 sec l or 50 Hz) the electrons increase 2) Modulator.
their energy every turn by a voltage equal to that 01 primary 3) R.F. power amplifier.
VolVwlndlng. 4) Wave - guide.
Exampfe: for 35 Volt/winding 01 primary, the electrons during 5) Electronic Injector.
the ascendent quarter wave make about lOll turns increas- 6) Accelerator.
ing their energy by 1()8 times thu s reach ing an energy of 7) Target.
35 . lOS "" 35 MV. 6) Beam.

GILARDClNI. RAOIOLOOV ELECTROMEDtCINE 297

 Chapter 10.4. - DEEP TUMOUR RADIOTHERAPY
IS A MISS, BUT UNTIL NOW NE-
CESSARY

Everyone has lost relatives, friends or acquaintances be-

cause of cancer, even when treated with Betatron, Une-
ar Accelerators. Cobalt Bomb, etc.

For about 50 years we have been studying cancer radio-

therapy problems as a mission; we co-operated in com-
posing the Handbook "Roentgen and Curie Therapy by
Prof. Perussia, 2 vol., Ed. Garzanti 1947.

We published about 100 papers on Radiotherapy topics

Fig. 13/10 (par. 10.3.7.) Unear Acceleralor (Linac).
Equipment for deep tumour therapy. 8 MV.
10.3.B. Photonlc (X and y ) and electronic (J3) tissue
Iransmlssion curves up to SO MV energy.
(see Bibliography page 362) and developed new radio-
therapic equipment, including Cobalt Bomb and Beta-
tron 35 MV, but ou r conclusions are rather negative for
deep tumour Radiotherapy.
Radiotherapy Is effective in Plesiotherapy (Contact Thera-
py) or therapy with rapid dose decay in tissue. because
in these cases tumour is superficial, and the ratio
tumour Doselhealty tissue Dose (BallistiC Efficiency) is
favourable (see par. 2.9. 15. page 111).
Radiotherapy is less effective In deep tumour therapy
because the tumour Dosel healty tissues Dose ra tio is
unfavorable, and the width and infiltration level are diffi-
cult to establish.

Figs. 14/ 10 and 15/10 give these data. Deep tumour therapy is practically used as a comple-
mentary treatment of surgery and as a palliative.

Our opinion is that the cancer problem will find a soiu-

'R~
tion in the future with Chemiotherapy, as it happened
I- with antibiotics with respect to Infectious diseases.

In the meantime, we have to fight it with the weapons

that we have at our disposal and Radiotherapy is one
'" of these.

"
, .. " " >
10.4.1. Choice of radlotheraplc equipment
" " l C H I. lD With regard to deep radiotherapic equipment, every type
<,., 112 0 of radiation from 200 kV to 40 MV, X, y and {J has
been experimented (see table 21/2 page 105).
Fig. 14/10 (par. 10.3.8.) PfIolonlc (X and y) tiSSUfl Irans-
mission curves till SO MV energy.
The conclusion is that the -energy optimum.. lies be-
With high energy, Inciden t dose is tower than emergent one. tween 400 and 600 kV (see fig . 114/ 2 page 112) and
that one of the best equipment is the one illustrated in
fig. 115/2 page 112 (Centered Therapix) , with incorpo-
rated tmage Intensifier-TV acting as a Simulator for the
tumour centering and collimation: obviously with the in-
herent limitation proper of deep tumour therapy.

For Information about the radiotherapy equipment instal-

lation see par. 12.3.2. page 315) .
\ 1\ 1\

10.4.2. Specialist ability is an Important factor In a suc

cestui therapy.

Besides the equipment efficiency, the therapeutical out

" " " " em H20

. come depends on the competence and ability of the
specialist; he must solve very complicated problem s
such as: preventive diagnosis, desease evaluation, treat-
Fig. 15/ 10 (par. 10.3.8.) Electronic (fJ) lissUfl transmission
ment plan study, centering and collimation for G.T.E.
curves till 50 MV energy. optimization , dose evaluation and splitti ng , irradiation
chronology, monitoring, patient reactions evaluation, etc.

298 GlLAAOONI. RAOIOLOGY ELECTROMEOICINE

 PART 11

RADIOLOGICAL PROTECTION
 PART 11 11.1.2. Units (roentgen, rad-gray, rem-slever1)
RADIOLOGICAL PROTECTION
For the physical quantities described in par. 11 .1.1. there
are standard and new measurement units.
The new ones are adopted by ICRU (International Com-
Chapler 11.1 . - PHYSICAL aUANTITIES AND THEIR
mission on Rad iation Units) and thei r use is recom-
MEASUREMENT UNITS (ROENT- mended in Radiological Protection.
GEN, RAO-GRAY, REM-SIEVERT)
However, the standard units are stili commonly used
nowadays; for this reason in th is part and in the whole
book the more fam iliar older units are used.
11 .1.1. Physical quantities
in tab. 2/1 1 the relationship between new and standard
The physical quantities used in Radiological Protection units is reported.
are hereunder listed with the definitions taken from ICAP
Publication N<' 15. TABLE 2/11 (par. 11.1.2.) -
Relationships among
standard radiological units and new International
System units (SI).
11.1.1.1. Exposure (X)
f>t1ysical Standard New Sl
It is the term reserved for the quantitative assessment of Ouantity
Symbol
Unit Unit
Relationship
ion izing electromagnetic radiation fields .
The exposure at a given place is a measure of the ra- Exposure X R C/kg 1 C/kg - 3876 A
diation based upon its potential abiiity to produce ioni-
(roentgen) (coulomblkg) 1 R =
258.1()-4 Clkg
zation in the air. Ab",,""" 0 "d Gy 1 Gy - 100 rad
=
""'" (gray) 1 rad 0.01 Gy

11 .1 .1 .2. Absorbed dose (D) Kerma K ,,' Gy

(gray)
1 Gy = 100 rad
1 rad = 0.Q1 Gy
It is the energy imparted to matter ionizing particles per
unit mass of irradiated material, due to any directly or
00..
Equivalent
DE "m S,
(sievert)
1 Sv - 100 rem
1 re m =0.01 Sv
indirectly ionizing radiation.
Activity A C; Bq 1 Bq - 27. 10-11 CI
(curie) (bequerel) 1 Ci = 37.101' Bq
11.1.1.3. Kenna (K)
Chaple, 11 .2. - DOSE LIMITS FOR INDIVIDUALS
It is a dosimetric measure of the radiation field for un-
charged particles, such as neutron or X- rays.
It is like the kinetic energy of charged particles gene- 11 .2.1. Annual dose limits
rated per unit mass of the material, with which the un-
charged particles in teract. The International Commission on Radiological Protection
(ICRP) established the following limit doses: 5 .. rem,. for
controlled persons and 0.5 .. rem .. for the civilian popula-
11 .1.1.4. Dose equivalent (DE) tion for full body irradiation.
The " rem ~ unit practically corresponds to R or "rad"
It is the product of the absorbed dose (0), for a given unit for X, gamma and beta rays.
type of radiation at a given location in the body and a
given qual ity fact or.
11.2.2. Weekly dose limits
In lact, equal absorbed doses of radiation may not al-
ways give rise to equal risks of a given biological effect, They are:
since the biological effectiveness may be affected by
differences in type 01 radiation or irradiation conditions. 0.1 rem/ week for persons working in radiology and con-
trolled by film~ badge or other personal dosimeters.
Some recommended values of the quality factor are list-
ed in tab. 1/11. 0.03 rem/ week for persons not working in radiology ha-
ving only occasional contacts with radiological depart-
ments.
TABLE 1/1 1 (par. 11 .1.1.4.) - Quality factor IQ) 0.01 rem/week for persons having nothing to do with
values, recommended by ICRP, for calculation of any kind of radiation.
Dose Equivalent (DE) from Absorbed Dose (D):

DE = DxQ. 11 .2.3. Dally and hour1y dose limits

Considering 0.1 A/week dose (100 mremfweek) and 5

Ouellty work ing days a week (40 hourS/week). admitted values
Ioni~ing radiation quality
lactor (0)
are: 17 mrem/day and 2.5 mrem/ h.
1 X-rays, y-rays ",d electrons. These doses are easy to measure using the instruments
in fig. 8712 page 94, and fig. 88/2 page 95.
10 Neutrons. protons and single-<:harged particles 01
rest mass greater than one atomic mass unit of
unknown energy. 11 .2.4. Natural radioactiVe background
20 a particles "d multiple-<:harged particles (and
particles 01 unknown charge) 01 unknown energy. it ranges from 10 J,lR/h to 100 J,lR/ h depending on the
ambient condition (see fig. 93/2 page 98).

300 GILAAOONI , RADIOLOGY ELECTROMEOICINE

Chapter 11.3. - PROTEXIMETRIC CONTROL IN-
STRUMENTS

Proteximetric instruments are very sensitive dosimeters

allowing the evaluation of very small doses and intensi-
ties of radiation (few mR/h).

11 .3.1. Ionization chamber proteximeters

Figs. 1/ 11 and 2111 show two of these instruments.

Fig. 1/17 (par. 11.3. ' .)

Small ioniza tion do-
sime ter.
Too small dimensions
do not all ow high
precision and hig h
sensi tivity. Full scale
reading in hundreds
of mR: therefore dif-
ficult evaluation 01 Fig. 3/1 1 (par. 11.3.3.) Gilardon/ Protellimeler - film bBdge
lOW doses. wh ich are sys tem.
the most required in SmaJi plastic case containing various fillers, where a common
protellimelry. dental film is placed.
The case Is given to persons under control.
When control period IS over (for Instance after \ month) pro-
leKimetri c films are developed at the sam e time and under
the same condi tions as 9 other films ellposed to pre-mea-
sured does from 10 to 90 mrem lor example by means o f
dose-prolexlmeter in lig. 21 11.

Fig. 2/ 11 (par. 11.3. 1.) - Gllardonl Integra ting dose-Plole-

lIime ter.
lerger dimensions than the instrum ent In fig. 1/1 1 (8 )( 13
II 4 em, pocket size), therefore higher precision and higher
senslUvity. Full scale reading 30 rnA.

11 .3.2. Geiger counters Fig. 4/11 (par. 11.3.3.) - Dose evaluation Wllh film badges In
fig. 3111.
These are described and shown in fig. 8712 page 94 Left: Comparative densitometric scale.
and fig. 88/ 2 page 95. Right: Four 111m badges carried by lour people fo r 1 month.
Comparison with left densitometric scale g ives dose recei ved
by each person.
Blackening difference (elaled to filter oilers an indicallon of
11.3.3. Film-badges radiation energy (soft or hard rays).

Film-badge proteximelry is based on film blackening .

There are official organ izations that provide for film-
badge proteximetric cont rol. 11.3.4. Gilardonl Bottles
This method is not very accurate but sufficient for prac-
tical purposes. They are described in par. 2.8.2.6. page 96.
Figs. 3/11 and 4/ 11 describe and show the Gilardoni Particularly interesting for easy assembli ng and use is
proteximetric film-badge system. the small 0,2 liter bottle.

Oll.l<ROONl. AAOIOl.OOY - ElCTROMEOICINE 301

Chapter 11.4. - PROTEXtMETRIC CALCULATION
FOR RADIOLOGICAL INSTALLA- TABLE 3/1' (par. " .4.2.) - Half Value Layer (HVL)
TION in em of principal shielding materials with con-
stant potential (kVc) (rom 20 kV to 35 MV.
For pulsating voltage (kVp) utifize the relation:
11.4.1. Speclflc references kVp 5!! 1.15 kVc

The basis for proteximetric evaluation are given in the

foll owing publications: ICAP (International Commission SPECIFIC WEIGHTS (Kgldm3)
on Rad iological Protection) Publication N" 21 ; Handbook
76 NBS (U.S.A.); NF C74-100 (France); DIN 681 ' and
6812 (Germany) , 'N'.'" w

All four give about the same figures. 1.0 1.5 2.2 3.2 7.8 11.3

20 kV 0.1 0.04 0.005 0.003 0.001

11.4.2. Half Value layer (HVL) of the principal shielding
materials of energy 20 kV-35 MV and shielding 0.03 0.02 0.003
50 kV 2 0.4 0.2
calculation (practical example)

Tab. 3/11 gives these data, which are fun damental to 100 kV , 1.3 0.7 0.1 0.07 0.Q1
evaluate protection shielding.
200 kV 7 3 2 0.3 0.23 0.04

11 .4.3. Shielding requirements for selected sources

:lOOkV 8.5 , 3.0 0.6 0.5 0.06

Examples of X-ray shielding requirements are given in

tab. 4/ 11 for primary beams and in tab 5/ 11 for scatter 400 kV 10.5 5 3.5 1.1 0.7 0. 12
and leakage combined .
500 kV 6 , 0.9 0.2

TABLE 4/ 11 (par. 11.4.3.) - Primary X-ray Beam 1 MV

"
, 6 3 1.5 0.6
Shielding Requirements for 0.1 rem per Week.
2 MV 16 8 5 2.0 1.2
Elleelive em I&Itd required cm coocntte required
PoIenlial workload . at toUrce distances 01 /II toUrt:e dislances 01 5 MV 20 7 3.0 1.8
~" mA min.
per week 1m 2 m 4m 8m 1m 2m 4m 8m
10 MV 28 20 7 3.3 1.8
50 500 0.04 0.03 0.02 0.01 3.4 2.5 1.6 0.9
125 0.03 0.02 0.01 0.01 2.5 1.6 0.9 0.4
30 0.02 0.01 0.01 0.01 1.6 0.9 0.4 0 2O + 35MV 23 7 3.2 1.5
8 0.01 0.01 0.Q1 0 0.9 0.4 0 0

75 500 0.10 0.08 0.05 0.03 9.7 7.4 5.0 3.0

125 0.08 0.05 0.03 0.02 7.4 5.0 3.0 1.2
30 0.05 0.03 0.02 0,01 5.0 3.0 1.2 0.2 Example of shielding requirements calculation according
8 0.03 0.02 0,01 0 3.0 1.2 0.2 a /0 HVL method.
Ques tion: Determination 01 conc rete thickness of a wall
100 1 000 0.24 0.19 0.14 0.09 17.0 13.6 10.4 7.1 at 4 m distance from a therapy X-ray generator opera-
250 0.19 0.14 0.09 0.05 13.6 10.4 7.1 ' .1 ting at 500 kVc - 10 rnA to reduce dose output under
60 0.14 0.09 0.05 0.03 10.4 7.1 4.1 1.' 2 mRlh.
18 0.09 0.05 0.03 0.01 7.1 4.1 1.5 a
Answer: Tab. 2112 page 105 gives an outPUI of about
150 1000 0.30 0.25 0.19 0.14 25.5 21.1 16.8 12.3 130 Rlmln. lor 500 kVc. 10 rnA. 3 mm Cu fil tration and
250 0.25 0.19 0.14 0.09 21.1 16.8 12.3 8.0 50 c m. distance. that is 130/62' ... 2 Rlm ln at 4 m. that
0.14 0.09 0.05 16.8 12.3 8.0 4.0 is about 120 R/h.
'"
16
0.19
0.14 0.09 0.05 0.02 12.3 8.0 4.0 0.8 Tab. 3/11 gives HVl '" 4 cm concrete for 500 kVc. 4 em
concrete thickness reduces the dose rate from 120 RIh
200 0.66 0.58 0.51 0.43 46.3 41 .0 35.9 30.6 to 60 R/h. Iherefcmt: 8 cm to 30 RIh - 12 cm 10 15 R/h
'" 000
10000 0.58 0.51 0.43 0.35 41 .0 35.9 30.6 25.4 - 16 cm to abolll 8 RIh - 20 em to 4 RIh - 24 cm to
2500 0.51 0.43 0.35 0.28 35.9 30.6 25.4 20.1 2 R/h 28 cm to 1 R/h - 32 cm 10 0.5 R/h - 36 cm to
625 0.43 0.35 0.28 0.20 30.6 25.4 20.1 15.0 abolll 0.2 RIh - 40 c m to 0.1 R/h .= 100 mRlh - 44 cm
10 50 mRlh - 48 cm to 25 mR/h 52 cm 10 12 mRlh
250 1.26 1.09 0.91 0.74 51.8 46.5 41 .0 35.4 56 cm to 6 mR/h - 60 cm to 3 mR/h - 64 cm to
'" 000
10000 1.09 0.91 0.74 0.59 46.5 41.0 35.4 29.8 1.5 mRlh.
2 500 0.91 0.74 0.59 0.44 41.0 35.4 29.8 24.1
825 0.74 0.59 0.44 0.31 35.4 29.8 24.1 18.6 Eventually. to reduce the dose rate of 500 kVc generator
output from 120 R/h at 4 m to 2 mR/h, a conc rete wall
2.38 2.04 1.70 1.36 58.4 52.5 46.3 40.2 of about 62 cm (equivalent to 15-16 concrete HVls) is
"'" '"
10 000
000
2500
2.04 1.70 1.36
1.70 1.36 1.04
1.04
0.76
52.5
46.3
46.3 40.2
40.2 34.0
34.0
27.8
required .
Baril. for 500 kVc has an absorption 4/ 1.5 = 2.7 times
625 1.36 1.04 0.78 0.52 40.2 34.0 27.8 21.9 more than concrete: therefore. using barit instead 01
cor'ICrete. the wall should be: 82/2.7 = 23 cm thickness.
4.05 3.49 3.02 2.50 65.0 59.0 53.0 46.8
"10000
000 3.49 3.02 2.50 2.02 59.0 53.0 46.8 40.6 Lead shIelds 4/0 .2 '" 20 times more than concrete;
2500 3.02 2.50 2.02 1.54 53.0 46.8 40.6 34.4 therefore the wall built in lead should be about 62120 '"
625 2.50 2.02 1.54 1.1 2 46.8 40.6 34.4 28.5 3.1 cm thickMSS.

302 GILARDONI. RADIOlOGY Et.EC"mOMEOICINE


TABLE 5/11 (par. 11.4.3.) . Scatter and Leakage
X-ray Shielding Requirements fo, 0.1 ,em pe'
Week.
Publication Ng 21 : Data for Protection Against Ionizing
Radiation from External Sources: Supplement to ICRP
Publication Nt' 15.
Publ ication Nt' 26: Recommendations of the Interna-
tional Commission on Rad iological Protection.

"""'... """-.
-
Eflective em lead required em concrete required
at IKM.m;:e distances 01 at source distances 01 For other information about ICRP Publications. see Bi-
rnA, min .
>V

SO
... 500
, m 2m

0.02 0.01 0
'm .m

0
, m 2m

' .0 0.3
' m .m

0 0
bliography.
In the following chapters 11 .6., 11.7., 11.B., 11.9. the
". 0.01 0 0 0 0.3 0 0 0 most interesting paragraphs are reported from Publica-
tion N" 15.
7. 500 0.06 0.02 0.01 0 3.' '-' 0.' 0
".
30
0.02 0.01 0
0.01 0 0
0
0
'-'
0.'
0.'
0
0
0
0
0
For the meaning of the asterisk see paragraph 151
(chapter 11 .8.)
,,>00 0.06 0.04 0.02 0
2.7 2.7 0.3 0
"" 250
00
0.04 0.02 0
0.02 0 0
0
0 0.3
0.3
0
0
0
0
0
Chapter 11.6. - PROTECTION AGAINST RADIA-
'so ,,>00 0.11 0.06 0.03 0 B.' 4.9 '-3 0 TION USED FOR MEDICAL PUR-
2SO 0.06 0.03 0 0 4.9 '-3 0 0
eo 0.03 0 0 0 ' .3 0 0 0 POSES
200 40 000 0.40 0.32 0.24 0.16 26.'
2 1.6 16.4 11 .3
"000 0.32 0 .24 0.16 0.09 21.6 16.4 11 .3 6.'
2500 0.24 0.16 0.09 0.04 16.4 11.3 6.' 2.0 11.6.1. X-ray diagnostic Installation
825 0. 16 0.09 0.04 0 11 .3 6.' 2.0 0
(75) ' Every X-ray tube used for diagnostic purposes
250 40000 0.78 0 .61 0.45 0.28 30.' 25.' 19.4 13.9 shall be enclosed in a housing such that the exposure
"000
2500
0 .61 0.45 0.28 0.14
0.45 0.28 0.14 0.05
25.' 19.4
19.4 13.9
13.9

3.'
from the leakage radiation measu red at a distance of
one metre from the focus does not exceed 100 mR in
825 0.28 0.14 0.05 0 13.9 ' .S 3.' 0
one hour at every rating specified by the manufacturer
300 40000 1.51 1.18 0." 0.52 34.'
28.7 22.6 16.3 for that tube in that housing.
"000 1.18 0." 0.52 0.25 28.7 22.6 16.3 '02
2500 0." 0.52 0.25 0.07 22.6 16.3 '02 ' .6 (76)' Means (control settings or meters) at the control
825 0.52 0.25 0.07 0 16.3 '02 ' .6 0 panel shall be provided to indicate tube potential and
current when these can be varied.
400 40000
"000
2.33
'-85 '-"
1.37
1.37
0.91
0.9 1 40.' 34.7 28.7 22.'
0." 34.7 28.7 22.' 16.2
2500 1.37 0.91 0.54 0.23 28.7 22.S 16.2 9.' (77) Diaphragms, cones or collimators shall be used to
0

825 0.91 0.54 0.23 0.02 22.' 16.2 9.6
Table is based on typical Irradiation characteristics:
50 cm source to scatterer distance;
90" angle 01 scatter;
400 cm2 irradiated area, Implying 0.1% of the incident
e)(posure rate scattered to 1 m;
100 mA . mln/h maximum continuous tube rating at
50 and 75 kV. 200 mA . min/ h at 100 and 150 kV,
and 1 000 mA . mln/h at 200-400 kV;
,-S limit the useful beam to the area of clinical interest and
shall be so constructed Ihat. in combination with the
tube housing, they comply with the exposure requ ire-
ments for leakage radiation as given in paragraph 75. A
lig ht-beam localizer for indicating the cross-section of
the useful beam shou ld be used. The use of a multi-
plane type coll imator will usually result in a reduced
Integral dose to the patient, and less scattered radiation .
(78) The minimum permanent total filtration in the use-
0

ful beam shall be determined by the maximum voltage

leakage radiation 0.1 R/h at 1 m from the target for
50-150 kV and 1 R/h at 1 m for 200-400 kV. at the
maximum continuous tube rating.
Chapter 11.5. - RECOMMENDATIONS OF THE tN-
TERNATtONAL COMMtSSION ON
RADIOLOGICAL PROTECTION
(ICRP) (many thanks for the cour-
t..y)
These recommendations are the result of the work of
the International Committees and indicate the require-
ments necessary to ensu re adequate protection for dif-
specified fOr the tu be in its housing. The permanent to-
tal filtration for normal diagnostic work - including den-
tal radiog raphy - shall be equivalent to not less than:
1.5 mm AI at voltages up to and including 70 kV;
2.0 mm AI at voltages above 70 kV up to and inclu-
ding 100 kV;
2.5 mm AI at voltages above 100 kV.
Exception: In some special procedures at operating pa-
tentials below 50 kV (e.g. mammog raphy), the minimum
total permanent filtration shall be equivalent to at least
0.5 mm AI (see paragraph 180 for filtration with direct
flu oroscopy of the chest) .
(79) The total filtration permanently in the useful beam
0

ferent radiological applications. as specified in paragraph 78 shall be indicated on the

Particu larly Interest ing are the following reports:
Publication N 15: Protection Against Ionizing Radia-
tion from External Sou rces.
Publication N 16: Protection of the Patient in X-Ray
Diagnosis.
tube housing .
{BO)O Some special radiog raphic procedures (e.g. mam-
mography) require very soft rad iation. Such procedures
should be carried out on special equ ipment and not on
standard X-ray equipment intended for higher potentials.

GILAROONI. RAOtOLOOV ElEC~EOtCI N E 303

Under no circumstances shall the total permanent filtra-
tion be equivalent to less than 0.5 mm AI. Where spe-
cial equipment is not employed, means shall be pro-
vided whic h ensure that the tube is not used at higher
potentials with inadequate filtration (see paragraph 78).
(81 )" Vario us types of timers are required for fluoro-
scopic and radiographic work (see also paragraphs 93
and 104). The proper functioning of timers Is of particu-
lar importance and special attention should be given to
those com ponents wh ich may wear out or become de-
tached and, in consequence, cause malfunctioning of
the timer.
(82) No person shall remain in an X-ray room when ra-
diological procedures are being carried out, unless his
presence is essential.
(83) Persons who work within the X-ray department
should not hold patients during diagnostic examinatlons.
Motion-restricting devices shall be used as much as
possible and cassettes shall never be hand-held during
exposure. When children or other individuals must be
held duri ng an examination this should either be done
by staff members of other departments or by parents or
other persons accompanying them. If it is necessary to
ask such staff members to hold patients. a rotation sys-
tem should be employed , subject to the appl icable ma-
xImum permissible doses. No pregnant women or per-
sons under the age of 18 years shall be permitted to
hold patients. Those holding the patients shall wear pro-
tective aprons and gloves (see paragraphs 98 and 99)
and should ensure as far as practicable that no part of
their body, even if covered by protective clothing, is in
the path of the beam .
(84)' Attention is drawn to the special problems asso-
ciated with the use of X-ray diagnostic equ ipment in
surgery. The X-ray equ ipment and protective devices
used should be such that they are not unnecessarily
obstructive to the work of the surgeon or members of
his staff; however, adequate protection shall be pro-
vided . Image Intensifiers should be used for all surgical
procedures requiring fluoroscopy.
(85) ' Mobile equipment (i .e. eq uipment not used routine-
ly at one location) should only be employed when It is
impractical to move the patient to a fixed installation.
11 .6.1.1. Fluoroscopy
(86)' An adjustable collimator or diaphragm shall be
provided to define the useful beam.
(87) The X-ray tube, collimating device and fluoroscopic
screen or image intensifier shall be linked together in
such a way that, under normal operating conditions, the
beam will not fall outside the screen irrespective of the
source-screen distance. The so-called - hand fluoroscop&-
or -head fluoroscope .. shall not be used .
(88) The fluorescent screen shall be covered with a pro-
tective glass sheet having a lead equivalent of not less
than:
304
1.5 mm for apparatus having a maximum operating
potential up to and Including 70 kV;
2.0 mm for apparatus having a maximum operating
potential above 70 kV up to and including 100 kV;
an additional 0.01 mm per kV above tOO kV.
Image intensifiers and adjacent mounting parts subject
to useful beam exposure shall provide the same protec-
tion as that required for a conventional fluoroscopic
screen assembly.
(89) In the equipment permits spotfilms to be taken in
connection with the fluoroscopic examination, the beam
shou ld be intercepted by a barrier having a lead eqUi-
valent as specified in paragraph 88, with the maximum
operating potential being equal to the highest potential
at which such radiographic exposures can be made.
(90)" Under the conditions that obtai n in direct fluoro-
scopy, screen definition is not a limiting factor in the
perception of the image and therefore high sensitivity
screens should be used. Old screens which are found
to be much less sensitive than new ones should be re-
placed . The protective glass should be replaced If its
optical density has increased significantly due to discolo-
ration.
(91)" Recommended values for minImum distances be-
tween focus and patient are given in paragraph 92. The
design of the equipment shall be such as to ensure that
these distances cannot be less than those specified. In
the case of mobile equipment, cones, diaphragms or
spacer frames shall be provided to achieve this result.
(92)' In radiography and fluoroscopy with mobile equ i-
pment, the focus-skin distance shall not be less tha n
30 cm. In radiography and flu oroscopy (other than of
the chest) with sfatlonary equipment, the focus-skin dis-
tance shall not be less than 30 cm and should not be
less than 45 cm . In flu oroscopy 01 the chest the focus-
skin distance should not be less than 60 cm (see also
paragraph 180) and. for equipment specifically and not
only occasionally used for chest examinations, shall not
be less than 45 em. Photofluorography and radiography
of the c hest shall be performed with a focus-skin dis-
tance of at least 60 cm.
(93)' The device referred to in paragraph 70 shall be
supplemented with means for providing the fluroscopi st
with an audible signal. The maximum setting of the de-
vice terminating the exposure shall not exceed 10 mi-
nutes; the setting of the audible signal shall be adjusta-
ble within the overall time.
(94)' The fluoroscopiC exposure switch shall be of the
- dead-man.. type, i.e. a switch so constructed that the
circuit-closing contact is maintained only by continuous
pressure on the switch. It shall be located at the posi-
tion occupied by the fluroscopist and should be pro-
tected against accidental operation .
(95)' Means (control settings or meters) shall be pro-
vided to indicate the X-ray tube potential and current.
These means should be located so that the values of
voltage and current can be observed by the operator
during cineradiography and by the fluoroscopist during
fluoroscopy. Observation of these values is particularly
important when using image intensifiers with -:automatic
GllARDONI. RADIOLOGY - El..ECTROMEDICINE
brightness control (automatic variation of either voltage
or current, not under the direct control of the fluoro-
scopist, in order to maintain constant brightness) .
(96) All tables and stands for flu oroscopy shall be pro-
vided with adequate means for protecting the fluorosco-
pist and his assitants against scaHered radiation from
the patient and from scaHering materials between the
source and the patient. A shield equivalent to not less
than 0.5 mm lead shall be provided to cover openings
such as the ",Bucky slot- . The fluoroscopist shall be
protected by an ",apron_ or ..drape- which may consist
of overlapping parts to facilitate palpation. The apron
shall have a lead equivalent of not less than 0.5 mm
and dimensions of not less than 45 cm x 45 cm. It
shall be attached to the lower edge of the screen holder
when the latter is vertical and to the edge nearest to
the operator when the screen is horizontal. A separate
hinged or sliding panel shield should be located at the
side of the table and should be of sufficient dimensions
to protect the legs and feet of the fluoroscopist. When
image intensifier are used, the same protection shall be
provided as is required for conventional fluoroscopy,
particular attention being paid to stray radiation when
the X-ray tube is located above the table.
(97)' Fluoroscopy shall not be carried out with mobi le
equipment unless an Image Intensifier Is employed. The
equipment shall be so constructed that the radiation
beam is fully intercepted by the image intensifier.
(98) Whenever poSSible, members of the staff shall re-
main beh ind protective screens or shields during aU ty-
pes of fluoroscopic examinations. If this cannot be done.
protective aprons having a lead equivalent o f at least
0.25 mm shall be worn.
(99) Protective gloves having a lead equivalent of not
less than 0.25 mm shall be worn when any fluoroscopic
examination may involve placing the hands in or near
the radiation beam. The gloves shall cover the whole
hand Including back, palm , fingers and wrist. Even when
wearing protective gloves, the hands shall not be placed
in the beam unless It has been attenuated by the pa-
tient.
(100)' The exposure rate for direct fluoroscopy as mea-
sured at the patient entrance surface should be as low
as practicable and should not exceed 5 Rlmin.
(101) ' Before a direct fluroscopic examination is begun,
the eyes shall be sufficiently dark-adapted. In order to
enable work with the lowest possible exposure rate, the
adaption period should be at least 10 min. To avoid
disadaptation when an examination has to be interrupt-
ed, either a coloured light or means to dim the room
lighting shall be provided. The room illum ination during
such interruptions should nol exceed 10 lux and prefer-
ably should be less than one lux. Alternatively red gog-
gles should be worn during the interruption. When im-
age intensifiers are used dark adaptation is normall y not
necessary. Excessive room lighting should, however, be
avoided.
11.6.1.2. Radiography
(1 02)' The beam-defining system shou ld be adjustable
and provide rectangu lar fields. The proper limitation of
the field to the area of clinical interest should be de-
GILAAIX)NI. 1V.DI0000GV ELECTROMEDICINE
monstrable on the film. Means shall be provided to veri-
fy that the film is aligned with the beam, and all edges
of the beam should show on the film.
(103) ' Recommended values for mi nimum distances be-
tween source and patient are given in paragraph 92
and, for dental radiography, in paragraph 113. The
equipment shall be so operated that the actual d istances
are not less than these values. In the case of mobile
equipment, cones, diaphragms or spacer frames shall be
provided to ach ieve this result. Stationary equipment
should, when practicable, be equipped with auxiliary de-
vices in order to facilitate the distance control.
(104) A device shall be provided to terminate the ex-
posure after a pre-set time or exposu re. If a recycling
timer is used , It shall not be possible to make repeat
exposures without release of the exposure switch to
reset the timer except in the case of speCial techniques
where repeated exposures are requi red.
(105)' Means (control settings or meters) shall be pro-
vided on the control panel to indicate the X-ray tube
potential and current and the exposure time (or to indi-
cate whether timi ng is automatic) . A meter to indicate
the product of milliamperes and time (mAs-meter) may
be used in place of current and/ or exposure time indi-
cators.
(106) The operator shall be adequately protected during
patient exposure. This may be achieved either by pro-
viding a shield for the operator with in the X-ray room
or by locating the control panel and operator outside
the X-ray room.
(107) The X-ray exposure shall be controlled from the
control panel only, except in the case of special tech-
niques when It Is necessary to control the exposure
from the table or stand. In such special techn iq ues, it
may be necessary for the personnel to wear protective
aprons and gloves (see paragraphs 98 and 99).
(108) The minimum distance of the operator from the
tube and patient during mobile radiog raphic procedures
shall be 2 m. High workloads may require that the op-
erator stand behind an adequately sh ielded screen. The
operator shall ensure that the only person exposed to
the radiation beam, until it has been adequately attenu-
ated, will be the patient
11.6.1.3. Photofluorography
(109) In photofluorographic work paragraphs 87, 90-92,
102 and 104-107 shall apply wherever applicable.
(110)' High-efficiency optical systems, which enable the
dose to the patient to be reduced, shall be used.
(111) Mass photofluorographic survey equipment shall
be so arranged and shielded that all personnel associa-
ted with the procedure are adequately protected during
routine use without the necessity for protective clothing.
11 .6.1.4. Dental Radiography
(11 2) ' In dental exami nations, the total fitration in the
useful beam shall not be less than the values specified
in paragraph 78. Fluoroscopy with dental equipment in-
volves unnecessarily high exposu re of the patient and
shall not be used.
305
(1 131' For conventional dental radiography (intra-oral
radiography) a field-defining spacer cone shall be em-
ptoyed, which provides a minimum focus-skin distance
of not less than 20 cm for equipment operating above
60 kV, and not less than 10 cm for equipment operating
at 60 kV or below. Open-ended cylinders or divergent
cones conforming with paragraph 77 should be used
rather than the so-called "pointer cones. The field dia-
meter at the cone end should not exceed 6 cm and
shall not exceed 7.5 cm.
(11 4) ' X-ray equipment used for special dental radio-
graphy, e.g. the so-called panoramic equipment "flash
(capacitor discharge) apparatus and equipment for ce-
phalometric (profi le) procedures, shall comply with the
applicable recommendations in the section on medical
X-ray radiography.
(115)* For conventional dental radiography the maximum
range of the exposure timer should not exceed five se-
conds. The timer shall be capable of consistently repro-
ducing the short exposure times needed for high-speed
film. The exposure switch shall have a circuit-closing
contact which can be maintained only by continuous
pressure. It shall not be possible to make repeat expo-
sures without release of the exposure switch. The timer
(X-ray exposure) switch shall be so arranged that ac-
cidental exposure is unlikely.
(116) Oental installations shall be so arranged that the
operator can remain outside the radiation beam at least
2 m from the tube and from the patient. Work-loads of
more than 30 rnA-min per week may require the use of
an adequately sh ielded screen.
(117) Whenever possible the film shall be fixed in posi-
tion or be held by the patient. The film shall never be
held by the dentist or by a member of his slaff.
(118) The tube housing shall nol be held by hand dur-
ing exposure.
11.6.2. Diagnostic uses 01 radioactive substances
(119) Most uses of radioactive substances for diagnostic
purposes involve small activities and do not cause any
significant external exposures. However, this may not be
the case in certain procedures such as dispensing from
stock solutions, injection of radioactive gases and. the
use of radioactive material in scanning techniques, par-
ticularly when shortlived nuclides are used. Whenever
there is reason to believe that significant external expo-
sure may occur, suitable protective measures shall be
instituted. Recommendations on the handling of radioac-
tive substances in hospitals are given in ICRP Publica-
tion 5.
Chapler 11.7. - THERAPEUTIC INSTALLATIONS
(120) All the appropriate provisions of the general re-
commendatio'ns shall apply.
306
11 .7.1. Beam therapy
(121) No person other than the pat ient shall be in the
irradiation room during any form of treatment, except
that employing superficial therapy up to 50 kV (see pa-
ragraph 130).
(122)' All beam therapy equ ipment shall be calibrated
by a qualified expert before it is first put into use for
treatment, and at regular intervals thereafter. The initial
calibration shall include measurements of the output, an
assessment of the radiation quality and the beam ho-
mogeneity and a test of the constancy and reproducibi-
lity of all factors determining the radiation exposure.
The minimum requi rements in respect of the extent and
frequency of repeat calibrations should be determined
by the competent authority.
(123)* The interruption of a patient's treatment is unde-
sirable. Appropriate additional measures shall therefore
be taken to prevent inadvertent entry into the treatment
room and the consequent automatic interruption of the
treatment.
11.7.1.1. Conventional X-ray therapy
(124)' Every X-ray tube used for conventional X-ray the-
rapy shall be enclosed in a housing such that, at every
specified rating of that tube in that housing, the expo-
sure rale from the leakage radiation measured at a di-
stance of one metre from the focus does not exceed 1
Rlh, nor 30 Rl h at any position accessible to the pa-
tient at a distance of 5 cm from the surface of the
housing or its accessory equipment.
(125)" Means (control settings or meters) at the control
panel shall be provided to indicate tube potent ial and
current when these can be varied and for quick reco-
gnition of the filtration being used . Whenever practica-
ble, equipment which provides pre-set combinations of
tube potential , current and filter should be employed.
(126)' Permanent diaphragms or cones shall be so con-
structed that, in combination with the tube housing, they
comply with the exposure requirements for leakage ra-
diation as given in paragraph 124. Additional cones or
adjustable diaphragms should be constructed so as to
reduce the integral dose to the patient as much as
practicable. They should not transmit more than 2 per
cent of the useful beam and shall not transmit more
than 5 per cent. Where cones are not used, the diaph-
ragm shall provide a light beam.
(127)" Unless it is possible to bring the X-ray output to
the prescribed value sufficienlly rapidly that the treat-
ment is not impaired, the tube housing shall be fitted
with a shutter, electrically operated from the control
panel and complying with the esposure requiremen ts for
leakage radiation as given in paragraph 124. The posi ~
tion of the shutter shall be indicated at the control
panel by a reliable system, and operation of the shutter
shall be independent of the orientation of the tube
housing. Such a shutter system shall be checked for
correct operation at frequent and regular intervals. When
such a shutter system is employed, the automatic timer
shall not commence operation until the shutter is open.
Gl lARDON I. RADi OlOGY ELECTROMEOICINE
(128)' In order to ensure that the prescribed dose is
delivered, the equipment shall be provided with an au-
tomatic timer which will terminate the exposure by de-
energizing the X-ray tube after the pre-set time has
elapsed. A transmission monitoring chamber shall be
positioned in the useful beam to provide a continuous
check on the constancy of the radiation output. In view
of the potentially serious consequences resulting from
giving a dose in excess of, or less than, that prescribed,
the monitoring chamber should also be employed as an
integrating meter capable of terminating the exposure
after a pre-set value has been reached. The chamber
shall be positioned on the patient side of any tube filter
em ployed. The timer and the integrating meter shall
preserve their accumulated response in the event of any
fail ure or interruption in the operation of the equipment
during treatment.
11.7.1.2. Superficial X-ray therapy
(129)' The housing of tubes designed for superficial X-
ray therapy shall conform to the requirements given in
pa ragraph 124, except for tubes intended to operate at
potentials within the range 5-50 kV which shall be pro-
vided with a special tube housing such that. at every
specified rating of the tube in that housing the expo-
su re rate from the leakage radiation does not exceed
100 mR/h at any position 5 cm from the tube housing
Of its accessory equipment.
(130) For treatment at potentials up to 50 kV it is per-
missible for the operator and other essential persons to
remain in the room, subject to the provisions of para-
graph 131, and provided that the tube housing is of the
special type referred to in that paragraph .
(131) The X-ray tube may be held by hand if its hous-
,ng meets the special requirements of paragraph 129
and if it is fitted with a shield which protects the per-
son holding the tube from exposure to radiation scat-
tered from the patient. Holding of the tube by hand
shall only be done when clinically necessary. The per-
son holding the tube shall wear protective gloves and a
coats or apron having a lead equivalent of not less than
0.25 mm .
(132)' Due to the low inherent fillration and short fo-
cus-window distance, the exposure rate close to the
wi ndow of a low-voltage tube used for superficial thera-
py is very high, and even brief exposure to the radia-
tion beam may cause serious injury. For this reason
special care is necessary to avoid accidental exposure.
An audible signal or a warning light prominently moun-
ted on the housing shall be provided for any tube that
may be held by hand, in order to indicate when the
tube is energized. When practicable. a cap of at least
0.5 mm lead equivalent shall be fitted over the tube
window when the tube is not in use.
(133)* Superficial X-ray therapy equipment shall be so
designed as to prevent unintentional combinations of
tube potential and filtration. The provisions of paragraph
125 shou ld apply.
11.7.1.3. Megavolt" X-ray and particle beam therapy
(1 34) The appropriate provisions of paragraphs 125 and
128 shall apply.
GllAR DONI . RADIOLOGY EL ECTf10MEDICINE
(136)' The housing of conventional megavolt equipment
shall be so designed that the dose rate of the leakage
radiation measured at one metre from the source does
not exceed 0.1 per cent of the dose rate of the useful
beam at that distance. In the application of new tech-
niques or equipment, e.g. neutron therapy, this require-
ment may not be practicable. In such circumstances,
special consideration shall be given to the protection of
the patient.
(136)* Permanent diaphragms or cones shall be so con-
structed that, in combination with the tube housing, they
comply with the requirements for leakage radiation as
given in paragraph 135. Additional cones or adjustable
diaphragms should be constructed so as to reduce the
integral dose to the patient as much as practicable.
They shall not transmit more than 2 per cent of the
useful beam. Where cones are not used, the diaphragm
shall provide a light beam.
(137), Special consideration shall be given to the design
of machines capable of emitting either X-ray or electron
beams, in order to ensure that the electron beam can-
not be emitted inadvertently when an X-ray beam is re-
quired.
(138)' Where equipment is capable of delivering dose
rates greater than 100 rads/min in air at a distance of
one metre, a completely independent integrating dose
meter system shall be employed, In addition to what is
required in paragraph 128. This second system shall al-
so be capable of terminating the exposure when a pre-
set dose has been given .
11.7.1.4. Sealed .ouree beam therapy
(139)" Every sealed y-ray source used for beam therapy
shall be enclosed in a housing such that, with the
beam control mechanism in Ihe OFF position, the expo-
sure rate from the leakage radiation measured at a dis-
tance of one metre from the source does not exceed 2
mR/ h. At any readily accessible position 5 cm from the
surface of Ihe housing, the exposure rate from the
leakage radiation shall not exceed 20 mR/h unless the
useful beam exposure rate is less than 100 R/h at one
metre from the source, in which case the exposure rate
from the leakage radiation shall not exceed 40 mR/h.
(140)' With the beam control mechanism in the ON po-
Sition, the exposure rate from the leakage radiation mea-
sured at a distance of one metre from the source shall
not exceed either 1 R/h or 0.1 per cent of the useful
beam exposure rate at one metre from the source, whi-
chever is the greater. When the useful beam exposure
rate is less than 100 R/h at one metre from the source,
the exposure rate from the leakage radiation shall not
exceed 1 per cent of Ihe useful beam exposure rate.
(141)' Permanent diaphragms or cones shall afford the
same degree of protection as the source housing . Addi-
tional cones or adjustable diaphragms shall be construc-
ted so as to reduce the integral dose to the patient as
much as practicable. In no case shall they transmit
more than 2 per cent of the useful beam. Where cones
are not used, the diaphragm shall provide a light beam.
(142)' Where the useful beam exposure rate exceed
100 R/h at a source distance of one metre, the beam
control mechanism shall be such that it will automatical-
307
Iy return to the OFF position at the end of an exposure
or in the event of any breakdown or interruption of the
activating force. The OFF position shall be maintained
until the mechanism is operated from the control panel.
Additionally. the apparatus shall be so constructed that.
in case of failure of the automatic return system, the
exposure can be interrupted by other means, e.g. ma-
nually. in order to protect the patient and to make it
possible to unload or repair the treatment head without
exceedIOg the dose limits for planned special exposures.
11.1.2. Non collimated sealed source therapy
(143) A separate room or designated area shall be pro-
vided for the preparation of sources and applicators.
During such preparation olny those persons engaged in
the work shall be allowed in the area and eating, smok-
ing, and drinking and the application of cosmetics shall
be prohi bited.
(1 44)' The tdentlficati on of needles and capsules of the
same appearance but of different activity or nuclide
shoukl be facilitated during treatment, by such means
as coloured beads or threads.
(145) The preparation, sterilization, dismantling and clea-
nang of applicators and sources involve manipulations
with incomplete shieldi ng. Proper tools shall therefore
be used to ensure the minimum practicable irradiation
of the body. These tools shall be constructed so as to
provide the optimum relation between distance and time.
Dummy capsules, clearly identifiabl e as such, shall be
used until a high degree of skill has been achieved.
Sealed sources shall never be picked up with the fin-
gers.
(146)' Both ambulatory and bed patients containing sea-
led radioactive sources shou ld be segregated into rooms
or wards where properly trained personnel are available.
The bed and the; room or ward shall be suitably identi-
fied when occupied by such patients.
(147)' The number and position of removable sealed
sources in or on the patient shall be checked during
treatment. Dressings from patients receiving treatment
with sealed sources shall not be destroyed until it has
been ascertained that they do not contain any sources.
After removal of the sources from the patient, all sou r-
ces shall be accounted for and , in addition , the patient
and his dressing shall be monitored as an additional
precaution.
(148)' Patients with removable sealed sources contain-
ing material of radioactive half-life greater than 5 days
in or upon their bodies should not be permitted to
leave the hospital. For the conditions applicable to pa-
tients receiving treatment with sealed sources with half-
life shorter than 5 days, see ICAP Publication 5.
Chapter 11 .8. - PROTECTION OF THE PATIENT
11.8.1. Introduction
(150) This section is concerned with medical exposures
in the same sense as defined in paragraph 32 of ICAP
Publication 9. For the purpose of the following recom-
mendations, and in order to include all types of dia-
gnostic and therapeutic exposure to ionizing radiation,
308
the term medical exposure is therefore extended to
apply to all types of exposu re of patients ad ministered
by radiologists, other medical practitioners including ob-
stetricians and general practitioners, dentists, osteopaths.
chi ropractors, etc.
(151) A number of the recommendations in the previous
section of the chapter on medical uses of radiation are
also aimed at reduction of the radiation dose to the pa-
tient. These paragraphs have been marked with an aste-
risk. The following paragraphs mainly deal with protec-
tion aspects which are less di rectly related to equ ip-
ment. Although no guidance is given with regard to the
best methods of diagnosis or treatment, recommenda-
tions are given on various aspects of the operat ional
procedures. It is important that those who use radiation
on patients keep abreast of technological and clin ical
developments in respect to the methods.
(152) The dose limitations recommended by ICAP relate
to radiation exposures other than those received by the
patient in the cou rse of medical procedures or from
natural background radiation . On the assumption that
the frequency of harmful effects is proportional to the
dose received, each increment of dose will correspond
to a resu lting increment of the risk of such effects. The
appropriate limitations on the contributions to the total
dose received from occupational and medical exposures
can and should then be considered separately, in the
light of the importance of these types of exposure. A
particu lar radiolog ical procedure would not be justified
un less the associated risk is offset by the medical ba-
nefit expected to accrue to the ind ividual or to the
population . It is therefore not appropriate to give any
predetermined , generally applicable dose limitations, and
the ideal judgement of what should be considered to be
an acceptable dose would have to be based upon the
known circumstances in each case, including the con-
sideration of alternative techniques that may permit a
dose reduction.
(153) When the probability of a harmful effect cannot
be assumed to be proportional to the radiation dose -
e.g. at high doses which may produce acute radiation
injury - the risk from a certain medical exposure is
not determined solely by the resulting dose but is also
influenced by previous high exposures, irrespective of
source. In such cases, the total radiation dose in the
relevant organs and tissues, and the time over which it
has been received, must be taken into consideration.
(154) The risk of certain harmfull effects at low doses
of radiation was estimated in ICAP Publication e, on the
assumption that the expected number of cases in an
exposed population per unit dose is the same at very
low doses as that observed at the considerably higher
doses for which reasonably quantitative observation is
possible. The values enunciated in that report were thus
considered to represent upper limits of the risk .
(155) Theoretically, it should be possible to balance the
expected need or benefit of the exposure against the
risk imposed by the irradiation. In practice, this is not
possible with regard to individual patients, except at
high doses in radiation therapy. For most types of X ray
diagnostic examinations, however, the radiation dose and
the most pessimistic estimate of the related risk are so
low for properly considered and conducted examinations
that any detailed consideration of benefit-risk is unne-
cessary in individual cases.
GILARDONI. RADIOLOGY ELECTROMEOICINE
(156) Provided that a certain diagnostic procedure as
such is generally considered justified because the medi-
cal benefit to the patients is believed to outweigh the
risk from the exposure, the remaining judgement in the
individual case would relate to the choice of X-ray exa-
mination as being appropriate for that individual, the
conduct of the examination and the interpretation of the
resu lt. If anyone of these three actions is impaired by
ig norance, negligence or lack of resources, the radiation
exposure may still be justified from the point of view of
the diagnostic information but the diagnostic yield has
then been obtained at an unnecessarily high cost in
terms of radiation dose and corresponding risk.
(157) The decision as to whether a certain radiation
dose to a patient is justified is sometimes the responsi-
bi lity of the referring physician, someti mes of the radio-
logist. In either case, however, it is imperative that the
decision is based upon a correct assessment of the in-
dications for the examination, the expected yield from
the examination and the way in which the results are
likely to influence the diagnosis and subsequent medical
care of the patient. It is equally important that this as-
sessment is made against a background of adequate
knowledge of the physical properties and the biological
effects of ionizing radiation.
(158) No person shall operate radiological equipment
without adequate technical competence nor apply radio-
logical procedures without adequate knowledge of the
physical properties and harmful effects of ionizing radia-
tion.
(159) The curriculum for medical students should in-
clude at least the foundation that is necessary for an
understanding of the basic aspects of radiation protec-
tion, particularly with regard to the elements necessary
in the exercise of good clinical judgement. Since most
physicians are likely to become involved in some deci-
sions implying irradation of patients, more extensive trai-
ning in radiation fundamentals, including protection ,
wou ld be valuable for all medical students.
(160) A special ICAP report deals with the elements of
ed ucation and experience necessary for the exercise of
sound judgement in the clinical, administrative and tech-
nical aspects of diagnostic radiology. This report should
be included in Ihe course material for medical students
and in postgraduate courses where appropriate.
(161) Protective measures in the widest sense include
900d clinical judgement and proper design of radiation
sources and protective equipment as well as good ope-
rational practice and competent interpretation of the di-
agnostic information.
(162) Good clinical judgement implies that no patient is
exposed unnecessarily as far as can be judget when the
exposure is decided. It is therefore important that all
relevant clinical information, including previous radiolo-
gical data, is studied and that alternative techniques are
considered before examinations or treatments with radia-
tion are requested or initiated. It is, however, equally
important that necessary examinations or treatments are
not withheld because of a radiation risk which in the
majority of diagnostic cases, is very low.
(163) Once a technique of radiological examination or
treatment has been chosen, it shall be applied with the
mi nimum patient exposure consistent with securing the
desired diagnostic information or therapeutic result.
GILARDONI. RADIOlOGY El..ECTIlOMEDICINE
(164) Due to lack of comprehension, the interpretation
of recommendations on protection of the patient has,
on occaSions, caused unwarranted alarm and has there-
fore led some patients to hesitate in seeking necessary
medical attention. Every effort should be made to give
the public a sound view of the magnitude of the radia-
tion risks and of the general benefit from and need for
various types of diagnostic and the~apeut ic irradiations.
(165) The following recommendations on the protection
of the patient relate to operational procedures. The re-
commendations are limited to the various types of ex-
ternal exposures even though a number of the general
statements in the previous paragraphs would naturally
apply also to the use of radioactive substances as in-
ternal emitters. The recommendations mainly relate to
X-ray diagnostic procedures.
11.8.2. Recommendations with regard to operational pro-
cedures
(166) The basic protective requirement is that the radia-
tion dose to the patient, especially the integral dose and
the dose to the gonads and the active bone marrow,
shall not be greater than necessary to obtain the rele-
vant diagnostic information or to produce the desired
therapeutic result. In general, the most effective way of
ensuring this is by limiting the field size.
(167) The patient dose is also influ enced by quantities
and parameters such as radiation quality (kV, filtration).
sensitivity of the recording system, beam direction and
source-skin distance. An assessment of this influence in
diagnostic radiology is given in the ICRP report on the
protection of the patient.
(168) Particular care should be exercised when the pa-
tient's gonads are within or near the useful beam or
when a foetus may become irradiated . If the patient's
gonads must be within the limits of the beam , but do
not actually need to be exposed, they should be shiel-
ded.
(169) Particular attention shall be given to filters that
will prevent non-useful low-energy radiation from reach-
ing the patient and unnecessarily increaSing the dose. It
should be recognized that this radiation may not only
be harmful to the patient but may also reduce the qua-
lity of the image in X-ray diagnostic work; it will usually
limit the total tumour dose that can be delivered in
deep therapy. Specific recommendations on filtration for
diagnostic equipment are given in paragraph 78.
(170) Medical exposure of humans shall never occur as
the result of administrative decisions e.g. for legal pur-
poses, without due consideration of the relevant medical
data and the need for the examination or treatment in
each individual case.
(171) Special precautions shall be taken with regard to
the protection of patients awaiting examination or treat-
ment. Waiting rooms with adequate protection shall be
available, and any exposure which is not part of the dia-
gnostic procedure or therapeutic irradiation shall be sub-
ject to the limitations that apply to non-medical expo-
sures.
309
11.8.2.1. Xray diagnosis
(172) All diagnostic Xray work shall be performed with
the most appropriate combination of operating potential ,
filtration, focalskin distance, field lim itation and record
ing medium. Guidance on the choice of these factors is
given in the special report on the protection of the pa
tien!. Minimum requirements on filtration and focalskin
distance are given in paragraphs 78 and 92, respectively.
(173) It is of primary importance to decide on the mini
mum field size in relation to the size of the region of
interest. The field size may be smaller than but, with
the exception of intraoral dental radiography, shall in no
case be larger than the size of the film or screen to be
used . Apart from this exception, the proper limitation of
the field to the area of interest shou ld be demonstrable
on the film.
(174) The ICRP has for a number of years called atten-
tiOn to the embryonic and foetal sensitivity to ionizing
radiation. The possibility of pregnancy must be taken in-
to account by the attending physician when deciding on
exami nations that involve the lower abdomen and pelvis
of women of reproductive capacity. The Commission
has pointed out that the 10-day interval following the
onset of menstruation is the time when it is most im
probable that such women cou ld be pregnant. There-
lore, it is recommended that all radiological examina-
nons of the lower abdomen and pelvis of women of re-
prod uctive capacity that are not of importance in con-
nection with the immediate illness of the patient, be
limited in time to this period when pregnancy is im-
probable. The examinations that it will be appropriate to
delay until the onset of the next menstruation are the
few that could without detriment be postponed until the
conclusion of a pregnancy or at least until its latter
half.
(175) While pelvimetry is sometimes of great value, it
should be undertaken on ly on the rare occasions when
this is likely to be so and should never be carried out
on a routine basis.
11 .8.2.2. Fluoroscopy
(176) In general, fluoroscopy should only be used when
radiography is not expected to provide the required in-
formation, e.g. in some dynamic studies or when the
time element is of importance. Image intensifiers should
be used with the aim of reducing the patient's dose and
increasing the information content of the examination.
(177) The exposure rate for direct fluoroscopy as mea-
sured at the patient entrance surface shall be as low as
practicable and should not exceed 5 Rlmin.
(17S) A transmission monitoring chamber in the useful
beam may be used for observing the radiat ion output.
Such a chamber should be arranged to measure the
product of field size and either exposure or energy flu-
ence. This is of particular value in fluoroscopy, in train-
ing operators to restrict to the minimum both X-ray
beam size and fluoroscopic time.
310
(179) Before a direct fluoroscopic examination is beg un.
the eyes shall be suffiCiently dark-adapted. In order to
enable work with the lowest possible exposure rate, the
adaptation period should be at least 10 minutes (see
paragraph 101).
(1S0) Where direct fluoroscopy cannot be avoided in
chest examinations, it shall be performed at tube po--
lentials of SO-100 kV, a filtration equivalent to at least
4 mm AI, a tube current not exceeding 2 mA, and a
focus-skin distance not less than 60 cm.
11.8.2.3. Radiography
(181) Screen-type fi lm is less sensitive to direct X rad ia-
tion than non-screen film and should therefore not be
used for non-screen techniques.
(182) When the highest definition is not essential, a
high-speed film -screen combination shall be used in or-
der to reduce the patient dose.
(183) Special precautions shall be taken in order to
make retakes of radiographs unnecessary. For example,
the operating conditions shall be checked before the
exposure is made, and care shall be taken that the pa-
tient is correctly positioned and im mobilized .
(184) Technicians and radiographers shou ld see their
films after processing, since this enables techniques to
be adjusted to produce films of optimum diagnostic
value for minimum patient dose.
(185) It is particularly important to avoid re-taking a
long series of films. To ensu re that correct radiographic
settings are used, a sing le preliminary film shou ld be
exposed and processed before the main series is taken.
(186) Care should be taken to prevent fogging of the
film . Fogging may be caused by an unsatisfactory dark-
room safe-light, by scattered radiation in the X-ray room
or by X-rays from unexpected sources such as rectify-
ing valves in a high tension generator cabinet. Unavoida-
ble fogging is caused by the natural radiation back
ground, but this may be reduced if particularly radioac-
tive building material is avoided and if film storage time
is limited .
(187) Good processing techniques are essential also for
the protection of the patient. It is Important not to use
a technique which involves overexposure and subsequent
underdevelopment of the film . Normal development
should enable a medium speed film, with medium speed
screens, when exposed to about 1 mR, to have an ac-
ceptable density for diagnostic purposes (average densi-
ty about 1.0).
(188) The correct developer and fixer should be select-
ed for the types of film to be used and for the process-
ing temperature. Routine control of film density by in-
spection during development is strongly deprecated. The
density should be controlled by lime and temperature in
GILAAOONI. RADIOLOGY - ELECTROMEOICINE
a consistent technique. The developer shall be replen-
ished as necessary and replaced at regular intervals;
du ring development, it shall be subject to the correct
amount of agitation. The content of the fixing bath
should be strictly confined. If wash ing is carried out in
run ning water, this should preferably be at about the
same temperature as the processing solutions. Drying
should be carried out in a special cabinet.
(189) Where there is a sufficient throughput of films to
ensure correct use and to justify the expense involved,
automatic processing machines should be used as they
facilitate compliance with most of the recommendations
in paragraphs 187 and 186.
(190) The dark-room shall be adequately lig ht-proof: it
should not be possible to see any light from outside af-
ter twenty minutes dark-adaptation from daylight. 11 is
essential to use the correct safe-lights, including correct
fi lters, bulb power and fittings.
(191) Mass examinations shou ld not be initiated unless
the expected yield, the radiation risks, and the availabili-
ty of adequate follow-up of positive cases, have been
evaluated. Fluoroscopy shall not be used for such exami-
nations.
11.8.2.4, Dental radiography
(192) Standard X-ray equipment designed for dental ra-
diography shall not be used lor other radiographic work.
If panoramic dental radiographs or other special projec-
tions are needed, the necessary specialized equipment
shall be employed (see paragraph 114).
11.8.2.5. Radiotherapy
(193) In addition to paragraphs 166-171, the following
paragraphs in the previous sections specifically relate to
projection of the patient in radiotherapy: 122-129, 132,
133, 135-142, 144 and 146-148.
11.8.3. Medical research
(194) In special circumstances of medical research in-
volving new procedures, the recommendations in this
chapter may be unreasonably restrictive. A review of
each such procedure shall, hOwever, be conducted by
an appropriate and designated group of qualified ex-
perts. Reference is made to more general statements on
medical research , such as the Declaration of Helsinki.
GllAROONI. RAOtOlOOV - ElECTAClMEOtClNE
Chapler 11.9. - SUMMARY OF OIFFERENT ORGAN
DOSE LIMITS FOR INDIVIDUALS
Tab. 6/11 , reported from ICRP Publication N 15, gives
these data.
TABLE 6/11 (par. 11.9.) . Summary of different
organ dose limIts for individuals.
Maximum permissible doses Dose limits tor
Orga n or tissue lor adults e~ pased In the
rembe~ 01 the public
course 01 their work
Gonads. red bone-
marrow 5 rem In a yea r1')I7I!3l 0.5 rl!fll in a year
3 rem in a yeart)
Skin, boM. thyroid 30 rem In a yean ')P\
Hands and Ior6arms;
fOOl and ankles 75 rem In a yeart ')P\ 7.5 rem in a year
Other single organs 15 rem in a year1 'l(lI 1.5 rem in a year
(1) In (lny one year the MPDs should not be exceeded. but
In a period of a Quarter of a year up to one-half of the
annual MPD, or, for Internal exposure. a dose commitment
resulting from Intake 0 1
'"
radlonuclide equivalent 10
amount to the intake for one half-year at the maximum
permissible concentration . may be accumulated in conformi -
ty with the considerations on additivity and multiple organ
irradiation given in paragraphs 53 and 68 of ICRP Publica-
lion 9. The recommended values for the quarterly quotas
may be founded upward to the next whole number. If ne-
cessary. the quarterly quota may be received as a single
dose. but the Commission believes that it would be unde-
sirable for doses of th is magnllude to be repeated at close
intervals.
(2) It may sometimes be necessary to provide lIexlbili ty lor
the MPD for exposure Invotving the whole body, where the
gonads and the red bone-marrow are the cr itical organs. In
such cases (and the Commission believes that they will be
infrequent) It will be justifiable 10 permit the quarterly Quota
to be repeated In each quarler 01 the year. provided that
the total dose accumulated at any age over 18 years does
not exceed 5{N- 18) rem . where N is th e age in years.
Under special conditions discussed in paragraphs 66 and 67
of ICRP Publication 9. single doses or a series of doses up
to a total 01 twice the annual limit may be permitted to criti-
cal organs. subject to cerlaln restrictions.
(3) Tho recommendation permitting dose accumulation al
rates up to 3 rem in a quarter (as derived from paragraphs
54 and 56 of ICRP Publication 9) should not apply in cir-
cumstances Involving abdominal exposure of women of re-
productive capacity. Such women should be occupationally
employed only under conditions where the dose to the el>-
domen is limited to 1.3 rem in a quarler. correspondi ng to
5 rem per year delivered at an even rate . Under these con -
d itions, the dose to an embryo during the critical first 2
months of organogenesis would normally be less than 1
rem , a dose which Ihe Commission considefS to be accep-
table. When a pregnancy has been d iagnosed. arrangements
should be made to ensure that the exposure of the woman
be such that the dose of the foetus. accumulated during
-
the ream ining period the pregnancy. does not exceed 1 rem.
Practical experience Indicates that Ih. d~ 10 Ih, 10-
etus during this period is usually substantially less than 1 rem.
10 practice, many 01 lhe women 10 this category
with diagnostic X-ray equipment. For exposures result ing
from X-ray equipment operated at low kilovoltage, the re-
commendation will usually be satisfied even if the pregnant
woman continues to be occupationally employed under cir-
cumstances wh ere the dose to the abdomen is limited to
1.3 'Om in a quarter. In the case of exposures received
from X-ray equipment opera ted at high kilovoltage. it will
usually be necessary to assess the dose received by the fo-
etus.
(4) 1.5 rem in a year to the thyroid 01 children up to 16
years of age.
311
 PART 12
PLANNING OF RADIOLOGICAL DEPARTMENTS
AND EQUIPMENT SELECTION
PART 12
PLANNING OF RADIOLOGICAL DEPARTMENTS
AND EQUIPMENT SELECTION
Chapler 12.1. - GENERALITIES
12.1.1. References
Radiolog ical planning has been the subject of many
publications; the most important ones are hereunder re-
ported;
BETZ F.: The influence of planning on technology. In
.. Planning of Radiological Departments.. (Kormano e
Stieve Ed.). Pages 235-242, G. Thieme Verlag. Stuttgart,
1974.
BETZ F.: X-ray examination frequencies: influences and
changes. In "ISPRAD 3" Book of papers. Pages 23-25
Smits Publ., The Hague, 1980.
CHIESA A., PAPAGNI L.. CORSI M., LOMBARDO 5. ,
VEARIENTI M.S.: Some data on the radiological work-
land in Italian hospitals. In .. ISPRAD 3" Book of pa-
pers... Pages 9-11, Smits Publ., The Hague, 1980.
COCKSHOTT W.P" ZEIDLER E.H. : The intestitial
space frame and radiology design. In Planning of
Radiolog ical Departments". (Kormano and Stieve Ed.).
Pages 133-142, G. Thieme Verlag, Stuttgart, 1974. .
312
HOLM TH.: Modular plannIng of diagnostic X-ray de-
partments. In - Planning of Radiological Departments...
(Kormano and Stieve Ed .). Pages 126-132, G. Thieme
Verlag , Stuttgart, 1974.
Mc CREADIE DW.A. MONTGOMERY R.: Design
and organisation at radiodiagnostic departments in
district general hospitals in Scotland. In - Planning of
Radiological Departments (Kormano and Stieve Ed.).
Pages 39-45, G. Thieme Verlag, Stuttgart, 1974.
PUIJLAERT C.B.A.J.: Growth and surface: general re-
view and conclusions of the inquiry. In ISPRAD 3<'
Book of papers>o. Pages 1-5, Smits Publ., The Hague,
1980.
TERRY W.G ., Me LAREN J.W.: Planning a diagnostic
radiology department Saunders Pub!. London, 1973.
VERHAGEN J., VERBEETEN W.H.: Some considera-
tions designIng a diagnostic X-ray department Raad-
gevend Technies Buro van Heaglen B.V. P.O. Box
305, 6500 AH Njimegen, 1980.
PISTOLESI G.F., 01 GUG LI ELMO L. : Criteri generall
per la planiticaz/one del presidi di Radiologia. Sup-
plemento a II Radiologo, N. 2, 1982.
This field is divided in Iwo main branches:
1) Medical Organization and 2) Technical Organization.
The latter, and particularly the criteria for the choice of
the equipment and the suggestions for their installation,
will be dell with.
GIIJ-.FIDDNI. RAOIOLOGY - LECTROMEOICINE
Chapler 12.2. - X- DIAGNOSTICS 12.2.3. Suggestions for the planning of X-diagnostics
Section

12.2.1. Percentage of different X-ray examinations. ex- Three different cases are considered:
ams/year per 1000 Inhabitants, execution lime 1) Private radiologist and small hospitals.
and retatlng equipment.
2) Hospitals from 50 to 500 beds.
Table 1/ 12 gives these dala. 3) Hospitals over 500 beds.

12.2.3.1. Private rad~ogl.ts and small hospitals

12.2.2. Orientallve guide-line for the selection of X-dia-
gnostics equipment and accessories
Table 2/12 gives these data.
Digitized and computerized equipment must be consi-
dered as new ones (see par. 4.4.1. page 152).
Equipment: Traditional remote controlled Tilting Table
with II-TV (n. 2 01 tab. 2112, or better n. 1 of the same
table). and Bucky lable (n. 5 of tab. 2112).
Installation: as exemplified in lig . 1/ 12.

TABL E 1/ 12 (par. 12.2.1.) -

Percentage of diffe rent X-ray examinations, exams/year per 1000 inhabitants,
execution time and relating equipment (some data are from "S upp/emento a /I Radi%go " n. 2 1982) (see
also tab. 2/12 page 314).

N. Exam. type
, .d_,
%
of total """""'
.... "JOO"
Inhabitants
3
Execution
time
(8Vfi111\18j
.
EqulPlTl6f1t
,
, """'. 30,81 233 12' 12" Cheo' stand
2 Digestive System 7." 57 41'13" Tilting table II-TV, better universal Iype, lelecon-
trolled, digitized and compulerized

3 Gall bladder 3.86 29 42'47" Bucky lable with tomograph

4 Kidney, Urinary bladder 3,5 1 26 62'3,- .. e _

S Skeletal System 31,67 Zl7 15'57' Bucky table or better universal tilling lable .ele-

7
Skull

B.OOd System
10,22

0."
77

7
25'32"

81'15"
..
controlled, digitized "d computerized

above;
" possible with skull device

Bucky table or Universal Telecontrolled tilting table

II-TV with anglograph, better digitized and compu-
terized

Nervous System 0,49 ,... 65'33" above

8
, examinations '0 bedded 4,75 3S 37'69"
'"
Mobile unit
patient

Tomography 1,82 Bucky table or beller Universal nltlng table dlgi-

10
" ' 5'
tlzed and computerized

.
Abdomen 3,75 28 14'01" Tilting table II-TV, belter Universal telecontrolled
" type digitized end computerized

12 Special exams 0,25 2 43'18" e _ '" special equipment ,Cn

13 Compuled Tomography ,Cn 0,25 2 6CY CT skull " d whole body
HXl 750 23' (average) - - -
COMMENT:
1) Column 2: Skeletal System, CheSt and Digestive System are the more Irequent exams; special examination. Neuro, cardio
and CT, together, are only 2% 01 total ones.
2) Column 3: the total exams/year per 1000 inhabitants are 750 as literature Indicates. CT year exams are about 2000 per 1
million people that is lor 250 wor1< days per year about 8 CT exams per day each lasting about 60'. Therefore 1 CT
apparatus, fully utilized, could serve about 1 million inhabitants. In practice it is suitable to have a CT fo r every 500.000
inhabitants.
3) Column 5: fundamental equipment referred to Table 2/12 page 31 4 are: Bucky table with tomograph (N. 5). Chest stand
(N. 4) and Tilting table II-TV (N. 2), better universal type telecon trolled with tomograph, 3/sec. angiog raph in table etc.
digitized and computerized (N. 1) allowing also special exams (cardio, neuro, etc.).
4) Special Neuro, Cardio equipment are utilized only in Hospitals specifically dealing with this lield.

Glu.RDON!. RADIOI,.OOY fUCTAOMEDlCINf 313

 TABLE 2112 (par. 1.2.2.2.) - Orientative guide-line for the choice of X-diagnostics equipment and accessories
(see tables 1/4 page 149, 1a/4 page 150 and 2/4 page 152).

Radiological Tables Image

T""" Automatic Video Angio.-
N Equipment Generator
"'-, Tube Siands and
Act:eSsori6s
Intens.
(II-TV)
Expo!lure
"~"'
graph
ApplicaUons

, 2 3
5 6 7 , 9
, Universal Threephase 70 kW 90"/90". ceiling tube mov.: Double Functi~i~ Fully 3/"" Routine 00'specialistic
Telecontrolled 12 pulses Double longil. transv.. rotational. field f Densi digitized 35 )( 35 (Neuro. Cardio, Angio .
Digitized 100 kW Focus film changer. Tomograph under in Table etc.).
Computerized 10CX> rnA 9000 'Pm Full Computerized table Compu- Very high quality equip-
(UTOC) 3 m, terized ment similar >0 Roent-
gen-Gil (,o. par. 4.4.1.
pa9' 152)
2 Traditional as above 90"/45. floor tube stand; optional optional Routioo and angiography.
Telecontrolled
(TI) as ebove
mov: longit. transv. rota-
tional, film changer.
"
above "
above Similar to Cosmographi)(
s. (see par. 4.5.3. page
or 6 pulses Tomograph 153)
80 kW
10CX> rnA

3 Digestive as above as above as above with out tomo-

" Digitl- - Rou tine digestive e)(a -
System graph oe cheap ly with
II-TV ;0 front of fi lm
above "
above ,ad minations

changer
, Chest as above as above Ceiling or floor stand tu- - - - Special for mass e)(ami-
be with Chest stand sto-
re film type with au to-
"
above nations. For routine any
equipment with separate
maliC developing Chest stand sing le cas-
",n.
5 Skelotal as above as above Bucky table. floor - - -
" usable

Routine also foe Gall.

System or tube stand; mov: longit. tran-
3000 rpm sversal, tomograph Chest
'"'" "
above Kidney. Bladder. T hree
grids stand (see fig. 3812
stand whole Spine telera- page 62) Ratio 6. 12. 20
dlograph also for full Spine tele-
radiog raph

6 Neuro With equipment N1 (U TDC) or other special equipment. Digital subtraction. spatial obser- Special Research
Ang iography vat Ion (tridimensional) and other Image processings as allowed by Nl equipment open
",w important possibilities.

7 cardlo Special Research

Angiography " ",0'"

6 Mammography Generator 250 rnA. 25-50 kV, microfocus Beryllium window tube. Special stand. automatic Aoutine
expos. soft-ray Invisible 200 line grid.

COMMENT:
1 ) Table indicates best solu ti on; cheap ones are possible changing o r elim inating some accessories. Example: replace of
threephase 12 pulses generator with 6 pulses one; tube 9000 rpm with 3000 rpm etc.
2) Digitalization and computerization are recommended because give better results end save doses. films and work.
3) For mobile equipment with II-TV lor surgery. Orthopaedics etc. see Table 1/4 page 149 and Chapter 4.3. page 152).
') Classic recommended equipment are; Nl (UTDC) o r cheaply N2 (TT) and N5 (Bucky Table) with Chest Bucky stand
for Single cassettes utilized also for full Spine teleradiography w ith invisible lines cross grid. Ratio 20.
5) For very powerful and advanced diagnostics the new _Universal CondensorgU,., 150 kV, 5 ,uF, " Multifocus tube,. and
compu terized digitized . Roentgengi l, see par. 4.4.1. page 152 is recommended.

Fig. 1/12 (par. 12.2.3.1.) Classic dia- - ----- --- . ---- . -~,

gnostics installa tion. TOILET TOILET TOILET : TOILET ;

DAAK ----- ---- , -------
-~ -- ~
Central dark room with automatic AOOM
processing unit and cassette transfer INDEPENDENT RADIO-
cabinet. DIAGNOSTIC TILTING STAATI- UAO- NEURO-
Two separate rooms. 000 for the Tilt- L-I GRAPHIC RADIO- RADI O-
ing Table and the other for the Bucky AOOM TABLE LOGY , LOGY
Tomographic table.
CENTAAL TABLE
,,,
Possibly other two or more rooms
for Urorediology, Neuroradiology. etc.
L ___ _____ ._______ _ _
CONTROL
,
_________ L_____ __ _
-

314 Gll.AIIOONI. RAOIOLOGY ELECTAOMEOICINE

12.2.3.2. Hospitals trom 50 to 500 beds The radiological departments should be placed in the
basement or on the ground floor for the following rea-
Equipment: (for references see tab. 2/12). sons:
N. 1 Universal remote controlled Digitized Computerized 1) remarkable equipment weights.
(UTDq (n. 1). 2) easily reacheable by the patients.
3) radiological protection, mostly for radiotherapy.
N. Traditional remote controlled (n . 2).
N. 2 or more if the beds are 500: Bucky Tables with
Chest stand (n. 5).
N. 1 if the beds are 500: Chest stand, store film type,
Chapter 12.3. - RADIOTHERAPY
with automatic developing (n. 4) .
N. 1 Mammography. 12.3.1. Fundamental equipment and orientative guide-line
selection.
Installation: as shown in fig. 2/12.
Table 2112 page 105 and par. 10.4.1. page 298 give these
data.

12.2.3.3. Hospitals over 500 beds 12.3.2. Installation examples

Equipment: About twice of those indicated in the pre- It Is illustrated in fig. 3/12.
Vt OUS paragraph.

Installation: A suitable type of Installation Is the follow-

ing one: the reception is at the entry of a large room,
in the middle of which are placed about 20/25 dressing
boxes.
After having received the key, the patient goes in the
box, undresses and waits to be called and taken to the
examination room.
After the examination, he goes back to the box, dresses
and reaches the reception where he will receive further
instructions.
The examination rooms are always lined up on large
corridors, as shown in figs. 1112 and 2112.
The dark room should be placed about at the centre of
the department.
Chapter 12.4. - GENERAL SUGGESTtONS FOR
THE PLANNING OF X-RAY DE-
PARTMENTS
Location: if possible, basement or ground floor, due to
equipment weight and for protection from radiations.
Electric power: three-phase, 25-50 kW for private radio-
logist and small hospitals, 50-100 kW for large hospitals.
Airing: efficient, beller if with air conditioning.
Every hospital and every radiological department have
their own problems that require their own particular so-
lutions.

L ..~. I w c. D ~~ ,.c ' L ~'P wc ~ c ~

I~
" ~ wCo, ~ CI. we
--fJ: .- -,

p~
rh
LfI
$ -r~8 ~ ..-


c. o.

..
@
-
1...................

-10
*.: !J-/ . --
J ,
\,' \
.\.I

I-;:-J r;:-- I-s~.~l i I So I @i F$-; ..

'
I.. 1 i e~
~. ~
i,
I.- -
". i 1.:: lo.

Fig. 2/12 (par. 12.2.3.2.) EIIBmp/6 of Radiodiagnostics department.

: Telecontrolled d iagnostics with lilting II TV table. 1$: Tilting table. 0: Oark room with developer lank. passer tank, automatic
processing unit, drier, dry bench, cassette tmnsler cabinet and electric air exhauster. 0: Control box with control desks to supply B,
E, F, G Diagnostics rooms. ~: Bucky tomograph ic Table with Teleradiograph. $: Ur0l"8dlology. (J): Neuroradiology.

Fig. 3/12 (par. 12.3.2.) . Elfample 01 8

Fisio-radiorharapic Section.
,i ..
: PhVlllotherapy (8 boxes). ill: The-
rapy 250 'V. 0, Central Control
.:. ,
@ @ '" 1(;:"
~
room . C : Plesiotherapy- Dermotherapy.
I
l.=.'
: Deep-therapy: 400-500 kV equi-
pment with Incorporated centering sl -
mutator. Sp) dressing rooms.

I
.. ;l Es ,\,,\,J I

.
,::...
.. ,
- "
i i i

GIL.o\flOONI . RAOIC)lOOV ElECTROMEOtClNE 315

 PART 13

INDUSTRIAL RADIOLOGY
AND NON DESTRUCTIVE TESTING (NOT)
 PART 13
INDUSTRIAL RADIOLOGY AND
NON DESTRUCTIVE TESTING (NOT)
(For further information, refer to: Gilardoni NDT, Hand-
book, English edition, 240 pages, 403 fi gures, 70 tables;
publisher Gi lardonl Raggi X, Mandella Lario, Italy).
Chaple, 13.1. - RADIOGRAPHIC TESTING (RT)
13.1.1. RT utilization examples In Industry
The figures from n. 1/ 13 to 5/13 show the practical utili-
zations of RT.
Fig. 1/13 (par. 13.:. 1.) - Radiograph of a turb/nfl shell (Gi/ar-
doni;
On the left, the control panel IOf the r&gulatlon 01 radiologi-
cal parameters. On the right, placed Inside the turbine shell,
the rad iation monobloc generator.
Fig. 2113 (par. /3.1.1.) - Panoramic radiOgraph of e circum-
ferential welding on a large diameter tube (Gi/ardoni)
The X-ray monobloc source is equipped with a lIat anode
tube able to emit a circular beam 01 radiation (360"). The
monobloc Is placed on the center of the tube by an oleody-
namlc lift whilst the fil ms, in th eir dull paper envelops, are
fixed to the external wel ding with permanent magnets, so
that it is possible to take the whole circumferential welding
with a single exposure.
GItAROONI. RAOIOI..OOY - ElECTFIOMEOICINE
Fig. 3/13 (par. 13.1.1.) - RadiOgraph of an aeroplane wing.
Here, radiographic testing is made with the X-ray unit placed
on a stand, and the integrity of such an Important element
for fli ght safety can be determined.
Fig. 4/13 (psr. 13. 1.1.) - Gammagrsphy Wl/h radioactive iso-
lope (Gllardon/)
The Ilgure shows: the source cootalner (45 curle Cobalt),
shielded according to ICRP recommendations, the flexible
tube lor the source positioning: the radiographic film row.
Once the guide tube Is positioned, by remote control. the
gammagraphlc source is translorred from the container to
the Irradiation point through the guide tube (up to 25 m. in
length) (see fig. 25/13 page 322) .
F/g. 5/13 (psr. 13.1.1.) - Equipment for rhe fluoroscopic II- TV
testing of light elloy car wheel's (Gilerdon/).
On the background. the lead shielded cabin where the
wheels are introduced.
On the left side of the cabin, the fluoroscopic Image Intansi-
lier.
On the right, the telecontrol unit with TV monitor.
The Introduction and extraction of the wheels in the lead
shielded cabin takes place according to a continuous cycle
controlling automatically all parameters, such as the penetra-
tion onergy selection in function of the examined thickness.
The operator, who observes the fluoroscopic Images on the
monitor, decides the pre-admissibility (see lig. 38113 page
325).
317
13.1.2. G llardoni graphs and ru le fo r rad iographic expo-
sure based on film d ose

Fig. 6113 shows the exposure graphs and fig. 7/ 13 the

exposure rule for steel (Fe) . Other similar exposure
graphs and rules have been prepared for Aluminium
and other metals.

FO in mr
(w.lh I'tJ ..... n t l
::E GEVAERT
6 40
04
300
-
160
07
GILARDONI GRAPHS Fe.
=
~
D U PONT NOT 55 NOT 65
T
NOT 7C
KODAK M
4m' 3m' 4m' 3mA 4m' 3m' DU " \mr/min 1o . lmA at70e m )

I >'"
,.
:l30" 320' 1"20" 140' 30
Fe. mm 10 20 30
,
40 50
,. ,. . ..,. 120
-
fJ ,n I I 1

,. ,. ,. 1* 11)- 60
f--1e

"
'0 '0 10 -
j j
-
pro ". OJ ". ,. ,. 6
r
~ 70
w
:;;
r- ". ". '0
". ".
OJ 4
3
- . - -
- ~

.
- -
-
0-
" ".33
20 2
80
w

"'"
0'"
.0 52 1 - - ~ t V- ~ -, /y
--
90

~
,- '-l -
- 100
'"w -
'Ii -
- I --
~

- - .. --
'*"
- t1
-~~ ,-[-f1 --,r/tl: r}J
'h
'f '-;rj 1-
0'
KV p 100 150 200 250 3 00 350 400

Fig. 6/ 13 (par. 13. 1.2.) Gilardonl Graphs 101 radiography on Sfeel (Fe).
The curves afe sper1mentally detennined and are the base for a correct exposure.
They approximately e)(pross the relation: mRlmln ::: K . mA . kY'f D2.
The table besides the curves gives the exposure time for different types of lilm lor 3 and 4 mA selfrectlfylng equipment and for a
locus film distance of 70 em.
With 6 mA instead of 3 mA exposure time shall be halved, while with 12 mA instead 01 4 rnA exposure lime shall be reduced
to 1/3.
For a focus-film distance 01 50 em exposure time Shall be halved, while for a focus-111m distance of 100 cm exposure time shall
be doubled.

318 GII..AROONI. RADtOLOGY - ELEC TROMEOICINE

 17 20

Fig. 7/ 13 (par. 13. 1.2.) Gilarcfonl Xradiographic fJ)(posure rule (01 s/eel (Fe).
The rule is derived from Gllardonl Graphs Fe and is widely used.
It is composed 01 three concentric rotating disk:
Ihe Ilrsl, UPPtlf lransparent one with scales 131 lor kV and () fOi el(p05ure time;
the second, middle transparent one with an appendix with scales <21 lor density and () for Fe thickness;
the third, bonom largest diameter one with scales (J) lor film speed and ~ lor focus-film distance.

DIRECTI ON FOR USE:

1) Set the requ ired density value (scale 2) according to the type 01 film used (scale 1).
07 04 : AGFA GEVAERT
Film type:
1 AA TM : KODAK
NDT70 NDT65 NDT55 : DU PONT.
2) Move kV curve (scale 4) to correspon d to the thickness of piece to be radiographed (scale 3).
3) Read In co rrespondence of focus-film distance (scale 5) min. rnA val ue required (scale 6).
Scale 6 give exposure time for equipment with 5 and 6 rnA; for equipment with 3 or 12 rnA double or halve the exposure
time given.

GlLARDON1. RADIOLOGY - ELECTAOMEDICI Ne 319

13.1.3. Equipment for X-ray and gamma ray radiography

The figures from 8/13 to 25/13 illustrate characteristics

and performances of some Gifardoni equipment. They
are taken from the above mentioned Gifardoni Hand-
book - NDT".

Fig. 8113 (par. 13.1.3.)

X-Gil.
70 kVp . 5 rnA . 2.0
mAlmin at 70 cm with
5mm Fe. 5 kg. 17)(
10 )( 8 cm.
Radiography and fluoro-
scopy of AI. lighl alloys,
pIastlcs, electronic instru-
Fig. 11{13 (par. 13. 1.3.) - MonogIl250/B.
ments, etc.
Lelt: ready lor radio- 250 kVp, 6 rnA, 7,5 rnA/min , a\ 70 cm with 50 mm Fe.
graph y. X-ray generator 49 kg, 54 )( 27 0 cm.
Below: in a case with ContrOl 28 kg. 44 )( 33 )( 18 em.
lis accessories. Radiography with Pb screens till 50 mm Fe.

Fig. 12/13 (par. 13.1.3.) - Monogll 300/6 D.

300 kVp. 6 rnA, 26 rnA/min. at 70 em with 50 mm Fe.
X-ray generator 57 kg, 102 )( 23 0 em.
Control 28 kg, 44 )( 33 )( 18 cm.
Radiography with Pb screen! till 60 mm Fe.

Fig. 9/13 (par. 13. 1.3.) - Radiolighl 8B.

5-80 kVp, 5 rnA, 6 mAlmln at 70 cm wilh 5 mm Fe, 19 kg,
28 )( 19 )( 12 cm.
Beryllium window tube.
Radiographs of very high contrast of AI, light alloys from 0.1
to 40 mm, plastics caoutchouc, electronic components, mI-
croradiography, etc.
Automatic stabilization of kV and rnA.

Fig. 13/ 13 (par. 13.1.3.) - Monogil 300/6 P.

Fig. 10113 ((l8r. 13.1.3.) - Minispot 16015.
160 kVp, 5 rnA, 6 rnA/min , at 70 cm with 25 mm Fa.
X-ray genarator 25 kg, 45 )( 26 I2l cm.
Control 28 kg, 44 )( 33 )( 18 cm.
Radiography with Pb screens till 20 mm Fe.
300 kVp, 6 rnA, 26 rnA/min. at 70 em with 50 mm Fe, 57 kg,
102)( 280 em.
Circumferential (360") and directional (50").
Control 28 kg, 44 )( 33 )( 18 em.
Classic lor circumferential radiography (360").

320 GllAROONl. FV.DIOI..OGY - ELECTROMEOICINE


Fig. 14/13 (par. 13. 1.3.) - Battegil-RoundiJC 200/0.1
Battery led equipment.
200 kVc, constant potential, 0.1 rnA, 10 rnA/min at 70 em
with 10 mm Fe. 14 kg. 98 II 12.5 0 em.
Battery 12 V. 35 Amp hour. Feed power 12 V. 4 Amp.
Speclalistie for substitution of trldlum gammagraphy.
Radiography with Pb semens 01 Fe tubes 0 130 mm. 10 mm
thickness in 7 sec: Fe tubes 200 mm 0 35 mm thickness in
10 min; Fe lubes 1000 mm 0. 10 mm ltIiekness in 6 min.
Fig. 15113 (par. 13. 1.3.) Mon09Il35O/6-12
350 kVe, 6 rnA, with 350 kV and 12 rnA with 250 kV.
76 mRlmin at 70 em with 50 mm Fe al 350 kV with 6 rnA.
X-ray generator 110 kg, 67 II 46 II 24 em.
Control 350 kg. 118 II 100 II 80 em.
Automatic stabillzallon 01 kV and rnA.
Radiography with Pb screens till 80 mm Fe.
Fig. 16113 (par. 13.1.3.) - rrimegagll C.P. 400110 (Constant
potential).
400 kVe, 10 rnA. with 600 mAlmin at 70 em with 50 mm Fe
and 14 mA/mln at 70 em with 100 mm Fe.
Head 130 kg, 75 II 52 II 27 cm.
Constant potential. three-phase, 12 pulses, two stage tube.
Control 380 kg. 118 II 100 II 60 em.
Automatic stabilization of kV and rnA.
Radiography with Pb screens till 100 mm Fe.
GIU\ROONI. RAD IOLOGV - ELEeTROMED ICINE
-
Fig. 17/13 (par. 13.1.3.) - CP-GIL 200/4-20 (Constant poten-
tia/ bifocus).
250 kVc, 4 and 20 rnA, 9.2 mA/mln. at 10 em with 50 mm
Fe. 225 kg. 78 II 63 II 61 em.
Control 380 kg, 118 II 100 II 80 em.
Bilocus: small locus lor enlargement technique: large locus
for normal technique.
Beryllium window tube. Automatic stabilization 01 kV and
mA.
Utilized In Scoplll TV unit (see lig. 20113 page 322).
Fig. 18113 (par. 13.1.3.) - Monogll 600/6.
800 kvp. 6 rnA. 700 rnA/min at 70 em with 50 mm Fe and
20 rnA/min. with 100 mm Fe. 350 kg. 102 II 55 II 35 em. two
stage tube.
Control 380 kg, 118 II 100 II 60 em.
Radiography with Pb screens lill 120 mm Fe.
Fig. 19113 (par, 13.1.3.) - Fluorogil Be.
Unit lor direct fluoroscopy and radiography, automatic stabi-
lization 01 kV and mA.
Equipped with Radiolight Be (see fig. 9/13).
Auoroscopy tilt 5 mm Fe and 50 mm AI.
321
 Fig. 20/13 (par. 13.1.3.) - ScOp/x.
Equipment for the Ituoroscplc testing of assembled and light
alloy parts with fluoroscopic screen (vision in total darkness).
It can be equipped with Image Intensll ier and TV monitor, as
the equipment lIIustratad in fig . 5/13 page 317).

Fig. 23/ 13 (par. 13.1.3.) - Llnac 8 MeV in operation.

High penetra tion generator lor radiographies 01 high thick-
ness weldlngs and castings.
With this equipment, betler Image quality and lower exposure
time In comparison with gammagraphy are reachad.

Fig. 21/13 (par. 13. 1.3.) - Scholagll. Teaching case for radia-
tion physics and technique with relating accessories
allowing many didactic axperlments.
X-ray generator 70 kV , ICRP pro tection , 25 kg,
31 x 33 )( 55 cm.
Fig. 24113 (par. 13.1.3.) - Gila/ron 5.
Gammagraphy equipment for 5 Curie Cesium source;
t6 kg; 12 )( 14 )( 15.5 cm.
Source translation: 5 meters.
Protection in depleted Uranium according to ICRP
recommendations.

Fig. 22/ 13 (par. 13.1.3.) - GI/betron 35 MeV during assem-

bling (GI/ardonl). Fig. 25113 (par. 13. 1.3.) - GI/alron 45.
1) Magnet core; 2) 3) magnetization coil; 4) 5) magnetic Powertul gammagraphy equipmen t protected lor 45 Curie
poles; 6) doughnut. Cobalt. Blsource (for example Cobalt and Cesium).
Left, condensors for electromagnet. Right, control unit during Weight: 250 kg. Telecontrollad transfer of source up to
assembling. 25 meters.
Weight 5500 kg; dimensions 90 x 95 )( 130 cm. Protection according to ICRP recommendations.

322 GllAAOONl. RADIOLOGV - ELEClMOMEDICINE

13.1.4. Examples of Radiographic Tel ling The most important applications of radiographic testing
are in the field of castings and weldings: every day
The figures from 26/13 to 42/1 3 show some industrial many kilometers of weldings are radiographed in the
radiographs. world.

EXAMPLES OF RAOIOGRAPHIC TESTING

Incomp le'e ly filled

lil'oove
, , Slo'1 in clU$ion
,I Hi 9"er :
,I Hi'1"~
:, :, '' E:'---'"'~""'-
'I
' --;
0"'li'1 , ' ', ----..;
,'-:,-Y- Lowe'
,.,
, I Lo..."
.., ,

T! 54 IlIEm
~l ~" ,;,j. . . .~:""I:\t\
.r II .. . ,1'1 , ,' " W. ' ~; , ','.hi.h n ,.. " .."" ,." " .,." ~:.,,,,riITI.,,t.If h.t, ~ ... "". " ,
",
Fig. 26113 (par. 13. 1.4. ) Slag Inclusions,
'" Fig. 29/13 (par. 13.1.4.) - Incomp/erely filled weld groove.
a) Schematic cross-section Of Incompletely filled groove
a) Schematic cross-secl lon through weld Inclusion (above) (above) and the resultant radiographic density (below):
and resultant )(-ray Image density (below): b) radiograph b) radiographic Image showing Incompletely filled weld
showi ng numerous small stag inclusions in bun weld. groove.

,7 ,, 7 SI09 linu
l, ::
"!
. ":
II'
,I Hill"" ""
,I Hill"" , ','--- --' 0.n1i11
' I Lo..... " r-----i
'-.:-V' CoMovil1 01 I",
:1Lo..... VJ1
,., ,., .~,

.1 1f __ All.. : .' F< n.I~; . T .k" I. ~ . Hoon, ",,,"ITO" " ~.,,., ;,,, . ,,, .lf 1t.'. :<. "1 .. ,,
,'>
(h)

Fig. 27/13 (par. 13. lo4.) Slag lines. Fig. 30/ 13 (par. 13. 1.4.) - Concavity af the rOOf 01 butt weld.
a) Schematic cross-section through slag lines (above) and a) Schematic cro5&-s&ctlon 01 concavity at the rOOI (above)
resultant x-ray Image density (below) : b) rad iographic and resultan t radiographic Image density (below): b) rad io-
Image of slag Inclusions between run s (slag lines). graph 01 weld with concavity at the root.

,
f :\,.../ i
!f -----c,-':""f-I-I- - - -; loe" of penetrotion
, II '

,t Hi9"" , "
I 11 '
,
Oenl1l1 \j)- ---'
; )Lo.....
"J
,.,

(h)
(h) 1'0';' .. ''',,"0 J, }! i" ~o, Holy.
Fig. 31/ 13 (par. 13. lo4.) Undercutting.
Fig, 28/13 (par. 13,104.) - Lack of pene/rar/on a/ weld root.
a) Schema tic c ross -section 01 weld with undercutti ng
a) Schematic crosssectlon through wel d (above) and (above) and resultant radiographic image densities (below):
resultant x-ray image density (below); b) rad iographic b) radiograph 01 weld with undercutting on both sides of
image of weld with lack of penetration at root. weld bead.

GlLARDONI. RADIOt.OGY ELECTf'lQMEOICINE 323

 Fig . 32/13 (par. 13.1.4.).
DISCONTINU ITY: porosity (0 ... 1 mm) and blowholes
(0) 1 mm).
DEFINITION: round Inclusions void or with gas.
RADIOGRAPHIC INDICATIONS: rounded and dark spots.
METALLURGICAL ORIGINS:
a) Oxyacetylene welding: lIame not properly adjusted,
carbon excess In metal base. unkilled steel, excessive
distance flame-to-piece, excess of acetylene.
b) Manual elec tric welding; 100 long arc, moisture in
welding room and in electrode.
c) Argon-arc welding: too long arc , lack of inen gas or
lack of purity of Inert gas.
d) Submerged arc welding: unlike, lack of protective flow.
Fig. 33/1 3 (par. 13. 1.4.).
DISCONTINUITY: wormholes. pipes.
DEFINITION; elongated gas Inclusions, single or scattered.
RADIOGRAPH tC INDICATIONS: elongated dark spots.
METALLURGICAL ORIGINS:
a) OlCyacetylene welding: unlike. poor operat ion technique.
b) Manual electric welding : typical discontinuities with
basic electrodes, moisture In welding room and in
electrodes, excess in welding current. poor electrode
quality.
c) Argon-arc weld ing: unlike.
d) Submerged af weld ing: unlike.
FIg. 34/1 3 (par. 13.1.4.).
DISCONTINUITY: tungsten inclusions.
DEFINITION: rounded or irregular tungsten inclusions.
RADIOGRAPHIC INDICATIONS: white spots wilh irregular
shapes and dimensions.
METALLURG ICAL ORIGINS:
a) Oxyacetylene welding.
b) Manual electric welding.
c) Argon-a rc welding tungsten electrode contact with
base metal In welding operation.
d) Submerged arc welding.
324
Fig. 35/13 (par. 13. 1.4.).
DISCONTINUITY: Ioogitudinal crack.
DEFINITION: longitudinal failure in lhe weld.
RADIOGRAPHIC INDICATIONS: irregular. filamentary dart.:
Ioogitudinal line.
METALLURGICAL ORIGINS:
a) Oxyacetylene welding: internal shrinkage, incorrect pre-
or post- healing In alloyed welded steels, faulty heat
treatments.
b) Manual electric welding: as above.
c) Argon-arc welding: as above.
d) Submerged arc welding: as above.
DISCONTINUITY: trans ...erse crack.
DEFINITION: transverse failure In the weld.
RADIOGRAPHIC INDICATIONS: Irregular, Iilamentary oark
transverse line.
METALLURGICAL ORIGINS;
al Oxyacetylene welding: Int&mal shrinkage, Incorrect pre-
or posl- heating In alloyes welded steels, faulty heat
treatment.
b) Manual electric welding: internal shrinkage, incorrect
pre- or post- heating In alloyed welded steels. faulty
heat treatment.
c) Argon-arc welding: Internal shrinkage, Incorrect pre- or
post- heating in alloyed welded steels, faulty heat
treatment.
dl Submerged arc welding: -.
Fig. 37113 (par. 13. 1.4.)'
DISCONTINUITY: spatters.
DEFINITION: small drops of melted metal on base metal
or on weld.
RADIOGRAPHIC INDICATIONS: rounded white spots.
METALLURGICAL ORIGINS:
a) Oxyacetylene weld ing: -.
b) Manual electric welding: excessl ... e cu rrent, reversed
polarity, wrong electrode.
b) Argon-arc weld ing: - .
b) Submerged arc welding: -.
GllAAOONI. RADIOt.OGY ELECTROMEDICINE
 Fig, 38/13 (par. 13,1.4.) - Fluoroscopic image of a car wheel
(see fig. 5/13 page 317).
In correspondence of the black arrows, many discontinuities
can be seen. which are determined by incorrect manufactur-
ing.

Fig. 39113 (par, 13, IA.) - Radiograph of a light alloy support.

Many wormhole discontinuities can be noted.
The remarkable thickness difference between the rims and
the central part does not allow the complete evaluation with
a single radiograph.
Fig. 41/13 (par. 13,1.4.) - Radiograph of an aeroplane ler-
engine.
The rad iographic testing allows the evaluation of th e engine
condi tions during the periodical Integrity Inspection.

Fig. 40/13 (par. 13.1A.) - Radiograph of an aeroplane wing

structure, Fig. 42/13 (par. 13.1.4.) - Radiograph of a fish.
Radiographic testing is essential for the control of the cor- The radiographic testing with a berillium window tUbe. allows
rect assembly and integrity of the various aircraft parts. to study fish growth in different environmental conditions.

G tlARDONt , RAO tOl.OGY - ELECTROMEO tC tNE 325

Chapter 13.2. - ULTRASOUND TESTING (UT)

13.2.1. Physics of Ultrasound (US)

In Part 5 page 181 the Ultrasound Physics has been

treated and there the reader can refer to.

13.2.2. UT utilization examples In Industry

The figures from 43/ 13 to 46/13 show some practical

utilizations of UT.

EXAMPLES OF ULTRASONIC TESTING

Fig. 45/ 13 (par. 13.2.2.) Ultrasonic f8/1S testing (Gi/erdon;).

The simultaneous inspection 01 both rails with 8 battery 0pe-
rated equipment: lour double straight and 81lgled probes.

Fig. 43/ 13 (par. 13.2.2.) - Ultrasonic tes ting made with the
universal ultrasoniC detector, Gllardonl RG 21.
The equipment, shown In fig. 47/13. is battery operated, has
a very large screen and alloW! laboratory, workshop and on
site testlngs.
In this specific case It Is utilized lor the testing of the large
forging nozzles used In nuclear lield.

Fig. 44113 (par. 13.2.2.) - Thickness gauge Gi/ardon; DG 35
(S88 fig. 49/13).
Control of Internal corrosion presence in a pipe-line with
thickness gauge, by means 01 II focalized double probe and
visualization on a digital display.
Fig. 46113 (psr, 13.2.2.) - Automatic inspection of pipes.
Automatic Inspection of longitud inal or spiral welded pipes.
The inspection is carried out by means of four X or K posi-
tioned probes for Ihe detection of discontinuities with longi-
tud inal or transverse orientation.

326 GILAROONI. RAOIOI..OGY - ELECTROMEDlCI ~E

13.2.3. Equipment for Ultrasound Testing (UT)

Figures from 47/ 13 to 51/ 13 illustrate characteristics and

performances 01 some Gilardoni equipment. They are
taken from the above mentioned Gilardoni Handbook
- NDT- .

Fig. 49/13 (par. 13.2.3) - DG 35 thickness gauge (Gi/ardonl).

The operation principle Is based on the pulse-echo method
with a T -R probe: the automatic gain control allows an high
reliability measure also with buttered surfaces.
The reading visualization Is obtained by Ihree luminous dis-
plays which read only with good coupling between probe
and specimen.
Possibility 01 readings memorization for later printing.
Fig. 47/13 (par. 13.2.3.) - RG 21 unit (Gl/ardOnl).
II is an universal portable ultrasonic detector with advanced
electronics, very large screen. wide band and tuned receiver,
last rise time transmitter, OAC circuit, selective attenuator of
bottom echo, automatic monitor suitable for analoglc record-
Ing and Immel'!lon testing, provided with echo start (this cir-
cuit allows to stop the monitor on test area while changing
speclment-probe distance).
For these advanced performances, the RG 21 unit can be
used for sophisticated Inspections and In the research field.
On the other hand, the battery supply allows in loco controls
with high assurance and reliability.
All Gllardonl Instruments are manufactured according to In--
tematlonal recommendations (ASME, 8$f, DGZfP) with certi-
fication .

Fig. SO!13 (par. /3.2.3.) - SME 500 - Automatic control

equipment (GI/ardoni).
This equipment allows the ultrasoniC testing of large quanti-
lies of pieces having a simple shape, such as tubes, bal'!,
blUets, etc.
The testing II fast and completely automatized with signal -
ling and marking of the faulty zones.

Fig. 48/ 13 (par. 13.2.3.) - MG 12 ponable unrasonic flaw de-
lector.
It Is a portable universal ultrasonic equipment ultralight and
compact wich resolves all the inspection problems on site.
The MG 12 has a wide band receiver whlth proportional re-
ject which maintains the vertical linearity, it has a continuous
adjustment of the transmission pulse.
Optional devices to enlarge the performance possibilllies are:
- automatic monitor with proportional and ON-Off output
- digital thickness gauge.
, ..
,," <"
~ .
Fig. 51/13 (par. 13.2.3.) - Spherometer system (Gl/ardonJ).
Uttrasonlc system for the determination of spheroidization
grade by evaluating the US velocity.
This device allows the automatic reject of specimens with
unsatisfactory spheroidization.
A suitable device connected with the probes set allows
to take into account the effective thickness 01 the material
under test.

GIVd'lOOJ,II. RADIOLOGY ELECTROMEDICINE 327

13.2.4. Ultrasonic Rule 13.2.5. Ultrasonic Probes

Fig. 52/13 shows the ultrasonic rule. It allows to evalua Fig. 53/ 13 shows some Gilardoni probes for industrial
te the three parameters: ultrasound beam travel, depth ultrasound testing .
and projection in function of the effective transmission In lab. 1/13 are listed the characteristics of the probes
angle. illustrated in fig. 53/13.

.-

UL.TRA B ON IC
..
RUL.E
Fig. 53/13 (par. 13.2.5.) - Some of the principal Gilardonl
probes.
On each probe is ir"ldicated: denomination Initials. crystal dia-
0, meter in mm . freQuency , refraction angle lor angled probes
and Identification number (see table 1/ 13).
@lnNII
, .. " Chapler 13.3. - MAGNETIC TESTING (MT)

" " " 13.3.1. Prlncl.,.e

Fig. 54/ 13 shows the principle.

Si nce 1932 A. Gitardoni introduced MT with magnetic
particles. Fig. 55/13 shows the first "Metalloscopio made
in 1932 by Gilardoni for MOTO GUZZI of Mandello
Lario.
Fig. 56/13 shows a manual perma nent magnet for MT
white fig . 57/13 shows the principle of longitudinal and
Fig. 52/ 13 (par, 13.2.4.) - Gilardoni ultrasonic rule. transversal magnetization with electric current for MT.
The rule Is made up 01 two circular disks: an opaque one
with the scale 1 0 1 the range values and the scale 4
lor the dB evaluation. and a movable transparent one with
the scales 2 and 3 lor path ar"ld distance evaluation.
Instruction manual:
, . Determination 01 ultmsonlc path p and distance d
Irom a known thickness s.
Bring reference index to correspond wi th thickness ,
value s. scale 1. and read pa th value p in
correspondence of probe angle {J on scale 2
and distance d on scale 3.
2. Determination 0 1 depth s' of a discontinuity and Its
distance d', with a known ultrasonic path p'.
Bring on scale 2 the index relevan t to probe
angle /J in correspondellCe 01 value p' ar"ld read on
scale t depth s' by means 01 reference index.
Keeping index still read in correspondence 01 probe
angle /J the distance d' value on scale 3 .
3. Determ ination of mtio h/h' of signal amplitude with a
known amplification difference tJ. dB. Fig. 54113 (par. 13.3. I.) . Magnetic field distofsion by cracks
- Read in correspondence of difference tJ. dB the In a magnetized steel piece.
amplitude ratio on scale 4 .
In correspor"ldence 01 the flaw, part of the magnetic flux
Example: Probe angle {J "" 70' flows outside the piece in the air.
ultrasonic path p' :: 55 mm. Spreading on the piece fine grain magnetic powder as
According to point 2 the results are: black ferromagnetic oxide (Fe30.). free or in liquid suspen-
5 :: 18 mm sion, magnetic particles are attrac ted by the dispersed fl ux
d' = 53 mm. in correspondence of the flaw, revealing it.

328 GIv.AOONI. RAOIOlOGV ElECTl'IClMEOICINE

 ,
TABLE 1/13 (par. 13.2.4.) - Initials and characteris-
tics of the 36 US probes shown in fig. 53113.

N. Initials ',po o (mm) MH,

, ON Stlll.ight N_' p,-

2 ON
"'" p""", '" 2

"'" Straight Normal

p""",
'" 2,
3 ON 301> Straight Normal
'" ,
Straight Nor""",1 p",,,
ON 301>
'"
, ON 30/0.' Straig ht ""'~,
"""" '" 0.' Fig. 55/ 13 (par. 13.3. I.) Metalloscoplo (Magnetoscope)
6 ON 30/0.25 Straight N_' Gllaldonl (1932).

, """" '", ,0.25 1) Magnetizing coil, 2) mobile magnetic yo ke between

OS W, Straight Normal p,- wh ich pieces lor inspection are placed. 3) brass container

8 OS W, Straig ht Normal Probe , , of magnetic Ink (power Fe30. in petroleum) that is

poured on the piece with a spoon, 4) socket for magnetic
coi l feed ing.
9 00 2015 "'. A Straig ht Double Probe crystal Incllnati1:ln 20 5 This primitive equipment. which allowed to solve very
"'. tor thickness between t5 + t OO mm Impo rtant problems. has boon remarkably Improved and
developed.
StllliOht OoIJble Probe cryetal Incllnatiof1 3
" DO 2Q13 "'. fI
"'. tor thickness betWe&ll 15 + 100 mm
20

ON 2Or.l Stlllight Normal p""", 20 3

" .,
ON 2Or.l Stllll"ht Normal p- 3
">3 ,,-
"
ON 2012

ON 2012

ON ,...
Straight -,
Stlllight Normat

StJllight N_ '
""'''
.,
.,
,
" ,
2

" ON ,... """"

p-
" ON
SIJlIiOht Normal

p,-
"
" '''' StJll,,,ht Normal

..... "
-
3

AN 90/2
" Angled Normal P,," ,U. 90" 2

" AN 90/2 Angled Normal Probe rltr. ..... .,. - 2

Fig. 58/13 (par. 13.3. I.) - Manual permanent magnel for MT
20 AN '~2 Angled Normal Probe rlfr. ..... '0' - 2 with adaplallon arms.

AN 6012 Angled Norma l p"" rltr. ang. OO' - 2

" p- - C<!I'
,
,,
AN Ang led Normal rlfr. an g. .~ 2
22
"" ..... -
23 AN 3SI2 Angled Norma l p"" rlfr. 35' 2

UniWlraal Probe Vir. angle 35 + -

" "" 90'

.,.
2

"
26
AM 9013

AM 9013
Miniature angl.

Miniature angl.
p""" rltr.
,,- rit . ..... ...
an"la -
-
3

27 AM 7013 Miniature an"l.

""''' ril ."," ",. - 3

28 AM <lOI3 Minlalure angl.

"""" m. .....
ril . ."," .,. - 3

29 AM Miniature angl. P""", .~ - 3

"" -
'" AM 3SI3 Miniature angl. P - .ilr. angle 35' 3

....' Probe fiI . angle 90' - ,

"
32 AS
AS 9015 Submlnial.

Submlnlat. Angl. Probe riff . angle 90' - , Fig. 57113 (par. 13.3.1.) - Longitudinal and transversal magne-

33 AS
'''''
,~,
Submlnilt. Angl. Probe rltr. angle 70' - S
tiza tion with aleclrlc current.
Above: high Intensity longitudinal magnetic field is obtai-
,. AS 60IS Submlni at. Angl. Probe - rll . angle 60' - , ned with numerous windings of the coil and relatively
small cu rrent.

3S AS ""S Submlnlat. Angl. Probe - rlfr . ang le 45" - , Below: high Intensity trensversal magnetic field (Circum-
ferential ) is obtained with slrong current flowing through
the rod .
36 AS 3SI> Submlnlat. An"l. Probe - riff. angie 35" - , Cracks parallel to magnetic force lines are not detectable.

GllARDONI . RAOIOLOGY - ELECTFIQMEOICINE 329

13.3.2. Magnetic particles test equipment

The figures from 58/ 13 to 61 / 13 show some equipment

for MT with their characteristic and performances.

Fig. 59/13 (par. 13.3.2.) - Sialimagil Gllerdon/.

It Is derived Irom previous equipment in I lg. 58/13, w ith the
addition of lunher automation devices.

Fig. 58/ 13 (psr. 13.3.2.) - Magnascop Gilardon/ 60,000 AT.

1) Axia l magnetic field with continuously adjustable ma-

g netic force up to 60,000 Amp turns alternate and
reclilied current.
2) Continuously adjustable 8)(ial current up to 10,000 Amp,
alternate and rectilied.
3) Automatic magnetization cyc le with electro-pneumatic
conlrol, lor: a) sp&Cimen locking, b) sp&Clmen rotation Fig. 60/ 13 (par. 13.3.2) - Magnascop Gilardon/ 10,000 for
plus spraying. c) longitudinal o r transversal magnet!-
longlludine/ end transversel magnatizet/on.
zal ion, d) Inspection during rOlation with locking
control. Continuous by adjustable current; alternate and rectified
4) Adjustable automatic demagnetization. current up to 10.000 Amp.
5) Dark-room for Wood light inspections. Demagnetization circuit, motor device fo r magnetic ink
8) Connecting possibility in automatic inSp&Ction lines. spraying, silicon high Intensity rectified up 10 10,000 Amp,
7) Supply 220 - 380 V. supply 220 - 280 - 380 V.

Fig. 61 /13 (par. 13.3.2.) - Magnascop Gilardon/ 3000 AR fOl longitudinal magnatizatiOn (detection of transversal defects) end Irans-
versal megnetizatiOn (detec/iOn of longitudinel defects).
Left: fronllli view.
Right: Back view with accessories.
Weight 35 kg. dimensions 18 x 27 x 48 cm, suppty 220-280-380 V, magnetizing current up to 3000 Amp.
Alternate and rectified current.
l oogiludlnat magnelizallon is made by wind ing some turns of high intensity cables around the specimen.

330 GI\.AROONI. RAOIOlOGY - ELECTROMEDICINE

13.3.3. Examples of MagneUc Testing utilization and
Inspection

The figures from 62/13 to 65/13 show some Magnetic

Testing inspection and utilization examples.

Fig. 64/13 (par. 13.3.3.) - Delects feWJal&d with magnfllic

Fig. 62/13 (par. 13.3.3.) - Magnetic testing 01 large castings.
With strong magnetic currents obtained with mobile equip-
ment It Is possible to have a good inspection lor superficial
or Internal delects.
InkS.
aJ Some ferromagnetic specimens belore magnetization;
b) Same specimens sprayed with magnetic ink during
magnetization. Machining and hardening defects are
revealed .

Fig. 63/ 13 (par. 13.3.3.) - Automatic equipment for the

inspec tion of shellt springs 01 railway vehicles (Gi/ardonl
production).

Axial Ilux up to 60,000 Amp turns, automatic pneumatic

positioning 01 the sheet spring independent 01 terminal
10ffll and specimen rotalion.
Motorized teiecontrolled displacing 01 the pole lor posi-
lioning 01 the sheel spring Irom zero to 280 cm.
Automatic dynamometric device to prevent dangerous
mechanical stress on the sheet spring terminal.
Automatic inspection cyc le lor specimen rotation, magne- Fig. 65/13 (par. 13.3.3.) Examples 01 Inspect/on with fluo-
ti c fluorescent ink spraying, electronically controlled rescent InkS and Wood light.
magnetization, Wood light Inspection, programmed demagne-
tization. Defects detected with Wood light and lIuorescent magnetic
Total length 4 m. inks by magnetization.

GlLAFtOONI. RADlOlOGV ElECTAOMEDIC!NE 331

Chapter 13.4. - PENETRANT TESTING (pn
13.4.1. Principle

FigS. 66/13 and 67/13 show the two principal methods

of Penetrant Testing.
This technique employs coloured dyestuffs to penetrate
surface cracks and flaws

,
leiS I ':1

Fig. 69/ 13 (par. 13.4.2.) - Woodgil, ultra-violet lamp for flaw

Fig. 66/ 13 (par, 13.4. 1.) - RfKi dye penalrsnt INling.
1) Oegreosing, 2) application and penetration of Ink,
3) removing of Ink surplus with kerosene or water and
drying, 4) developer application and inspection under
natural light.
detection with lluorescent dye penetrant.
Lamp and reactor with voltage stabilization from + 20'\10 to
- 5O'!Ii. This Is Important because when al the factory
furnaces and welding machines are working. If no stabi--
IIzation is provided, voltage drops may cause the black
out of the lamp, that requires some time to be re-operated.

aJ

~ W ood - I...(}
.0 lighl -0
r""". .........., I'"~"'""'I ......~
~---. ",.

Fig. 67/13 (par. 13.4. 1.} Selfwashing fluorescent p6r1f1lrant

lasting.

1) Oegreaslng: 2) appllcallon and penetration of sell-washing

penetrant; 3) removing 01 penetrant surplus with water and
drying; 4) ctevelOpef applicatloo and inspection with Wood
light.

b)

Fig. 68/13 (par. 13.4.2.) Pens/filar: equipment for penetrant Fig. 70/ 13 (par. 13.4.3.) - Defects revealed by red dye pene-
testing ( GUerdon! production). tran t.

It is composed of different containers, dryers, fan, Wood a) Cracks in a tungsten carbide tipped tool.
light cabin, etc., according to the needs Of penetrant b) Defects in a magnesium bar.
technique. c) Cracks in welded steel specimen.

332 GILAROONI. RAOIOlOGY - ElECTROMEDlCINE

13.4.2. Penetrant testing equipment 13.4.3. Examples of applications

The penetrant testing of large size pieces or of small Fig . 70113 shows the defects revealed by Penetrant
series of them is made without any equipment by Testing.
spraying directly on the piece itself.
For large series of pieces, testing is made with equip- Chapter 13.5. COMPARISON AND SELECTION
men! like that illustrated In fig. 68/13. OF NOT PROCESSES
Fig. 69/13 shows the ultra-violet lamp for flaw detection
with fluorescent dye penetrant. Tables 2/13 and 3/13 illustrate the topics.

TABLE 2/13 (chapter 13.5.) - Principal NDT methods and theIr applications.

p" P". ""hod Application.

, Radiography Intemal: holes, cold shuts. porosity, inclusions, voids, lack of fusion. lack of
penetration, shrinkBg8, corrosion pits, cracks, surface cracks, welded seams. Thickness
measurements.

, Fluoroscopy Same as radiography lor aluminium, light alloys. thin sections. assembles, organic
material plastics. etc.

, Ultrasound Internal: cracks, holes, voids. PinS, lamination delects. bursts. cold shuts, internal
lIakes, seams. inclusions, lack 0 fusion. lack of penetration.
Thickness measurements and metallurgical variations.

3 Magnetic particles Ma~nel iC materials only.

Su ace and subsurface cracks, seams, cold shutS. laps. flakes, lack of fusion. lack
01 penetrat ion. stress corrosion.

3 Eddy current Surface cracks. metallurgical variations, laps. seams. shrinkage crack s.

4 Penetrants Nonmagnetic malerlals: Surface cracks. shrinkage crac ks, cracks

grinding cracks, fatigue cracks, stress corrosion.
00' lears,

TABLE 3/13 (chapter 13.5.) - Principal defects detectable with NDT methods.

N. Material Detects NOT method

, Sheets and Thickness control Ultrasound. X and ray gauges.
pla tes
Ho",
, Tubes and Laps. seams
Radiography. lIuQfoscopy, ultrasound.
Magnetic particles. ultrasound. X-ray, peneeranes.
"'~ internal defects Radiography. ultrasound. Eddy curren\.
3 Castings Cold shuts Radi ography. fluoroscopy , magnetic particles.
Holes porosity Radiography. fluoroscopy . ultrasound.
Shrinkage UltraSOUnd. radiography.

I 4 Forgings Inclusions

"po
UltraSOUnd. radiography.
Magnetic particles. penetrants. radiography.
Internal flaske Ultrasound, magnetic particles, radiography.
Internal bursts Ultrasound. radiography. magnetic particles.
Cracks and tears Magnellc particles, ultrasound. rad iography.
5 Welds Slag inclusions Radiography, ultrasound, magnetic part icles.
Lack of fusion Radiography. ultrasound. magnellc particles.
Lack 01 penetration Radiography. ultrasound.
Porosity Radiography, ultrasound.

, Processing
Shrinkage cracks
Grinding cracks
Radiography, magnetic particles, penetrants. ultrasound.
Magnetic particles, penetrants.
Heat treat cracks Magnetic particles. Eddy current. penetrants.
7 Service Fatigue, heat cracks Magnetic particles, Eddy current, penetrants.
Stress corrosion Magnetic particles, penetrants.
Blistering Ultrasound. magnetic particles.
Thinning Ultrasound. radiography.
Corrosion pits Radiography, ultrasound penelrants.

GlLAAOONI. AADIOlOGY - ElECTROtIIEDlCINE 333

 PART 14

ARTISTICAL RADIOLOGY

. ...
: ~
,
,

" .

.. ~.
 PART 14
ARTISTICAL RADIOLOGY
(Further information on Gilardoni Handbook "X-RAYS IN
ART, English Edition, 232 pages, 262 figures; publisher
Gilardoni Raggi X, Mandella Lario, Italy).
Chapter 14.1. _ RADIOGRAPHY OF PIECES OF
ART
14.1.1. Foreword
Experience shOws that there are few pictures inspected
with X-rays which do not hold some surprise in store,
the most unpleasant being the discovery of a bad, not
to say disastrous, state of conservation or of an element
which invalidates the authenticity of the work.
By penetrating a panel, a canvas, the wood of a carving
or the porcelain of a vase the X-rays undergo a variable
degree of absorption, depending on their wavelength
and the density of the components of the Objects under
exami nation .
14.1.2. Films used In art radiography
They are the same as those used in industrial NOT.
Normally, no intensifying screens are used in art radiol-
ogy; film size is generally 30 x 40 cm; the average re-
qui red film density is 0.7-1 .0.
The most widely used films in art radiographic testing
are those requiring about 0.4 A for 0.7-1 density.
14.1.3. Blackening film dose, the basis of radiographic
exposure in art radiology
Radiog raph ic exposure is determined by four factors:
kV, mA, time and focus-film distance, in relation to the
X-ray transparence of the object.
Generally, a radiograph is taken by operating on these
fac tors and repeating the exposure when the results are
not good.
Unfortunately, faulty radiographs are rather frequent with
this exposure method, especially due to the difficulties
encountered in the evaluation of transparence of the
work s of art.
A very efficient system is the dosimetric method based
on the fact that, in practice. in a limited range of values
of radiation energy, film blackening or density is propor-
tional to the film dose.
The film dose is also the basis of film-badge protexi-
metric dosage.
Gilardoni successfully introduced the film-dose system
in NOT many years ago.
Gl lAROONI. RADIO LOGY - ELEcrnOMEDICINE
14.1.4. Art pieces of interest for radiography and relat-
ing investigation energy (kV)
They can be divide into four groups.
1) High transparence pieces requiring energy from 5 to
30 kV.
These are: stamps, paper money, prints, drawings,
acrylic and pastel paintings on cardboard, linen or
canvas support with thin preparatory layer (gesso)
etc.
The radiography of these objects requires generators
with beryllium window tube.
2) Medium transparence pieces requiring energy from 30
to 80 kV.
These are: paintings on wood support with thick pre-
paratory layer (gesso), wood sculptures, ceramics,
mummies, etc.
With 80 kV energy it is possible to take radiographs
up to a wood thickness of 40 em and more.
3) Low transparence pieces requiring energy from 80 to
250 kV.
These are: very thick wooden pieces, mummies in
heavy coffins, metal sculptures and other metal pie-
ces.
4) Very low transparence pieces requiring energy from
250 to 1000 kV.
These are: marble and metal sculptures or similar
thick pieces etc.
Chapter 14.2. - PAINTINGS: THE MOST IMPOR -
TANT WORKS OF ART FOR RA-
DIOLOGICAL INVESTIGATION
14.2.1. Painting components
These are:
1) the base or support, which may by either of linen or
canvas, wood, cardboard, copper etc.;
2) the preparatory layer, "gesso or calcium su lphate,
generally with binding agents or drying oils;
3) the paint layer, mixed colored pigments and binders,
generally lead carbonate or zinc oxide for white, iron
oxide for ochre and other mineral, earth colors etc.
The paint layer is the expression of the spirit of the
artist;
4) the protective layer consisting of a transparent film of
varnish.
14.2.2. X-ray absorption of painting components
Referring to the preceding paragraph, tables 1/14 and
2/14 give the related data.
X-ray absorption increases with atomic number and the
specific weight of the material.
335
 TABLE 1114 (par. 14.2.2.) - X-fay absorption of painting components. ( The radiographic image ;, also
determined by the concentration degree and the thickness of the pigments).

COw Medium High Very high

- lines. canvas. cardboa rd - thic k wood support - iron o~ ide - lead carbonate
support (base) (.2Q..60 mm) (ochre) (white)
- thin wood support - calcium carbonate - zinc o~ ide - lead-lin yellow
(up to 20 mm) (white)
- binding agents - calcium sulphate - other mineral pigments of - mercury sulphide
(drying oil etc.) (gesso) medium atomiC number aod (vermilion cinn abar)
medium weigh t
- animal and vegetable colors - lighl minerals colors - other cavy metal pigments
(organic colors)
- acrilyc pigments

TABLE 2/14 (par. 14.2.2.) - COlor. chemical composition, and X-ray absorption of some basic pigments.
Composite colors are obtained by mixing basic pigments.

N'~ Chemical co mposition X-rsy 8b60rption

""" Silver White Silver-lead caroonate hi h
Flake White Lead carbonate "v:e!Y. hi h
White Zinc While Zinc O)lide h' h
Chinese White Zinc O)lide high
LIme mortal wh ite Calcium carbonate medium
Chromo Yellow LeacI Chroma te very high
~Ig ht."aeep: orange)
Cadmium Yellow Cadmium sulphide high
ili~;tll. medium, deep, orangeJ
linc Yellow Zinc chromate ", h
Aurora Yellow Cadmium aulphlde high
Yellow Yellow Ochre (gold, tranaparent, tron txlde, alumina medium - high
M'
Orange
brown. alone ochre, ra w Siena,
burnt SlOfIa
Gom 0 Gom o resin or anic low
Naples Yellow Lead IIntomonickl very hi h
Masslcot Lead odde hi h
Mars Yellow Iron O)llde "
medium
Yellow Lake LB ~ ~ 0<) low
Read Lead Lead O)lide
" hihi hh
Vermilion-Cinnabar
Venetia Red
Mercu ~I
Iron odele
"'" "medium
Rod Carmine Lake Lacquer anic low
Rose, Brown, Purple Madder 0 anlc low
Rowand Burnt Umbra Iron O)lide-alumina medium - high
Florence Brown Co per c anlde hi h
Mara Brown Iron O)llde medium

B~o
Prusaian Brown "00
0 0<
al1lde medium
low
Bistro Or anlc low
Bitumen Or anlc low
Geruloan Blue Cobalt stannate hlg ~
CObalt Blue CObalt aluminate medium
BI~ Li ht Ultramarine $odIum sulphide medium
Prusslan Blue
Indigo
"00
Organic'"'"
medium - hi
low "
Cobal! - Violet Cobalt medium
Violet Mart Violet "'" Iron oxide medium - high
Mineral Violet Man anese hosphale medium
Medium Violet Manganese hosphate medium
Emerald Green COpper arwnate hi h
Green Chrome Green Chrome O)lide medium
Cobalt Green Zi nc. cobalt O)lide high
Green Lake 0 o. k>w
I~ Black CalciumJ)hOSphata aod organic medium
Iron Black Iron O)lide medium - hi h
Grey and Bleu Black Organic low
Black Carbon Black Or anic low
Carbon Black Organic low
AU colors Acrylic Organic low

336 GILAROONI, IVoDlOlOGY - El..ECmOME~CINE

14.2.3. Equipment characteristics required for paintings'
radiography
These are: possi bility of contrast control for better quali-
ty. device to calibrate the correct exposure, X-ray output
stabilization, indication of the radiograph resolvi ng pow-
er, easy transport, easy centering and easy collimation.
Transportability is an importanl requirement of equip-
ment for art radiology because galleries, museums, pri-
vate collectors, etc. are reluctant to have works of art
carried away for examination.
14.2.4. M-Gll, electronic instrument for optimal contrast
choice and correct exposure
M-GIL is substantially an X-ray intensimeter.
It consists of Ihree special X-ray pick-ups measu ring
through an electronic device wi lh a precisi on meter, the
radiat ion Intensity or oulpul in R/ min passing through
the dominant zones of exposed object.
Fig. 1/1 4 shows the instrument.
Fig. 1/ 14 (per. 14.2.4.) - M-G IL, contrss t and exposure merer.
Electronic Instrument to evaluate correct exposure and
optimal rad iographic contrast (3.5 kg). Consisting of three
special pick-ups detecting. through an electronic unit and
a precision instrument. radiation Intensity In R/min as
emerging from the piece to be raoiographed (radiological
tmnsparency).
The th ree pick-ups are positioned on the three most
intefesling zones (dominant zones) 01 the piece.
The instrument will measure the emerg ing radiation in-
tensities, tha i Is, the radiological transparency of each of
the three dominating zones separately and assess their
aV9fage value. in order to lind the correct exposure.
It atso makes il possible to choose the contrast value
required .
Exposure wilt be based on the film dose at a pre-esla-
bUshed density and all possible radiography lallure Is thus
eliminated.
14.2.5. Quick correct exposure evaluation with M-GIL:
no more faulty radiographs
M-G IL allows to quiCkly determine the correct exposure
parameters according to the opacity of the different
works of art thus saving time and films.
No more faulty radiograph s occur with M-GIL and
ART-G IL. Th is is one of the peculiar characteristics of
M-G IL, pract ically well confirmed.
G1LAAOONI. flAOIOlOGV E~ECTROMEDICINE
A correct exposure is essential when the necessary
equipment is not available for immediate processing of
film s.
With M-G IL and ART-G IL it is possible to make expo-
sures in loco and then take the fil ms to the Center for
processing. with the certainty that all the radiog raphs
will be of good quality.
46 perfect radiographs of painting were taken at the
Museo Poldi-Pezzoli in Milan in 2 hours without wasting
one film. Paintings were on canvas or wooden base
and, moreover, they had different pigment absorptions.
Simitarl y, several hundreds of radiographs were taken in
a short time at the Pinacoteca Ambrosiana in Milan , at
the Capodimonle Museum in Naples. at KunstHistorisches
Museum in Vienna. etc.
14.2,6. Gllardonl's exposure system. Constant factors:
film blackening dose, mA and distance. Variable
factors: kllovollage In relation to contrast choice
and exposure time In order to reach the pre-set
blackening dose
The title itself explains the system . This system allows a
correct exposu re and the best radiographic contrast to
be achieved .
14,2,7. ART-GIL extra-thin beryllium window tube, energy
5 to 80 kV, 5 rnA - Fundamental equipment tor
art radiology
ART-GIL is the basic equipmen t for art radiology allow-
ing optimal radiographs o f: stamps, paper money, paper
drawings, tapestry, acrylic, oil and tempera paintings on
linen and canvas support as well as on th ick wooden
support. ceramics, wood pieces up to 40 cm thickness.
mummies. etc.
Figs. 2/14 and 3/14 show the equipment.
Fig. 2114 (par. / 4.2.7.) - ART-GIL, Gilardoni equipment for
art radiofogy raady fO be carried.
1) M-GIL with protection cover (3.5 kg. 24 x 16 x 15 cm) .
2) Case containing feed cab lea (7 kg. 45 x 33 x 10 cm).
3) Case containing pick-ups. cables. Densogil instructions.
exposure tables. treatise _X_RAYS IN ART~, note paper.
etc, (3 kg. 36 x 24 x 6 em).
4) Case containing X-ray tank Unit (18 kg. 35 x 25 x 18 em) .
5) Control oox with cover (20 kg. 44 x 33 x 18 cm).
6) Bag con taining trestle (10 kg. 117 em long 15 em dia.).
337
 Fig. 3/14 (par. 14.2.7.) - ART-GIL Unit ready for use.
On the Iloor, under the trestle, is the X-ray generator and
beside it. the con trol box.
X-ray generator characteristics: 17 kg. 28.5 x 18.5 x 12.0 cm,
5 to 80 kV. 5 mAo extra thin beryllium window tube, wide
field.
Con tro l box characteristics: 20 kg, 44 x 33 x 18 cm, con tin-
uous tension adjustment over a 5 to 80 kV range from 1 to
5 mAo
Automatic kV and mA stabilisation.
Double scale exposure timer: for minutes and seconds.
Trestl e provided with two sliding bars to allow positioning of Fig. 5/ 14 (par. 14.3.) - Radiograph of a 0.2 mm thick parch-
small size paintings. ment.
Correct centering is obtained through an orthogonal view ing Written Side in direct contact with lilm: 30 cm focus to film
alignment of both the inCident and emergency central beam distance: 6 kV, 5 rnA, 3 min.
simu lators and by shifting the X- ray generator on the floor The image shows wri tten letters and parchment structure.
accordingly.
The emergency centering device consists 01 a light alumini-
um tube ring with needle.

Chapter 14.3. - SOME RADIOGRAPHS OF STAMPS,

MUMMIES, PAINTINGS, WITH RE-
LATIVE INTERPRETATIONS

They are ill ustrated in figs. from 4/14 to 16/14.

Fig. 4/14 (par. 14.3.) - Stamp radiographs taken with

ART-GIL (0.25 mm beryllium of inherent filtration).
10 kV, 5 mAo 50 cm d istance. D4 Gevaer! film (0.4 A dose
for 0.7 density). 1 minute exposure time. Exposure of the
unpacked IiIm in dark-room. Stamp fron t in d irect contact
with the film.
The radiographic image depends on the ink type. paper
structure, printing system etc.
Counterfeit stamps, bancknotes, cheques etc. give different
radiographic images than genuine ones, thus allowing to find
out fo rgeries.
Fig. 6/ 14 (par. 14.3.) - Mummy skull radiograph taken with
ART-GIL at the Museo Egizio in Turin.
Radiograph shows, besides bone structure, also earrings and
necklace made of rings presumably of gold.
For radiography of mummies and low transparence pieces
radiographic intensifying screens such as those in medical
radiology are recommended.

338 GllARDONI. RADIOI..OGY - ElECTROMEDICINE

 Radiograph 01 Madonna's hand. Some lingers are
broken . perhaps by Michelangelo himself during
sculpture wor1:.

Fig. 7/ 14 (par. 14.3.) - Plel~ - by Michelangelo.

Radiographic cassette positioning lor radiography for Radiographs were taken with gamma equipment
insurance purpose before sending the famous statue . Gllatron 4S. by G. Me Corney 01 Kod ak with the
to the Universal exposition of New Yor1: In 1964. collaboratloo 01 Tecnider.

Photograph Radiograph
Fig. 8/14 (par. 14.3.) - Raphael, MADONNA OF THE GRAND DUKE, 16fh century (Ga//aria Pa/alina, Palazzo Pi/fi, Florence).
The X-ray shows an alaborate background.
The Madonna is on the throne with surrounding architecture and an arch through which a landscape can be seen (not included in
this radiograph).
These part were covered by a dark layer. either because of changing taste or possibility for some retigious reason.
There may be a .pentimentoo In the execution of the Maddona's eyes, which may originally have been open.
Tha painting is typical of the 15th century and is without traces of brush strokes.
Radiography by Gilardoni-Mucchi.
(Art-Gil, M-GII: 38 kV, 5 mA, 1 min. 1 m. 0.4 R).

GllAAOONI. RAOIOlOOY - aECTROMEDlClNE 339

 Photograph Radiograph

Fig. 9/14 (par. 14.3.) ROMAN CHARITY, Gal/fJria degli Ullizl (s /ore), FlorenCfl.
The X-ray shows that the painting was done on a canvas which was painted In the 17th-18th century, representing an ~Adoration of
the Kings .
The lorger then applied the canvas on an old panel whose fiber and butterfly tolnts can be seen. and wrote on its back leonardo-.
Numerous woodworm tunll9ls IlIled with thick stucco.
By courtesy of ISlilUlO del Reslauro - FlortmCfl.

Photograph Radiograph

Fig. 10/ 14 (par. 14.3.) - TItian, PORTRAIT OF PIETRO ARETlNO, 161h Century (Galleria Pa/alina, Florence).
The X-ray shows two superimposed ponraits. That of the ponrait below is much richer.
The uniformity and the oenslty of the wh ite used for the lace without brush marh and with a very reduce(! anatomic emphasis are
characteristic of Ti tian's an as shown by X-ray.
As to the visible portrait. brush strokes are much less charged wi th color, as Is almost always the case in superimposed paintings.
The brush movement in the description of garments is similar in both ponralts.
Radiography by GilafdoniMucchi (23 kV, 10 mA, 1 min. I metsf, 0.4 R).

340 GllAROONI. RADiOlOGY - ELECnlOMEDICINE

 Photograph Radiograph

Fig. 11/14 (par. 14.3.) - Rambfandr. SELF-PORTRAIT. 77th century (StlJlHliche Kllnstsammlungen, Kassel).
The radiograph revea ls the head of a woman lying beneath the Rembrandt sell-portrait.
From "R(lnlgenbrlef - I I: Rembrandt Selbslbildnlsse 1m R6ntgenbild" - Du Ponl.

Photograph Radiograph

Fig. 12/14 (par. 14.3.) - GOYB, MAJAS ON THE BALCONY. 19th century (Museo del Prado, Madrid).
This is B painting by Goya underneath which the X-ray reveals a religious painting.
In both paintings there is a resemblance in lhe use 01 white and in lhe pictorial technique.
From "Medicamundi" - Vol. 18, 3, 1973.

GIlARDONI. RAOIOI.OGY _ ElEcmOMEDICINE 341

 ~T
. ',;/11.1'
'lV,

Photograph Radiograph

Fig. 13/14 (psr. 14.3.) - Picasso. GIRL WITH PIGEON. 20th century.
As the X-ray 01 this picture shows, even modern painters sometimes use already painted canvases. For th is work the master used
a canvas on wh ich a woman's portrait was painted. From the radiographic analysis the two paintings appear to be similarty executed
and to belong to the same period 01 activity of the artist.
From ~ The //Iustrated London News - Vol. 254, n. 6762, 1969.

Photograph Radiograph (de/ails)

Fig. 14/14 (par. 14.3.) - Leona/do da Vinci, THE ANNUNCIATION, 16th century (Galleria deg/i Uflizi, Florence).
The X-ray reveals a ~penti ment()o in the position of the Angel's head. The rad iograph ic aspects 01 the painting of the heads of the
Angel and the Virgin (radiograph on the left) are different.
Arou nd the head and the bust Of the Virgin a dark band can be seen: it could be an area of the panel left free for Verrocchlo by
Leonardo.
Very wide cracks due to overheating 01 the paint layer in the area of the Virg in'S hair.
Geometrical drawing 01 the architectural structures behind the Virgin; it was made with a lead pointer and use 01 the square.
By courtesy Of Istltulo del Res/auro - Florence.

342 GILAAOONI RAOIOLOGY - ELECTROM EOICINE

 Photograph RadiOgraph

Fig. 15/ 14 (par. ' .3.} TitIan. VANITY. 16th cen tury (Alte Pina/(oth6/(. Munich}.
The X-ray shows an important ~pentimento~: the head was straighter: the position 01 the bust was changed and the neckline re-
painted with different 9!Irmenta.
Besides the pentlmento- the use 01 con lused and lIal brush strokes on Ihe lace and the neckline, the locompleteness of the paint-
Ing 01 the right hand and the thin and very wh ite brush strokes of the shirt are Iypical 01 the master.
By courtesy 01 Alte Pmakothek - Munich.

Photograph Radiograph

Fig. 16/14 A (par. 14.3.} A. Pollaiolo, PORTRAIT OF A YOUNG WOMAN, 15th century (MusfJO PoldiPeuoli, Milan).
The X-ray shows the perfect sta te 01 conservation of the painting.
1\ outlines the pictorial characteristics which are also found in the Berlin and Florence portraits: the thin black line outlining the fig-
ure shows that the drawing was made with a pointer in the ground layer: the very th in bu t dense whi te brush strokes lor the hair:
the use of a very low density white for the flesh--color which appears darker than that of the hair; the application of a more dense
white strip along the profile of the lace and 01 the neck; th e minute brush strokes for the brocade.
Radiography by ' Mucchi.

GIt.AAOONJ. RADiOlOGY ELEcmO~EOICINE 343

 Photograph Radiograph

Fig. 16/14 B (par. 14.3.) A. PoI/alolo. PROFILE OF A WOMAN. 15th century (Slaatliche Kunstsasmmlungen. BerHn).
The X-ray ouUines ,he Clear correspondence 01 the ways 01 pain,ing applied in thiS portrait and in the one al Museo Poldi-Peuoli
showing details which cannot be seen by the naked eye. snd clearly supporting the recent change 01 attribution from Domenico
Veneziano to Potlaiolo.
By courtesy 01 Staa/liehe Kuns/sammlungen - Berlin.

Photograph Radiograph

Fig. 16/14 C (par. 14.3.) - A. Polla/olo. PORTRAIT OF AN UNKNOWN WOMAN. 15 /h century (Gal/erla dog/i Uffizi. Florence).
In this thi rd portrait the X-ray clearly shows the widespread wear of the paint.
n also confirms the change of attribution Irom Piero delta Francesca 10 Pollaiolo.
Although less evld9flt. because of the considerable wear of the paint, the techn ical characteristics resulting Irom the X-ray are very
SImilar to those of the two previous portraits.
ThIS unlorm paint wear is certainly due to previous cleaning operations: the restorer has redUced the strenght and the character 01
Itt.s portrait.
RadIOgraphy by Gllarda!iMucchi (36 kV, 10 mA, Imin, I mtlt6r, 0.4 R).

GlLARDON1. RADIOLOGY ELECTROMEOICINE

 PART 15

, . . .

' . .

HALF CENTURY EXPERIENCE

. ....
~

. -,'"

 PART 15
HALF CENTURY EXPERIENCE. PRACTICAL
SUGGESTIONS FOR RESEARCHERS,
DESIGNERS, ENGINEERS, TECHNICIANS
AND ALSO FOR AUTHORS
Chapter 15.1. - COMPUTER AGE. HUMAN BRAIN,
THE BEST COMPUTER
The XX century can be considered the computer age.
The human brain Is always the best computer and the
five senses are its pick-up
Chapter 15.2. - THE FIVE SENSES, PICK-UPS FOR
HUMAN BRAIN COMPUTER
Use lirst the precious instruments we have been pro-
vided with by Mother Nature, thai is, the five senses;
sight, touch, hearing, smell and taste.
15,2.1, Sight
Get accostumed to estimating dimensional values of pie-
ces.
Through a little practice in estimating sizes at sight and
checking with meter and caliper you can easily learn to
estimate dimensions from 1/10 mm to a meier or more,
with remarkable accuracy.
In checking materials, their characteristics, faults, etc.
use a battery operated torCh, black light (Woodgll), X-
rays (fluoroscopy) and for enlargement a simple small
commercial lens, 6-8 magnifying.
Temperature from 7000C up are fairly easy to assess by
observing the degree of incandescence; Just visible red
at 700>C, white at 15OO>C, dazzling white at about
2000'C.
15,2,2, Touch
Get accostumed to manually assessing weights, mechan-
ical strength (springs, etc.) by practising and then check-
ing on a scale.
Through practice, weights can also be easily estimated.
Temperature can be assessed by thouch of fingers; at
40" to 6O"C fingers can be kept in contact with solids;
at 6()0 to 8IJ'C they can be kept in contact only for a
few seconds; at 1{)()DC or more, solids tapped on with
saliva wetted fingers will cause saliva to evaporate by
" frying ~; at 200' to 300'C it is possible to smell burnt
air motes.
The sense of touch is also precious to check rough-
ness, ondulations, hunches, bucklings, working defects,
etc. on manufactured pieces.
15.2.3. Hearing
Sound and noises are precious signs in detecting faults,
characteristics, etc. Percussion sound may provide in-
formation in evaluating faults.
The man checking train-wheels with the hammer is
looking for possible faults in the wheels.
346
15.2.4. Smell
Smell can also be a fault detector, reveal technical fea-
tures, etc.
Overheated materials let out a peculiar smell.
In the electrotechnical jargon they can say "'here is a
smell of Ampere and in transformers "of burnt oil-
from -corona effect, discharge, bad contacts, etc.
Identification of organic matter of various kinds, like
plastic, insulating materials, etc. is carried out by bu m-
ing some small parts of it and smelling.
15.2.5, Ta ste
Detection and evaluation of the materials chemical pro-
perties can often be effected with one's tongue. For ex-
ample by wetting one's finger-tip in radiographic de~
opment and fixing solutions - and by touching it with
one's tongue it is possible to make a rough estimation
about the bath's effectiveness.
Whit this simple method, sometime, dar1!.-room problems
can be solved .
Obviously, as soon as these "organolectic,. tests are car-
ried out, it is necessary to spit and rinse one's mouth
thoroughly.
Chapter 15.3. - SUGGESTIONS FOR RESEAR CH,
DESIGN, PRODUCTION
1) These can be seen as plays for adults, similar to
those for children.
Researchers. designers, manufacturers must have
great enthusiasm and fantasy (like children), plea-
sure to create (like artists) and be modest (like
Saints).
2) Refine the spirit of observation, correlation and in-
formation (magazines, books, catalogues, etc.).
Refine sensitivity making good use of the five sen-
ses.
3) Simplicity. Mother Nature is Simple - men com pli-
cate it.
Simplicity solves the problem belter and more easi-
ly.
4) Remember that when a solution is found there are
always ten others, Simpler, more efficient, more ac-
curate and cheaper.
5) When you find a fault try to eliminate it instead of
making a radical changement otherwise you may in-
troduce ten other unknown faulis.
6) If a component brings about difficulties, try tirst to
eliminate it. In th is way sometimes the problem can
be solved.
A component taken away will not fail any more.
7) Equipment is not produced for your own factory.
Think about the utilization by the customer, easy
assembling, disassembling, packing, transport and re-
pairs.
8) Think also about the costs. Good designers and
good manufactures produce at low cost.
9) Take into account good performance before design.
A functional equipment is always well designed.
G1LAAOONI. RADIOlOGY - ELECTROMEOICIM::
10) When planning, make first a numbered list of the
goals you are aiming at.
11) When planning electric equipment think also to elec-
tronic solutions. Sometimes electronics solves the
problem better, easier and cheaply.
12) Plan with a good margin because a small unex-
pected fact or may cause a great damage.
13) A good researcher reaches his goals quickly with-
out getting around the problem with no conclusion.
Accuracy is not always necessary in the first tenta-
tive experiments. If necessary, improvement will
come afterwards.
14) Get used to plan on drafts in scale 1 1 or 1 : 10
for big pieces, on squared sheets of common note
books.
15) Short and conclsed reports, with clear writing and
order using numerical classifications.
16) When mak ing a researCh, experiment etc., it is a
good rule to have a dated table to write down fig -
ures, complete with object of the experiment, in-
struments used, constant parameters and pretraced
lines to define the space where to place the varia-
ble figures obtained during the experiment.
A good tabulation is fundamental for a good exper-
iment.
17) The same applies for graphs. A good laying down
of graphs, a correct choice of figures for abscissa
and ordinates scales etc. facilitate the experimenta-
tion.
18) Order and organization are the basis of modern
progress.
Order begins on one's desk, one's working table,
19) The cerebral order, that is, the custom to classify
with method knowledges, facts etc. is very impor-
tant.
20) Amending one'S faults. Life is a succession of er-
rors. Wisdom consists in correcting one's errors day
by day when they are stHl small and corrigible.
The obstinate man is dangerous for himself and the
others.
21) Memory has limits. thus needs to be helped with
written nOles. II is therefore useful to have a per-
sonal memory relief, that Is, a small pocket note-
book to write down ideas and engagements imme-
diately at every moment.
22) Memorandum for important meetings. Write memos
with numerical classifications and in three copies:
one for own use, one for the interlocutor and one
for the file,
With this system the discussion is facilitated.
23) Pre-written drafts. They are well accepted because
they save time and work .
Chapler 15.4. - GENERAL RECOMMENDATIONS
1) Avoid groups and talking to no purposes. This is
not olny a loss of your time bul also of the others
time.
Eliminate useless polemics.
2) If possible only one person for one job: two per-
sons or more for the same job do less and general-
ly worse than only one. They instinctively th ink that
the other one is responsible,
GllARDONI. RAOIOt.OGY - Et.ECTROMEOICINE
3) Face the problems with decision, do not postpone
them hoping that the solutions will come by them-
selves or someone else will solve them. Never put
off till tomorrow what can be done today ... it has
to be done anyhow.
4) The work done in advance is more productive and
less tiring Ihan that done at the last moment under
time consiraints and pressure. Working in advance
is a pleasure, working in delay is a trouble.
5) The beginning of a work is the most difficult mo-
ment. Therefore face it with decision. Once this
stumbling block has been overcome the work con-
tinues easily with satisfaction.
Remember that "well begun is half done,..
6) Inside and outside cri ticisms. Often we tend to cri-
ticize the other to value ourselves or to lay on oth-
er difficulties and fai lures as if we were fau ltless
and misunderstood.
Those ready to criticize the others and never them-
selves are generally worthless. Thus, instead of cri-
ticizing, if we can, it Is better to give advices, in-
structions and to correct them politely.
This in the best way to value ourselves,
7) Continuous complaint. Some people complain con-
tinuously about too much work, they pretend to be
worn out and depressed by work.
With this altitude they think to emphasize their ac-
tivity but they only obtain the opposite result.
The lazy person, even if only by words, is never
appreciated.
If one is really III he only has to say so and he
will have lull comprehension,
But, away with the -continuous complaint- that, by
the way, is not an in tell igent behaviour.
8) Some people, laced with a new responsibility or a
new jOb. raise lots of difficulties with the aim of
acquiring merits if the work is succesful or being
justified in case of failure.
This is trying to be clever and can be easily found
out.
9) Fluent talking and good dialectis are useless when
not followeed by facts.
Words alone are like soap bubbles.
Chapler 15.5. - SUCCESS AND LIFE SATISFAC-
TION FACTORS
Edison, one of the big constructors of modern times,
said: Success is produced by 20% - inspiration, that is,
by genius, and by 80% perspiration_, that is, by sweat-
ed work-,
By our own experience and extending the subject we
can figu re out: success and satisfaction (100%) = work
(80%) + good sense (10%) + culture (8%) + genius
(2%1.
Old sayings state -amor et labor omnia vinci!" and work
ennobles man.
Success, satisfaction, profits, welfare both individual and
collective come mainly from work rather than from ge-
nius or intelligence. And, even more, if genius is not
accompanied by " good sense and moral it can be very
dangerous as history teaches.
Good sense, common sense or equilibrium, as you
prefer, has to be placed, by our experience, before
culture.
347
It is better to have greater good sense" and less cu l-
ture- than viceversa.
If good sense is supported by "culture" and pleasure
for work you can consider yourself very lucky. Great
success can be achieved and great satisfactions enjo-
yed.
A 2% genius more or less is in everybody.
A lot of ideas. substantially expressions of genius, can
come from workers with "good sense" that have only
attended the primary schooL
Chapler 15.6. - PRACTICAL SUGGESTIONS. FOR
PUBBLICATIONS (BOOKS, MAGA-
ZINES, ETC.)
15.6.1. IntroducUon
These suggestions, together with other dispositions and
experiences, make the acting philosophy of Gilardoni
Press Office, who published hund reds of papers for
Congresses, magazines and many handbooks.
They are given in the next chapter.
Chapler 15.7. - SUGGESTIONS FOR AUTHORS
15.7.1. Inspiration
The idea-, together with the principal inspiration points,
must be written down at once, otherwise they may be
forgotten.
Collect the papers containing the ideas in a folder dat-
ing each of them.
15,7.2. Creattvlty
The most creative moments are those of apparent idle-
ness.
It is usefu l to have a list of the Ideas already deve-
lopped and of the papers already published : it repres-
ents a precious source of inspiration.
15.7.3. Documentation
Find the greatest amount of materials. such as papers,
catalogues, photographs dealing with the treated matter.
15.7.4. Start of a work
Prepare five note-books for text. figures, tables, biblio-
graphy and a rough copy to write the new ideas imme-
diately; they will be developed later.
15.7.5. Draft
Start with title and text, using the inspiration notes and
sketch a kind of rough index of the matters that will be
developed.
The beginning of the work is the most difficult moment.
Among the different ways to overcome this moment it
is suggested to refer to the preceding publications dea-
ling with similar matters and to the development of
technologies in the treated field.
348
Treat the subject simply and clearly with short periods.
Think of a numerical classification of the matters; organ-
ization is at the basis of the development of the work .
Make frequent references to figures, chapters and para-
graphs, always reporting the number of the page for an
easy finding.
Make a good and frequent use of figures with datailed
explanations and tables with examples, they draw the
reader's attention more than any other expedient.
Prepare a single sheet for each figure and table with
the relative footnotes; they will represent the lead ing
structure of the publication.
15.7.6. Figures
The footnotes of the figures must report title, numbered
indication of the principal elements of the figure, a short
functional mention, a text that explains the figure synthe-
tically and practical examples; the whole within thin
lines.
15.7.7, Tables
Title, notes and explanations must be put above and
the practical examples below the table, the whole cir-
cumscribed by thin lines.
15.7.8. Conclusions
An attractive, clear and comprehensible publication Is
characterized by a short title. a detailed index, fi gures
with wide footnotes and tables with practical examples.
A scientific-technical publication can have more numbers
than words.
The sheet format must be large (standard DI N A4) to
allow a wide vision 01 text and figures. without turning
pages too often.
Space the different paragraphs to relieve the pages and
make the text more attractive for the reader.
Remember that the reader of a scientiflctechnlcal publi
cation tooks first at the litle, at the index, at the figures
and afterwards reads and consults the text at the parts,
which more interest him.
Chapler 15.8. - COMPOSING ADVICES
Decide with the author of the publication the kind 01
print, format and type to be utilized, on this ground de-
fine the final dimensions of figures and tables.
State tiUe, summary, conclusions, etc.
Calculate the press space starting from the typed lines
of the rough draft.
Prepare three folders for the typescript: for the text, that
will include the bibliography, for the figures and for the
tables.
Each folder must be prepared in three copies, that have
to be corrected by the author and by two revisors.
Once the first prin ter's proof is ready, correct it care-
fully and start to prepare the final dummy on numbered
pages. .
Correct the second printer's proof with some collabora-
tors and afterwards, check and correct the final print
scrupolously.
Preserve cliches or photolitographs after a precise clas
sification for a possible reutilization .
GILARDONI. RAOIOt.OOV ELECffiOMEDICINE
 PART 16

TABLES OUT OF TEXT

 PART 16
TABLES OUT TEXT
ATLAS OF 18 TABLES OF PRACTICAL INTEREST

TABLE 1/16 (par. 16.1 .1.) - Fundamental PhYSical constants (B.N. Taylor, W.H. Parker, and D.N. Langenberg).
This table is reproduced with permIssion of the copyright owners from Rev. Mod. Phys. 41, 375 ( 1969). The
numbers in parentheses are the standard deviation uncertainties in the last digits o( the quoted value, com-
puted on the basis of internal consistency.
Error
Quantity Symbol Va lue (ppm, SI ,g,

Io~=
.~-=~'~:'C- ----------------------++--'-'"-; ';'":'=-i2~.-=-~"jI
~.

::.
;:

"m.
"_ux quantum, .,
(,' '("''''' Of.
~ , ,
"i::
",.,., N'

,
"''''g '00"'''.
""", - aIo.R.
.
R.
, ,'" g."

'"
'" m-
10- " m
' ''' ,m-
,,- ,m
~m" ~, " 10 " m '0-" =
~
~
. m'~" ",,"00. '" " ,0
,,!2. ",. ,,'-Hi:, "
"
" '''' 0' ",0 ",. .

6.2

G ~ ,,,...
, , o
to '" ( '" 1.537.tOO Iocu
0'
"
~ "iWKO,"~:".
5.6
= ( , A'
Note thai the uni fied atom ic mass IICII~ \2C 12 has been used . that amu atomic mass unit. C coulomb. G gauM. Hz. Mrtz
~ ..:' . Jjoule. K kelvin (oegree kelvin). T. 'A!~~ (10" G)~_V.~"" A~~:..and W watt. In cases where formulas lor constants are given
'''' .11. R, . the relation are wriUenas the product 01 two ,..... ""~ The secorl_d '_,V'., in is the expression to be used when al l quantiti"
I re ~ 1~_ ,cgs ..units~_,,:,~I~ ~~ electron charge in : units. The .f lr'l faClor, In brackets. is 10 be InclUO&d only il all quantit~ are ex-
pressed I I 51 uni~ We re;"iod . the~eaoer .~~8t with ~. . i ' 01 t~ !u=z ( ; are . and therefore the general law 01 error

350 GIv.ROONI. RAOIOt.OGY - aEcmoMEDIClI'IE

 TABLE 2/ 16 (par. 16.1.2.) - Trlgor/ome/ric data.

0 ,"0, 0
0 sin a Ian Q

40' 0.0 11 6 IS' 0.259 0.268

0.0 17 2()" 0.342 0.364
"
1"30' 0.026 30' 0.500 0.577
2' 0.035 35' 0.573 0.700
3' 0.05 2 45' 0 .70 7 ,
5' 0.087 6 ()" 0866 , 73
7' 0. 1226 7()" 0.940 2.75
' ()" 0. 175 60' 0.98 5 5.6 7

", 0.209 90' , -

cos f1 - sin (90 - 0)

TABLE 3/16 (par. 16.1.3.) . Periodic /able of the elements.

"
,. ~ .. '" M ,. "
,. " " " ,H, , 0 , 1>0\

~ . .: KI!Y 1"0 C lt " RT

,
,0-
,
U
.,
Ok
"'- ~~-,
$ "'1><>1 ~I
_ rn
",_", :t:..,~, . 11 . 1>'1
II II
.:
'~
0 ..... '''''' $< .....

_ , ....,,,,,.. ( .. ", ftl ~r. '"",

, .,., ,
H "' C ., N ..""'
0
, , 10 ,
F
I~J"1l11lO
N,
.,
",
' .01 1 .. ,. , ,,-
. . ..
'0 ., I: 0 11 " 006 1 I. 9'11-16 !(I 11.
t: I.
" ., " . . '''0'''.,,, " , ., "p " " ., "
~,, "Mg "
T,.",,,,,,,, ........ "" r ..""",,
" Si " .," S" .,, CI" .,'.,, M"
AI
14

. . , .
l) '
. . ., ... , .,, ., .,, ,. ,
l l . "~l l l ' lO, 1. Oh J1 00 JQOUI

., , , " , . .."'
n",!,r I l . ... " JO ' 7).1
" ,., ",. ., 30
1 I I 1 I 1 1_. 1 I. ' ! I
"
,
"".. , " . "...,,-
" " . " " "
..
" F, . Ni C, . Zo " " " " " , " "
. ., " ., .. . , " .. ., " " .. ... . .". .. , ". .,.". .,., " .,..." .., ..
Ti C, G, Ge S, B, K,
,' . .. .
K C. " V
" Mn " CO .J ,~ A.
.. <I, ,. ., . 0 0
M 10 ,
I -I I
~.M
-I ' I
.,
,,~

I 10 I
JO. ~1.

": ,. ,
'J - I
~
I} ! ,
,
1
!-I'll
' : ""
~ 1
~
I If I II :
t'lIl
I If J
ll,.
"
, . _1
" ,., h
I - II
N_
I .. 7
UN

, d ., , ., . ., I "

" " .., . ., . .,, ..., . .. 41

.,,
Rb S, Y Z, Nb Mo Tc R, Rh Pd Ag Cd I, Sn . Sb T, I X,
,
, " .. . . " .
" ~7. ' 1.91 "." '10" . , 11 n -.
.1 ,(1 1 _" .2-1 , l1li 'I00I1 ,0 . 01
, 10: <,(I' ~ ,01 1"- II I .., , 10 II
.. II I '1_11_ 1 -!' "I - I"
'2" ' I I
)j .ll 00 1!6'i1OO'

" " " .. " ."

II ... I' .. 6 . , . II_I "11_ -,
' lO

.
.. I I 1 2 oJ II. ,~
.. .. (I II M ~ (I

" , " " 74" "

, 1 !
T.
" " I
, .,
"" ..
~! S7' .J
" " " " .,
t~'<Ij'
.1
B, L, Hf
.. W Re
," , ,1 ""0' I _to.
,~ Os , - I, p, I\u J Hg ': TI Pb , . Bi Po At Ro

., . ....
1 "J."
: : ,:ll.
" I I
' JU'
II I 1
, )f.IIO)
II 2
17 1 . ~9
II 10_1 _Jl _"
' . ... 07.
l ! 12 ! II "
' ~l l l IVj iW
. J! ' j l ! ..
1....'<66)
II "
~
II II ~"
H_" tl_II ....
.'till
II " I
, :0<11
n it
' 110,
H_" l l _" _ N tl P
17 '04 tM
F,
. ., .,
" ,
illl i
R,
411. ,
II 1
" Ac .
um
1 -
n _.o 1
-

., . .. ., .. . .. .. ., .. , .. ..
11- ' - 1 0 '.

..... ........... "'''''.1: "

Cc P, Nd . l
60 I~I
Pm ,J Ir Sm .')1 Eu ". J Gd "Tb D, "'''Ho'lOJ E, Tm
'"Yb " 71
L,

... .. . ."k .. .. ., ..
~,

'" ... n .,

"P.. , " , nNp;;. Po ....."

.~.~ ' '' l~ I ' ~ )I .JO o III :, "I ' l l-! , .110 161 : 6 ' I>I.':W: U l (loO
:0-1- 2 -1 ' -' - 1 l~_ ~ ! ll i l : 0-1 : 2) I 1 II I !l 1 :. I : 1'< I 1 JO I 1 l' I I l!_1 l Jl v 1 _N 0 P

.,
Tb
. .. '"
OIl '00 10' ' OJ
U I\m" Cm Cf E. Fm Md No L,
.. ... ;" odco I' l"' l
l)1 (1oO'~ ,1""
3. I I a"l
I ll-On'l 11l.Oll IJI.OZ'J , 1" 1 , 101 , ,l~ ll ,11 11 , l l-! . , HJI
'._UI_2 - :0-9--1 1' I n _v!. :0-' I - ll-' - l l' 1 !lll II , I Z'J -I - l - JO-I 1 ll- ' - I _Jl _t 1 -O- ~ - Q

~ " "'b<" ,~ ,,""~'~'" ""'.. "~_.. of""", ... blt ... ~, .... 0(, ..., . ......"'

GltAROONI. RADIOlOGY - EUCTROMEDICINE 351

 TABLE 4/16 (par. 16.1.4.) - Commonly available radionuclides listed alphabetically,

I I i r , ..

I ,
I ,

"

~
~
I

I .)

~
~ III

~'
I
I
.
.
I

.... , )DR)

S: '" second. m - mlnul~; ~.:' hour. d "" day, y - year, O.A. daughter radiation .
i '. electrons (e' I ..'" listed If they ara prominenl in the alectron spectrum . Decay products may glvt! ri$8 to olher typeS of radiation. This
. Is l i t ~,Whare _ i ,by the nOlallon (O.A.).
Source: Half-llvea and radiDtion Dra taken from Tllfl Tflblfl of Isofopes. by C.M. Lederer. J.M. Hollandar. and I. Pflrlman (6th 00 .; NfIW Yoril: John
Wiley &. SOns. Inc .. 1967).

352 GILARI)ONI . RADIOLOGY - ElECTROMEOlClNE

 TABLE 5/ 16 (par. 16.1.5.) - Alpha emitters by increasing energy.

M.V Sou~ Half-life v; MoV Sou~ Half-life

~
~

_ . !ii;
-
,
,., , ,
.,,
,

--
~ _..
_
--=.j:
_.
~ _
_ .. :i
_
_ ..
___ ...
~ , _
_ ..
1-- .
I--
_
_ ..
I--
I-- , _
_ ..
_ .
.~
I--
I-- _ .
I-- _ .
_ . , ,
~
~
, _ .
_ .. ,
I--
r- . ,,
_
_ ..
r-
r-
. _
_ . ~
r- .
r- .
r-
r- -_
r-
r-
.
r-
r-
. . ..- -
r-
r-
r- ~ r-
r- M
r-
r- ~
r-
r-
r- M
I--
I--
r-
~ .
~ 1 1m '50
. Percentage of the lotal decay \!V8nl3.

Gl lARDONI. RADiOlOGY - ElECTR()t.lEOtCINE 353

 TABLE 6/16 (par. 16.1.6.) - Prefixes and Multipliers Table 8/16 (par. 16.1.8.) - Conversion from inches
for Metric System and SI to mm.
Symbol Mlliliplie. !>feli. Symbol ~ \Illlpll
P"h
lera T 10" centi , 10'
giga G 10- milll m 10
mega M ",. micro , 10
nano , lOe
kilo
hecta
k
h ""
10' pico P 10. 12
deka d. 10 lemla 1 ler l5
deci d 10.1 aUo 10. 1'

TABLE 7/16 (par. 16.1.7.) Factors for conversion

to Sf Units.
,,
TABLE 9/ 16 (par. 16.1.9.) - Peak voltage (kVp)
in re/atlon with spark-gap distance.

,, .,,
1

3S4 GllAROONl. RADIOt.OGY ElECTROMEDlCINE

 TABLE 10/16 (par. 16.1 .10.) - Fundamental and de- TABLE 11/16 (par. 16.1.11.) - Temperature energy,
rived units of MKS System. power conversion graphs.

Qy~ntU1 Unit 5 5
Olm e n,ion , I, - I. - (I'_ J')
4 9
Denomina ti on ,~~ De nomination S1 m bol kW - 1.36PS
4 4 PS - 0.735 kW
leng th I I meter m I. - I, - (t'- n )
5 9 kWh - 860 kcal
time I I second ,., 9 9 kcal - 0.001163 kWh
5 t c~ n - 4
I, - (t Rq, )
energy W ml~lt~ joule J
u
, ,
'"c power P
,
m1 2/P watt W
". , - w
".
,.
.~
". ..
~ ,,
~_ ; '1.0
'"E velocity III meter/sec mfsec

,. w "E- ". ,.
,
o
. -r "
--;:
, ..
acceleration , lIt2 meler/sec l m/sec' .. .~

0
:E- * .+


force f milt' newton Nw

-...
- ,: -


,,-
+.f
,
w

, ,.

"
~
"
0
~

--;:
,

'.

:::: . .....,,- -
~ .w

- ---:::::: -.-- ,-. "-. It

,
mass m m kilogram kg ' ,
'W
.w
'-
resistence R R ohm 0
~
I~
w ,-
conductance G 1/R siemens S
-

, -
-

.. -
,. - ;E- - .. , -
current
~ ~ w '
Intensity I {lm 2/A!3) '" ampere A .
"
"""

tension aM
e.m.1.

el. quality
V;E

and diel. flux 0;1.11

RI volt V '.

,

, ,

'.

H

- - ,::::
'~ .
- ),'
~- ~

It coulomb C

capacity C (O/V) tfA F

..
farad

u tension
'0 Impulse U (Vt) All volt. sec. Vsec

..
;;
inductanc e

current
L (UII) Rt henry H TABLE 12/16 (par. 16.1.12.) - Maximum, effective,
medium values of a sinusoidal quantity.
density S 1/12 amperelm J Ai m'
Maximum Value -
change Effective Value x 1.41 - Medium Value x 1.57
density c;D (0/1 2) 11m coulomb/m' elm'
Effective Value -
electric force K (VII) AlII voller/meter Vim Maximum Value x 0.71 - Medium Value x 1.1 1

resistivity (K/8) AI ohm meter Om Medium Value -

P Maximum Value x 0.64 - Effective Value )( 0.90
conducibility V (8/K) l/RI siemens/m Sim
n I
157- - - - -
dielectric . 2 0.64
constant , (DIK) lilA faradlm F/m

permeance A (L/lurn2) Rtfsp' henry/lurn 2

1.41 -.f"'[ - 0.~1 (amplitude factor)
H

magnetic n 1
flux
(Ulturn) Alt/sp weber Wb 1.11 - -2 n - 0.9 (form factor)
..
.!!
c
magneto
motive force M (l/I\) I . turn amper turn A,p 2 1
0.64 - - - - -
~u magnetic
" 1.57

E induction B (lIP) RII/I' turn weberlm 2 Wblm 2

0.71 - n - 1.41
1

magnetic
force H (MIl) I . turn II amp. tum/m Asplm
2~ I
0.90-------
magnetic
constant , (BIH) Rtll Sp2 henry/m Him
n 1.11

GILARDONI. RADIOLOGY ElECfflOMEOICINE 355

 TABLE 13/16 (par. 16.1.13.) - Electric field intensify (k. Vl cm) for various electrode shapes and distances.

Example Mall. Field Intensity E _ kY for Voltage U - kV

om
Eu m plll
" EllclrOdu Formul .

u - 100 kV, d - 2 cm
U
Two parallel planes E -- E_ 100 _ 50 kVfcm
d
2

2
Two concentric r~d U - 150 kV, r - 3 cm, R - 5 cm

150 5

R~
spheres E - --' - - 125 kYfcm
2 3

3 Sphere and plane re d '. :~

U- 200kV, r- 5cm,d -Bcm

E- 200 . 5+B ' ~ -585kYfcm

8 5 10 .
" . : :.
, , U - 200 kY, r - 5 cm, d - 12 c m
4 Two spheres r~
\ ..J ,: - V
U
E- -
d
r+'hd
I
9
'--
'"
200 5+ , - 9 "
E - - - ' - - ' - - -33kVfcm
12 5 10
/,

U - 100 kV, r - 5 cm, R - 12 cm

Two concen tric
5
cylinders
E_ -:-::-,U'---", 100
2.3 r ig r E- 12 -23kYfcm
2.3 ' 51g , -

U - 200 kV, r - 5 cm, d - 10 cm

U
6 Cylinder and plane E-
2.3 r Ig
-.-
+d . ti:I E-
200
2.3 ' 51g
.-

10
- 32 7 kVfcm
.

U - ISO kV, r - 6 cm, d - 20 cm

Two parallel U 9
7 E - -,--"....,..", . - 75 g .
cylinders 2.3 r Ig r+;W 10 E- . - - - 11 .5 kVfcm
2.3 ' 610 10

U - 200 kY, r - 10 cm, d - 10 cm

Two crossed U 9
6 E- . 100 9
cylinders 2.3 r 10 r+:w ti:I E-
2.3 . 10 Ig ~
.-
10
- 22.3 kVfcm

U-loo kV, 0-10cm

Hemisphere E- 3U
and plane
d 300
E - - - - 30 kV/cm
10

u - 200 kV. d - 12 cm
E _ 2U
Hemicylinder
10 d 400
and plane E - - - - 33.3 kY/cm
12

U - 100 kY, r" - 4,r" - 1, d - 10 em

100
11 Two dielectric E- - - - IOkY/cm
10
4
E, - 10 . - - 40 kY/cm
1
U - 100 kY, r" - 4, r" - I, d - 10 em
100
'2 Two dielectric E - - - - 10 kY/cm
10
1
E, - 10 '"4 - 2.5 kV/cm

356 GILARDONI. RADIOt.OGY - ELECT1l0ME0ICINE

 TABLE 14/ 16 (par. 16.1.14.) ~ Electrical features of insulating materials.

Irel loss FaClor ResislI.ily

Male".1 (ai. - 1)
50 HI
", 10'
20"C
D'eleCI"C
.UenglM
Modulu. 01
eloslicil y 2O"C
Kglcm'
Wo rldng higMe,
Ihermic I,mil
50 Hz I MHz 0 om 'Vlm ~

Cellulose Acetate 3.5 --i- 7 150 +300 500 10" + 10" 20 + 30000 90
Cellulose Acetate Butyrat e
(TRIAFQL BN) 3.8-4 .1 70-110 240-260 10 '~ 125- 130 33000 120

d ried 2 + 2.5 25 + 40 200 + '00 10" 7+8 - -

Paper
oil impregna te 3+ 4 30 + 100 - 10' 55 + 100 - 90
Silicon Rubber (SllQPREN) 2.5-5 5-500 10' 3- 1 0' ~ 20-30 > 500 - 150
Mineral Wax 2.1 + 2.5 - 9 10' 20 + 30 - -
Polyvinil Chlo ride s (PYC) 3.4-6 120-1500 60- 1000 10')-10 16 30-50 10000 - 3000 80
Ace tal Resins (DELRIN) 3.7 - 4 10'5 20 15000 100
Vulcanized Rubber 3.5 + 5 - 50 + 150 10'. + 10 11 IS + 30 - 70
Mica 4 - - 10 ') 17 - -
Transformer Oil 2 + 2.5 + 10 1 + 10 10,3 + ' 10" 10 + 25 - 90
Paraffin 2.0 + 2.3 <2 < 2 10'1 + 10" 10 + 30 - -
Polyamide (UL TRAMI O) 3 .5-4 300-1000 230-270 1()6-1 0" 30 (secco) 13000-28000 80- 100

Polycarbonate (MAKROLO N) 3 7 11 0 10 16 -10 17 26- 27 21000 120

Polychlo ro trillu oroet hylene
(HOSTAFLON, KEL F) 2.5-3.3 150-350 100- 150 10 'T 25-300 5000 180

PolyethyleneS (LUPOLEN) 2.3 2- 4 2- 4 16 '& 40 2000- 11000 68-60

Polylsobutylene (OPPANOL) 23 4 2 > 10'5 20- 60 < 500 60

Acrylics (PLE XIGLAS) 3.5-4.5 500-600 150-300 10'& 35 30000 90
Polypropylenes
(HOSTALEN PPJ
2.3-2.5 - 5-6 10'1 75 10000- 33000 80- 90

Ply styrene 2.5 \.5:"2.5 1.5 - 2.5 10'T - 55 30000- 33000 80- 90

Polyt et ra II uoroet hylene

(TEFLON) 20 < 2 < 2 10' 7 ' 25 5000 250

Polyvinllcarborole (LUVIKAN) 3 6-10 6-10 10'61 50 35000 170

Porcelain 6 - 60 + 120 101 1 35 - -

Epoxy Resins 3.2-3.9 35-50 100-200 10'6- 10'1 120-145 35000-40000 8-120
(ARALDITE. LEKUTERM)

Phenolic Resins 5- 15 100-300 50- 700 1()9-10" 10- 40 60000-80000 120- 150

Polyes t er Resins (lEGUYAL ) 3-7 30-300 60-400 10 " -10 '5 25-45 30000-40000 120-140

Stea tite 6 - 3 -;- 20 1012 -;- 10' 3 30 -;- 45 - -

Polyethylene Terephthalale -
(HQSTAPHAN. MYLAR) 3.2 20 190 > 10'5160 40000 130

Impregn ating paints 3+4 65 + 200 300 + 400 - 10 --i- 15 - -

Glass 3.5--;.- 9 - 5--;.- 100 10 13 10 --;.- 40 - -

GILAADONI. RAOIOl.OGY ELECTROMWICINE 357

 TABLE 15/16 (par. 16. 1.15.) - Velocity of Sound (Compiled by Gordon E. Becker. Bell Telephone Laboratories).
The da ta for the Velocity of Sound in Various Materials were compiled 'rom a varie ty of sources. For more
extensive tables one is referred to the following books:
Al P Handbook: Smithsonian Tables.
Mason: Physicals Acoustics and the Properties of Solids (1958).
Chalmers and Quarrel: Physical Examination of Metals (1960 ).
Mason: Piezoelectric Crystals and their Application to Ultrasonics (1950) .
Bergmann: Der UltrBschall (H irzel, 1954).

S 'DS I Q 105
Density Y, Y. Y~ Vlliocity
Substar>ce Density - 6v/6t
a~~
mJ~ Substance Formula
""~
,,,,,~
""~
, .,
""~ 'C
,,,,,~

~ I"""'"
' .7
I ..,. ",",0 0."
""
.......
*- ..
1 <D
, " -
eoo.-. '"""""
eoo.-.
, "'..,
<7'"
50.0 ""
2270 3750 , ~, ~
"S ,." 832D
"'"
I Co.." '"' , ""
~
+ *'
.....-
I'~.

L'-' ""..,
.., ".
H.'
~
....
"" 100
*+ H'"
'''D
~'
~
~ ,
,
, ~
~
~
--ifi-

;~
.....
_

1--
, .... ~
""
7.85 I
* ".,

3000
.'"
~~
~
~
,"
.~
,- ~
~
~ -f.li-
.'"
""
=-

1 - ,<7 ...,,"" 7.' 51'" ""

37'" 5DOO GASE AND ' ' ' 0 IS

~C'
7." ::,::Z Velocity 6v/61

.. i=
Formula

I""
Substance
1 3>" , ""~ ""~'C

NH, O.m ."

,,, '''' 5D8O

"" T.--
S220 280D
Ie.""," CC >2,

~~
~I
Fused silica
G_ py~.
,.,

.... ~
'32

~
H'"
S"" 37"
*....
5760
3>70
C"""'M
I EI"'M ""'"
I ""'~
C,
CoHo
,.".
..
".

,%<~ ~
208

3D8

L~'"
Ny"" ...
, '.H "'"

=I
.070

~ ,,
..,co., ,,,'
"" H' 5."

i~
R, _ _

B,'"
"
.. ...
>." 1-
'" ,
~ ~

"".. ,. ~
38.0
~ ~
".,," .0.'
0 .."
.'" 37' 0."
ToII~

~ IA~'~ ",",0 239 0.32

Co""'" ~
I"", ",." "" ""'I' "'" ~
~
1- ""'" "" ,It. .

, , ~ ~
0.,.

: ","' ", III,,, ,

~~ ~=~ E:::;:
358
, w.~ '"._~" m""'"
wa.!e (~ar!..:~~~. wave) in thin rods.
"'"

GIl.AFUXlNI. RADIOlOGY - El.EemOMEDICINE

 TABLE 16/16 (par. 16.1.16.) - Properties of metals as conductors.

Resis tivity
mic rohm
Temp.
Speci fiC r"".He M oiling
Me lel ea eTlieie"1 s tre ngth. p Oint
c e~t ime t e r ' IIr.. lty .
, OOC ,<re Ibs/in . OC

TABLE 17/16 (par. 16.1.17.) Thermal properties of pure metals (From Handbook of Tables for Applied Engi-
neering Science by R.E. 80lz and G.L. Tuve, The Chemical Rubber CO).

ll te" t
Mit 01 SPlcllle Spec ific
fUl lon. he". hut.
c,llg cIllg"C eal/g"C Bolllnll poin t lempe,a tutu. "K

68

GlLAR DONI. RADIOI..OGY - EL ECTRDMEDtCt NE 359

 TABLE 18116 (par. 16.1. 18.) - Melting, Boiling Points and Atomic Weights of the elements. Based on the
assigned relative atomic mass of 12 C = 12.

The follo wing values apply to elements as t hey exist in materials of terrestrial origin and to certain art illeial elements. When
used with the footnotes. they are reliable to 1 in the last digit. or 3 if last digit is in small type.

I ,0.1.101. . , "C B.P. "C Neme At No. AI. 101. M.P. "C

..
SymbO At No.

I ""","m " ",'" I '"'' "" " "" ""

,
"" ,,
'" ""
" , ---iiii "" " "'"
I ,,"" " " , , ;ii I ",o m
...;:' " ", " ..
-'00."
," ", ."
"" ~

--, "" ""

I~ Cd .. ",., "" '" I ""m.m "". "
'" - - .",
a ."
"'"
" ", "",
"" ,

,,
,.... ,... ""
,
"."
"" i.i "" "
.,"'" .- ,- ,
", " "'."
,
" '" "
""
: '.m'.m
,,
"' "
,, '" "''''
,," ,
"" ,
"" ,, ,
"" ,""",," w

-
"'"
'8<l." ""
~ --iiii- "'" ,,"
- -.. ~ *-
I . ,""" "'" -"." ,... '" "" .,
Mononuc!ldlc.
" '" '00" " " '"
Ellmenl tor wlllcl'l UII" ..e Clutloned Iglln" 11'1, possl bll'ly ot Illge
b Element willi one pr,domln ant I,otopl ,Ibout 99 to 100 a bllndance). ."',tlonl In alomic wI,gl'll due \0 In.d .....,.nl or undi,clo.. d .1111k:11
Isolopie IIpll"lon In commercially .. a l!l bl, mltlriets.
C Elemenl lor which Il'Ie I lom lc weight II bUl d on ca llb,ued m"lI ure' Mo st commonl~ 1.,llabl, 10ngli.ed I,otope.
menll .
g In lome Olologlel' I Plcim e n, Il'Iil ,llmlnt 1'1 . . . I'Ilgl'lly Inomiioul
d EI,men t I", which .,lltion In Il otopic a bundenc I in t"rreslrial IImpln Iiolopic compolltlon. corrupono;llng to In Itomle " Iigl'll "'gnillelntly
limill Ille p'flcilion ollhe IIomlc w" lgh l gl.en. dme,"nt Irom thl' Ol"n.

360 GII..oO.RDONI. RAOIOLOGY ElECTAOMEDIC!NE

 PART 17

BIBLIOGRAPHY
 PART 17 ~No. 23
=:::'~ Man: Anatomical, Physiological and Me-
BIBLI OG RAP" =- Characteristics.

Chapler 17.1. - HA NOBOO~

" 1) ICAP Publication No. 24
Radiation Protection in Uranium and Other Mines.

The bibliography on "''''''''';!t IS vaSI

and it is suggested ~ Ee"'A,!rzed publi- 12) ICRP Publication No. 25
cations on the ma::I!r ~ OOOKShops. Handling and Disposal of Radioactive Materials in
Hospitals.

17.1.1. ~.-.~;.~..
;;., =--t m portant publications of In- 13) ICRP Publication No. 26
~ .........1Ii:sWon on radiological protection Recommendations of the ICRP.

Hereunder are listed the ICRP Publications as treating
about rules of fundamental international interest.
(Publications available from Pergamon Press - Oxford -
New York - Frankfurt) :
1) ICAP Publication NO.7
Principles of Environmental Monitoring Related to
the Handling of Radioactive Materials
2) ICAP Publication No. 10
Evaluation of Radiation Doses to BOdy Tissues from
Internal Contamination due to Occupational Expo-
sure.
14) ICAP Publication No. 27
Problems Involved in Developing an Index of Harm.
15) ICAP Publication No. 28
Principles and General Procedures for Handling
Emergency and Accidental Exposures of Workers.
16) ICAP Publication No. 29
Radionuclide Release into the Environment: Assess-
ment of Doses to Men.
17) ICRP Publication No. 30
Limits for Intakes of Radionuc/ides by Workers.

3) ICRP Publication No. 10a 18) ICAP Publication No. 31

The Assessment of Internal ContamInation Resulting Biological Effects of Inhaled Radionuclldes.
from Recurrent or Prolonged Uptakes.

19) ICAP Publication No. 32

4) ICRP Publicati on No. 14 Limits of Inhalation of Radon Daughters by Workers.
Radiosensitivity and Spatial Distribution of Dose.

20) ICRP Publication No. 33

5) ICAP PUblication No. 17 Protection Against Ionizing Radiation from External
Protection of the Patient in Radionuclide Investiga- Sources Used in Medicine.
tions.

21) ICAP Publication No. 34

6) ICAP Publication No. 18
Protection of the Patient in Diagnostic Radiology.
The ABE for High- LET Aadiations with Respect to
Mutagenesis.

22) ICAP Publication No. 35

7) ICAP Publication No. 19 General Principles of Monitoring for Radiation Pro-
The Metabolism of Compounds of Plutonium and tection of Workers.
Other Actinides.

23) ICAP Publication No. 36

8) ICAP Publication No. 20 Protection against Ionizing Radiation in the Teach-
Alkaline Earth Metabolism in Adult Man. ing of Science.

9) ICRP Publication No. 22 24) ICRP Publication No. 37

Implications of Commission Recommendations that Cost - Benefit Analysis in the Optimization of Radia-
Doses be kept as Low as Readily Achievable. tion Protection.

362 GILARDON I. RADIOLOGY _ ELEcrnOMEDICINE

Chapter 17.2. - MAGAZINES
U.S.A.:
1) American Journal o( Roentgenology
Official journal of the American Roentgen Ray So-
ciety. Published monthly by American, Roentgen Ray
Society, 428 E. Preston Street, Baltimore MD 21202.
2) Computerized Radiology
The International Journal of Radiological Diagnosis
using. : CT, NMR, PET, Dig ital Fluoroscopy, Compu-
ter Imaging. Published bimonthly by Robert S. Led-
ley, Georgetown University Medical Center, Washing-
ton, D.C.
3) Diagnostic Imaging
The Magazine of Rad iology, Nuclear and Ultrasound.
Published monthly by Miller Freeman Pubblications,
Inc., 500 Howard Strett, San Francisco, Californ ia
94105.
4) International Journal o( Nuclear Medicine and Biolo-
gy
The Official Organ of the American College of Nu-
clear Medicine. Published quarterly by Joseph Stern-
berg, The University of Montreal.
5) International Journal o ( Radiation, Oncology, Biolo-
gy, Phisics
Published monthly by Phillip Rubin , Cancer Center
& Radiation Research Center, University of Roches-
ter School of Medicine.
6) Magnetic Resonance Imaging
International Journal of basic Research & Clinical
Applications in Medicine. Published quarterly by Per-
gamon Press Inc., Maxwell House, Fairview Park,
Elmsford, New York 10523.
7) Radiology
Journal devoted to clinical Radiology ad allied Scien-
ces. Published monthly by The Radiological Society
of North America Inc., 20th Northampton SIS., East-
on, Pa. 18042.
B) Radiologic Technology
Journal of the American Society of Radiologic Tech-
nologists. Published bimonthly by The American So-
ciety of Radiologic Technologists, 55 E. Jackson
Blv., Suite 1820, Chicago, Ill inois 60604.
9) Ultrasonic Imaging
International Journal. Published quarterly by Aca-
demic Press. Inc., 111 Fifth Avenue, New York , N.Y.
10003.
Canada:
1) Journal of the Canadian Association of Radiologists
Organ of the Canadian Association of Rad iologists.
Published quarterly by Canadian Association of Ra-
diologists, Su ite 806, 1440 SI. , Catherine SI. W. Mon-
treal, Quebec H3G 1R8.
2) Ultrasound in Medicine & Biology
Official Journal of the World Federation for Ult ra-
sound in Medicine and Biology. Published bimonth-
ly by Denis N. White, 230 Alwington Place, King-
ston, Ontario K7L 4P8, Canada.
GllARDON I. RAD IOLOGY ELECTROMEDIC INE
United Kingdom:
1) The British Journal of Radiology
Official organ of the British Institute of Radiology.
Published monthly by The British Institute of Radio-
logy 36 Portland Place, London W 1N 3DG.
France:
1) Journal de Radiologie
Official organ of the Societe Francaise de Radiale-
gie Medicale. Published monthly by Masson Editeur,
120 bv. S1. Germain, 75280 Paris Cedex 06.
Germany:
1) European Journal of Radiology
Published quarterly by Georg Thieme Verlag. Rudi-
gerstrasse 14, Postfach 732, 7000 Stuttgart 30.
2) Fortschritte auf dem Gebiete der R6ntgenstrahlen
und Nucklearmedizin
Official organ of The Deutsche Rontgengesellschaft.
Published montlhy by Georg Thieme Verlag, Audi-
gerstrasse 14, Postfach 732, 7000 Stuttgart 1.
3) A6ntgen BIiHrer
Published month ly by Georg Thieme Verlag, Rudi-
gerstrasse 14, Postfach 732, 7000 Stuttgart 1.
4) R6ntgen Praxis
Organ of the Deutsche Aontgengesellschaft. Publi-
shed by Georg Thieme Verlag, Rudigerstrasse 14,
Postfach 732, 7000 Stuttgart 1.
5) Strahlentheraple
Organ of the: Deutsche Rontgengesellschaft; Gesell-
schaft fUr Lichtforschung; Oeutscher Zentralausschuss
fUr Krebsoekampfung und Krebsforschung. Published
by Urban & Schwarzenberger, Berlin .
Sweden:
1) Acta Radiologica
Official organ of The Societies of Medical Radiology
in Denmark, Finland , Norway and Sweden. Publi-
shed mounthly by Erik lindgren, Stockholm , Swe-
den.
Belgium:
1) Journal Beige de Radiologie
Organ of the La Societe Royale Beige de Radiolo-
gie. Published bimonthly by J. Pringot, Leopold III
laan 22, 3030 Heverlee.
Italy:
1) La Radiologla Medica
Official organ of Associazione Italiana di Rad iologia
Medica e Medicina Nucleare.
Published monthly by Minerva Medica, Corso Bramanle
83, 10126 Tori no.
2) /I Radiologo
Organ of Sindacato Nazionale Radiologi. Published
bimonthly by OMICRON , Passo Donaver 17, 16143
Genova.
363
Chapler 17.3. - SOME GILARDONI SCIENTIFIC 1959
TECHNICAL PAPERS
GlLAROONI - Researc::h Labor-nories
New universal dos imetric Equipment for ,adiologica/, pro-
(For other ones, oyer 500, ask for relevant list). tection and contamination measurements, etc.
Proceedings ",IX International Congress of Radiology" -
1935 Munchen - July 23-30. 1959.
GlLARDONI A. - GALLAVR ES I L
La sfumatura cine-geometriea nella radiografia po/mona- 196a
r. GI LARDONI - Research Laboratories
La Radiologia e Fisica Medica - 2, 489, 1935. Performance of Industrial X-ray Equipment and Standard
Exposure on the Basis of kV/mR Graphs.
1936 Nondestructive Testing.. - 7-8, 263, 1960.
GILARDONI A 1961
Del rendimento radiografico
La Radiologia Medica" - 23, 545, 1936. GILARDONI - Research Laboratories
Appareillage pour teleisotopotherapie bisource (Co 60 -
Cs 137).
1937 Proceedings V Congres des Medecins Electro-Radiolo-
GILARDONI A. - GALLAVAESI L. gistes del Cu lture Latine - Paris - July 24-29, 1961 .
Studio microfotometrico della sfumatura delle immagini
radiografiche determinate dagl; schermi di rinforzo. 1962
" La Radiologia Medica - 24, 1041. 1937. GILARDONI - Research Laboratories
A set of cobalt isodoses to fac/lifate treatments.
1939 X International Congress of Radiology" - Montreal
26 August-1 -September 1962.
GILARDONt A.
Generator; di lampl di Iuce Roentgen di un millesimo di GILARDONI - Research Laboratories
secondo per Regmografia e Seriografia . Automatic Radiography with PhOtotimer and Anatomic-
~ La Radiologia Med ica - 26, 51, 1939. Thicknees Technique.
X International Congress of Radiology" - Montreal -
1940 26 August-l -September 1962.

G ILARDON I A. GILARDONI - Research Laboratories

La radiografia a/ milionesimo di secondo
"La Radiologia Medica - 27, 944, 1940.
1943
GILAADONI A.
Regmographle und Mllligraphie
Fortschrltte auf dem Gebiete der Roentgenstrahlen
67, 185, 1943.
1951
GILARDONI - Research Laboratories
Note sur la RoentgentMrapie a courte distance (Plesio-
roentgen tMrapie)
Journal de Radiolog ie, d'Electrologie et de Medecine
Nucleaire" - 5-6, 496, 1951
GILARDONI - Research Laboratories
Agrandissement Radio/ogique et optique.
Proceedings I Congresso Internazionale dei Radiologi
di Cu ltura Latina and .. VIII Congresso dei Medici Elet-
troradiologi di lingua frances&> - Bruxelles, July 28-29, 1951 .
1952
GILARDONI A. - SCHWARZ G.S.
Magnification of radiographic images in clinical roent-
genno/ogy and its present day limit (from the Depart-
ment of Radiology, Columbia University and Presbyter-
ian Hospital, New York, N. Y.).
Radiology - 59, 866, 1952.
1957
GILARDONI A. - PUGNO VANONI F.
A fundamental method of determining the radiographic
efficiency of X-ray machines.
The X-ray Technician - 29, 159. 1957.
A dual purpose Diagnostic X-ray Machine with Automa-
tic Technique for routine work and free Technique for
research work.
X International Congress of Radiology" - Montreal -
26 August-1-September 1962.
GILARDON I - Research Laboratories
Independent ionisation radiome tric equipment for air and
liquids contamination survey and measurements In civil
and military radiological defence and generally for Ioni-
sation radia tion measurement from microroentgen to me-
garoentgen
",X International Congress of Radiology" - Montreal -
26 August-l-September 1962.
1965
GILAADON I - Research Laboratories
Plesioterapia endocavitaria con Cavix 200 kV.
Proceedings ",XI Congresso Internazionale di Aadiologia
- Aoma - 22-28 September 1965.
GILAADON I - Research Laboratories
Apparecchi frifasi per X- Terapia Intensiva e diagnosfica
a raggi duri e ultraduri (400 kV).
Proceedings XI Congresso Internazionale di Radiologia"
- Roma - 22-28 September 1965.
1967
GILAADONI - Research Laboratories
L'impiego deg/i ultrasuoni in Diagnostica.
Suppl. .. L'Elettronica n. 7 - July 1967. Enclosed at ",No-
tagil" - Vol. 6, n. 1, 1968.
1969
GILARDONI - Research Laboratories
Electrical or Radiological power.
Material Evaluation - 27, 45 A, 1969. Notag il S.1. -
5, 13, 1969.

364 GllAA[)()Nl . RADIOLOGY ELECTROMEDICINE

1970
GILARDONI - Research Laboratories
Automazione in X-Diagnostics .
Proceedings XXIV Congresso Nazionale S.I.R.M.N." - Pa-
lermo - April 26-29, 1970.
1972
GILARDONI - Research Laboratories
Eleltronizzazione deyli appareechi radiologici.
Proceedings XXV Congresso Nazionale S.I .R.M.N."
Montecatini Terme - June 1-4, 1972. ",Notagil.. - 10, 68, 1972.
1975
GIL-SUD - Research Laboratories
Dose Volume.
. Notagil .. - 13, 114, 1975.
1976
GILARDONI A. - ASCANI ORSINI R. - TACCANI S.
Nuovi metodi radio/ogici per 10 studio delle opere dane.
"Convegno Internazionale sui Restauro delle Opere d'Ar-
te~ - Firenze - November 2-7, 1976.
1978
GILARDONI - Research Laboratories
Impiego del ragg; X nei controlli ant;terrorismo.
Presented at . X Convegno Nazionale Prove Non Distrut-
tive (PND).. - Salsomaggiore - October 24-26, 1977. " No-
tag il" - 16. 170, 1978.
1979
GILARDON I - Research Laboratories
Le sonde per ultrasuonodiagnostica medlcale (USDM):
caralteristiche, costruzlone e certificazione.
Proceedings IV Congresso Nazionale della Societa Ita-
liana per 10 Studio degll Ultrasuon i in Mediclna" - Mo-
dena - November 9-10, 1979. ",Notagil,. - 18. 214. 1980.
1980
GILARDONI - Research Laboratories
Immagine US a colori con elaborazlone digitale.
Proceedings _XXIX Congresso Nazionale S.I.R.M .N."
Napoli - September 24-27, 1980.
1981
GILARDONI - Research Laboratories
Art Radiology: basis, technique, interpretation.
.,XV Congresso Internazionale di Rad iologia" Bruxelles
- 24 June-l July 1981 .
GILARDONI - Research Laboratories
C%ur Ultrasound image with digital processing.
.. XV Congresso Internazionale di Rad iologia- - Bruxetles
- 24 June-l July 1981 .
GILAR DON I - Research Laboratories
The new Invisible grids 150 lines/ inch (6 per mm).
"XV Congresso Internazionale d i Radiologia" - Bruxelles
- 24 June-l July 1981 .
GILAROONI - Research Laboratories
Probes for ultrasound medical diagnosis construction tes-
ting and certification.
"XV Congresso lnternazionale di Radiologia
- 24 June-1 July 1981 .
1982
GILARDONI - Research Laboratories
Gilardoni Bott/e: misuratore di radiazioni da bomba ato-
mica e utilizzabi/e anche per altre valutazioni scienti-
fiche-mediche-industriali.
",Notagil .. - 19, 230. 1981.
GILARDONI - Research Laboratories
Computerizzazione integrale in Radiologia.
Proceedings . XXX Congresso Nazionale S.I.R.M.N... -
Milano - June 7-12, 1982.
GllAROONI. RAOIOl.OOY - ElECTROMEOICINE
GILARDON I - Research Laboratories
Migfioramento dei te/eradiogrammi della colonna in piedi
sotto carico con fe nuove grigJie a trama invisibile.
Proceedings . XXX Congresso Nazionale S.I.A.M.N." - Mi-
lano - June 7-12, 1982.
GILARDONI - Research Laboratories
Carafterizzazione delle apparecchiature per ecografia me-
dica/e.
Proceedings ..XXX Congresso Nazionale S.I.R.M.N." - Mi-
lano - June 7-12, 1982. " Notagi!o> - 21, 274, 1983
GILARDONI - Research Laboratories
Esperienze in diagnostica digitafe.
Internal publication.
GILARDONI - Research Laboratories
La dfgltalizzazione delle immagini ne/ quadro della com-
puterizzazione integra/a in radio/ogia.
Presented at: " Riunione Associazione Campana di Rad io-
legia.. - Napoli - October 27. 1982.
"CXCIV Riunione Associazione di Radlologia e Medicina
Nucleare,. - Roma - June 28, 1982.
" II Corso di Aggiornamento Tecnici di Radioiogiao>
Parma - November 13, 1982. Notagil - 20, 260, 1982.
GILARDON I - Research Laboratories - TAUA B.
BARBOLINI G. - 1st. Rad . Unlv. Modena.
Importanza della scelta della sonda ai flnl del risultafo
diagnostico.
Proceedings ",IX Convegno di Diagnostica U.S." Mo-
dena - October 27-30, 1982.
GILARDONI - Research Laboratories
Medico ed /ndustrla per 10 svi/uppo di nuove tecnologie
blomediche.
Internal publication.
GILARDON I - Research Laboratories
L'impianto eeotomografico - Criteri di scelta.
Internal publication.
GILARDONI - Research Laboratories
Roentgen-Gil.
.. Notag il,. - 20, 252, 1982.
1983
GILAROONI - Research Laboratories
Nuovl impianti Gi/ardonl per la radiologia e la roentgen-
terapla veterinaria.
.. Scienza Veterinaria.. - VoL II. n. 3. 1983.
GILAROONI - Research Laboratories
Nuovl metodi di diagnosl per immagini in campo me-
dicale; svlluppi altua/i e prospettive future.
" Rotary Club di Sondrio- - February 1, 1983.
GILAROONI - Research Laboratories
Ottimlzzazione delle radiografie degli artl (mano, piede,
glnocchio) per nuovi stud! di patologie ossee e musco-
/arl.
GILARDONI - Research Laboratories - BARBOUNI G.
TALIA B. - 1st. Rad. Univ. Modena
Misuratore rapportuale di livelli: lilosofia realizzaliva e
note teeniche.
Proceedings ..X Convegno di Diagnostica con ultrasuoni.
- Modena - October 5-8, 1983.
GI LARDONI - Research Laboratories - BARBOUNI G.
TAUA B. - 1st. Rad. Univ. Modena
Misuratore rapportuale di livelli: modalite d'uso e appli-
cazionl per la caratterizzazione fissuta/e.
-x Convegno di Diagnostica con ultrasuoni,. - Modena -
October 5-8, 1983.
GILARDONI - Research Laboratories
Rivoluzione nella radiologia: /e immagini digitali elabo-
rate con il computer.
Article appears to publication of the U.S.L n. 11 of Cor-
regg io "Informazioni sanitarie per la nostra salute" -
n. 4 - " year - September-October 1983.
365
1984
G ILARDONI - Research Laboratories
In GUardon; si slanna sviluppando Ie tecniche di Iratta-
mento del segnaJe ecografico in radio/requenza.
"Ecomodena,. - N. 1 - April 1984.
GILAADONI - Research Laboratories
/I genera/ore rad/ogeno nell'imaging digita/e: e/emenla
landamentale per f'oWmizzazione del sistema.
Proceedings .VII Carvat. - Roma - February 6-10, 1984.
GILARDON I - Research Laboratories
Imaging digitale e compuferizzazione radiologies.
Proceedings .. Convegno Nazionale sull'Angiografia Oigi-
lale.. - Savona - Aprit 6, 1984.
" Notag i1>. - 22, 302, 1984.
GI LARDONI - Research Laboratories
Uti/izzarore di detettori a fotodiodi nella rad/ologia maxil-
la- faceiale.
Proceedings .. I Convegno Nazionale di Aadiologia Odcn-
iostomatologica e Maxillo-facclale ~ - Castrocaro Terme -
30 April-1 May 1984.
GI LARDONI - Research l aboratories
Computer/zzszione integrale in radio/ogia.
Paper presented at round table KXXXI Congresso Nazio-
nale S.I.R.M .N. - Flrenze - November 4-8, 1984.
GILARDONI - Research laboratories
Totsl Body Radiography nuova tecnics ad omogeneiz-
zazione bidimensionale per la radiografia di tutto if cor-
po in un/ca esposizione.
Proceedings Incontro Cli nico Radiologico" - L'Aquila -
April 27-28, 1984.
- XXXI Congresso Nazionale S.I.A.M.N.- - Firenze - No-
vember 4-8, 1984.
G1LARDONI - Research Laboratories
Soft Ray System - Tecniche radlografiche dl alto con-
uasto con nuovo stumenfario -dedicato per parti sottili
e ressvtl molli.
Proceedings -Incontro Clinico Radiolog ico - L'Aquila -
...... 27-28, .984
-Raouno Gruppo Emtlia Romagna e Marche- - Pesaro -
May 25-26. .984
-XXXI Congresso NilZJonale S.I.R.M,N.- - Firenze - No-
vember 4-8, 1984,
GILARDONI - Research laboratories
Una nuova apparecchiatura da media energia (500 kV)
con simulatore incorporato per radioterap/a operante al
massimo della " Geometrical Therapeutical Efficiency
(G TE)>> e della Relative Biological Efficiency (RBE) ...
Internal publication.
GllARDON I - Research Laboratories
Elaborazione computerizzata del/e immagini ecotomogra-
fiche per la caratterizzazione delle strutture parenchima-
fiche.
- Ecomodena- - N. 2 - September 1984.
GllAADON I - Research Laboratories
Radiodiagnostica medica e protezione civile.
Internal publication.
GILARDONI - Research Laboratories
La griglia in mammografia.
Proceedings .. Seminario di tecnlche fisiobiomediche -
Gallipoli - September 24-28, 1984.
GllAADONI - Research Laboratories
L 'archlVlazlone di dati e immagini ecotomografiche can
partJcOIare riferimento alia possibilita di postelaborazioni
ai finl della caratterizzazione fissuta/e.
_XI Convegno di Diagnostica con ultrasuoni - Modena
Decembet 5-7. 1984.
366
GILAROONI - Research laboratories
Gilardoni: attrezzature rad/o/ogiche per /'emergenza.
Internal publication .
GILARDO N[ - Research Laboratories
Gilardoni Totaf Body Radiography (G TBR)" strumenta-
rio Leonard-Gil".
" Notagi l - 22, 310, 1984.
GILARDON I - Research Laboratories
La generazione dell'immagine in Angiogrsfia Digitale:
ottimizzazione degli apparati.
Proceedings " XIX Convegno Nazionale della Sezione di
Rad iologia Cardio-Vascolare S.I.R.M.N ....
Perugia - December 8, 1984.
Chap'er 17.4. - GILAADONI HANDBOOKS
1)
TRATTATO 0 1 ROENTGEN E CURIE TERAPIA
Perussia e Pug no Vanoni (G ilardoni collaboration) .
Italian Edition - 2 volumes.
Editor: Garzanti - Milano - Italy - 1947.
2) NON DESTRUCTIVE TESTING HANDBOOK
Me Master (Gilardoni collaboration with W. Coolidge) .
2 volumes
Editor: Ronald Press - New York - 1962.
3) NOZION I SULLA MISURA OELLE RADIAZIONI 10 -
NIZZANTI
Italian Edition - pages 36, figures 4, tables 4.
Editor: Gilardoni S.p.A. - Mandello Lario (Co) - Italy
- 1963.
4) ATLANTE 0 1 RADI OGRAFI E INDUSTRIALI
Italian Edition .
Ed itor: Gilardoni S.p.A. - Mandella Lado (Co) - Italy
- 1965.
5) DEFECTOLOG IA - CONTROLLI NON DISTRUTTIVI
- eN D
Italian Edition - pages 174. ligures 262, tables 53.
Editor: Gilardoni S.p.A. - Mandello Lario (Co) - Italy
- 1971.
6) RAGG I X IN MED ICINA
Italian Edition - pages 282, ligures 410, tables 58.
Editor: Gilardoni S.p.A. - Mandello Lario (Co) - Italy
- 1973.
7) X-RAYS IN ART
English Edition - pages 232, ligu res 262.
Editor: GUardoni S.p.A. - Mandello Lario (Co) - Italy
- 1977.
8) NON DESTRUCTIVE TESTI NG - NDT
English Edition - pages 240, figures 403, tables 70
Editor: Gilardoni S.p.A. - Mandella Lario (Co) - Italy
1981.
Chap'er 17_5. - GILAADONI MAGAZ.NES
1) " NOTAGI L (Medical)
Edited since 1962 quarterly and deals with Rad io-
logy, Electromedici ne, Radiation Physics, Electronics,
Nuclear Physics, Ultrasound, etc.
2) " NOTAGI L S. I. (I ndustrial )
Edited since 1964 quarterly and deals with NDT,
Industrial Radiology, Radiation Physics, Ultrasound,
Nuclear Physics, etc.
GllAA DONI. RAOIOlOGY ElECTRQMEDtCINE
 PART 18

GLOSSARY
 PART 18 LCD ... least common divisor
LCM . least common multiple
GLOSSARY LD ...... lethal dose
LPO ..... ... .... left posterior oblique
mA ... . milliampere, milliamperage
mAs .... . milliampere second
Chap, 18.1. - PRELIMINARY MeV .... . million electron volts
MHz .... . million hertz
mm .. millimeter(s)
Glossary includes new terminology of DIGITAL, CT.
MPo . maximum permissible dose
NMR. PET, ULTRASONIC, etc. megohm, 1000 ohms
MO .
"ci ............ . microcurie
JJV ...... . microvolt
mV .... . millivolt
Chap.er 18.1.1. - ABBREV.ATIONS
NCRP National Council on Radiation Protection
A, amp ....... .. ampere and Measurements
A .... .......... .. . Angstrom unit Obi ............. . oblique
AC .............. . alternating current OFo ........... . object-lilm distance
AoR ........... . air dose rate OML .. orbitomeatal line
AP ... ........ . anteroposterior PA ....... . posteroanterior
APLO .......... . anteroposterior lateral oblique PALO ... .... .. . posteroanterior lateral oblique
APMO ......... . anteroposterior medial oblique PAMO .. posteroanterior medial oblique
ARS ............ . acute radiation syndrome P-B ............. . Potter-Bucky
ASIS ........... . anterior superior iliac spine PE ..... ..... ... . photographic effect
AWG ........... . American Wire Gage PF . photofluorography
B.E. ............ . barium enema PFD ....... .. . part~film distance
BSF ............ . backscatter lactor PFX ............ . photofluorographic X-ray
Ci ............... . curie PHT ............ . primary circuit of the high~tension circuit
cm .............. . centimeter(s) PSIS ......... .. . posterior/superior iliac spine
CA ............. . central ray A ............... . roentgen
DC ............. . direct curren t rad ............. . radiation absorbed dose
DNA ........... . deoxyribonucleic acid AAO ........... . right anterior oblique
dps ........... . disintegration per second RBE ............ . relative biological effectiveness
OPT ............ . double-part th ickness rem .... . roentgen equivalent man
rep .... . roentgen equivalent physical
EAM ........... . external auditory meatus r-m~s ........... . root mean~SQuare value
EFS ........... . effective local spot RNA ........... . ribonucleid acid
EMF ............ . electromotive force rpm ... . revolution per minute
EOP ............ . external occipital protuberance APO ......... . right posterior oblique
eV .... . electron volts
AA .............. . remnant radiation
FFO ............ . focal-film distance, focus~'ilm distance SB .............. . small bowel
FAC ............ . Federal Radiation Council SOA ....... . skin dose rate
FS .............. . focal spot sec ........... .. . second(s)
FSD ............ . focal spot distance SHT ....... . secondary circuit of the high~tenslon
GB ............. . gallbladder circuit
GCD ........... . greatest common divisor SMV ........... . submentovertex, submentovertical
GI or G. I. .... . gastrointestinal SA ............. . . secondary and scattered radiation
G.U. genitourinary TFD ...... . target~film distance
H.U. ............ . heat units TMJ ...... . temporomandibular joint
HVL ............ . half-value layer TSD ............ . target-skin distance
Hz .............. . heltt UGI or U.G.I. upper gastrointestinal
ICRP ........... . International Commission on Radiation U.S.P. .. United States Pharmacopeia
Protection V ......... . volts
ICRU International Commission on Radiation VPT ..... . volts~per-turn ratio
Units and Measurement
I.M . ............. . intramuscolar W ......... ....... watt
I.V .. intravenous
IVC ............ . . intravenous cholangiogram, inferior vena
cavagram
IVP ............. . intravenous pyelogram Chap' 18.1.2. - PREFIXES
IOML .......... . infra--orbitomeatal line
KeV ........... . kilo electron volts (one thOusand electron
volts) a or an .................. . without. not, absence of.
kH, kilohertz, 1000 hertz ad .......................... . to, toward .
KUB ........... . kidneys, ureters, and bladder adeno ................ . of or pertaining to a gland.
kV ............. . . kilovolts ambi or amphi ... . . both; pertaining to or affecting
kVp ........... . kilovoltage peak both sides.
\W ............ . kilowatt angio .... ... ... pertaining to a blood vessel.
LAO ........... . left anterior oblique ante ..... ..... . before
Lat ............. . lateral antero ....... . in front of, front.

368 GILARDONI. RADIOLOGY - ELECTROMEDICINE

 anti .................... . opposite. against, counter nephr, nephro kidney.
ap or apo ............. . separation of derivation from. neur, neuro ..... _........ . nerve.
arteria .............. . pertaining to the arteries ob ............... . in front Of. against.
bi or di ........... . two of twice odonto tooth.
bio ... life. ophthalmo ....... ........ . eye.
cardia pertaining to the heart. ortho ............ . straight. normal, correct.
caphalo pertaining to the head skull. osteo bone.
cerebra pertaining to the brain. oto ear.
chiro hand . pan . all.
chole . pertaining to bile or to the bil- para .... ,.,..... beside, alongside of. apart
iary tract. from.
co with, together. peri ........... . around, about.
colo ............... . pertaining to the colon. pneuma ..... . lung . air, or respiration.
can .................. . with. pod, podo ............. . fool.
costa ....................... . rib. poly ....................... . many, much.
cysto ................ . cyst, sac, or bladder. post ............... . after.
dactylo ............. . finger, toe, digit. postero ...... . behind .
derma or dermato skin. prae, pre ......... .. before.
dextro of. pertaining to, or toward the pro ,........... ,. before or in front of.
right. proct, procto rectum.
dl. ...... . twice. pseudo ........ . fal se.
dia through or apart. pya ........... . pus.
dis .......... . reversal or separation. pyr. pyro ...... . lire or heat.
dys difficult. painful or bad. relro ............... . backward , located behind , or
ec, ecto, ex ............. . out or out of; without, on the against the natural course.
outer side, external away from. rhin, rhino ............... . nose.
en ................... . in. within. semi ., ... ,.................. . hall.
encephala ................ . pertaining to the brain. sphygmo ... . pulse.
endo or ento .......... .. innermost. within . sub ........................ . under. beneath.
entero ..... ... ...... .. pertaining to the Intestines. super. supra excess of. above, upon.
epi ,.,... .,. ,.,... ,.,. on. upon. above. sym. syn with. together, same.
extra or extra on the outside, beyond. in ad- ter. tri three, thrice. threefold.
dition. trans ................... . across, through, over.
gastro ................ .. pertaining to the stomach . uni ........................ .. one.
hema. hemato. hemo pertaining to the blood . uro ....... . pertaining to urine or to the
hemi ...................... . one-half; pertaining to or affect- urinary tract.
ing one side of the body.
helero .................. . dilleren!.
homo .... ,., ............... .
Chapter 18.1.3. - SUFFIXES
the same.
hydro water.
hyper .................... .. above, beyond. or excessive. agogue .. . inducing agent.
hypno ............. .... .. sleep. agra .............. .. seizure of acute pain.
hypo ......... . beneath, under. or deficient. algla ..................... .. painful cond ition.
hyslero .,. uterus. cele .. .. tumour or swelling
ileo ........ ,....... ....... .. ileu m. ectomy ............. . excision .
in, ii, 1m, Ir .... not. in, within , inward. into. to-
ward. graph ..................... . a record .
infra ....................... . beneath. ia ...................... . disease condition.
inter .......... . between. itls . ,................... ,.. . inflammation.
intra ................. ... . within. inside of. logy science of.
iso .......... . equal, alike, or the same.
man ia .......... . excessive preoccupation with
kilo . one thousand.
something.
latero ,. to the side of. meter ........... . instrument 01 measuring.
leuko . white or colorless.
levo .. . ,... ,............. ,. oid like, resembling .
of, pertaining to, or toward the
left. oma .. . tumour.
litho ....... . stone or rock. opia ............... . eye or vision.
macro .................... . osis ............. ..... . lulness, redundancy, excess.
large; abnormal size.
mal ....... . bad, abnormal. phaty . a morbid condition or disease.
mega .................... . great size. one million times. phobia .. morbid or exaggerated fear or
melano ................... . black. dre~d
meso .................... .. . middle. plasty plastic surgery.
meta .............. . change. after or next. rrhea ........... . flow of diSCharge.
micro ............ . small , one-millionth of. scope instru ment for making a visual
mono one or single.
morpho .......... . form. examination .
mult i ............. . many. scopy ..... visual examination.
myelo .......... .. . bone marrow or spinal cord. stomy .. surgical creation of an artificial
my a ...... ..... . muscle. opening,
neo ..................... . new, recent, young. tomy incision.

GllAROONI. AADIOt.OGY _ Et.ECTfIOMEDICINE

369
Chapler 18.2. - PHYSICAL, RADIOLOGICAL AND
MEDICAL TERMS
A wavelenght.
.scan display - (U.S.) - A cathode ray tube display in
which the received signal is displayed as a vertical
excursion from the horizontal sweep time trace, the
horizontal distance between any two signals repres-
ents the material distance between the two conditions
causing the signals.
absorbed dose - Of a ionizing radiation . The energy
per unit mass Imparted to an irradiate material. Dose
Is expressed ideally in ergs per gramme, the unit be-
ing the rad, but for X or gamma rays of quantum
energies up to 3 MeV the roentgen may be used.
absorbed dose, Integral - see Integral absorbed doss.
absorption - T he process whereby the particles or
quanta in a beam of radiation are reduced in number
or energy as they pass through some medium. The
particles lose energy by interaction with either the
nucleus (core) or electrons (sheU) of the atoms of
the medium.
absorption, apparent - see Apparent absorption.
absorpHon, broad-beam - see Broad-beam absorption.
absorption, compton - see Compton absorption.
absorption. narrow beam - see Narrow beam absorp-
DOn.
abIorption, nuclear - see Nuclear absorption.
abIorption, seiective - see Selective absorption.
absorpUon, sett - see Sell-absorption.
absorption, specific - see Selec tive absorption.
absorption, total - see Total absorption.
absorption, troe - see True absorption.
absorptkH1, wall - see Wall absorption.
absorption coeffldenl - Of a uniform substance for a
parallel beam of homogeneous radiation. The ratio 0 1
the rate of decrease (in the direction 01 propagation)
of the intensity at any point to the intensity at that
point. The coefficient may refer to total , apparent o r
true absorption. The rate of change of intenSity may
be related to length, mass per unit area, molecule,
atom or electron. The absorption coefficients are cal-
led : Linear (Pl , Mass (PIp) , Molecular (mIJ) or Elec-
tronic (eJI) respectively. Each of these comprises one
or more of the following absorption coefficients: Pho-
toelectric (1) , Scattering (0'). Nuclear and Pair pro-
duction (SymbolS non established).
absorption coeHIclent, eHective - see Effective absorp-
tion coefficient.
absorption conlrast - The absorption contrast is the
difference (or ratio) between radiation intensities emer-
ging from two adjacent areas (see also Radiographic
contrast).
absorption cross-section - see Cross-section.
absorption edge - see Critical absorption wavelenght.
absorption exponential law - When radiatio ns cross
matter they decrease according to the exponential
law. The absorption value depends on type of radia-
bon, characteris tics and thickness of the crossed
material. The law is given by I. = 10 e- px where
I. = Intensity at depht x; 10 = Intensity at depht zero;
e = Natural logarithm (2,718); J.I =
Absorption caefti-
caent of the material.
absorption line - (NMR) - Peak in NMR spectrum, cor-
responding to absorption by spin system of AF ener-
gy of a specific frequency.
absorption wavelenght, critical - see Critical absorption
abundance, relative - see Relative abundance
accelerator, linear - see Linear accelerator
accelerator, developer - see Developer accelerator.
acid fixing bath - see Fixing.
acoustic Impedance - (U.S.) - The factor which con-
trols the preparation of an ultrasonic wave at a boun-
dary interface. It is the product of the material densi-
ty and the acoustic wave velocity within the material.
activation - The process by which neutrons bombard
stable atoms to make them radioactive.
active deposit - Solid radioactive deposit formed by the
decay of a radioactive emanation.
activity - A measure of how radioactive a partic ular
radioisotope is. Activity is calculated by the number
of atoms d isintegrating per unit of time. Its unit 01
measurement is the curie.
activity, eHective gamma-ray - see Effective Radium
(Radon) content.
activity, gamma-ray - see Gamma-ray activity.
activity, linear - see Linear activity.
activity, specific - see Specific activity.
added filter - see Filter.
adiabatic fast passage - (NMR) - Alternative technique
to pulse method : in which the magnetization vector is
rotated by the sweeping static or rotating (AFl mag-
netic field through resonance, in a time short com-
pared with the relaxation times. Often used to Invert
magnetization (akin to an 180" pulse).
aerial fog - see Chemical fog.
afterglow - The persistence 0 1 light emission from an
intenSifying screen or fluorescent screen after an ex-
posure. It is a form of phosphorescent radiation.
air-cooled tube - A tube In which heat generated is
dissipated to the surround ing air. One form, the ra-
diator tube, is provided with a fin radiator fitted to
the external end of the anode stem.
air dole - see Free-aIr dose.
air equivalent material - Material suitable for use In the
walls of an air-wall ionization chamber.
air-wail Ionization chamber - An Ionization chamber
with solid walls of such design that when exposed to
1 roentgen of X- or gamma radiation the charge car-
ried by the ions of either sign per 0.001293 gramme
of air in the chamber is 1 e.s.u.
air-wail matet1a1 - see Air equivalent material.
aliquot - A small sample of radioactive material as-
sayed in order to determine the radioactive of the
whole.
alkali - In a developer. The alkaline constituent (e.g.
sodium carbonate) which is normally added to the
developer to bring the solution to, and maintain it at.
the desired level of chemical activity.
allotropy - The occurrence of an element with more
than one crystal structure.
alpha decay - The radioactive decay process character-
ized by the emission of an alpha particle. The parent
atom involved is called an alpha emitter.
alpha eml"er - see Alpha decay.
GllAROONI. RADiOlOGY - E1..EcmOMEOICINE
alpha particles - A positively charged particle emitted
by certain radioactive materials. It is made up of two
neutrons and two protons; hence il is identical with
the nucleus of a Helium atom.
alpha-ray electroscope - see Electroscope.
alpha rays - Formed by positively charged particles
having the mas of 6,6 . 10- 24 g and charged with
2e = 9,60 . 10~10 e.s.u. They are Heli um nuclei and
make lum inous the phosphorescent and fluorescent
bodies and expose the photographic ' films. Alpha
rays are very ionogenic, deflected by an electric or
magnetic lield as positive particles and have a short
penetration in matter (as f~.r as 50 J1 of AI.).
alternating current - Alternating current is a current
that reverses its direction of fl ow at regular intervals.
Abbreviation AC.
alternation - On&-half cycle of alternating current; one
alternation lasts 1/120 second. Also called an impulse
or pu lsation.
aluminium equivalent - The thickness of aluminium af-
fording the same attenuation, under specified condi-
tions, as the material in question.
am~ent temperature - The temperature of the air sur-
rounding the heated parts 01 an electric circuit.
ammeter - An electrical instrument which measures cur-
rent flow in amperes.
amniography - The radiological examination 01 the ut&-
rus following the injection of a contrast medium into
the amniotic sac during late pregnancy. It is used in
the diagnosis 01 suspected placenta praevia.
amorphoul m.teri.1 - Material In which no repeated
orderly arrangements of atoms exists over a region
large compared with atomic or molecular dimensions.
ampere - The ampere is the unit of current that will
flow through a conductor with a potential of 1 volt
and 1 ohm of resistance. The ampere ind icates the
rate (quantity per second) of electron flow through a
conductor. One ampere equals 6,28'101/1 electrons per
second.
amplifier, head - see Head amplifier.
amplifier, Image - see Image intensifier.
amu - see Atomic mass unit.
analog - (Digital R.d.) - Representation 01 number by
magnitude of a measurable physical quantity, such as
Ught or voltage. Since light or voltage measurements
include some small error, analog recordings will not
be perfected reproductions. By representing a quanti-
ty or function which allows magnitude to take on
any value within range of responses, it lacks dis-
creteness.
analYIII, diffraction - see Diffraction analysis.
analYIII, X-ray - see Diffraction analysis.
angiocardiography - The radiological examination 01
the heart and great vessels following injection of a
contrast medium.
angiography - The radiographic examination of the
blood vascular system after the injection of an aqu&-
ous solution 01 contrast medium.
angle ot Incidence - (U.S.) - The included angle be-
tween the direction of the transmitted wave and the
normal to the interface at the point 01 incidence.
angle of reflection - (U.S.) - The angle defined by the
direction of the reflected wave and the normal to the
interface at the point of incidence. The angle of r&-
flection is equal to the angle of incidence.
GllAROONI . RADIOLOGY ELECTROMEDlCII'fE
angle ot retraction - (U.S.) - The angle between the
refracted rays of an ultrasonic beam and the normal
to the refracting surface.
AngstrOm - A unit of length. The international AnQ.;"
strom is defined by aSSigning the value 6438'4696 A
to the wavelength of the cadmium red line in dry
normal air at 150C and standard atmospheric pres-
sure. It is 10- 8 cm to within 2 parts in 107. Symbol
A.
angular frequency - Frequency of oscillation defined in
radians/second; w = 2m where f is in Hz or cycles!
second.
annihilation radiation - Electromagnetic radiation pro-
duced as a result o f the disappearance 01 an elec-
tron pair. Two photons, each of quantum energy
0.511 MeV, are emitted by each electron pair.
anode - The positive electrode of a discharge tube. In
a X-rays tube the anode usually carries the target.
The face of Ihe largel in stationary tubes is cut to
an angle of 18-20"; in rotaling anode tubes Ihe face
is 13-15.
anode hooded - see Hooded anode.
anode slem - The metallic rod (solid or hollow) on
which is mounled the target, and which is sealed 10
the envelope of the tube.
anode thermal capacity - The quantitative ability 01 the
anode portion of the X-ray tube to store and with-
stand large amounts of heat.
anli-colncldence counting - The recording, from one or
more counters of a coincidence ci rcuit, of all counts
except coincidences.
anlldiffulion grid - see Grid.
aperture - (Digital Rad.) - Opening in lens system.
II light level of output phosphor of image intensifier
is too low (too little radiation or gain) , aperture can
be increased to provide proper tight level for televi-
sion camera.
apparent ablorptlon - That part of the total absorption
which arises from the dellection of radiation out of
the primary beam.
applicator -a) An attachment to an X-ray therapy tub&-
head or telecurie-theraphy unit, designed so that it
delines the cross-section of the radiation beam. It
may also ensure that the entry portal shall be at a
prescribed focus-skin distance. It is sometimes called
an X-ray therapy applicator, te/ecurie-therapy nozzle,
or treatment cone. b) A device containing radium or
other radioactive material, designed to be placed in a
known relationship to the part to be treated. The
term may be qualified to indicate the nature of the
source, e.g. radium applicator, radiophosphorus appli-
ca tor, or the site of use, e.g. Intracavitary applicator,
lip applicator. When such an applicator is mou lded to
fit the contou r of a patient, It is often called a
mould .
apron, body - see Lead-rubber apron.
apron, lead-rubber - see Lead-rubber apron.
apron, protective - see Lead-rubber apron.
.rc, pin and - see Beam direction indicator.
are. monitoring - The survey and measurement of ty-
pes of ionizing radiation and dose levels in an area
in which radiation hazards are present or suspected.
armature - The part of a generator or motor that ro-
tales between the field poles and carrying windings
in which Ihe electromotive force acts for operating
the machine.
371
armature coil - A coil of wire placed on the armature
of a generator or motor; part o f the armature wind
ing.
armature core - The iron cylinder or ring on which, or
in which, armature windings are carried.
arteriography - The radiographic examination of the ar
teries after the injection of a contrast material.
arthrography - The radiological examination of a joint
cavity following di rect injection of air or other can
trast mediu m.
artifacts - Foreign or artificial marks on a radiograph
which may be caused by static, dirty or damaged
screens, toose foreign bod ies in the cassetle, et cete--
ra.
artificial radloac:ttvlty - see Induced radioactivity.
A.S.T.M. Index - A card index published by the Ameri
can Society for Testing Materials in which the X-ray
powder diffraction lines obtained from a large nu-
mber of substances are recorded and classified in
terms of the th ree most intense ones. Other informa-
tion which might assist in the X-ray identification of
an unknown substance is also Included.
alom - The atom is the smallest unit of matter (ele-
ment) remaining unchanged in chemical reactions. It
consists 01 a central positively charged nucteus sur-
rounded by enough electrons 10 produce an equival-
ent negative charge to make the atom electrically
neutral. The number of positive charges on the nu-
cleus (atomic number) and thus the number of elec-
trons around the nucleus determines the properties
of the atom.
atom, daughter - see Radioactive decay.
atom, parent - see Radioactive decay.
atomic absorption eoeHicient - see Absorption coeffi-
cient.
atomic eron-sectlon - The cross-section of an atom
for a particular process. For the absorption of phot-
ons it can be shown to be equal to the atomic ab-
sorption coefficient.
atomic mass - The sum of proton and neutron masses
in a nucleus. Assuming the mass of a proton as a
unit, the atomic mass is equals to the num ber of
nucleons of an element. Symbol A.
atomic mass unit (AMU) - One sixteenth of the mass
of one atom of the oxygen isotope of mass number
16. (One amu equals 1.657' 10-2<1 g). Abbreviation :
amu.
atomic nucleus - see Nucleus.
atomic number - The number 01 protons in a given
atomic nucleus. Symbol Z.
atomic pile - see Nuclear reactor.
atomic scattering factor For X-rays or electrons this is
usually defined as the ratio of the amplitude of the
wave scattered by an atom to that scattered accord-
ing to classical laws by a sing le electron under the
same conditions. Symbol! More generally, it may be
expressed in terms of the distance from the centre of
the atom to a point at which the amplitude of the
scattered wave would be equal to that of the incident
wave. For Xrays and electrons the factor is then the
ratio of this distance to the corresponding distance
for an electron. For neutrons it is stated absolutely
as a lenght- the scattering length.
atomic stopping power - Of a material for a particle.
The average energ y loss suffered by the particle per
atom of the material. A measu re of stoppi ng power
often used is the atomic stopping power relative to
air or relative stopping power.
372
atomic weights, chemical scale of - A scale of atomic
weights based on assigning the value of exactly six-
teen to the atom ic weight of naturally occurring oxy-
gen. The ratio of an atomic weight measured on the
chemical scale to its value on the physicat scale is
1:1.000 272 0.000 DOS.
atomic weights, physical scale of - A scale of atomic
weights based on assigning the value of exactly six-
teen to the mass of the most abundant isotope of
oxygen.
atlenuatlon-X-ray - X-ray attenuation is a situation in
which the X-rays on passing through tissues are re-
duced in intensity or altered in direction (secondary
radiation).
aHracUon - The effect between magnetized bodies, as
that between a magnet and iron or steel, by which
they are drawn together.
auger electron - An orbital electron emitted by an
atom through the complete absorption 01 a photon of
characteristic radia tion arising within that atom.
auto-electronic emission - see Field emission.
autoradiography - The production of a record of radia-
tion from radioactive material in an object placed
with its surface in contact with a photographic emul-
sion.
auto-stereogram - -Any type of stereogram which can
be seen threedimensionally without the need for indi-
vidual viewing devices.
autotransformer - A transformer in which part of the
winding is in both the primary ci rcuit and the secon-
dary ci rCUit, used to boost or reduce line voltage for
voltage corrections, contrOl, etcetera; a transformer
in which the primary and secondary are combined.
The autotransformer is thus employed to adjust the
primary voltage applied to the step-up transformer
which produces the high voltage applied to the
X-rays tube.
average binding energy per nudeon - see Total nu-
clear binding energy.
average life - The aritmetic mean value of the lives of
the atoms of a radioactive nuclide. It is the reciprocal
of the decay constant. Symbol T.
axial ratios - The ratios of the lengths of pairs of
edges of a uni t cell. Such ratios will usually be the
same as those defined from a macroscopic exam ina
tion of the crystal faces.
axis, crystal - see Crystal aKis.
B
8 .. dose - see Pastille dose.
b-scan display - (U.S.) - A cathode ray tube display in
which the received signal is displayed as an illumi-
nated spot. The face of the CRT represents the area
of a vertical plane through the material. The display
shows the location of a discontinuity as it would ap-
pear in a vertical section view through the thickness
direction of the material.
back pointer - see Beam direction indicator.
back reflection - (U.S.) - The signal receiVed from the
back surface of a surface test object.
back scatter - That part of the scattered radiation wich
has a scattering angle of more than 00'.
back scatter factor - The mult iplyi ng factor by which
the dose rate at a point in a beam of radiation is in-
creased when that paint is included in the incident
surface of a body being irradiated.
GIL..AAOOHI. RAOIOlOGY ELECTROMEDICINE
background count - The counting rate of a counting
system arisi ng from causes other than the radiation
to be measured.
background counting rate - The counting rate arising
from background radiation.
background noise - (U.S.) - Extraneous signals caused
by signal sources within the ultrasonic testing sys-
tem, including the material in test.
background radiation - The radiation of man's natural
envi ronment consisting of that which comes from
cosmic rays and from the naturally radioactive ele-
ments of the earth, includ ing that from within man's
body. The term may also mean radiation extraneous
to an experiment.
badge film - see Film badge.
ballistic milliammeter - A milliammeter having a weigh-
ted needle and which measures the product of milli-
amperes (rnA) and time (sec), and is designed to
read in milliampereseconds (mAs).
bandpass - (Dlgllal Rad.) - Range from lowest to
highest frequency (Hz) that can be transmitted by
system. Typical television bandpass is 262 1/2 cycle!
scan lines x 525 scan lines/frame x 30 frames/sec or
4,130,000 Hz (4.1 MHz). If X-ray image contains high-
frequency data, bandpass must encompass that fre-
quency to allow data transmission. Electronic noise
level of television camera is directly dependent on its
bandpass. Optimization of bandpass for resolution
and noise is therefore necessary.
bandwith - (Digital Rad.) - see Bandpass.
barfum - A metallic element. The term barium is usual-
ly used to refer to barium su lfate, an insoluble com-
pound of barium and sulfuric acid , which is used as
a contrast medium medical radiography because of
its high radiopacity.
barium clay - A molding clay blocking material con-
taining barium, used to elim inate or reduce the
amount of scattered or secondary radiation reaching
the film .
barfum concrete - Concrete containing a high propor-
tion of barium compounds. It is used as a protective
building material.
barfum enema examination - The radiological examina-
tion of the large intestine following the rectal injec-
tion of a contrast medium containing barium.
barfum meal examination - The radiological examina-
tion of the alimentary tract following the ingestion of
a contrast mediu m containing barium.
barium plaster - Builder's plaster containing a high
proportion of barium compounds. It is used as a
protective building material.
barium swallow examination - The radiological exami-
nation of the oesophagus and cardia during the pas-
sage of a mouthful of a contrast medium containing
bariu m.
barium titanate - (U.S.) - (Polycrystalline Barium Titan-
ate BaTi0 3 ). A ceramic transducer material composed
of many individual crystals fired together and polar-
ized by the appl ication of a dc field for use as a
transducer.
bam - A very small unit of area used in measuring
the cross sections of atoms. nuclei. electrons. and
other particles. One barn is equal to 10-2 square
centimeters. The term is a mesure of the probability
that a given nuclear reaction will occur.
barrier - (Protective). Barrier of atten uating materials
used to reduce radiation exposure.
GILAROONI . RADIOLOGY ELECTROMEDICINE
,
barrfer, potential - see Potential barrier.
bath, X-ray - see X-ray bath.
beam - A directed flow of energy into space or matter.
The X-ray beam is the bundle of X-rays that emerges
from the portal of an energ ized X-ray tube. For radi-
ographic purposes, it com prises primary radiation and
remnant radiation when an object is in its path . The
center of the beam is known as the central ray (CA) .
beam, polarized - see Polarized beam.
beam direction Indicator - A device wich indicates the
direct ion of a beam radiation in the body. Examples
are the back pOinter, a mechanical or optical device
which indicates the emergent ray pOint, and the pin
and arc, a geometrical instrument which indicates the
direction by reference to a known su rface mark.
beam energy subtraction - (Digital Rad.) - Type of im-
age subtraction wich exploits energy-dependent dif-
ferences in X-ray attenuation occu rring with different
substances. If two X-ray beams of different photon
energy penetrate tissue, lower-energy beam will be
relatively more attenuated by substances having hi-
gher atomic number (bone, iodine), owing to photoe-
lectric effect.
beam spread - (U.S.) - The divergence of the sound
beam at is travels through a medium.
beam unit, radium - see Telefadium unit.
beta decay - The radioactive decay process character-
ized by the emission of a beta particle. The parent
atom involved is called a beta emitter.
beta emitter - see Beta decay.
beta particles - An electron or positron emitted from a
nucleous during decay. The term beta particle is
reserved for electrons and positrons.
beta-ray electroscope - see X-ray spectrometer.
beta-ray plaque - see Radium plaque.
beta ray. - A stream of beta particles deflected as
negative particles. Fast electrons with higher penetra-
tion than alpha rays. They are stopped by 2-3 mm
thick Aluminium foil.
betatron - A high energy electron accelerator used to
produce electrons with energies on the order of 1()8
to 107 electron volt. In th is apparatus electrons are
accelerated in a ci rcu lar orbit of constant radius by
means of the electric force associated with a varying
magnetic field linked with that orbit. These high ener-
gy electrons impinge on the heavy metal target to
produce high energy X-rays.
binary - (Digital Rad.) - System of nu'mbers (based on
power of 2) wherein each digit is either 0 or 1. In
the binary number 1101, equivalent number is one 8
plus one 4 plus no 2 plus 1 for total of 13.
~ndl ng energy, electron - see Electron binding energy.
~ndlng energy, total electron - see Total electron bind-
ing energy.
~ndlng energy, total nucle.r - see Total nuclear bind-
ing energy.
bioelectricity - Electricity produced by human body
(like muscle, heart, brain, etc.) . These voltage differ-
ences (from some JiV to some mV) can be deflected
and displayed. (See also Electromiograph, Electrocar-
diograph and Electroencephalograph).
biological haH-life - The time required for half of a
specimen of a particular substance to be removed
from the body or from a specified tissue by biologi-
cal means, when the rate of removal is approximately
exponential.
373
blackening - see Density.
blocking medium - Material of appropriate radiation
opacity for applying to an object, either round the
edges or as a filling for holes, to reduce the effect
of scattered radiation and to shield portions of the
film wh ich would otherwise be over-exposed (e.g. ra-
diographic putty) .
blocks, mosaic - see Mosaic structure.
blood count - The determination of the number of red
and white cells per cubic millimetre of peripheral
blood.
blur - Unsharpness arising from the relative movement
of the source of rad iation, irradiated object, and film
or screen.
body apron - see Lead-rubber apron.
body burden - The amount of radioactive material
present in the body of man or animals.
bolus - Phantom material in form suitable either for
modelling or for enclosi ng in a bag which can be
used, for example, to fill spaces in the beam of radi-
ation between the patient and an X-ray applicator.
bomb - see Gamma-ray source container.
bomb, radium - see Teleradium unir.
bone toferance dose - see Tolerence dose.
boundwt echo - (U.S.) - A reflection of an ultrasonic
...... from an II\tefface.
......dM, W4_0elc:ngth - In a continuous X-ray spec-
-n. sI'aw.t wa'I'86eng present It IS inversely
pn:IP(ll'tIOnaI '0 &:he peilJ( voCtage applied to the X-ray
a.oe.
Bragg ~ - see Bragg reflectIOn.
Bragg l.- - see Bragg reflection.
Bragg reflection - The dillracted beam produced by
reinforcement of the contributions from successive
members of a set of crystal planes when their com-
mon normal is suitably oriented with respect to an
incident beam of monochromatic radiation. The con-
dition for such reinforcement is expressed by the
Bragg law, which may be stated : ~ = 2d sin 8,
where ~ Is the X-ray wavelength, d the interplanar
spacing and 8 the Bragg angle, i.e. the glancing an-
gie between the incident beam direction and the re-
fl ecting plane.
bragg scattering - see Ordered scattering.
branch - see Branching.
branching - The occu rrence of competing radioactive
decay processes (Branches) in the disinteg ration sche-
me of a particular nuclide.
branching fraction - That fraction of the total number
of atoms involved which follows a particular branch
of the disintegration scheme. It is usually expressed
as a percentage.
branching ratio - The ra tio of two specified branching
fractions. The term is also commonly used as a syn-
onym of branching fraction.
bravais lattice - see Space laWce.
bremsstrahlung - Electromagnetic radiation emitted by
charged particles when they are slowed down by
electric fields in their passage through matter. literal-
ly, bracklng radiation in German. (From the Ger-
man bremsen, to brake). Bremsstrahlu ng may be of
any wavelength up to the maximum energy of the
electrons.
374
brightness - Brightness of image is represented by
lambert, defined as average brightnees of perfectly
diffusing surface emitting or reflecting one lumen per
square centimeter. Lumen is amount of luminous fl ux
emitted into unit solid angle by light source of one
candle intensity.
broad-beam absorption - Absorption measured under
conditions in which scattered radiation is not exclu
ded from the measuring apparatus.
bronchiography - The radiological examination of the
trachea, bronch i or the p ronchlal tree followi ng the
introduction of a contrast med ium.
bucky - A device containing a moving grid and which
is placed between the patient and the film to reduce
the fogging effect of secondary radiation on the ra-
diograph. See Grid.
build-up - An Increase in radiation transmitted throug h
material because of forward scatter.
Bunsen-Roscoe reciprocity law - States that the end
resu lt of a photochemical reaction Is dependent only
on the product of the radiation Intensity (I) and the
duration of the exposure (t), and is dependent of ab-
solute values of either quantity. This implies that the
resultant density of a film wou ld depend only on the
products of the radiation intenSity reaching the fil m
and the exposure time.
by-product material - In atomic energy law, any ra-
dioactive material (except source or fissionable mate-
rial) obtained in the process of producing or using
source or fissionable material. Incl udes fission pro--
ducts and many other radioisotopes produced in nu-
clear reactors.
byte - (Digital Rad.) - Group of adjacent binary digits
usually equivalent to eight bits (binary digits) . In prac-
tice byte is usually used to represent alphanumeric
character or number in range of 0 10 255.
c
c-scan - (U.S.) - A data presentation method yielding
a plan view through the scan ned su rface of the part.
Through gating, only echoes arising from the interior
of the test object are ind icated . In the C-scan no in-
dication is given of the signal depth.
cable, shock proof - see Shock-proof.
calcium tungstate - A flu orescent chem ical compound
which emits visi ble blue-violet light when activated by
either X-or gamma radiation.
calibration - The standardization of instruments. prior
to use, to a know reference value.
Callier coefficient - The ratio of specu lar to totally dif-
fuse density. Owing to the scattering of light in pho--
tagraphic emulsions. the value of Q is greater than
unity (usually between 1.0 and 2.0) .
camera, electron diffraction - see Electron diffraction
camera.
camera, movlng-fiekt - see Moving-field camera.
camera, powder - see Powder camera.
camera, single crystal - see Single crystal camera.
camera, Weissenberg - see Moving- field camera.
camera, X-ray - see X-ray camera.
cannon tube shield - A tube shield in the form of a
long cylinder, generally supported in cantilever fa-
shion. The X-ray beam emerges through an aperture
in the lead-lined wall of the cylinder, at right angles
to its axis.
GILARD<>NI. RADIOLOGY - E.l..ECTROUEOICINE
capsule, gamma-ray - see Gamma-ray capsule.
capture, electron - see K-electron capture.
cardia-angiography - The radiographic examination of
the heart and great vessels after intravenous injection
of an aqueous solution of contrast medium. Also. re-
ferred to as angiography, angiocardiography.
Carr-Purcell sequence - (NMR) - Sequence of 90" and
1aO' RF pulses used to measure T2 . Reduces errors
due to molecular diffusion, apparent in simpler spin-
echo experiments.
carrier - Inactive material isotopic with a given radioac-
tive nucl ide. Carrier is someti mes added to carrier-
free material.
cascade generator - see Generator of high voltage
(Marx circuit).
cascade tube - A high-vol tage X-ray tube of cylindrical
form divided into sections, the potential di fference
across each of which is a fraction of the voltage
applied to the whole tube. The electron stream is
accelerated to its maximum energ y in stages.
casseHe - A lightproof container used for hold ing radio-
graphic films in position during the radiographic ex-
posure, which mayor may not contain intensifying
and, or, fi lter screens. Its fron t is radiotransparent;
the lid is backed with thin lead sheet or is made
with heavy steel.
cassette changer - A piece of radiographic equipment
designed for quick changing of cassettes so that suc-
cessive exposures may be made without changing
the position of the patient, as in stereoscopy.
castle - A lead housing designed to contain both a
counter and the radioactive material for assay.
CAT - Computerized Transax ial Tomography.
cathode - The negative electrode of a discharge tube.
cathode, cold - see Cold cathode.
cathode dark space - The relatively non-luminous re-
gion which, at a gas pressure of the order of 0.1
mm of mercury or less, envelopes the cathode in a
discharge tube. The lower the pressure the wider is
the dark space.
cathode of Coolidge tube - The part in the X-ray tube
that emits electrons produced by the filament. Th is.
when heated , produces a cloud of electrons that may
be pushed across the tube to produce X-ray. The ca-
thode is so designed that can focus an electron beam
on the focal spot of the anode.
cathode ray lube (CRT) - Vacuum tube for studying
cathode ray. The principaf parts are the following:
electric gun; screen made with phosphorous material;
electric and magnetic systems to deflect the beam on
the screen.
cathode rays - A stream of electrons emitted by a
heated structure (or by a cold structure under the in-
fluence of an electric field of high intensity) and pro-
jected in a somewhat confined beam by means of an
electric field or a changing magnetic field.
CO curve - (Digital Rad.) - see Contrast-detail curve.
cell, radium - see Radium cel/.
cell, unit - see Unit cel/.
centigrade - Temperature scale having 100 degrees of
graduation, and in which O' represents the freezing
point and 100" the boiling point of water under stan-
dard conditions (sea level) .
centimeter - A unit of measurement equal to approxi-
mately 0.4 inch.
G llARDONI . RADIOLOGY - ElECTROMEOICINE
central ray - The theoretical center of the X-ray beam.
The central ray leaves the focal spot at gO' from the
long axis of the tube housing. Also called prinCipal
ray. The symbol is CR.
cephalometry - Of the foetus. The radiological mea-
surement of the dimensions of the foetal head in
utero.
cesium 137 - A radioactive isotope of the element ce-
sium having a half life of 30 years, plus or minus
three years.
chain reaction - A reaction which is self-sustai ning. In
a nuclear pile this is achieved by arranging that for
each fission that occurs as least one neutron is made
available to produce a further fission.
chamber, air-wall ionization - see Air-wall ionization
chamber.
chamber, condenser Ionization - see Condenser ioniza -
tion chamber.
chamber, extrapolation - see Extrapolation chamber.
chamber, free-air ionization - see Free-air ionization
chamber.
chamber, ionization - see Ionization chamber.
chamber, thimble ionization - see Thimble ionization
chamber.
change-over switch, high voltage - see High-VOltage
Change-over switch.
characteristic curve - A curve showing the relation be-
tween the common logarithm of exposu re (frequently
expressed in arbitrary units) and the phOtographic
density under specific conditions of processing .
characteristic X-radiation - X-rays which are produced
by interorbital shi fts of electrons within an atom .
These rays are characteristic in wave-Ienght of the
specific atom wich produced them. Characteristic
X-radiation arising from the absorption of X-or gamma
radia tion is sometimes ca lled fluorescence X-radiation.
charge, space - see Space charge.
chart, exposure - see Exposure chart.
chart, Isodose - see Isodose chart.
chemical cell - Device that converts chemical energy,
coming from two different metals dipped into a d ilute
acid, into electric energy. CaUed also "pila.
chemical fog - Fog arising from unwanted chemical
reactions during processing. Examples are: a) Oxida-
tion fog . Fog caused by exposure of a film to air
during development. b) Dichroic fog. Fog arisi ng from
the deposition on an emulsion of a very thi n layer of
finely divided silver. When examined in white light
the deposit appears in complementary colours, e.g.
red by transmission and blue-green by reflection.
chemical scale of atomic weights - see Atomic weights,
chemical scale 0/.
chemical shiH - (NMR) - Difference in resonant fre-
quency between simi lar nuclear species bound to
different chemical sites in a molecule. Provides in-
formation relating to chemical structu re. Usually mea-
su red in parts per million (ppm) relative to some
standard reference absorption line.
choke coli - A device consisting of a coil of wire with
an adjustable soft iron core. The choke coli is used
as a voltage and current regulator.
cholangiography - The radiographic examination of the
biliary tract following intravenous injection of a suita-
ble contrast medium. It may be performed during or
followi ng surgery.
375
 chok!cystography - The radiological examination of the
gall bladder and its functioning atter the administra-
tion orally or intravenously of a contrast medium.
chromosome - A rod-shaped or thread like body of
chromatin, in the nuclear structure of a cell , which
splits longitudinally as the cells divides, one half go-
ing to each daughter cell.
clne-fluorography - A radiographic procedure wherein
motion pictures are taken of images on a fluorescent
screen.
cine-radiography - The production of a succession of
radiographs which can be wieved rapidly in order,
thus creating an illusion of continuity.
cine-radiography, Indirect - see Cine-fluorogrsphy.
circuit - The complete path through which the current
flows; a certain part of the complete part, such as
one of its conductors.
circuit, closed - see Closed circuit.
circuit, Cockcrott-Walton - see Generator of higt '10/-
tage (Cockcroft-Walton circuil).
circuit, constant potential - see Generator of high vol-
tage (Constant potential circuit) .
circuit, full-wave - see Generator of high vollage (Full-
wave circuit).
circuit, half-wave - see Generator of high voltage (Half-
wave a rcuit).
circuit. Latour - see Generator of high vollage (Liebe-
now-Gremachef o rcult).
circuit. Uebenow-Grelnacher - see Generator of high
voltage (Liebenow-G reinacher ci rcu it).
Circuit, Marx - see Generator of high voltage (Marx
circuit).
circuit, rectified three-phase - see Generator of high
voltage (Six-valve ci rcuit).
circuit, sealing - see Scaling circuit.
circuit, six-valve - see Generator of high voltage (Six-
valve circuit).
circuit, Villard - see Generator of high voltage (Villard
circuit) .
circuit, Wltka - see Generator of high voltage (Wltka
circuit) .
clealing time - Time required for the fixer to dissolve
unexposed salts in X-ray film emulsion.
clockwork timer - A timer controlled by a clockwor1c:
mechanism.
closed circuit - An electric circui t that is com plete and
through which current may flow when voltage is applied.
cobalt 60 - A radioisotope of the element cobalt.
Cockcrott-Walton circuit - see Generator of high vo/-
tage (Cockcroft-Wa/ron cirCUli).
coefficient absorption - see Absorption coefficient.
coefficient, Callier - see Caffier coefficient.
coeffiCient, effective absorption - see Effective absorp-
tion coefficient.
coeffiCient, reduction - see Effective absorption coeffi-
cient.
coercfve force - The value of the inverse field (- H) of
the hysteresis cycle necessary to bring back to zero
the flux density (B) .
coherent soaHer - The part of the unmodified scatter
wh ich bears a definite phase relationship to the
primary rad iation, and is therefore capable of produc-
ing interference.
376
I
coincidence counting - The record ing by two or more
counters of a single ionizing event, or by each coun-
ter of separate ionizing events, occurring within a
specified (small) time intervaL
coincidence counting, anti - see Anti-coincidence court-
ing.
coincidence counting, delayed - see Delayed-coinci-
ence counting.
coincidence loss - Loss ot counts due to the occur-
rence of ionizing events at intervals less than the re-
solution time of the counting system.
cold cathode - A cathode which provides an electron
stream by field emission.
cold field emission - see Field emission.
collimation - The process by which a divergent beam
of energy or particles is converted into parallel beam,
or the limiting of a beam of radiation to the required
dimensions.
collimator - A device, usually made of lead used to
su rround a radiation source and so constructed as to
both minimize Ihe scattered radiation and to direct
the primary or useful radiation into a more or less
parallel beam onto a localized area.
collimator - (U.S.) - A lens assembly attachment de-
signed to reduce the ultrasonic beam spread.
combination screens - A pair of salt screens in which
the front screen (to be placed in the tube side of the
film) is thinner than the back screen.
compensator - A device whereby the voltage per tu rn
of an autotransformer can be kept constant. It is
generally operated manually.
complier - (Digital Rad.) - Program that translates one
computer language into another. Most commonly, term
refers to program thaI translates higher-level language
into computer's native language.
composite filter - A filler of two or more materials
chosen so that the longer wavelengths of a beam are
strongly absorbed , and within this range anomalous
transmission in avoided . The materials are usually ar-
ranged so that the second material filters secondary
radialion produced in the first material and so on . A
particular example is the ..Thoraeus filter which con-
sists of 0.44 mm of tin, 0.25 mm of copper and 1
mm of alum inium in this order in the beam of radia-
lion.
composite video signal - (Digital Rad.) - Complete tel-
evision signal consisting of three parts: video, blan-
king, synchronization pulses.
compression - (Of t issues) : Compression of body
tissues serves to reduce the thickness of tissue being
radiographed. II makes possible a reduction in MaS,
the production of secondary radiation fog, and the
depth of tissue to be penetrated.
compressional waye - (U.S.) - Waves in which the par-
ticle motion or vibration is in the same direction as
the propagated wave (longitudinal wave) .
Complon absorption - The reduction of the energy of
a photon by its interaction with an electron . Part of
the photon energy is transferred to the electron
(Compton electron or Recoil electron) and part is re-
directed as a photon of reduced energy (Compton
scatter or Modified scatter).
Compton effect - see Compton absorption.
Compton electron - see Compton absorptiOn.
Compton scaner - see Compton absorptiOn.
G llAROONI . RADIOLOGY ELECTAOMEDICINE
concentration, maximum perml.aitHe - see Maximum
permissible concentration.
concentration, radioisotope - see Radioisotope concen-
tration.
concrete, barium - see Barium concrete.
condenser dosemeter - A dosemeter consisting of a
condenser ionization chamber and an electrometer.
condenser Ionization chamber - Name given to an ioni-
zation chamber which, having been charged to a cer-
tain potential, can be irradiated and subsequently att-
ached to an electrometer to measure the residual
charge, whereby the dose received is ascertained.
conductance - The conducting power of a body or a
circuit for electricity. When expressed in figures, con-
ductance is the reciprocal of resistance . The unit is
mho.
conductors, bodkts - Bodies In wh ich an external con-
stant force acti ng on free electron s, can make them
drift in a determined directon, thus causing an elect-
ric current.
cone, treatment - see Applicator and Cylinder.
consJMcutty - (O~ltal Rad,) - Conspicuousness of ob-
ject within image or its ability to stand out from sur-
roundings. Subtraction images have i mproved conspi-
cully because Interfering anatomy (structured noise)
has been removed .
constancy meter - An instrument designed to indicate
the dose rate at a given point in a beam of radia-
tion. and thus to facilitate the maintenance of a con-
stant dose rate.
constant, decay - see Decay constant.
constant, dlslntegraUon - see Decay constant.
constant, potential - see Constant voltage.
constant, potential cl rcuit - see Generator of high vol-
tage (Constan t potential circuit).
con. tant, transformation - see Decay constant.
constant vottage - A unidirectional voltage of constant
magnitude. In practice there may be a small periodic
variation, called the Ripple voltage.
contact transducer - (U.S.) - A transd ucer which is
coupled to a test surface either directly or through a
thin film of cou plant.
contact tube - An X-ray tube which can be used at a
very short focus-ski n distance.
contact X-ray therapy - Superficial X- ray therapy by
means of a contact tube usually operated at less
than 60 Kvp.
Contagil - Protexi metric geiger-cou nter with instantane-
ous luminous and acoustic indication made by Gilar-
doni.
container, radium - see Radium container.
container, radon - see Radon container.
contamination, radioactive - see Radioactive contamina-
tion.
content, effective radium (radon) - see Effective radium
(radon) content.
content, equivalent radium - see Equivalent radium con-
tent.
content, estimated actual radium (radon) - see Esti-
mated actual radium (radon) content.
content, radium - see Radium content.
content, radon - see Radon content.
OILAflOON I. IVIOIOLOOY - ELECTROMEOICINE
continuous spectru m - The characte rlstic radiation pat-
tem that exibits energies for an unbroken series of
frequencies over a wide range. See also Heterogene-
ous radia tion, Bremsstrah lung and White radiation .
continuous wave - (NMR) - NMR technique now lar-
gerly superceded by pulse methods, in which AF ra-
diation is supplied continuously to the sample. Ab-
sorption is detected by sweeping either the static or
the ro tating magnetic field through the resonance
values.
contour, isodose - see Isodose curve.
contracted sweep - (U.S.) - A contraction of the
horizontal sweep on the viewing screen of the ultra-
sonic instrument. Contraction of this sweep perm its
viewing reflections occurring over a greater depth of
material or duration of time.
contrast - In general terms. contrast re fers to the dif-
ference in density between the high lights and sha-
dows seen in a radiograph. Mathematically, contrast
may be defined as the ratio of the g reatest density
to the least density on a radiograph ; the larger th is
ratio is, the greater the contrast is said to be.
contrast - (Digital Rad.) - Difference between two re-
gions in image divided by average of two regions
([A- B] / 'h [A+ BJ) . In subject contrast, units of A
and B may be numbers of photons passing through
two regions of patient. Radiographic contrast with
film specifies A and B in units of optical density. A
and B can be expressed as pixel val ues with digital
radiography and computed tomog raphy. Above holds
true for image acquisition or formation and does not
apply to viewing stage, since apparent contrast of ob-
ject depends on backg round illumination, shape, com-
plexity and foveal pool size.Contrast " almost never
refers to concentration of iodine in blood at anatomic
site.
contrast, absorption - see Absorption contrast.
contrast, film - see Film contrast.
contrast, Image - see Image contrast.
contrast, long -sca~ - see Long-scale contrast.
contrast, radiation - see Radiation contrast.
conlrast. radiographic - see Radiographic contrast.
conlrast, shor1 scale - see Short-scale contrast.
contrast, sublect - see Subject contrast.
contrast, subjective - see Subjective contrast.
contrast, ti..ue - see Tissue contrast.
contrast detail (CD) curve - (Digital Rad.) - Plot of
threshold contrast detected at various diameters of
detail, . obtained from radiograph 01 contrast-detail
phantom .
contrast media - Substances which are introduced into
tissues or organs fo r the purpose 01 producing radi-
og raphic contrast where contrast does not normally
exist.
contrast ratio - The relative amount of light emitted or
reflected as between an indication and its background .
contrast scale - The scale of contrast in a radiograph
constitutes the range 01 visible densities in an image
and determines the number of deta ils that can be
visual ized .
contrast sensitivity - (Digital Rad.) - Ability of system
to detect differences in photon values. System with
high contrast sensitivity can separate small differen-
ces in contrast. Contrast sensitivity and dynamiC ran-
ge are inversely related.
377
control, dual - see Dual control. counter, scintillation - see Scintillation counter.
controlled area - A defined area in which the occupa- counter efficiency, intrinsic - see Intrinsic counter effi-
tional exposure of personnel to radiation or to ra- ciency.
dioactive material is under the supervision of an indi- counting, anti-coincidence - see Anti-coincidence count-
vidual in charge of radiation protection. (This implies ing.
that a controlled area is one that req uires control of
access. occupancy, and working cond itions for radia- counting, coincidenc e - see Coincidence counting.
tion protection purposes) . counting, delayed coincidence - see Delayed coinci-
converging-beam therapy - A form of cross-fire techni- dence counting.
que in wh ich a number of beams of radiat ion are counting rate - The average rate at which counts are
used simu ltaneously to treat a particu lar region throu- recorded.
gh different entry po rtals.
counling rate, background - see Background counting
converging-field therapy - see Moving-field therapy. rate.
conversion, electron - see Internal con version. counting-rate meter - An instrument for indicating
conversion, Internal - see Internal can version. counting rate.
converter, frequency - see TripIer transformer. counts, spurious - see Spurious counts.
Coolidge tube - The first type of hot-cathode tube to couplant - (U.S.) - A substance used between the lace
come into general use. 01 the transducer and test surface to perm it or im-
prove trasmission of ultrasonic energy across th is
co-precipitation - The precipitation of a radioisotope boundary or interface.
with a similar substance which precipitates with the
same reagent and which is added in order to assist crest voltage - see Peak voltage.
the process. crimp mark - see Pressure mark.
corona - A si lent discharge of electricity in the gas critical absorption wavelength - The wavelength, chara-
adjacent to a conductor when the potential gradient cteristic of a given electron energy-level in an atom
at its surface is sufficiently high. In air it is visible as of a specified element, at which an absorption dis-
a purple glow. This potential gradient is usually less continuity occu rs.
than requi red to produce brushing or sparking.
critical angle - (U.S.) - The incident angle of the sound
corpuscular radiation - A stream 01 atomic or sub- beam beyond which a specific refracted mode of vi-
atomic particles which may be Charged positively (e.g. bration no longer ex ists.
alpha particles) or negatively (e.g. beta particles) or
not at all {e.g. neutrons} . Crookes dark space - see Ca thode dark space.
cosmic radiation - Ionizing radiation from unidentified cross-fire technique - The irradiation of a deep-seated
extraterrestrial sources. There is reason to believe region in the bOdy from several directions so as to
that the primary component is corpuscu lar in nature reduce damage to surrounding tissues for a given
and gives rise to secondary corpuscular and other dose to that region .
ionizing radiations by collisions in the atmosphere. cross-section - The effective target area presented by
Atmosphere shields the earth from this radiation an atom or a sub-atomic particle to an incident par-
bombardment. Cosmic radiation intensity is a function ticle or photon for a particu lar process, e.g. scatter-
of altitude. ing. According to the process involved there may be:
coulomb - A unit of electric charge in the "practical absorption cross-section, scattering cross-section. pair-
system of units. It contains 3 x lOS electros tatic units production cross-section, Fission cross-section and so
01 charge. on, including total cross-section .
Coulomb scanerlng - The scattering of a particle by cross-section, absorption - see Cross-section.
the coulomb field of a nucleus. cross-section, atomic _ see Atomic cross-sectIon.
count - A pu lse that can be recorded in some way cross-section, differential - see Differential cross-section.
and which has been initiated in a counter by an io-
nizing event. cross-section, electronic - see Electronic cross-section.
count, background - see Background count. cross-section, fission - see Cross-section.
counter - A device wh ich reacts to individual ionizing cross-section, nuclear - see Nuclear cross-section.
events. thus enabling them to be detected.
cross-section, pair production - see Cross-section.
counter, crystal - see Crystal counter.
croSl-sectlon, scattering - see Cross-sec tion.
counter, directional - see Directional counter.
cross-section, total - see Cross-section.
counter, end-window - see End-window counter.
cross talk - (U.S.) - An unwanted condition in which
counter, 471' - see 4 71' counter. acoustic energy is coupled from the transmitting crys-
counter, gas-filled - see Gas-filled counter. tal to the receiving crystal without propagating along
counter, gaseous-flow - see Gaseous-flow counter. the intended path through the material.
counter, geiger - see Geiger-MOiler counter. crystal, ideally imperfect - see Imperfect crystal.
crystal, Imperfect - see Imperfect crystal.
counter, Geiger-MOIler - see Geiger-MOI/er counter.
counter, Immersion - see Liquid counter. crystal, perfect - see Perfect crystal.
counter, liquid - see Liquid counter. crystal axis - One of the co-ordinate axes to which
the atomic positions and planar directions in a crys-
counter, liquid-flow - see Liquid-flOW counter. tal may be referred . Such axes are parallel to the
counter, proportional - see Proportional counter. edges of the unit cell.

378 GllARDON I. RADIOLOGY ELECTROMEDICINE

crystal class - A subdivision of a crystal system in
which a crystal may be placed according to its ma
croscopic symmetry elements. Each such characteris
tic group of symmetry elements is known as a point
group. They are 32 in number.
crystal counter - A crystal (e.g. diamond) which under
certain conditions may be used as a counter.
crystal method, oscillating - see Oscillating crystal me-
thod.
crystal method, rotating - see Rotating crystal method.
crystal plane - One of a set of parallel , equally spaced
planes in a structu re, characterized by a plane of
given Miller indices and a parallel plane through the
origin of co-ordinates.
crystat structure - see Unit cell.
crystal system - One of the seven main categories to
which a crystal may be assigned according to the
symmetry of Its external form or internal structure.
The systems are: cubic, tetragonal. hexagonal, trigo-
nal. orthorhombic. monocli nic and triclinic.
crystalline malerlal - Material which is characterized by
an orderly arrangement of atoms repeated more or
less perfeclly within a region large compared with
atomic dimensions.
crystallography, electron - see Electron crystallography.
crystallography, neutron - see Neutron crystallography.
crystallography, X-ray - see X-ray crystallography.
cumulative kmlzaUon - see Ionization by collision.
cumulative dOH - The lotal dose resulting from re-
peated exposure to radiation 01 the same region or
01 the whole body.
curie - A unit of radioactivity. It was originally defined
as: the quantity of radon in rad ioactive equilibrium
with 1 gm of radium. The curie is now broadly de-
fined as the radioactivity of any material which is dis-
integ rating at a rate of 3.7 x 1010 atoms/sec/curie.
Abbreviation : c.
Curle, discovery 01 - The discovery of M. and P. Curie
in 1934 In which the magnesium (Mg) after alpha ir-
radia tion emits beta particles at a rate decreasing
exponentially and halving every 2 min and 30 sec.
(Half-life of the beta emitter).
current, alternating - see Alternating current.
.current, direct - see Direct current.
current, hlgh. voltage - see High-voltage current.
current, Ionization - see Ionization current.
current, low.voltage - see Low-voltage current.
current, saturation - see Saturation current.
current, unidirectional - see Unidirectional current.
cursor - (Digital Rad.) - Movable point of area on ca-
thode-ray tube.
curve, characteristic - see Characteristic curve.
curve, Isodose - see Isodose curve.
cycle - One com plete wave of alternating current or
electromagnetic wave curve. A cycle consists of two
complete alternations of alternating current.
cyclotron - A particle accelerator in which the atomic
particles are whirled around in a spi ral between the
ends of a huge magnet gaining speed with each ro-
tation. The cyclotron is normally used for nuclear re-
search but the particles can be made to collide with
a target to produce X-ray.
GII.AAOONI. RADIOlOGY - ELE~EOICINE
cylinder - A cylindrically shaped device which is some-
times used In the place of a cone. A cylinder which
may be extended is called an extension cylinder.
cystography - The radiolgical examination of the uri-
nary bladder following the administration intravenous-
ly or through the urethra of a contrast medium.
D
dacryocystography - The radiolog ical examination of
the canaliculi, lachrymal sac and nasal duct following
direct injection of a contrast med ium.
damping - Hindering or decreasing the frequency of
vibrations or oscillations in the motion of a body or
in an electrical system subjected to external influen-
ces. Compare with attenuation . The ability of a metal
to absorb vibrations. changing the mechanical energy
into heat.
danger zone, radiation - see Radiarion danger zone.
dark space, cathode - see Cathode dark space.
dark space, crookes - see Cathode dark space.
daughter atom - see Radioactive decay.
dead time - 01 a GeigerMulier counter. The natural
interval after the initiation of a voltage pulse during
which gas amplification of an ionizing event cannot
occur, assuming no interference by an external circuit.
dead zone - (U.S.) - The distance in a material from
the surface of the nearest inspectable depth.
decay, alpha - see Alpha decay.
decay, beta - see Beta decay.
decay, radioactive - see Radioactive decay.
decay conl tant - The ratio of the rate of decay of a
rad ioactive nuclide to the quantity of that nuclide
present. Symbol it
decay product - see Radioactive decay.
decibel (dB) - Standard unit used to express relative
power levels. Decibel is log 20 times the log to base
10 of ratio of power output to power input. Decibels
are used In expressing dynamic range, signal-ta-noise
ratio, and bandpass (bandwidth) . A 60 dB signal-to
noise ratio is equivalent to 1.000/1.
decrement, mal l - see Mass decrement.
dee - A hollow heml-cylind rical electrode in a cyclo-
tron to which Is applied a high-frequency potential.
deep X-ray therapy - X-ray therapy of underlying tis-
sues by hard radiation (usually produced at more
than 180 Kvp) paSSing through superficial layers.
defect, mass - see Mass defect.
defect reflection - (U.S.) - The oscilloscope presenta-
tion of the energy returned by a rejectable fl aw in
the material.
definition - The measure of sharpness in the outline of
the image of an object recorded on film; the sharp
ness is the functi on of the types of screens, expo
sure geometry, radiation energy and film characteris-
tic. See also Detail.
degree of development - The degree of development
depends on development time, temperature, amount
of agitation and activity of the developer.
delayed coincidence counting - The recording of such
pairs of ionizing events as have a specified time in-
terval between them.
delayed sweep - (U.S.) - A means of delaying the start
of horizontal sweep, thereby eliminating the presenta-
tion of early response data.
379
delta effect - (U.S.) - Acoustic energy re-radiated by a
discontinuity.
densitometer - Instrument uti lizing the photoelectric prin-
ciple to determine the degree of darkening of deve-
loped photographic film .
density, diffuse - see Photographic transmission densI-
ty.
density, e~tron - see Electron density.
den.tty, ion - see Ion density.
density, parallel light - see Photographic transmission
density.
density, photographic transmission - see Photographic
transmission density.
density. reflectkm - see Reflection density.
densUy, regulaUon of - When a fi xed kilovoltage is
employed, the radiographic density is regulated by
increasing or decreasing the MaS to a correct value
so that the remnan t radiation will be sufficiently in-
tense to produce a satisfactory Image.
density, specular - see Photographic transmission den
sity.
density, tissue - T issue density may be considered as
the resistance of the tissues to the passage of X
rays.
denslty equalization fitter - A rad iog raphic accessory
devICe that is used when it is desi ra ble to cause a
'f8IlalIOn of X-faY intensity across a part 01 varying
'"""""""'-
d",:::~'*~_:~ti -
The change In densIty of a radio-
~ film ~ty per unit chan-
!.
....-,e =~~ dins.:
01 the exposure recesved
grJKltenl of
a film ISbyUSU-
CiIIeo -gel i. . .
c:IImItJ IW'IgIe.. I.IIIftII - see Useful densJry range.
deIIltity URIuI IIICiogI'IIPhiC range - The densities be-
tween Q,2 (normal film fog WIth almost complete trans
parence of IlOI'Hrradlated zones) and 4 (deep black-
ening). A good radiograph with a maximum of in
formations has a density around 2 - 2,5 in the -domi-
nant zones-.
Denlogll - Pocket radiograph ic densitometer made by
Gilardoni.
deposit, active - see Active deposit.
depth dose - The dose of radiation actually delivered
to a point at a specified depth below the surface of
the body.
depth dose, percentage - see Percentage depth dose.
detail - Detail is the degree of sharpness of outline of
the image. If the radiograph does not show a clear
definition of the Object or a discontinuity in the ob-
ject, it is of little value although it may have suffi-
cient contrast and density; same as -definition.
detector - A device which determines the presence of
radiation.
deuteron - A nuclear particle of mass number 2, hav-
ing a charge eq ual and opposite to that of an elec-
tron. The nucleus of deuterium (heavy hydrogen) is a
deuteron.
developer - A chemical solution which reduces ex-
posed silver halide crystals to melallic silver.
developer, rapid - see Rapid developer.
developer, regular - see Regular developer.
developer temperature of - The temperatu re of the de-
veloper solution influences the rate of development.
The higher the temperature, the greater the rate and
vice versa.
380
developer accelerator - Alkaline medium (sodium car-
bonate or hydroxide, etc. that makes possible the ac-
tivity of the developing agents.
developer constituents - T here are 6 chemicals found
in an Xray developer solution. These chemicals and
their functions are as follows: 1. Water-solvent; 2. EI-
onreduces the exposed silver emulsion; 3. Hydro-
quinone--reduces the exposed silver emulsion; 4. So
dium carbonate--accelerates rate of development. 5.
Sodium sulfite--preserves developer, controls solulion
oxidation . 6. Potassium bromide restrains or controls
rate of development.
developer dllultlon - The effect of diluition of a devel-
oper beyond that recommended is to cause the film
to be underdeveloped when a standa rd time--tempera-
ture development is employed. Frequently, the capac;
Iy of tanks is incorrectty estimated and insullicient
developer chemicals are dissolved in the solution.
developer InactIvity - Lack of developer activity may be
resu lt of: 1. Incorrect solution mixi ng; 2. An error in
di luit ion; 3. Inadequate replenish ment; 4. Excessive di-
luit ion with water. 5. Aerial oxidation; 6. Fixer or
stopbath contamination. 7. Low solution temperature.
development - Chemical process by which the latent
image formed by X-ray (or light) on the photographic
emulsion makes black metallic silver and therefore
the photographic image. The rate of development is
influenced by the time and temperature of the devel-
oper and its chemical activity. The optimum tempera-
tu re range of development is 6Q<> - 750 F. The term
- Development,. Indicates also the chemical solution
used in the above mentioned process (see also De
the
veloper) .
development, degree 01 - see Degree of development.
development, over - see Over-developmen t.
development, temperature compensation - As the tem
perature of a developing solution changes, the rate
of developmen t can be compensated by the devel-
opment time.
development exaustlon system - see Exaustlon system
of development.
development Inspection - Development by inspection is
poor practice. Errors in judgement occur as to when
development is complete because of: 1. Failure in
rapid eye accomodation from bright light to process-
ing room light and vice versa; 2. Low level of iIIumi
nation; 3. Opacity of uncleared film ; 4. Differences in
appearance of film made by direct X-ray or screen
exposures.
development replenishment system - see Replenishmen t
system of development.
diagnostic tube - An Xray tube designed for use in
diagnostic radiology.
diaphragm, poHer bucky - see Bucky.
diaphragm, tube - see Tube diaphragm.
dichroic fog - see Chemical fog.
dielectric - Any Insulating means, expecially vacuum,
with attitude to become seat of electric field and with
electrostatic properties depending Irom dielectric con-
stant of insulating means. Dielectric and insulating
means are substantially synonymous.
differential cross-section - The cross-section per unit
solid angle for scattering into a small element 01 a
solid angle in a given direction. In general it varies
with the angle between the incident beam and the
direction concerned .
Gll.AIlOONI. RADIOt.OGY El ECTIlOMEDlCll'IE
differentially-loaded radium needle - A cell-loaded radi-
um needle containing cells of different linear activi-
ties. In general the cells of high linear activity are
short, and are mounted at one or at both ends of
the active lenght.
diffraction - The phenomenon o f the prelerential scat-
tering of a beam of radiation in certain directions. It
arises Irom the interference between waves scattered
by different elements of volume of the medium.
diffraction analysis - The study of atomic arrangement
by means of the diffraction of X-rays or material par-
ticles, hence, for example, X-ray analysis.
diffraction mottling - (On film) - A diffuse diffraction
pattern on a radiograph resulting from X-raying thin
sections of crystalline material. The physical process
in which radiati on is selectively transmitted or reflect-
ed in a given direction affected by the lattice struc-
ture of the crystal.
diffractometer, neutron - see Neutron diffractometer.
diffractometer, X-ray - see X-ray diffractometer.
diffuse density - see Photographic transmission density.
diffuse reflection - (U.S.) - Scattered incoherent reflec-
tions caused by rough surfaces or associate interface
reflec tions of ultrasonic waves from irregularities of
the same order of magnitude or greater than the
wavelength.
diffuse scattering - see Disordered scattering.
diffusion - (1) Spreading of a constituent in a gas, liq-
uid or Solid, tending to make the composition of all
parts uniform ; (2) The spontaneous movement of
atoms or molecules to new sites within a material.
digital - Representation 01 process or function by dis-
c rete quantities. In computers, these discrete quanti-
ties are bits. Any functions digitized into eight-bit
computer memory will fit into one of 256 discrete
steps or values.
digital radiography - Acquisition or presentation 01 ra-
diographic image in digital formal. Digital radiogra-
phic systems all produce two-dimensional protection
images but may be video, line-scanned, or point-
scanned systems. Digital radiography includes several
new imaging approaches both lor angiography and
for general radiography which use digital and elec-
tronic recordings as opposed to analog and film tech-
niques.
digital subtraction angiography (DSA) - (Digital Red.) -
Visualization of vessels with digital radiographic ma-
chine using image subtraction. Contrast material can
be introduced by intra-arterial or intravenous injec-
tion.
digital video sublracllon angiography - (Digital Rad.) -
Any digital subtraction angiography carried out with
video imaging system.
dllultlon, lsotopk: - see Isotopic diluition.
direct current - An electric current in which the cur-
rent fl ows In one direction at all times, as opposed
to alternating current. A direct current in which the
electrons flow smoothly, without change 01 speed, is
called a - uniform direct current,,; one in which the
electrons are constantly changing speed but not di-
rection is called "pulsating direct current'". Abbrevia-
tion DC.
direct exposure film - A type of X-ray film which is
made to be especially sensitive in manufacture to the
direct action of X-rays. This type of film is designed
for use in card board holders only.
direct radiation - see Primary radiation.
GI L.A.flOON I. RADIOLOGY - ElECTAOMEOICINE
direction indicator, beam - see Beam direction indica-
tor.
direcllonal counter - A counter so arranged as to be
more sensitive to radiation from some directions than
from others. This is sometimes achieved by an ap-
propriate design of the counter itself (for exemple, by
using an elongated crystal in a scintillation counter)
and sometimes by suitable shielding, or both.
discernible Image - (On film) - Image capable of being
recognized by sight without the aid of magnification;
corrected vision expected.
discharge tube - A tube usually exhausted to a low
gas pressure and commonly provided with electrodes
for the passage of electricity.
disintegration, radioactive - see Radioactive decay.
disintegration constant - see Decay constant.
disintegrallon scheme - The modes of decay of a ra-
dioactive nuclide, generally expressed in the form of
a diagram which normally includes details of the cor-
puscular emission and of such subsequent radiations
as gamma rays or characteristic X-rays.
disk - (Digital Rad.) - Ci rcular piece of material which
has magnetic coating simi lar to that on ordinary re-
cording tape. Digital information can be stored magne-
tically on disk much as musical information is stored
on magnetic tape. Floppy disk is small fl exible record
platter lor storing digital information . l aser disk en-
codes data by creating pattern of holes and has ad-
vantage 01 storing vast amounts of information at low
projected cost per unit of information.
disk operating system (DOS) - (Digital Red.) - Collec-
tion of programs wh ich facilitate use of disk drive.
disordered scattering - Diffuse scattering due to crys-
talline imperfections; e.g. a disordered arrangement of
atoms, as in the disordered copper--gold alloy, CU3
Au , or atomic displacements ariSing from thermal
agitation . The scattering of radiation by liquids and
gases is largely diffuse.
distance, focus~to-film - see Focus-to-film distance.
distance, object-film - see Object-film distance.
distance, source-to-film - see Source-to-film distance.
distance Inverse square law - This law states that with
the same energy beam al double distance the inten-
sity becomes (1/2)2 = 1/ 4; at the triple distance the
intensity becomes (1/3)2 = 1/9 and so forth. The law
is valid as far as source dimensions are small com-
pared to object-focus distance.
distortion, Image - see Image distortion.
divergence - (U.S.) - Spreading of ultrasonic waves af-
ter leaving search unit, a function of diameter and
frequency.
Dogil - Electronic instrument for quantity (dose) and
intensity (dose rate) measurement made by Gilardoni.
donut - see Doughnut.
DOS - see Disk Operating System.
dose - see Absorbed dose.
dose, absorbed - see Absorbed dose.
dose, air - see Free-air dose.
dose, .. b.. - see Pastille dose.
dose, bone tolerance - see Tolerance dose.
dose, cumulative - see Cumulative dose.
dose, depth - see Depth dose.
dose, exit - see Exit dose.
dose, exposure - see Exposure dose.
381
dose, field - see Field dose.
dose, free-air - see Free-sir dose.
dose. given - see Field dose.
dose, In-air - see Free-air dose.
dose, Integral - see Integral absorbed dose.
dose, Integral absorbed - see Integral absorbed dose.
dose, maximum permissible - see Maximum permissible
dose and Radiation Protect/on Guide.
dose, mean lethal - see Mean lethal dose.
dose, pastille - see Pastille dose.
dose, surface - see Field dose.
dose, threshold - see Threshold dose.
dose, tolerance - see Tolerance dose and Maximum
permissible dose.
dose, total field - see Total field dose.
dose, total skin - see Tolal skin dose.
dose, percentage depth - see Percentage depth dose.
dose, skin tolerance - see Tolerance dose.
dose, tumor - see Tumor dose.
dose, volume - see Integral absorbed dose.
~tfect relation - The relationship between the dose
admmistered and the effect produced .
dose of an Isotope - The admin istered quantity ex-
pressed in any convenient unit. which in the case of
radIOisotopes is usually Ihe mi ll icurie or the micro-
cune
dosemeter - A deVice that measures radiation dose,
such as a film badge or ionization chamber.
dosemeter, condenser - see Condenser dosemeter.
dosemeter, Integrating - see Integrating dosemeter.
dose rate - The radiation dose delivered per unit time
and measu red , for instance, in rems per hou r (also
see absorbed dose) .
dose rate, maximum permissible constant - see Mexi-
mum permissible constant dose rate.
dose-rate meter - An instrument for measuring dose
rate.
dose-rate monitor - see Constancy meter.
double-contrasl enema technique - The outlining, dur-
ing radiological examination, of the large intestine by
the injection of a quantity of air following the eva-
cuation of an opaque enema usually containing bari-
um .
double crystal method - (U.S.) - The method of ultra-
sonic testing. using two transducers with one acting
as the transmitter and one as the rerceiver.
double-focus tube - An X-ray tube having two focal
spots. one of which is smaller than the other. The
smaller one is used for maximum detai l. the larger
one to permit greater energy to be applied to the
tube.
double fIIm radiography - Method that utilizes two
equal superimposed films with a sing le exposure. This
method has some advantages like contrast enhance-
ment. reduction of exposure time. comparison of two
films. division of total density in the reduced density
range by separate film viewing . Disadvantages are
double film cost and some complications.
doughnut - The toroidal vacuum chamber of a beta-
tron or syncrotron. in which electrons are accelera-
ted. It is generally made of glass or ceramic malerial
and is placed between the magnet poles.
382
dry cell - A primary electric cell using carbon and
zinc for electrodes with an electrolyte of sal ammon i-
ac and chloride of zinc carried by some absorbent
material in the cell . The carbon is the positive elec-
trode and the zinc is the negative.
drying marks - see Wetting agent.
drying process - The drying process is the removal of
water from the emulsion of an X-ray film so that it
may be freely handled.
DSA - See Digital Subtraction Angiography.
OfT ratio - The working distance for the X-ray tube in
relation to the film distance. The working distance. d.
and the specimen thickness, t. are both measured
with reference to the source side of the specimen.
dual control - The provision of two preset values of
voltage and current for screening and radiography
respectively. The desired settings are selected by the
dual control switch. whic h may be automatic.
dual - Kvp radiography - (Digital Rad.) - Imaging
technique in which images are produced with two
different X-ray beam spectra obtained by modulating
peak kilovoltage applied to X-ray tube and filtering X-
ray beam . A Compton-photoelectric decomposition
algorithm is used to form subtraction images with
bone and soft tissue removed . Technique has appli-
cations to chest. abdominal . and Skeletal radiography
as well as angiog rahpy.
dynamk: range - (Digital Rad.) - Range of intenSity or
brightness values over which image information is
acquired or displayed. For example. in rad iographic
image .. intrascen8. dynamic range refers to maximum
minus minimum radiation exposures that can be de-
tected. Typical intrascene exposure that can be re-
corded with image intensifier-television system is 1
mR (depending on F-stop setting). In computer. range
of radiation exposures that can be represented in
pixel depends on number of bits. For example. com-
puter with eight bits can represent radiation expo-
sures over 256 increments (28 ) . With X-ray film . dy-
namic range is given in units of optical density. For
television and electrical systems. dynamic range can
be given in decibels.
E
echo - (NMR) - see Spin-echo.
echo - (U.S.) - see Boundary echo.
edge, absorption - see Critical absorption wavalenght.
effect, compton - see Compton absorption.
effect, heel - see Heel effect.
effect, neighbourhood - see Neighbourhood effect.
effect, photoelectric - see Photoelectric effect.
effect, schOHky - see Field emission.
effect, waU - see Wall effect.
effective absorption coefficient - Of a substance for a
beam of heterogeneous radiation. The ratio of the
rate of decrease (in the direction of propagation) of
the intenSity at any point to the intensity at that
point. The effective absorption coefficient is not sin-
gle-valued but varies with the thickness of the ab-
sorber and the system of measu rement employed.
effective focal spot - The perpendicular projection or
effective size of the actual focal spot as it is presen-
ted to the film . The X-rays leave the rectangular ac-
tual focal spot and appear to be com ing from a
much smaller square area. In effect. the X-rays are
emitted from the square area or the effective focal
spot.
GllARDONI. RADIOt.OOY - ELE~ ME OICI N E
effective gamma-ray activity - see Effective radium (ra-
don) content.
effective half-life - The t ime required for the amount of
a particu lar specimen of radioactive nuclide in the
body or in a specified tissue to be reduced to half
of its in itial value, as a consequence of both biologi-
cal removal and radioactive decay.
effective penetration - (U.S.) - The maximum depth in
a material at which the ultrasonic transmission is suf-
ficient for proper detection of discontinuities.
effective radium (radon) content - Of a radium (radon)
container. That quantity of radium element (radon)
which, in the absence of self absorption and wall ab-
sorption, wou ld produce the same effect in a speci-
fied medium or apparatus as the given container.
effective wavelength - Of heterogeneous radiation . The
wavelength of that beam of homogeneous radiation
which, under the same specified conditions, is ab-
sorbed to the same extent as the given beam of he-
terogeneous radia tion.
elastic scattering - Scattering in which the scattered
radiation has the same quantum energy as the inci-
dent radiation.
electric charge - Of insu lator bodies. Superficial elec-
triCity produced by rubbing.
electric current - A flow of electrons through a con-
ductor.
electric generator - A device capable of displacing elec-
trons in a determined direction. It establish a "poten-
tial difference.. between its poles, that is, there is a
point in which electrons are pushed (negative pole)
and an other paint which is depleted of electrons
(positive pole). This happen at the expense of a force
called ~ e l ec tromotive force (e.m.!.) .
electric power - (In a X-rays equipment) . It is given by
the expression EP = k'mA'KV (KW) where k = 0,7
for equipment without rectifiers or with 1,2 or 4 recti-
fiers, and 0,95 for equipment with 6 or 12 rectifiers.
The electrical power is a linear function of KV, that
is, it doubles as the KV double.
electrical noise - (U ,S.) - Extraneous signals caused by
externally radiated electrical signals or from electrical
interferences within the ultrasonic instrumentation .
electricity - As a source of power, electricity is a flow
of electrons through a closed conducting circuit. The
ttow is governed by an excess of electrons at one
paint and a deficiency at another point. The flow is
in the direction of least electron concentration (lower
potential) .
electricity, static - see Static electricify.
electrizatlon - Process by wich electricity is produced.
electrocardiograph - Instrument that detects and re-
cords the voltage differences produced by heart
muscle.
electroencephalograph - Instrument that detects and re-
cords the voltage differences produced by brain work.
electrolyte - A chemical compound that can be io-
nized.
electromagnet - A soft iron or soft steel core magnet-
ized by the action of current passing through a coil
around the magnet. It loses most of its magnetism as
soon as the flow of current stopped.
electromagnetic generators - Electrical machines that
convert mechan ical into elect rical energy. The opera-
ting principle is electromagnetic induction, that is, the
prod uction of potential difference inside a conductor
when it crosses a magnetic field.
GILAROONI. RADIOLOGY ELECTROMEOIC INE
electromagnetic induction - The process by which a
current is caused to flow in a circuit due to a ma-
gnetic field moving through the wires of a portion of
the circuit. There are th ree types, of electromagnetic
induction. Relative motion, mutual induction, and self-
induction.
electromagnetic radiation - Radiation associated with a
periodically varying electric and magnetic field. It ex-
hibits phenomena characteristic of transverse wave mo-
tion. In vacuo it travels with a velocity of approxi-
mately 3 x 1010 cm/sec (more exactly 2.9979 x 1010
cm/sec).
electomagnetic waves - Electromagnetic oscillatory phe-
nomena which laws are in according with the laws
of the lightwaves. Like the lightwaves, the electro-
magnetic waves have refraction, re flection, interference
and polarization phenomena. They pass through the
vacuum space and approximately also through the air
with the same velocity (300,000 Km/sec) .
electromagnetism - Magnetism which exists about a
wire while it has an electric cu rrent flowing through
it.
electrometer - An instrument for measu ring a differ-
ence of potential by electrostatic means. In certain
circumstances it is possible to consider a grid of a
thermionic valve as an electrostatic device, in which
case the instrument is called a valve electrometer.
electromlograph - Instrument that detects and displays
voltage differences of muscular work.
electromotive torce - The work or energy which causes
the flow of an electric current. Expressed as volts. It
shou ld be noted that the term " force is a misnomer.
However. the term is so well established that its use
continues in spite of its being incorrect.
electron - One of the fundamental constituent of atoms.
The electron is a very small negative charged particle
with a rest mass of approximately 1/1837 that of the
hydrogen atom, or 9.107 x 10- 28 gm. It has an elect-
ric charge of 4.802 x 10- 10 statcou lomb (the electros-
tatic unit of charge). Electrons appear to be uniform
in mass and charge.
electron, auger - see Auger electron.
electron, compton - see Compton absorption.
electron. conversion - see Internal conversion.
electron, orbital - see Orbital electron.
electron, photo - see Photoelectric effect.
electron, recoil - see Compton absorption.
electron, shell - see Orbital electron.
electron bindIng energy - The energy requ ired to re-
move an orbital electron to infin ity. In the case of
the most weakly bound electron it is equ ivalent to
the fi rst ionization potential.
electron binding energy, tolal - see To tal electron bind-
ing energy.
electron capture - see K-electron capture.
electron cryslaUography - The study of crystals by elec-
tron diffraction.
electron density - The number of electrons per un it
volume. The term is also used in con nection with
Fourier synthesis to denote, for example, in a projec-
tion, the number of electrons per unit area.
electron diffraction camera - An apparatus for obta-
ining a photographic record, for subsequent measu-
rement of position and intensity, of the diffracted
beams produced when a specimen is irradiated in a
beam of electrons.
3B3
electron gun - A devicein in which electrons (usually
liberated from a hot filament) are focused and acce
lera ted, and are emitted as a narrow beam.
e~tron multiplier - A device, generally in the form of
a vacuum tube (electron multiplier tu be), in wh ich
small electron cu rrents are amplified in several stages
by a cascade process employing secondary emission.
In each stage, the electron stream is accelerated by
an electric field on to a sensitive surface, from which
a greater number 01 electrons is released.
e lectron ~multlpller tube - see Electron multiplier.
e~tron pair - An electron and a positron arising from
pair production.
electron radiography - Radiography by means of elec
trans.
electron volt - A unit of energy. The kinetic energy
acquired by an electron when accelerated through a
potential difference o f one volt. (One eV equals 1.602
x 10- 12 erg. One MeV equals 1.602 x 10-6 erg.)
Symbol eV.
electronic absorption coeffickmt - see Absorption coe/~
licient.
electronic cross~sectlo n - The cross section of an elec~
tron for a particular process. For the absorption of
photons it can be shown to be equal to the electron~
IC absorptJon coefficient.
.......... equilibrium - T he condition set up at a point
..,. ~ material when the energy transferred
., a srWiI YOUne about that point by secondary
t!lt!C~h"" 0'0SSII'Ig t IS the same as the total energy
! I ' 1 0IttPdt! the OIume by secondary electrons
IXII"O"'ced
.......... *
Iimer - A lJmer WlClOIJ)Ofatlng a thermoionic
'tCIi'I'e depends upon the time constant of a
senes arrangement of a cap8QtOf and a resIstor, one
of whiCh can be preset.
electroscope - An instrument for indicating a potential
difference by electrostatic means. It may be used to
detect the presence of Ionizing radiations, e.g. alpha'
ray electroscope, beta,ray electroscope, gamma,ray
electroscope.
electrostatic generator - A highvoltage d.c. machi ne in
which electric charges, form a relatively low vol tage
supply, are conveyed by mechanical means to an In-
sulated electrode, thereby producing a high potential
difference which may exceed one mi ll ion volts, e.g.
the Van de Graaff generator in which an endless in-
sulating belt is used to convey the electric charges
to a hollow metal electrode.
electrostatic unit - The quantity of electrical charge
equal to the charge of 2,080,000,000 electrons.
element - O ne 01 103 known chemical substances that
cannot be divided Into simpler substances by chemi
cals means. Exemples: hydrogen, lead , uran ium.
elementary particle - O riginally a term appl ied to any
particle that could not be further subdivided ; now
appl ied only to protons, electrons, neutrons, anliparti,
cles and strange particles, but not to alpha particles
and deuteron.
elon function - Elon is a reducing agent that starts ac~
tion on the exposed emulsion within a few seconds
and the entire image appears rapidly. Fine detail is
produced but the contrast is low.
emanation, radioactive - see Radioactive emanation.
emergent ray point - see Exit portal.
emission, aulo electronic - see Field emission.
384
emission, cold field - see Field emissIon.
emission, field - see Field emission.
emiMion, thermionic - see Thermionic emission.
emlutvtty - T he energ y emissio n rate usually expressed
as r/c/hr a 1 ft or mr/ mc/hr a 1 It.
emulsion - see Photographic emulsion.
emulskm, photographic - see Photographic emulsion.
emulSion, stripping - see Stripping emulsion.
encapsulation - The process of sealing radioactive ma-
terials to prevent contamination .
encephalography - The radiological examination of
the ventricles and subarachnoid space following the
injection of air by cisternal or lumbar puncture.
end,product - see Radioactive series.
end-window counter - A counter designed to be irra
d iated from one end . This end may have a very thin
window to permit the measurement of alpha-rays or
very soft beta rays.
enema examination, barium - see Barium enema exa
minatlon.
energy - The capacity for performing work (moving a
body through a distance) .
energy, electron binding - see Electron binding energy.
energy, total electron binding - see To tal electron bin~
ding energy.
energy, total nuclear binding - see Total nuclear bind,
Ing energy.
energy unit - The name given by Gray end Read to
the dose of radiation from which , through its asso-
ciated ionizing particles, the same energy is dissipat-
ed per gram me of material, as is dissipated from one
ronteng of hard X~ or radium gamma radiat ion in
one gramme of water (approx. 93 ergs per gramme) .
enlargement - The radiological enlargement, that is, the
dimensiona l image/object ratio, is given by:
E = focus fIImdistance I locus object,dlstance.
entry portal - The area th rough which a beam of radi-
ation enlers a patient's body.
epilation - Removal of the hair with the rool s.
epithermal neutrons - Neutrons having energies be t ~
ween those of thermal and fast neutrons.
equilibrium, electronic - see Electronic equilibrium.
equilibrium, radioactive - see Radioectlve equilibrium.
equilibrium, secular - see Radioactive equilibrium.
equilibrium, transient - see Radioactive equilibrium.
equivalent radium content - Of a radioactive specimen.
That quantity of rad iu m element which, under si mi lar
conditions of screenage, produces the same effect in
a specified medium or apparatus.
Ergll - Dosimeter for low output measurements utilizing
a big volu me ionization chamber. Made by Gi lardon i.
erytema - A superficial reddening of the sk in.
estimated actual radium (redon) content - Of a radium
(radon) container. An estimate of the radium (radon)
content of a given container derived from its effective
rad ium (radon) content, after co rrec tion for self ab
sorption and wall absorption .
examination, barium enema - see Barium enema exam~
Inatlon.
examination, barium meal - see Barium meal examins,
tlon.
examination, barium swaUow - see Barium swallow exa-
mination.
GILARDONI. RADIOLOGY - ELECTROMEOICINE
exhaustion system (of development) - In the exhaus-
tion system of development, the activity of the devel-
oper diminishes slowly with use, and radiograph ic
density is maintained by gradually increasing the de-
velopment time and adding fresh developer to main-
tain solution volume. The system requires that the
solution retained by the film be dra ined back to the
tank.
exit dose - The dose at the emergent ray paint.
exit portal - The area through which a beam of radia-
tion leaves a patient's body. The centre of the exit
portal is sometimes called the emergent point.
exponent, Schwarzschild - see Schwarzschild exponent.
exponential, absorption law - see Absorption exponen-
tial law.
exposure chart - A chart indicati ng the radiographic
exposures appropriate for dilferent thicknesses of a
specified material, or for dilferent parts of the human
body.
exposure dose - The amount of radiation , measured in
ron tgen (A), wh ich is delivered to a specific point.
exposure factor - The product of current and time di-
vided by the distance sq uared for X-rays, and the
product of curies and time divided by the distance
squared for gamma rays.
exposure latitude - The range of the curve (in which
abscissa reports exposure and ordinate density) in
wh ich the density Increase in proportion to the expo-
su re. It is the useful range of the film .
exposure meter - An instrument for predicting the ex-
posure time required for speci fied radiog raphic condi-
tions.
exposure radiographic - see RadIographic exposure.
exposure timer - A timer mechanism on the control
panel of an X-ray machine to regulate time of expo-
sure.
external quenching - see Quenching.
extinction - , . The attenuation of a beam of radiation
by diffraction, as distinct from absorption. Primary ex-
tinction occurs with perfect crystals and arises from
interference between the direct and multi-reflected
beams, the result being that only a ..skin of crystal
is able to reflect, the incident beam being extin-
guished before it reaches the deeper parts of the
crystal. Secondary extinction occurs with imperfect
crystals and arises from the shielding of underlying
mosaic blocks by identically oriented blocks nearer
the surface of the crystal. 2. The total absence of
Bragg reflections from certain sets of crystal planes,
caused by the symmetry of the space-group. (Space-
group extinctions).
extrapolation chamber - An ionization chamber of ad-
justable volume which permits the estimation of the
limit ing value of the ionization current per unit vo-
lume as the volume becomes vanishingly small.
eyeshleld - A shield of protective material arranged to
fit into the conjuctival sac so as to protect the eye,
and in particular the lens, from harmful quantities of
rad iation.
F
factor, atomic scaHering - see Atomic scattering factor.
factor, back scatter - see Back scatter factor.
factor, exposure - see Exposure factor.
GILAROONI. RAD IOLOGY ELECTROMEOIC IN E
factor, Intensifying - see Intensifying factor.
factor, K - see K-factor.
factor, speed - see Intensifying factor.
factor, structure ~ see Structure factor.
factor. temperature - see Temperature factor.
family, radioactive - see Radioactive series.
far field - (U.S.) - The region beyond the near field in
which intervals of high and tow acoustic transmission
intensity cease to occur.
fast film - Aadiographic film which has in herent graini-
ness characteristics of a coarse nature intended to
increase the relative fi lm speed.
fast Fourier transform - (NMR) - A particularty efficient
algori thm for performing Fou rier transform analysis
on a digital computer.
fast neutrons - Neutrons having energies greater than
about 0,5 MeV.
f-curve - The curve showi ng the variation of the atom-
ic scattering factor, f, with (sin 8) / ?t, where 8 is the
Bragg angle and ?t the incident wavelenght. (For neu-
tron scattering by nUClei there is no angu lar varia
tion) .
ferromagnetic materials - Materials which can be mag-
netized most strongly are ca lled ferromagnetic mate-
rials. Iron and steel exh ibit the strongest magnetic
characteristics of the more common substances.
fetography - The radiographic exami nation of the fe tus
in utero.
field - see Entry portal.
field - (Digital Rad.) - Portion of scanning cycle in
which image is scanned once, from upper left to
lower right; half of complete television image.
field, magnetic - see Magnetic field.
field, Fresnel - see Near field effects.
field dose - The dose of radiation given to an irradiat-
ed surface area, measured with back scalier un less
otherwise specified. When the dose is at a maximum
below the surface. e.g. in supervoltage therapy, the
term ..field dose may refer to the maximum dose
rather than the surface dose.
field dose. total - see Total field dose.
field emission - The emission of electrons in vacuo
from the surface of an unheated conductor due to
an intense electric field .
filament - (of Coolidge tube) - The incandescent ele-
ment situated in the cathodic cup, from which are
emitted electrons that, accelerated by the strong elec-
tric field between the electrodes, bombard the anode
in a limited area (focal spot) producing X-rays.
filament transformer - A transformer supplying power
to heat the filament of a hot cathode. The primary
and secondary windings must be sufficientty insulated
to withstand the peak potential difference between
cathode and earth.
film. direct exposure - see Direct exposure film.
film. fast - see Fast film.
film. non-screen - see Non -screen film.
film, screen type - see Screen-type film.
film, substratum - A film substratum (subbing) is a
very thin coating of a gelatin like material on X-ray
film base, glass, or paper that facilitates the adhesion
of the silver emulsion.
film, X-ray - see X-ray film.
385
film badge - A package of photograph ic film worn like
a badge by workers in the nuclear industry to mea-
su re exposure to ionizing rad iation . The absorbed
dose can be calcu lated by the degree of fi lm darken-
ing caused by the irradia tion. It is often partially
shielded to differentiate between types and qualities
of ionizing radiation .
111m base - The flexible transparent or translucent sup-
port on which an emulsion is coated .
film contrast - The effect of the film characteristics on
radiograph ic contrast. A measure of th is is given by
the slope of the characteristic curve 01 the fil m at
the relevant density.
fUm dose - The dose (mA) to be given to a rad iogra-
phic fi lm to obtain a fixed density value. The film
dose depends on the speed of the emulsion.
film holder - A light tight carrier for films and screens.
(see cassette).
film Illuminator - Equipment incorporating a suitable
source of iliumlnatfon for wieving radiographs or oth-
er transparencies.
film marker - see Identification marker.
film ring - A lilm badge worn as a ring to measure
the dose of radiation , usually beta radiation, received
by the fingers.
film speed - Relative exposure required to attain a
specified density.
filter - A layer of absorptive material that is placed in
the beam of radiation for the purpose of absorbing
rays of certain wavelenghts and thus controlling the
quality of the radiograph .
....,. composHe - see Composite filter.
..... Thof'aeus - see Composite filter.
..... bJbe - see see Tube filter.
..... wedge - see Wedge filter.
tittered b:k pro;ection - (NM R) - Algorithm used in
many field of science (notably CT and NM R) to re-
construct and image from a set of projection data.
filtration. Inherent - see Inherent filtration.
tlne-graln. non-screen film - see Non-screen film.
flulon - see Nuclear fission.
" sslon. nuclear - see Nuclear fission.
IIsslon croll-section - see Cross-section.
lI",on fragments - see Nuclear fission.
tlsslon products - The accumulated mass of radioactive
materials resulting from fission, which consists of fis-
sion fragments and their decay products.
fissionable material - Any material readily fissioned by
slow neutrons. for example, Uranium 235 and Pluto-
nium 239.
fixing - The chemical removal of unused silver halides
from an emulsion after development. A fixing bath
may be acidified (acid fixing bath), primarily to pro-
long its life.
flash radiography - Radiography in which the exposure
time is extremely short (e.g. 1 microsecond) .
nash tube - An X-ray tube designed for flash radio-
graphy.
flaw sensitivity - In a radiograph. The minimum detec-
table thickness of a specific flaw or defect, measured
in the direction of the primary beam of radiation. ex-
pressed as a percentage of the total th ickness 01 the
irradiated object, the latter being assumed to be of
specified homogenenous material. For a flaw, the
width or cross-section of which is large compared
with the unsharpness, the flaw sensitivity approxima-
tes closely to the penetrameter sensitivity.
386
fluorescence - The emission 01 electromagnetic radia-
tion by a substance as the result of the absorption
of electromagnetic or corpuscular radia tion having
greater unit energy than that of the fluorescent radia-
tion. Fluorescence is characterized by the fact that it
occurs only so tong as the stimu lus responsible for it
is maintained. The characteristic X-radiation emitted
as a result of absorption of X-rays of higher frequen-
cy is a typical example of fluorescence.
fluorescence X-radiation - see Characteristic X-radia-
tion.
fluorescent screen - A suitably mounted layer of mate-
rial, such as barium . platino-cyanide or zinc sulphide,
whic h fluoresces in the visible region of the spectrum
under the action of X-rays or other ionizing radiation.
It is commonly used to give a visual image of an ir-
radiated object.
fluorography - The photography of a fluoroscopic im-
age.
fluorography, cine - see Cine-fluorography.
fluoroscopy - The production of a visual image on a
lIuorescent screen (e.g. by X-rays) and its use lor di-
agnosis, examination of materials and for other pur-
poses.
flux, neutron - see Neutron flux .
flux density - This term means the number of flux
lines per unit of area, taken at right angtes to the di-
rection of the flux. It is the measure of magnetic
field strenght.
flux tines - Also caUed lines of force. Immaginary lines
used as a means of explaining the behavior of mag-
netic fields. Their conception is based on the pattern
of lines produced when iron filings are sprinkled on
a piece of paper laid over a permanent magnet.
focal-111m distance - (FFD or SF D) - The distance in
inches between the focal spot 01 the X-ray tube, or
the radiation source, and the film.
focal plane shuHer effect - (Dlgllal Rad.) - Feature of
scanned projection radiography wich allows dynamic
structures to be imaged with long exposure times
(seconds) without major effects from motion . Since
scan lines are acquired sequentially, each part of im-
age is acquired at different time interval. Each line of
image is taken. however, in milliseconds such that no
motion occurs during exposure time of that line. Im-
age will have kind of motion distortion that may or
may not be important.
focal spot - see Focus.
focal spot, effective - see Effective focal spot.
focus - The area of the target on wh ich the electron
stream impinges and from which X-rays are emitted .
The dimensions of the focal spot is one of the fac-
tors determining the geometrical unsharpness, that is
image qual ity. The focal spot size is determ ined on
the basis of the load (Watt) appl ied to the tube, that
is W = k . mA . kV. The form and the size can be
also determined experimentally by the pinhole came-
ra system.
focus, line - see Line focus.
focus-skin distance - The distance from the focus of
an X-ray tube to the surface of incidence on a pa-
tient, usually measured along the beam axis. Abbre-
viation : F.S.D.
focus-ta-IIIm distance - The distance from the focus of
an X-ray tube to a film set up for radiographic expo-
sure. Abbreviation : F.F.D.
GllAADONI . RADIOlOG V ELECTRDMEDICINE

focused transducer - (U.S.) - A transducer with a con-
cave face which converges the acoustic beam to a
focal paint or line at a definite distance from the
face.
focusing - (U.S.) - Concentration or convergence of
energy into a smaller beam.
fog, aerial - see Chemical fog.
fog, chem6cal - see Chemical fog.
fog, dichroi c - see Chemical fog.
fog, Inherent - see Photographic fog.
fog, oxidation - see Chemical fog.
fog, photographic - see Photographic fog.
foil - Metal in sheet form less than 0.006 in . in thick-
ness.
forbidden transition - A type of transition between two
states of a quantum-mechanical system which is much
less probable than an allowed transiti on. Transition
involving successively less probable changes in the
quantu m numbers are often called . 'irst forbidden .. ,
second forbidden .. , and so on.
forward scaHer - That part of the scattered radiation
wh ich has a scattering angle of less than 90".
Fourier translo rm (FT) - (NMR) - Mathematical tech-
nique for sorting out frequencies present in a com-
plex wavefo rm. In NMR, Fourier transfo rm of the FlO
yields the absorption spectrum.
Fourier syntesl s - A mathematical tecnique applied in
diffraction analysis to form a representation of a crys-
tal structure fro the measured diffracted intensit ies.
417 counter - A counter for measuring radiation emit-
ted in all directions by a specimen of radio-active
material placed within.
traction , branching - see Branch ing fraction.
fraction , packing - see Packing fraction.
fractionated treatment - A course of treatment given in
a succession of doses to the same reg ion spread
over a period of days or weeks.
fractionation - see Fractionated tr8atment.
fragme n", fiu lon - see Nuclear fission.
frame - (Digital Rad.) - Two television field s in inter-
laced pattern ; television image has been completely
scanned on time.
Irame grab - (Digital Rad.) - Capture on recording
medium of one complete television frame.
free-air dose - Air dose of radiatio n. measur
from which secondary radiation (apart from that aris-
ing from the air, or associated with the source) is
excluded.
free-air Ionization chamber - A ionization chamber so
designed that the observed ionization current is whol- gamma
from the
ly due to ions and electrons ariSing
commo nly
tion of radiatio n in air. This is
by passing a geometrically limited beam of radiation
widely separated electrodes.
free Induction decay (FlO) - (NMR) - Transient NMR
signal observed following RF pulse switch-off. Also
called free induction signal (FIS).
frequency - Numbe r of cycles per second
nating current or electromagnetic wave. The inverse
of the period T, that is, frequen cy = 1fT.
able quantity is time (T) , the frequency results in
sec- 1 that is Period/ Second: this is called also Hertz
(Hz).
G llAADONI. RAOIOlOGV ELECTROMEOICINE
frequen cy analysis - (Digital Rad.) - Repcescr;;a
radiographic image in terms of spatial frt!QU!!l'lC
tent; e.g. small anatom ic details have hIgh-fr e
components. Frequency analysis can be pel
on changes in information content with bme a
sured in serial or cine rad iation exposure sec
Harmonization is type of frequency anatyslS in
phase shift (dyskinesis) is represented by stv
gray.
frequency converter - see TripIer transformer.
lrequency tripler - see Tripier transformer.
Fresnel tleld - see Near field effects.
lriliing - The loosening of an emulsion from It
commencing at the edges. It is usually cau
prolonged immersion in a liqu id al too high a
rature or of unSUitable chemical compoSittOn
tull-wav e circuit - see Generator of high voh8f
wave circuit).
full-wave rectification - Rectification which alia
rent to flow during each hall-cycle of an alt
supply.
fUnctional Imagin g - ( Digital Rad.) - Use of
parameters to estimate functi on of organ or
Examples include tim ~oncentration curve I
frequen cy analysi s, and energy subtrachon.
G
gadolinium 153 - A radioiso tope of the eIemef1
inium.
gamma - The slope of the approximatety straf
tion of a characteristic curve between the
the shoulder. The steeper the slope the grea
film contrast. Symbol y.
gamma emlHer - An atom whose radloactN
process is associated with the emiSSion of
rays.
gamma Intlnlty - The maxim um gamma that
reached by prolonged development. Symbol )
gamma radiography - Rad iog raphy by means
rna rays.
gamma-ray activity - Emission of gamma rays.
gamma-ray activity , effective - see Effective rat
don) content.
ed in air,
gamma-ray capsule - A capsule wich can tam:
ma-ray source . It is usually of metal and of
thickness to reduce beta-ray transm iSSion 1
value. It is generally sealed .
-ray electroscope - see Electroscope.
absorp -
gamma-ray source - A quantity of mattet"
achieve d
gamma radiation and in a form conYenlefl1
ology.
gamma-ray source container - A contamer
material having a wall thickness sufficient Ie
safe handling for a specified limited time.
purposes, e.g . gamma rad iography. it can be
in an alter- to permit of exposures being made withou t
the source from the container.
If the vari-
gamma-ray source strenght - The output (
rays from a gamma ray source under spec
ditions of filtration.
gamma rays - High-energy, short-W8yelenght electro-
magnetic radiation emitted by a nucleus. Energies of
gamma rays are usually between 0.010 and 10 MeV.
X-rays also occur in this energy range, but are of
non-nuclear origin. Gamma radiation usually accom-
panies alpha and beta emissions and always accom-
panies fission . Gamma rays are very penetrating and
are best attenuated by dense materials like lead and
depleted uranium.
981 tube - An X-ray tube which depends on the pres-
ence of a small quantity of residual gas for the supp-
ly of electrons.
gas valve - A rectifying valve which depends on the
presence of a small quantity of residual gas for the
supply of electrons. lis suppressing property depends
on the shape and disposition 01 the electrodes.
gal-filled counte r - A form of ionization ctwr-.oer
which, when operated under suitable conddiClnS
be used as a counter Note that the word <0 ......
without qualification usually referes 10 ;.a fn
counter.
WlMOUs-ftow counter - A COUC'1ter lor
radioactivity of a gas flowing ........""
gau.. - This is the u"," "'::::..:, . ; :
_.
The strenght of fl8ld
- ..
is described as
.:...-....
--=~
designated
is one
~
~::~~ counter operated
magnitude of each
at oomber of ions initiating
_ ....._ _ _ - see GEl/gar-Mailer counter.
__ - A ~ I<e protein substance obtained from
tISSUeS by boili ng . It is used In X-ray film
~re as a means for suspension of the sensi-
~ siNer salts on the film base.
.,..,.or, electromagnetic - see Electromagnetic ge-
nerators.
generator, electrostatic - see Electrostatic generator.
generator, V.n der Graff - see Electrostatic generator.
generator of high voltage - Device that produces by
transformers alternate high voltage. Unidirectional X-
ray tube current Is assured by means of electric
valves allowing current to fl ow In one direction only.
The most important circuits used in Radiology are
the following : 1. cascade generator circuit - see (9.)
Marx circuit: 2. Cockcroft-WaUon circuit - A circuit
in which an assembly of transformers, condensers
and valves serves to charge a further condenser to
twice the voltage of the transformer. The output vol-
tage is substantially constant and may be increased
to any practicable mu ltiple of the transformer voltage
by the addition of further condensers and valves in
cascade; 3. constant potential circuit - Any circuit in
which an arrangement of condensers is used to main-
tain a VOltage which is substantially constant; 4. full-
wave circuli - A circuit in which the negative half-
cycle is reversed before it is applied, thus rendering
both half-cycles effective; 5. half-wave circuit - A
circuit arranged so that current can flow during al-
ternate half-cycles only; 6. Impulse generator clrcuH
- see (9.) Marx circuit; 7. Latour circuit - see (8.)
Liebenow-Greinacher circuit: 8. lIebenow-Grelnacher
circuit - A constant-potential voltage-doubling circuit
in which two condensers connected in series are
each charged in alternate half-cycles, thus giving a
388
substantially constant potential which app roaches
twice the transformer voltage; 9. Marx circuit - A
circuit so arranged that condensers can be charged
in parallel and discharged in series. The switching
can be either mechanical or by spa rk gaps, and the
process may involve one impulse or a succession of
impulses; 10. recti fied three-phase circuit - see (11 .)
Six-valve circuit: 11 . six-valve circuit - A circuit in
whk:h the negative half-cycles of the three compo-
nents of a three-phase supply are reversed before be-
ing applied, producing a unidirectional pulsating vol-
&age with a ripple of about 14 per cent; 12. Villard
circuit - A voltage-doubling circuit in which a con-
denser is charged, its voltage being added to that of
me transformer thus producing a unidirectional vol-
tage which may approach twice the peak voltage of
me transformer. There is also a small inverse vol-
tages; 13. Witka clrcuil - A voltage-trebling circult in
whICh two condensers are charged , their voltages be
ing added to that of the transformer, thus prodUCing
: a unidi rectional voltage which varies from the peak
voltage of the transformer to a value approaching
three times that voltage.
genetic effects of radatlon - Effects that produce chan-
ges in those cells of organisms which give rise to
egg or sperm cells and therefore affect offspring of
the exposed individuals.
geometric unsharpneu - Unsharpness arising from the
fin ite size of the source of radiation. Its magnitude
depends on the effective source dimensions and also
on the relative distances of source-to-object and ob-
ject-to-film .
geHer - Oevice of special chemical substance like ba-
rium, magnesium, zirconium, mounted in appropriate
sites inside the tube, that, by heating and evaporating
increase inherent tube vacuum by cleaning up gas
liberated during discharge, The result is longer life,
higher energies and smaller tube sizes for a given
load. This device is used since 1949.
given dose - see Field dose .
glass, Lindemann - see Lindemann glass.
glass, protective lead - see Protective lead glass.
gloves, lead-rubber - see Leadrubber gloves.
gloves, protective - see Lead-rubber gloves.
gradient - The slope of a characteristic curve at a
specified density. Symbol G.
gradient - (NMR) - In NMR imaging, magnetic field
gradients are required to provide a distribution of
Larmor frequencies over the sample, thereby render-
ing the signal spatially dependent. Measured (e.g.) in
tesla per meter (T . m- ' ).
graininess - A film characteristic which consists of the
grouping or clamping together of the counlless small
silver grains into relatively large masses visible to the
naked eye or with Slight magnification.
gramme-rOntgen - The real energy conversion when
one rontgen is delivered to one gramme of air (ap-
prox. 84 ergs). A convenient multiple is the mega-
gramme-rontgen (l OS gramme-ro ntgen).
gramme-unit, radium - see Telerad/um unit.
granularity - A physical measure of the inhomogeneity
arising from the particulate nature of a photographic
image.
Grelnaeher circuit - see Generator of high voltage (Lie-
benow-Greinacher circuit).
GlL.AROONL RADIOlOGY - ELEClflOI"U:OICINE
Grenz rays - Name given in radiotherapy to long wave
X~rays. when produced in a special type of tube
known as a Grenz tube. (From the German Grenz-
strah len. boundary radiation) .
Grenz tube - An X-ray tube having a window of low
absorption. permitting the transmission of X-rays pro-
duced at low voltages (e.g. below 12 KV).
grid - A device which consists of a series of alternate
radiopaque and radiolucent strips deeper than wide
which when interposed between patient and film al-
lows primary rays to pass through the radiopaque
strips, but the secondary radiation is absorbed by the
radiopaque strips. There are two general types of
g rids: stationary and moving. The efficiency of a grid
ranges from 80-95 per cent in the elimination of se-
condary radiation thereby enhancing contrast and in-
creasing detai l visibility.
grid, Lysholm - see Stationary grid.
grid, stationary - see Stationary grid.
grid focus - The point at which all of the radiopaque
strips in a grid would meet if they were extended.
grid radius - The distance from the grid focus to the
center of the grid.
grid ratio - In radiography. The ratio of the depth of
the opaque strips of a grid. measured in the direc-
tion of the primary beam. to the spacing between
them.
grid ratio - In grid therapy. The ratio of the total area
of holes to the total area of the grid.
grid therapy - Radiotherapy in wh ich the body su rface
is irradiated through a protective sheet having holes
arranged in a regular pattern. The opacity of the
sheet is usually chosen to reduce transmission of the
primary beam to one per cent or less,
grid tube - An X-ray tube in which a grid. operated
with negative bias, is mounted between cathode and
target.
ground - An electrical connection to the earth or the
metal framework or supports of electrical parts; a
wire connecting directly to the earth. usually through
a gas. water. or sleam line.
grounded circuit - A circuil completed th~ough ground.
through the earth . or Ihe melal framework of electri-
cal parts.
gun, electron - see Electron gun.
gun, ion - see Ion source.
gyromagnetlc ratio (r ) - (NMR) - Ratio of the nuclear
resonance frequency to the static magneti c field
strenghl . as defined by the Larmor equation. It is
constant for a particu la r nucleus. Also known as
magnetogyric ralio.
H the region treated.
half-life - see Half value period.
half-life, biological - see Biological ha/Hire.
half-life, effective - see Effective halflife.
half-value layer (HVL) - see Half-value thickness.
half-value period - The time in which the amount of a
radioactive nuclide decays 10 half its initial value.
Symbol T, T1f2 and T1!2'
half-value thickness - The thickness of a specified
substance which . when introduced into the path of a
given beam radiation, reduces its effect 10 one half.
It may be used as an indication of the quality of the
beam or of the opacity of the substance.
GllAROON I. RADIOLOGY ELECTROMEDICINE
haltwave circuit - see Generator of high voltage (half
wave circuit).
half-wave rectification - Rectification which allows cur
rent to flow only during alternate half cycles of an
alternating supply.
halide, sliver - see Silver halide.
Hall effect - An effect used in the measurement of
magnetic fields.
hanger processing - see Processing hanger.
hard radiation - A term used to describe qualitatively
the more penetrating types of X- rays, beta rays and
gamma rays.
hardener - A substance (e.g. chrome alum or formalin)
used to harden the gelatine in the emu lsion, com-
mon ly added to the fixing bath.
harmonic - A wave motion whose frequency is an in-
tegral multiple or the fundamental frequency.
hazard, radiation - see Radiation hazard.
head amplifier - A pulse amplifier placed at the head
of the circuit. next to the counter.
healt physics - The application of physics to the healt
problems created by ion izing radiation.
heat unit - An arbitra ry unit of measurement of the
heat produced in an X-ray tube. Heat un its are elec
Irically equivalent to watt-seconds, and are the pro-
duct of KVp . mA . sec.
heavy alloy - see Tungsten al/oy.
heel effect - The intensity variation within an X-ray
beam that is materially influenced by the angle at
whic h it is projected from the focal spot to ei ther
side (anOde or cathode) of the central ray. The in-
tensity is greatest on the cathode side of the X-ray
beam and progressively diminishes on the anode side.
The effect is materially influenced by the focus-film
distance. kilovoltage, and range of tissue densities be-
ing examined. It diminishes as the FFO and kVp in-
creases.
hertz - Unit of frequency measu rement. same as cycles
per second (1 KHz = 1()3 Hz, 1MHz = 1()6 Hz) .
heterogeneous radiation - Radiation of a particular type
having a variety of wavelenghts or quantum energies.
In Ihe case of X-rays. it is often referred to as the
continuous spectrum or white radiation.
high radiation area - Mean s any area, accessible to
personnel, in which there exists radiation originating
in whole or in part within licensed material at such
levels that a major portion of the body could receive
in anyone hour a dose in excess of 100 millirem.
high spot - A small volume so situated with respect to
one or more sou rces of radiation that the dose the-
rein is significantly above the general dose level in
high-voltage - According to italian standard (CEI) an
electrical system is called high voltage system when
the voltage is higher than 400 Vac and 600 Vdc. In
Radiology the high voltages generally used are of 40
-:- 400 KV. Higher voltage form part of the field of the
High Energies.
high-voltage change-over switch A device whereby
the high-voltage su pply may be con nected to any
one of several X-ray tubes.
high-voltage current - Current in high-voltage circuits.
These high voltage current posseses high voltage and
relatively low amperage.
high-voltage generator - see Generator of high-voltage.
389
hlgh-vottage circuits tor radiology - see Generator of
high-voltage.
high-voltage transformer - The device that supplies al-
ternate high voltage. It is maked by a primary and
secondary winding and a magnetic core. In radiology
is one of the part of the high-voltage generator.
hooded anode - A type of anode, in med ium or high
voltage X-ray tubes, in which the target is recessed
in a metal hood wh ich intercept electrons from the
focus. The hood may also incorporate a primary fHter
to absorb unwanted radiation.
hot-c::athode tube - An X- ray tube in which the ca-
thode is electrically heated to provide electrons.
hot-cathode valve - A rec tifying valve having a hot ca-
thode.
hot cell - A heavily shielded enclosure in which ra-
dioactive materials can be handled remotely through
the use o f manipulators and viewed through sh~
windows so that there is no danger to personnel.
hot spot - see High spot.
hyperscopic view - A stereoscopic view in whICh dt-
mensions in the direction of viewing are exaggerated
hypo - The com mon name for sod ium or ammoruum
thIOSUlfate, the chemicals used in fixig baths.
hyposcopic view - A stereoscopic view in whiCh dunen--
$IOnS III (he direction of viewing are diminished
btdi:...:~salpingography - The rad iological tJOn
01 the uterus and Fallopian tubes follOWing diI8CI II"t-
)eCtJon into the uterine cavity under controlled pres-
sure, of a contrast medium.
ideally imperfect crystal - see Imperfect crystal.
identification marker - A marker, usually of heavy me-
tal, used to provide a reference pOInt or identification
mark in a radiograph.
illuminator, film - see Film Illuminator.
Image - The deposits 01 black metallic silver in the
emulsion of the lilm wh ich represent the anatomical
structures of the part X-rayed.
image, latent - see Latent image.
image amplifier - see Image intensifier.
Image contrast - The contrast 01 image details. It de-
pends on a number 01 lactors such as definition and
the granual nature of the photographic emu lsion or
lIuorescent screen .
Image dlstomon - The perversion of the true size and
shape of the body part being examined and caused
by reason 01 the OFO and the angulation of the X-
rays passing through the part.
Image Intensifier - A device used in fluoroscopy and
incorporating a vacuum tube in which electrons re-
leased by X-rays from a special screen are accelerat-
ed and focused on to a fluorescent screen, giving an
image brighter than that produced by the unaided
action of the X-ray beam on a fluorescent screen.
The image may be observed by means of a mirror-
optical system or on a television monitor. Viewing
may be done is subdued room tight and dark adap-
tation is unnecessary.
image-intensifier cinefluorography - A radiographic pro-
cedu re wherein a motion picture is used with an im-
age intensification system to record a moving study
of the amplified images as they occur on the output
phosphor or the image-intensifier tube.
390
image Intensifier conversion factor - Ratio of lumens at
output screen, measured in candles per square meter,
to input exposure rate in milliroentgens per second .
image quality indicator - A device incorporating ele-
ments of different radiation opacity, which is used for
judging, from the appearance of its image in a radi-
ograph, the overall quality 01 that radiograph.
image quality indicator sensitivity - The smallest chan-
ge in object thickness which can be detected in a
radiograph , expressed as a percentage of the total
thickness, the object being assumed to be of speci-
fied homogeneous material.
Image repetition rate - (Digital Rad.) - Rate at wh ich
images can be acquired in repea ted manner with im-
aging system. With digital video rad iog raphy, repeti-
tion ra te is dictated primarily by time required to
store image data.
Immersion counter - see Liquid counter.
immersion testing - (U.S.) - A method of testing using
a liqu id as an ultrasonic couplant in which the test
part and the transducer face is immersed in the coup-
lant, and the transducer is not in contact with the
test part.
Impedance - Term used to refer the total opposition to
the flow of current represented by the combined ef-
fect 01 resistance, ind uctance and capacitance of a
circuit.
Impendance, acoustic - (U.S.) - see Acoustic impedance.
imperfect crystal - A crystal in which the regular peri-
od icity of the structure is impai red, due to strain, dis-
torsion, or the presence of a mosaic structu re. The
term ideally imperfect c rystal is sometimes used to
describe a crystal with a mosaic structure in which
the mosaic blocks can be regarded as negligibly
small.
Implant - The pattern of radioactive sources after im-
plantation.
Implant, permanent - see Permanent implan t.
Implant, planar - see Planar implant.
Implant, plane - see Planar implant.
Implant, lingle plane - see Planar implant.
Implant, two plane - see Planar implant.
Implant, volume - see Volume implant.
Implantation - The surg ical insertion of discrete solid
radioactive sources, such as radium needles, into the
body tissues.
Impulse generator - see Generator of high voltage
(Marx circuit).
Impulse timer - 1. A synch ronous timer wh ich is preset
in terms of the number of impulses of cu rrent re-
quired during an exposure, instead 01 the duration of
the exposure. 2. A timer desigend to close and to
open the main contactor at such points on the mains
cycle that sparki ng is reduced to a minimum . This is
sometimes known as a phased timer.
in-air dose - see Free-air dose.
incoherent scaHer - Scatter which bears no constant
and definite phase relationship to the primary radia-
tion.
Indices, Miller - see Miller indices.
indirect cine-radiography - see Cine-"uorography.
GllAA DONI. RAOIO!.-OGY - El ECTROMEDlClNE
induced current - Passing an alternating current through
a conductor will set up a fluctuating magnetic field ,
If a second conductor is placed in this field, the ac-
tion of the fluctuating field moving across the con-
ductor will set up a second alternating current of the
same frequency. This is an induced current.
Induced radioactivity - Rad ioactivity that is created by
bombarding a substance with neutrons in a reactor
or with charged particles produced by particle accel-
erators.
Industrial radiologist - see Radiologist.
inductance - When the current in a circuit is varied,
the change in the magnetic field surrounding the
conductor generates an electromotive force (voltage)
in the circuit itself. If another circuit is adjacent to
the first, the change in the magnetic field of the first
wi ll generate an electromotive force in the second.
The phenomenon is known as inductance, either self-
inductance or mutual inductance.
induction - Magnetic induction is the magnetism in-
duced in a ferromagnetic body by some outside
magnetizing force.
Induction, electromagnetic - see Electromagne tic induc-
tion.
inductive reactance - This is the opposition, independ-
ent of resistance, of a coi l to the flow of an alternat-
ing current.
inelastic scaHering - Scattering in which the scattered
radiation has a different quantum energy from that of
the incident radiation .
Inherent filtration - The filtration of an X-ray beam by
any parts of the tube or tube shield through which it
must pass.
inherent fog - see PhOtographic fog.
Initial pulse - (U.S.) - The first indication which may
appear on the screen. This indication represents the
emission of ultrason ic energy from the crystal face
(main bang) .
In-motion radiography - A method in which either the
object being radiographed or the source of radiation
is in motion during the exposure.
Insert tube - An X-ray tube intended to be placed
within a tube shield.
Insulating bodies - Called also non conductors~ . They
are the bodies that retain localized electric charges,
but do not allow the passing of an electric current,
and that have a behaviour opposite at the conduc-
tors. Insulating bodies are glass, ceramics, most
plastic and hydrocarbons. The insulating bodies are
used to separate two conductor bodies.
Integral absorbed dose - The total quantity of energy
imparted to an irradiated body from an ionizing radi-
ation . It is expressed ideally in gramme-rads (1 gram-
me-rad = 100 ergs). but where the rontgen is a
permissibile unit of dose, integral dose may be ex-
pressed in gramme-rontgens.
integral dose - see Integral absorbed dose.
integrated range - see Range.
Integrated reflection - The ratio of the total energy dif-
fracted by a crystal fragment to the incident energy
per second per unit area of the beam, when the
crystal, assumed to be bathed in the incident beam,
is rotated with unit angular velocity through a reflect-
ing position.
GILAADONI. RADIOLOGY ELECTROMEDICINE
integrating dosemeter - The name used for a doseme-
ter capable of registering cumu lative dose, usually in
multiplies of a specified dose. The instrument may be
arranged to operate various electrical cilcuits when a
preset dose has been delivered.
Intensification, photographic - see Photographic intensi-
fication.
intensifier, image - see Image intensifier.
intensifying factor - The ratio of the exposure time
without intensifying screens to that when screens are
used, other conditions being the same.
intensifying screen - A layer of suitable material which,
when placed in close contact, with a photograph ic
emuls ion, adds to the photographic effect of the in-
cident radiation. Two kinds of screen in common use
are: 1. salt screen - An intensifying screen consist-
ing of a material, such as calcium or cadmium tung-
state, wh ich fluoresces in the visible or ultra-violet
region of the spectrum under the action of X-rays or
other ionizing radiation: 2. metal screen - An inten-
sifying screen of meta! foil, usually lead, which emits
secondary radiation under the action of X-rays or
other ionizing radiation.
intensIty - At a po int in a beam of electromagnetic ra-
diation. The amount of energy passing per unit time
per unit area at the paint, the area being normal to
the direction of propagation.
intensity, linear - see Linear activity.
Intensity, meter - see Consfancy meter.
intertace - (U .S.) - The physical bou ndary between two
adjacent surfaces.
Interlace - (Dlgllal Rad.) - Method by wh ich two televi-
sion fields are displayed to form frame. This may be
positive interlace with accurate positioning of fields,
or random interlace without precise positioning of
fields.
interlock - A device for precluding access to an area
of radiation hazard either by preventing entry or by
automatically removing the hazard .
Internal conversion - The interaction of a gamma-ray
photon emitted by a nucleus with an orbital electron
of the same atom. The orbital electron (conversion
electron) is ejected from the atom and the subse-
quent filling of the vacancy so caused results in the
production of characteristic X-radiation .
Internal quenching - see Quenching.
Interplanar spacing - The perpendicu lar distance be-
tween a plane of given Miller indices and a parallel
plane through the orgin of co-ordinates.
interpretation - The process of determining the nature
of an indication.
interstitial Irradiation - Irradiation of part of the body
by radioactive sources introduced into the tissues.
Intracavitary applicator - see Applicator.
intracavitary Irradiation - Irradiation of part of the body
by introducing one or more moulds or applicators in-
to a natural or artificial body cavity.
IntracaVitary X-ray therapy - X-ray therapy in wh ich the
appropriate part of suitable X-ray apparatus is intro-
duced into a body cavity.
intrinsec counter efficiency - The proportion of phot-
ons or particles reach ing the sensitive part of a
counter which gjves rise to counts.
391
Inverse square law - The statement of the relationship
which exists between the intensity of radiation strik-
ing the film and the distance of the tube from the
film. The intensity of radiation is inversely propor-
tional to the square of the distance.
inverse voltage - A voltage which may appear across
an X- ray tube or rectifier during one half-cycle and
which reverses the polarity of the electrodes.
inversion-recovery - (NMR) - Two-pulse sequence in
which the magnetization is first inverted by an inver-
sion pulse and subsequently detected by a detection
pu lse.
ion - An atom, or aggregate of atoms, which is not
electrically neutral, viz. negative ion, positive ion. In
certain circumstances an electron may be described
as a negative ion .
lon, negative - see Ion.
lon, posilive - see Ion.
ion density - The number of ions per unit volume.
ion gun - see Ion source.
kln source - A device in which gaseous ions are pro-
duced, focused and accelerated, and are emitted as a
narrow beam .
ionization - The formation of ions.
ionization by collilion - The process in which an ion
(or an electron) gains sufficient energy in an electric
ftekj to enable it to ion ize neutral atoms or mole-
~
ioniz:ation chamber - A gas-filled enclosure containing
two or more electrodes, one of which may be its
wall. II is used to measure or to detect radiation by
means of the ionization current produced therein.
lonlzatlon chamber, air wall - see Air-wall ionization
chamber chamber.
Ionization chamber, condenser - see Condenser ioniza-
tion chamber.
Ionization chamber, tree-air see Free-air ionization
chamber.
Ionization chamber, thimble see Th imble ionization
chamber.
Ionization, cumulative - see Ionization by collision.
ionization, lpeclflc - see Specific ionization.
ionization current - The current arising from the flow
of ions and electrons to the electrodes of an ioniza-
tion chamber.
Ionization potential - The minimum potential (expressed
in volts) required to ionize a particular atom or mole-
cule.
Ionizing radiation - Electromagnetic or corpuscular ra-
diation capable of prodUCing ions.
Irldium-192 - A radioactive isotope of the element iridi-
um which has a half-life of 75 days. It is used ex-
tensively as a source of gamma radiation.
irradiation - The exposure of a body to X-rays, gamma
rays or other ionizing radiation.
Irradiation, Interslltlal - see Interstitial irradiation.
Irradiation, Intracavitary - see Intracavitary irradiation.
Irradiation, sandwich - see Sandwich irradiation.
Irradiation, surlace - see Surface irradiation.
isobars - Nuclides having the same mass number but
different atomic numbers.
isocount contours - The curves formed by the inter-
section of a series of isocount surfaces with a speci-
fied surface.
392
isocount surlace - A surface containing paints at which
the counting rates are equal.
isodose chart - A graphical representation of a number
of isodose curves in a given plane, which usually
contains the central ray.
isodose contours - see Isodose curve.
isodole curve - The curve obtained at the intersection
of a particular isodose surface with a given plane.
isodose surface - A surface such that, under specified
conditions, pOints on it receive equal doses.
isomeric transition - The decay of one isomer to
another possessing a lower energy state. It is ac-
companied by the emission of gamma radiation which
may be internally converted.
isomers - Nuclides having the same mass number and
atomic number, but whose nuclei have different ener-
gy states.
Isotones - Nuclides having the same neutron number
but different atom ic numbers.
Isotope, dose of an - see Dose of an isotope.
Isotope, stable - see Stable isotope.
Isotope, stable tracer - see Stable tracer isotope.
Isotope theraphy - Aadiotheraphy by means of radiois-
otopes.
isotopes - Atoms with the same atomic number (same
chemical element) but different atomic weights. An
eq uivalent statement is that the nuclei have the same
nu mber of protons but different number of neutrons.
Thus 602, 6C'3, 6C' are isotopes of the element carbon,
the subscripts denoting their common atomic num-
bers, the superscripts denoting the varying atomic
weights.
IsotopiC dllultlon - The mixing of a particular nuclide
with one or more of its isotopes.
Isotropy - Quality of having identical properties in all
directions.
Isotropy - (Digital Rad.) - Ability of detection system
to provide uniform image quality throughout field .
Image quality is always better at center of image
tube than at periphery.
K
K - (Digital Rad.) - Kilo, meaning a thousand . Value
1K is usually used to mean 1,024 (2 '0 ) . Computer
with 32K bytes of memory usually has 32 times 1,024
or 32.768 bytes of memory.
K-capture - see K-e/ectron capture.
K-edge subtraction - (Digital R&d.) - Type of beam
energy subtraction in which two images are taken
with beam spectra selected to be just above and just
below K-edge of iodine (33,2 keV).
K-electron capture - The radioactive decay process in
which an orbital electron from the K-shell of an atom
is captured by the nucleus. It results in the produc-
tion of X-rays characteristic of the daughter atom.
(This is a particular case of electron capture, of which
other examples are L-electron capture, and M-elec
tron capture.
K-factor - The gamma-ray dose rate in rontgens per
hour at a distance of 1 cm from a point source of
radiation with an activity of 1 mc. Each gamma emit-
ter has its own value of K-factor.
kilovolt - Unit of electromotive force or potential equal
to 1000 volts.
GILAR DON1, RADIOLOGY ELECTRO MEDICINE
kilovolt peak - The crest value of electromotive force
or potential in kilovolts, of a pulsating source of
electric potential.
kilowatt - A measurement of electrical power equal to
1000 watts.
kymograph - A device for rad iog raphically recording
the rangeJof motion of various organs, especially the
chambers of the heart throughout the cardiac cycle.
The method by which this is done is called kymo-
graphy.
kymography - A method of recording in a single radi-
ograph the excursions of moving organs in the body.
L forded by the use of metallic lead.
lamb wave - (U.S.) - A type of ultrasonic vibration
capable of propagation at specific angles dependent
upon the product of the test frequency and the part
thickness.
lamlnography - A special form of tomography which is
used for limiting an inspection to a single plane in
the material; images of the condition along the plane
of interest are brought into sharp focus while other
images are smeared or blurred.
large diameter contrast (contrast ratio) - (Digital Rad.)
- Operationally defined image quality test on image
tube that measures ability of region which receives
no X-radiation to provide zero brightness level. Be-
cause of veiling glare in imaging tube, region under
lead will have some numerical brightness. This large
test object, being of low spatial frequency, represents
modu lation transfer function (MTF) at zero spatial
frequency.
Larmor equation - (NMR) - Equation relating resonant
(Larmor) frequency fo to static magnetic field strenght
So via the nuclear gyromagnetic ratio y: fo = So(yI2rr) .
Larmor frequency - (NMR) - Resonant frequency de-
fined by the Larmor equation. Expressed in Hertz (fo)
or radians! second (WQ): Wo = 2rrfo.
latent Image - An invisible image produced in a layer
of emulsion by exposure to radiation and capable of
being converted into a visible image by development.
latent period - The period between exposure to ra-
diation and the onset of a particular effect
latitude - Latitude most closely aligned with contrast is
commonly called the scale of the film. Latitude is the
range of thickness of material that can be tranferred
or recorded on the radiograph within the useful read-
ing range of film density. A high contrast film has
little latitude and conversely a low contrast film has
great latitude.
Latour circuit - see Generator of high voltage (Latour
circuit).
lattice - A term loosely used to mean either a space-
latt ice or, incorrectly, an actual arrangement of
atoms.
lattice, bravais - see Space lattice.
lattice, reciprocal - see Reciprocal lattice.
laHice, space - see Space-lattice.
Laue equations - A set of three equations which must
be satisfied in order to permit reinforcement of the
contributions scattered from successive equivalent
points along each of the co-ordinate axes. This set
of equations represents an alternative to the Bragg
law as a method of expressing the conditions for
selective reflection.
G ILAAOONI . RADiOlOGY - ELECTAOMED ICINE
Laue method - The exam ination of the diffracted beams
which are produced, for any arbitrary setting of a
crystal, from a white beam of incident radiation;
effectively the crystal separates out the particular wave-
lenght component for which the Laue equations are
satisfied.
LAW - Liquid Active Waste.
layer, half value - see Half-value thickness.
lead castle - see Cast/e.
lead equivalent - The thickness of metall ic lead (usual-
ly expressed in mi lli metres) wh ich affords the same
protection as a given material under the same condi-
tions of irradiation.
lead protection - Protection from ionizing rad iation af-
lead rubber - Rubber containing a high proportion of
lead compounds. It is used as flexible protective
malerial.
lead-glass, protective - see Protective lead glass.
lead-rubber apron - A protective shield of lead rubber.
It may be a flap suspended from the fluorescent
screen of an X-ray couch or stand, or a garment to
be worn by the operator. In the latter case it may be
called a body apron".
lead-rubber gloves - Gloves incorporating lead rubber
as a protective material.
leak, natural - see Natural leak.
L-electron capture - see K-e/ectron capture.
lethal dose, mean - see Mean lethal dose.
leucopaenla - A decrease of the number 01 feucocytes
in the peripheral blood below about 5000 per cubic
mi ll imetre.
licensed material - Source material, special nuclear
material, or by-product material received, possessed,
used, or transferred under a general or special li-
cense issued by the Atomic Energy Commission .
Liebenow-Grelnacher circuit - see Generator of high-
voltage (Liebenow-Greinacher ci rcuit).
life, average - see Average life.
life, half - seeHalf-value par/od.
life, mean - see Average life.
limit density - (Film) - It is the maximum density ob-
tained when the film Is completely exposed and com-
pletely developed. The limit density reaches 4 and
over. Densities exceeding 3 (deep blackening) cannot
be used with normal negatoscopes.
Lindemann glass - Glass of low X-ray absorption
containing lithium, boron and beryllium.
line focus - An elongated rec tangu lar focus so placed
that, through foreshortening, an effectively square
source of X-rays can be achieved.
line focus principle - The process of making the angle
between the anode face and the central ray such
that the effective focal spot is small in relation to the
actual spot size.
line-focus tube - An X-ray tube havi ng a line focus.
line of force - The lines that can be prod uced by a
permanent magnet or a conductor carrying elect ric
current by the use of a sheet of paper and iron fil-
ings are called "magnetic li nes of force. These li nes
are immaginary lines but the concept is convenient
for describing a magnetic field. A magnetic field has
an intensity of so many lines per square inch. These
lines have a definite direction and always form closed
loops and return back onto themselves.
393
line pairs (lP) - (Olgltal Rad.) - Historical (Rayleigh,
1881) method of demonstrating resolution. It is larg-
est number of line pairs in given distance (e.g., mil-
limeter) that can be observed as two separate lines;
sometimes related to MTF at 2% contrast (although
on ly approximately). Typical values are film 5 LP/mm,
DSA 2 LP/mm , and com puted tomography 1 LP/ mm.
line scanned detector system - (Digital Rad.) - Radio-
graphic detector system wh ich uses linear array of
detectors which are scanned across patient to acquire
two dimensional projection image. X-ray intensifying
screens in combination with photo diode rays have
been reported as well as use of xenon ion ization
detectors (used in computed tomography scanners). Line
scan detector systems tend to have wide dynamic
range, low noise, and good scattered removal; limita-
tions are low frame rate and inefficient use of rad ia-
tion emitted from X-ray tube.
line scanning - (NMR) - Class of NMR imaging me-
thods in which spln-density distribution is interrogated
one line at a time. Line is scanned sequentially
through the sample to obtain the complete image.
(Also called "-Sensitive line or .. multiple sensitive-point-
imaging.
line-width - Width of absorption line, usually measured
as full -width-at-hatl-maxirnum height (FWHM) . In li-
quids, li ne-width V1/2 is related to T 2by the expression:
VI12 = 1/ " . T 2.
linear absorption coefficient - see Absorption coeffi-
cient.
linear accelerator - An apparatus in which charged
particles (electrons or positive ions) are accelerated
by continuous or successive applications of relatively
small voltages, at high frequencies, along an evacu-
ated tube. Called also Linac.
linear activity - The activity per unit lenght of an elon-
gated gamma-ray sou rce; usually expressed for radi-
um sources as mg/ cm and for other sources as
me/cm.
linear amplifier - Electronic device wh ich produces out-
put signal that is amplified in direct proportion to
input signal. Amplifier may be electron tube or transis-
tor.
linear Intensity - see Linear activity.
lip applicator - see Applicator.
liquid counter - A counter for measuring Ihe rad ioac-
tivity of a liquid. It may incorporate an annular
container for the liquid, or it may be designed for
immersion in the liquid (immersion counter). A liquid
counter is usually designed to measure beta rays as
well as gamma rays.
liquid-flow counter - A counter provided with an inter-
nal tube for measu ring the radioactivity of a flowing
liquid.
localize - To restrict or limit to one area or part.
localization - The determination of the position of an
object in the body by radiog raphic means.
log amplifier - Electron ic device which amplifies input
signal by logarithmic response lunction . Small signals
are amplified while large signals are compressed rela-
tive to input signal.
long-scate contrast - Long scale contrast is recogn ized
by the large number of translucent densities that
makes possible the visualization of an abundance of
image details. The transition between image densities
is small. Silver deposits representative of both thick
and thin parts are usually present. It is produced by
relatively short wave Jenght X-radiation.
394
longitudinal wave - see Compressional wave.
longitudinal wave velocity - (U.S.) - The unit speed of
propagation of a longitudinal (compressional) wave
through a material.
loss, coincidence - see Coincidence loss.
low contrast resolution - (Digital Rad.) - Ability of
imaging system to detect objects of low contrast and
usually relatively large size. Test for low-contrast
rendition provides useful evaluation of quantum, elec-
tronic, and other noise sources as well as optical
scattering effects.
low voltage current - Current in low voltage circuits.
These low voltage current possesses low voltage but
relatively high amperage.
luminescence - A phenomenon in which the absorption
of primary radiation by a substance gives rise to the
em ission of light characteristic of the substance.
Lysholm grid - see Stationary grid.
M
macroscoJMc - Visible with the naked eye at magnifica-
tions from one to ten diameters.
macroscoJMc magnetization vector - (NMR) - Net mag-
netic moment of a sample, considered as the inte-
grated effect of all the microscopic nuc lear magnetic
moments. Th is concept helps predict consequences
of NMR experiments performed on many simple sys-
tems. Also known as the macroscopic magnetic mo-
ment.
macroscopic stresses - Residual stresses which vary
from tension to compression in a distance (presuma-
bly many times the grain size) which is comparable
to the gage lenght in ord inary strain measurements,
hence, detectable by X-ray or dissection methods.
magnet - A body prossessing the property of magnet-
ism which causes it to attract materials made of iron.
magnetic discontinuity - This refers to a break in ma-
gnetic uniformity of the part, a sudden change in
permeability. A magnetic discontinuity may not be re-
lated to any actual physical break in the metal. but it
may produce a magnetic particle indication.
magnetic field - The space around a magnet In which
its magnetic properties are present.
magnetic flux - The total number of magnetic tines ex-
isting in a magnetic circuit is called magnetic flux".
magnetic force - In magnetic particle inspection the
magnetizing force is considered to be the total force
tending to set up a flux in a magnetic circuit. It is
usually designated by letter "H.
magnetic loop - If a conductor carrying an electric
current is bent in a loop the magnetic lines of force
enter on one side of the loop and leave at the other,
and the space within the loop is found to contain a
magnetic field which has very definite directional pro-
perties. Polarity is created within the coil with one
end being a north pole and the opposi te end a
south pole. The space enclosed by the loop is longi-
tudinally magnetized.
magnetiC materials - Materials are affected by magnets
in two general ways. Some of them are attracted by
a magnet, while others exert a repellent force. The
Itrst is called "paramagnetic" and the latter diamag-
netic". In magnetiC particle inspection we are not or-
dinarily concerned with either of the two classes, but
with what may be termed a subdivision of the first
class called ferromagnetic materials".
GllARDONI. RADiOlOGY - ElECTf'IOMEOICINE
magnetic moment - A property possessed by some mass spectrometer - An instrument in which positive
nuclei as a consequence of they inherent spin and ions are separated by the use of electric or magnetic
charge. The nucleus may be crudely pictured as a fields, or both. The ions are collected separately by
bar magnet, spinning about its North-South axis. an electrical measuring system which permits accu-
rate measurement of the relative abundance of the
magnetic poles - The ability of a magnet to attract or various isotopes present.
repeal is not uniform over its surface, but is concen-
trated at local areas called poles. Each magnet has mass unit, atomic - see Atomic mass unit (AMU).
two poles, one of which is attracted by the earth's material, air equivalent - see Air equivalent material.
North Pole and is called the north pole of the ma-
gnet, while the other is attracted by the earth's South material, air wall - see Air equivalent material.
Pole and is called the south pole of the magnet. material, amorphous - see Amorphous material.
magnetic resonance - (NMR) - The response of nuclei material, crystalline - see Crystalline material.
to discrete radiation frequencies and magnetic fields
which satisfy the Larmor condition. material, ferromagnetic - see Ferromagnetic materials.
magnetism - Mag netism is a property of matter. The material, phantom - see Phantom material.
ability of matter to attract or repel other matter is material, protective - see Protective material.
called magnetism if it is associated with the interac-
tion of lines of force (flux) between magnetic poles material, tissue equivalent - see Phantom material.
on the materials. Also recognized as a force-field matrix - (Digilal Rad.) - Number of pixels into which
surrounding conductors carrying electric cu rrent. field of examination is divided. Typical matrix sizes in
magnetograph - A magnetograph is a picture of a digital subtraction are 128 x 128, 256 x 256, 512 x
magnetic field made by the use of iron powder under 512, and 1,024 x 1.024 pixels.
conditions that allows it to arrange itself into the maximum permissible concentration - The recommended
pattern of the field . upper limit for the concentration of a radioactive subs-
tance in air or water liable to enter the human body.
magnetogyric ralio - see Gyromagnetic ratio.
The value of the limit is dependent among other
magnified distortion - see Image distortion. things on the nature of the radioactive substance and
its chemical form.
mammography - The radiolgical examination of the
breast with or without the injection of a contrast me- maximum permissible dose - The recommended upper
dium . limit for the dose which may be received during a
specific period (usually one week) by a person ex-
manometer - A U-shaped tube used for measuring the posed to ionizing radiation over an indefinite period .
pressure of gases. So far as is known a normal person so exposed will
marker, film - see Identification marker. suffer no harmful effect. For whole-body external ra-
diation the 1953 International value is 0,3 r per week
marker, Identification - see Identification marker. at the body surface for X- or gamma radiation of
Marx circuit - see Generator of high voltage (Marx cir- quantum energy less than 3 MeV .
cuit). maximum permissible constant dose rate - The dose
mAs - Milliampere seconds, utilized to standardize ra- rate which, if constant during a specific period, would
diographic exposures. Example: 5 mA x 60 seconds give rise to the maximum permissible dose for that
= 300 mAs. period.
mAs meter - see Ballistic milliammeter. maze, radiation - see Radiation trap.
mask - A device made of material such as sheet lead meal examination, barium - see Barium meal examina-
or lead-rubber, used to limit the area irradiated . tion.
mean lethal dose - That single dose of whole body ir-
mask subtraction - see Time mode (mask) subtraction.
radiation which will cause the death within a speci-
mass, atomic - see Atomic mass. fied period of 50 per cent of those receiving it. Ab-
breviation : MLD.
mass, rest - see Rest mass.
mean life - see Average life.
mass absorption coefficient - see Absorption coeffi-
cient. mechanical rectifier - A com mutating device, operated
synchronously by a motor, which interchanges the
mass decrement - The number obtained by deducting connections between the secondary of a high-voltage
the mass number of a nuclide from its mass mea- transformer and the X-ray tube in each successive
sured on the physical scale of atomic weights. Sym- hail-cycle, thereby ensuring unidirectional flow of CUf-
bolo. rent through the tube.
mass defect - The difference between the mass of a medical radiologist - see Radio/agist.
nucleus and the sum of the masses of its constituent
medical U.S. inspection - Inspection by ultrasonic equip-
nucleons.
ment. The physical principle is the same as that
mass miniature radiography - see Miniature-film radio- used in industrial ultrasonic testing: the echo reflec-
grahpy. tion . The frequency range used is between 1 to 10
mass number - The number of nucleons is a given MHz. Principal types of inspections are A, Band M
atomic nucleus. Symbol A. mode, and Real Time operation mode. Used especial-
ly for examination of the Abdomen, in Cardiology,
mass spectrograph - An instrument in which positive Obstetrics-gynaecology and Neurology.
ions are separated by the use of electric or magnetic
medium, blocking - see Blocking medium.
fields, or both . The ions are recorded on a photo-
graphic plate in order of their mass/charge ratios. megavoltage therapy - see Supervoltage X-ray therapy.

GILAROON I. RAD IOLOGY - ELECTROMEDICINE 395

Melboom-GIII sequence - (NMR) - A modification of
the Carr-Purcell sequence, designed to correct for
any slight inaccuracies in the 180" pulse lenghts.
M-electon capture - see K-electron capture.
meson - A sub-atomic particle, charged or uncharged,
having a mass intermediate between that of an elec-
tron and that of a proton.
metal rectifier - A rectifier, the operati on of which de-
pends on the different conductance in opposite direc-
tions across the surface 01 contact of certain pairs 01
substances, e.g. copper/cuprous oxide, iron/selenium .
metal screen - see Intensifying screen.
meter - An instrument for measurement; a measure of
lenght in the metric system.
meter, constancy - see Constancy meter.
meter, counllng rate - see Counting-rate meter.
meter, dose rate - see Dose-rate meter.
meter, exposure - see Exposure meier.
meter, Intensity - see Constancy meter.
meter, rate - see Counting-rate meter.
MeV - One million electron volts.
micro - A prefix that divides a basic unit by one mil-
lion.
micro-radiography - A tech nique used to examine very
small object or minute detail through the use 01 low
voltage X-rays and an ultrafine grain film emulsion
which is examined with the aid 0 1 optical enlarge-
ment.
micro-shrinkage - (On radiograph) - Discontinuities that
appear as dark feathery streaks, or irregu lar patches
that indicate cavities in the grain boundaries.
Miller indices - The reciprocals of the intercepts made
by a plane on the crystallographic axes, expressed as
the simplest possible whole numbers, the intercepts
being measured in terms of those made by a promi-
nent crystal lace chosen as parametral plane. In dif-
fraction work the term Is often extended to mean the
reciprocals 01 the intercepts made by any plane on
the axes of the unit cell. The reciprocals are ex-
pressed abSOlutely in term s of the edges of the unit
cell and not as the simplest proportional whole num-
bers, e.g. (200).
mUll - A prefix that divides a basic unit by one thou-
sand.
mlillamperage - A measu re of the current lIowing be-
tween the cathode and the anode In an X-ray tUbe.
The output intensity of the radiation Is a functi on of
this current.
milliampere - Unit of electric current equal to one
thousandth 01 an ampere.
milliampere-second - (mAs) - A measu re of X-ray ex-
posure expressed as the product of the milliammeter
read ing and the time of exposure In seconds. The
larger units .. milliampere-minute and "milliampere-
hour- are sometimes used. The mAs determines the
quantity of radiation which is produced by an expo-
sure.
millicurie-destroyed - The amou nt of radiation emitted
by a specimen of radioactive nuclide during the time
that its activity falls by one millicurie. In the case of
222Rn (lor which this term 1st most commonly used) ,
it is numerically equal to 133 milligramme-hours. Ab-
breviation: mcd.
millicurie-hour - A measure of gamma-ray exposure
expressed as the product of the radioactivity of the
source in millicuries and the time of exposure In
hours.
396
milligramme-hour - A measure of gamma-ray exposure
expressed as the product of the equ ivalent radium
content of the source, in milligrammes, and the time
of exposure in hours.
miniature-film radiograhpy - Fluorography using minia-
ture photographic film.
misregistra tion artifact - (Digital Rad.) - Subtraction ar-
tifact caused by any motion which occurs between
two frames in radiographic sequence. Common ex-
ample In artifact introduced by patient swallowing du-
ring carotid study.
mlsruns - (Radiographic) - Appear as prominent dar-
kened areas of variable dimensions with a definite
smooth outili ne.
mode - (U.S.) - The manner in which acoustic energy
is propagated through a material as characterized by
the particle motion of the wave.
mode-conversion - (U.S.) - The characteristic of surfa-
ces to change the mode of propagation of acoustic
energy from one mode to another.
moderator - A material used in a nuclear reactor to
reduce, by successive collisions and without exces-
sive absorption, the energy of the neutrons produced
at fission to lower energies, so as to permit further
fission.
modified scatter - see Compton absorprion.
modulation transfer function - (MTF) - Image quality
parameter wh ich expresses ability of imaging system
or component to transmit information of various spa-
tial frequencies. Object is broken down into basic
spatial frequencies. Knowledge of system's capabi lity
to transfer these frequencies allows prediction of con-
trast transfer for objects o f different sizes ans shapes.
molecular absorption coefficient - see Absorption coef-
ficient.
molecule - The sma llest quantity of a material which
can exist and retain all its chemical properties. Mole-
cu les may be chemically decomposed into atoms.
monitor, dose rale - see Constancy meter.
monitor, radiation - see Radiation monitor.
monitoring - Periodic or continuous determ ination 01
the amount of ionizing radiation or radioactive con-
tamination present in an occupied region.
monitOring, area - see Araa monitoring.
monitoring, personnel - see Personnel monitoring.
mosaic blocks - see Mosaic structure.
mosaic structure - A concept used to describe a par-
ticu lar type of imperfection exhibited by most crys-
tals. A crystal according to this concept consists of
mosaic blocks, i.e. perfect crystals of size about one
micron , misaligned with respect to one another by a
few minutes of arc.
mould - see Applicator.
movement blur - see Blur.
moving-field therapy - A form of cross-fire technique
in which there is relative movement between the beam
of radiation and the patient. such that the reg ion to
be irradiated remains in Ihe beam, bul Ihe entry por-
lal is constantly Changing. There are several forms of
moving-field therapy, for example, Pendulum therapy,
in which the source of radiation swings to and from
in an arc concave to the patient, Rotational therapy,
in which there is relative rotational movement between
the patient and the beam of radiation about an axis
passing through the patient, and Converging-field the-
rapy, in which the source of rad iation moves in a
spiral path.
GllAAOON I. AAOIOlOGY ElECTROMEOICINE
movlnglleld camera - A development 01 the single
crystal camera in which movement of the film is
synchronized with the crystal rotation or oscillation,
permitting direct identification of the diffraction spots.
A common type is the Weissenberg camera.
moving grid - A grid that moves according .to a preset
time 01 exposure, or reciprocates continuously.
MTF - see Modulation Transfer Function.
muttl fkttd therapy, ~ multaneous - see Converging-beam
therapy.
multlformat camera - Strictly, camera capable of ac
cepting more than one format of film size in image
plane: term has come to be accepted as describing
multHmage or mulliformat camera.
multi-Image camera - Camera capable of recording
more than one image on sheet of film .
multllpe back reflections . (U.S.) - Repetitive echoes
from the far boundary of the material being exam
ined.
multiple scaHer - Radiation scattered more than once.
multiplier, electron - see Electron multiplier.
mutation - A change in the characteristics of an orga
nism produced by an alteration of the hereditary
material.
myelography - The radiological examination of the spa
ce between the theca and the spinal cord, following
the injection of air or other contrast medium.
N diograph.
n unft - The dose of fast neutrons which, when inci
dent on a thimble ionization chamber of specified
characteristics, produces the same amount of ioniza
tlon as would one rontgen of X-or gamma radiation .
nanosecond - One billionth of a second .
narrow-beam absorption - Absorption measured under
conditions in which scattered radiation is excluded
from the measuring apparatus.
natural leak - The rate of loss of charge of an elec
trometer, electroscope or similar instrument, arising
from causes other than ionization by the radiation to
be measured.
near field effects (U.S.) - A distance immediately in
front of a transducer composed of . complex and chan
glng wave front characteristics. Also known as the
Fresnel field.
necrosis - The pathological death of a cell or group of
cells in contact with living tissue.
needle, differentlatlyloaded radium - see Differentially
loaded radium needle.
needle, radium - see Radium needle.
negative charge - An electrically unbalanced condition
which results when electrons are added to a neutral
body. A negative charge attracts positive charges and
repels other negative charges. See Positive charge.
negative halt-cycle suppressor - A device connected in
series with the primary winding of a highvoltage
transformer in a halfwave circuit, to reduce the peak
voltage during the unloaded half cycle. It usually
consists of a rectifier shunted by a resistor.
negative Ion - see Ion.
negative, radiographic - see Radiographic negative.
GllAROONI. RADIOlOGY ELECTROMEDICINE
neighbourhood effect - The name given to various ef
fects ariSing from the diffusion of developer which
has become locally exhausted or loaded with oxida
tion products by its action on a heavily exposed re
gion of an emulsion. Typical examples are developer
streaks and abnormal density variations near the
edges of regions of high density.
neutrino - A sutratomic particle which has been postu
lated in order to satisfy the conservation laws in
some rad ioactive decay processes, e.g. beta decay. It
possesses spin, but as no charge and proba bly zero
mass.
neutron - An uncharged elementary particle with a
mass nearly equal to that of the proton. The isolated
neutron is unstable and decays with a halflife of
about 13 minutes into an electron, proton and neu
Irino. Neutrons sustain the fission chain reac tion in a
nuclear reaction.
neutron crystallography - The study of crystals by neu
tron diffraction .
neutron diffractometer - An instrument used in diffrac
tion analysis for measuring with a neutron beam, Ire--
quently monochromatic, the intensities of the diffract
ed beams at different angles. An ionization chamber
or a counter may be used .
neutron flux - The intensity of neutron radiation. It is
expressed as the number of neutrons passing through
one square centimeter in one second .
neutron number - The number of neutrons is a given
atomic nucleus. Symbol N.
neutron radiography - A technique in which neutrons
are used as a penetrating radiation to produce a ra
neutron rtsntgen - see nunit.
neutrons, epithermal - see Epithermal neutrons.
neutrons, fast - see Fast neutrons.
neutrons, slow - see Slow neutrons.
neutrons, thermal - see Thermal neutrons.
neutron spectrometer - An instrument for measuring a
neutron spectrum . It is used for determining the
wavelenghts of neutrons and the relative intensities of
different wavelenghts in a neutron beam.
nolte (Digital Rad.) - All image Information that Is
not part of signal. There are several types: structured,
quantum, electronic, digitization, and others. Structured
noise in general sense could be called all anatomy
that is not vascular in a vascular study. Quantum
noise is the uncertainty due to the finite number of
Xray photons available to form image. Detector noise
in film~screen combination is primarily result of screen
mottle, while in an image tub&-television camera sys
tem the primary source of noise is in the preamplifier
of television camera. Noise is the fundamentally limit
ing parameter which determines contrast sensitivity.
nomogram - A graph that enables one by the aid of a
straightedge, to read off the val ue of a dependent
variable, when the value of the Independent variable
is given.
nonopaque - Radiolucent or penetrable by Xrays.
nonscreen film - Xray film designed for use with or
without metal screens, but not intended for use with
salt screens. It may be of relatively high speed and
coarse g rain (ordinary non screen film) or of lower
speed and finer grain (finegrain non sc reen film) .
non-uniformly loaded radium needle - see Differential
Iy-/oaded radium needle.
nozzle, telecurietherapy - see Applicator.
397
nuclear absorptton - Absorption by atomic nuclei.
nudear absorption coetfictent - see Absorption coeffi-
cient.
nuclear binding energy, total - see Tota' nuclear bind-
ing energy.
nuclear cross-section - The cross-section of an atomic
nucleus for a particular process.
nuclear fi ssion - A nuclear reaction in which a heavy
nucleus splits into two approximately equal parts,
which are referred to as fission fragments.
nuclear pile - see Nuclear reactor.
nuclear rays - The nuclear rays emitted by radioactive
elements. There are three types of nuclear rays: al-
pha (a), beta (13), and gamma (y) rays. (See).
nuclear reaction - A process which involves the trans-
formation of an atomic nucleus. It may be induced
by interaction with another nucleus, nucleon, sub-
atomic particle or photon. In the case of radioactivity,
it is spontaneous.
nuclear reactor - A device in which substances con-
taining fissile material, e.g. uranium, wilh or without a
moderator, are so arranged that for each nucleus of
the fissile material undergoing fission at least one
neutron is available 10 permit further fission and thus
to render the reaction self-sustaining.
nucleon - A constituent of the nucleus, I.e. a proton
or a neutron.
nucleus - The small , positively charged core of an
alom . It is only about 1/10,000 the diameter of the
atom, but contains nearly all the mass. Except for
ordinary hydrogen, all nuclei contain both protons
and neutrons.
nuclide - Any species of atom that exists for a measu-
rable lenght of time. A nuclide can be distinguished
by Its atomic weight, atomic number, and energy
state. The term is used synonymously with isotope. A
radionuclide is a radioactive nuclide.
number, atomk: - see Atomic number.
number, mass - see Mass number.
number, neutron - see Neufron number.
nutation - (NMR) - Rotation of the magnetization about
the axis of the radiofrequency field.
o particular radiograph. It may arise from development
obJect-film distance - The distance from the body part
to the X-ray film. As a factor of projection, it influ-
ences the size and shape of the image (magnification
and distortion) and image sharpness. Symbol: OFO.
oblique - Refers to a part having been rotated or
turned less than 90> with respect to the X-ray film
and the tube.
oersted - A unit of field strength which produces ma-
gnetic induction, designated by the letter .. Hw. The
magnetic field produced at the center of a plane cir-
cular coil of one turn and a radius of one centime--
ter, which carries a current of (1/2) abamperes.
ohm - The ohm is a unit of electrical resistance. It is
a value of resistance that will pass one ampere of
current at a potential of one volt.
Ohm's law - The relationsh ip between voltage (V), cur-
rent (I), and the resistance (R) in an electrical circuit,
and which may be expressed as: V = R . I.
oil-cooled tube - An X-ray tube in which the heat
produced on the target is dissipated, directly or indi-
rectly, by means of oil.
398
oil-Immersed tube - An X-ray tube designed for opera-
tion in oil.
oU-transformer - A transformer which is insulated by a
bath of oil which circulates and cools the heated
parts of the transformer whi le acting as an insulator.
opaque - Impenetrable by light or X-rays in the diag-
nostic quality range. Opposite of nonopaque and ra-
diolucent.
opaque media - Any contrast media which may be in-
troduced into a body cavity or structure to render it
radiopaque to X-rays.
open circuit - An incomplete circuit, one broken at
any pOint, so that current does not flow through any
part of it.
optimum kvp - A technique 01 exposure using a fixed
KVp, as opposed to variable KVp.
orbital ~ectron - An electron in the extra-nuclear struc-
ture of an alom.
ordered se,Hering - Elastic scattering from a crystal, in
which individual waves reinforce each other to give
constructive interference.
ordinary non-screen film - see Non-screen film.
orientation (crystal) - Arrangement in space of the axes
of a crystal with respect to a chosen reference or
coordinate system.
orthodlagraphy - A fluoroscopic technique for record-
ing the actual size of the heart.
orthoradlography - An examination minimizing distor-
tion to record a part in its actual size.
orthoscopic view - A three-d imensional view seen in
normal perspective.
OSCillating crystal method - A modification of the rotat-
ing crystal method in which the movement of the
crystal is restricted to an oscillation of a few de-
grees, in order to simplify correlation between the
individual diffracted beams (as registered on a film)
and the various sets of crystal planes.
overall treatment time - The duration of a course of
treatment in days or weeks from the first Irradiation
to the last.
over-development - Development which is greater than
that requ ired to produce the optimum results in a
for too long a time, or at too high a temperature,
and may give rise to excessive graininess and fog.
overexposure - The result of exposing an X-ray film or
person to an excessive amount of X-rays.
overtoad Interlock X-ray unit - A unit in which the
presetting of voltage, current and time are interlinked
in such a way that if their product, i.e. the energy to
be applied, exceeds the permissi ble loading o f the X-
ray tube, the laller cannot be energiZed.
oxldallon - The process of changing a compound by
removing one or more electrons from an atom, ion,
or molecule. Oxidation signifies the loss of an elec-
tron.
oxidation fog - see Chemical fog.
p
packing fraction - The quotient obtained by dividing
the mass decrement of an atom by its mass number.
It is frequently multiplied by 1~ for conven ience.
pair, electron - see Electron pair.
GILAROONI. AAOIOLOGY - ELECmOMEOIClNE
pair production - The complete absorption of a photon
of sufficient energy (at least 1.022 MeV) in the field
of an atomic nucleus with the production of an elec-
tronic pair.
pair-production absorpUon coefficient - see Absorption
coefficient. . penetrameter, plate - see Plate penetrsmeter.
pair-production cross-section - see Cross-section.
panoramagram, parallax - see P8rallaK panorsmagram.
paper, X-ray - see X-ray paper.
parallax panoramagram - An auto.stereogram, in each
vertical strip of which the image changes progressive-
ly from a leftwards aspect at one edge to a right-
wards aspect at the other edge. When viewed through
a li ne or lenticular grid the aspect changes, within
limits, with lateral changes In the position of the ob-
server. The orthoscopiC viewing zones are of consid-
erably greater width than the pseudoscopic zones.
parallax stereogram - An auto-stereogram consisting of
a com posite reproduction in which vertical strips from
a Ielt-eye and a right-eye.. view are interdigitated
and exposed to view through a screen of alternate
opaque and transparent lines, or alternatively through
a lent icular screen (e.g . a cylindrical lenticulated
screen) . The orthoscopic and pseudoscoplc viewing
zones are 01 equal width .
parallel - Lying evenly everywhere in the same direc-
tion but never meeting, however far extended; run-
ning side by side.
parallel light density - see Photographic transmission
density.
paramagnetic Ions - (NMR) - Paramagnetic Ions have
unpaired electrons, hence possess magnetic moments
and tend to align themselves in the static magnetic
field. Th is increases the local magnetic field slightly
and modifies relaxation times of NMR-sensitive nuclei
substanti'!llly.
paramagnetic matenal - All materials are affected by
magnetic fields. Those wh ich are attracted are called
paramagnetic. Those which are repelled are called
diamagnetic. The reaction to a magnetic field of these
two classes of substances is very slight indeed. The
few materials that are strongly attracted by magnetic
fields are called ferromagnetic.
parameter, unlt-cell - see Unit-cell parameters.
parametral plane - see Miller indices.
parent atom - see Radioactive decay.
part-thickness - The measurement, usually in centime-
ters, of the part bei ng examined.
particle - A minute constituent of matter with a meas-
urable mass, such as neutron , proton, or meson.
particle, alpha - see Alpha particles.
particle, beta - see Beta particles.
par1icle motion - Movement of particles in an article
brought about by the action of a transducer.
pass box - A two-way, ligthtight tunnel lor passing
exposed and unexposed films in cassettes between
the darkroom and exposu re rooms. Also called trans-
fer cabinet.
pastille dose - The dose of radiation required to chan-
ge the colour of a barium platinocyan ide pastille from
a specified apple-green colour (Ti nt ",Aoo) to a speci-
lied red-brown (Tint ,,8,,).
peak voltage - The max imum value of a varying vol-
tage.
pelvimetry - The radiological determ ination of the di-
mensions of the pelviC outlet.
GILAADON I. RADIOLOGY ElECTAOMEDICINE
pendulum therapy - see Moving-field therapy.
penetrameter - A device incorporati ng elements of dif-
ferent radiation opacity which is used for j udg ing ,
from the appearance of its image in a radiograph.
the overall quality of that radiograph.
penetrameter, step ~ see Step-wedge penetrameter.
penetrameter, step-wedge - see Step-wedge penetrame-
ter.
penetrameter, strip - see Plate penetrsmeter.
penetrameter, wire - see Wire pene /rameter.
penetrameter sensitivity - The smallest change in ob-
ject thickness which can be detected in a rad iograph,
expressed as a percentage of the total thickness, the
object being assumed to be of specified homogene-
ous material. The term applies to image details which
are sufficiently large for the effects of unsharpness to
be ig nored, and the quantity is largely a function of
radiographic contrast.
penetration - Refers to the ability of X-rays to pass
through materials. The penetration of tissue is a func-
tion o f X-radiation wavelenght and is controlled by
the applied kilovoltage.
penumbra - A region behind an object in a beam of
radiation such that if from any point in t his region
straight tines are drawn to different points in the
source, some pass through the object and some do
not. The penumbra is sometimes referred to as the
region of partial shadow.
percentage depth dose - Depth dose expressed as a
percentage of the field dose.
perleet crystal - A crystal in which the regular perio.
dicity of the structure is strictly maintained through-
out. Imperfections such as thermal agitation, which
do not impair the periodicity, may be present.
period, half-value - see Half-value period.
period, latent - see Latent period.
permanent Implant - An implant with radioactive mate-
rial of short half-tife (e.g . radon) so arranged that the
perscribed dose is delivered by the time that the ra-
dioactive material has decayed, thus rendering remo-
val of the sources unnecessary.
permeability - The ease with which a magnetic lield or
!lux can be set up in a magnetic circuil. It is not a
constant value for a given material , but is a ratio. At
any given value of magnetizing force, permeability is
8t H the ratio of flux density (8, to magnetizing force
H). It is a characteristic of the material being mag-
netized and is dependent upon the atloy, its heat
treatment and configuration.
permissible dose, maximum - see MaKimum permiSSible
dose.
permissible concentration, maximum - see Maximum
permissible concentration.
permissible constant dose rate, maximum - see MaKi-
mum permissible constant dose ra te.
perpendicular - Of or pertaining to any two tines which
meet at right angles.
personnel monitOring - The determination of the dose
received by a person who may be exposed to a ra-
diation hazard.
personnel monitoring equipment - Devices designed to
be worn or carried by an individual for the purpose
of measuring the dose received (e.g. film badges,
pocket chambers, pocket dosimeters, film rings, etc.).
399
pH - pH is the value that expresses the hydrogen ion
concentration of a solution-degree of acidity or alka-
linity. Pure water is neutral and its pH is 7. Solutions
with pH values less than 7 are acid in reaction ;
those above 7 are alkaline. A rapid developer is
strongly alkaline and might have a pH of 14. A strong
fixer is exceedingly acid in reaction and migh1 have
a pH value of about 3.
phantom - A volume of phantom material, usually large
enough to provide maximum back scaner.
phantom malerlal - A solid or a liquid whose radiation
absorbing and scattering properties are similar to
those of the human body.
phased timer - see Impulse timer.
phlebography - The radiological examination of veins
following the injection of a contrast medium . When
applied to the peripheral venous system it is known
as venography.
phosphorescence - Lum inescence which persists after
the period of irradiation.
photoelectric absorption coefficient - see Absorption
coefficient.
photoelectric effect - The complete absorption of a
photon by an atom with the emission of an orbital
electron (Photoelectron).
photoelectric timer - A timer incorporating a photoe-
lectric cell, usually in association with a fluorescent
screen. It is designed to terminate the exposure when
the integ rated photoelectric current reaches a preset
value.
photoelectron - see Photoelectric effect.
photoelectronlc digital radiography - (Digital Rad.) -
Radiog raphic imaging system which converts X-ray
photon image into light and then into electronic
form, which is dig itized and recorded electronically.
Imaging detector may consist of X-ray image intensi-
fier and television camera. Photoelectronic radiogra-
phy, computed radiography, and digital radiograhpy
are all general terms with similar meanings which
refer to new generation of radiograph ic imaging sys-
tems that use digital recording and processing tech-
niques.
photofluorography - The radiographic procedure by
which a photograph is taken of a fluorescent image
on a fluorescent screen. Also called photoroentgeno-
graphy.
photographic emulsion - A suspension of photo-sensi-
tive material. such as silver halide grains, in a medi-
um such as gelatine.
photographic fog - Unwanted blacken ing of an emul-
sion arising from one or more of the fOllowing
causes: 1. Development of grains which are inherent-
ly developable without exposure (inherent fog). Thys
type of fog generally varies with the age of the
emulsion, and with the conditions of storage. 2. Un-
intentional exposure of the emulsion to radiation or
to certain gases or vapours. 3. Chemical reactions.
photographiC Intenalflc.tion - Chem ical treatment of a
processed emulsion when under-exposed or under-
developed, to increase the overall contrast or density
or both.
photographic reduction - Treatment of a processed
emulsion, usually with an oxidizing agent, to lessen
the density. There may be change of contrast, de-
pending on the process used.
photographic transmission density - The common loga-
rithm of the ratio of the incident to the transm ined
luminous flux. The value of the density depends on
the method of measurement. Two extremes are in
general use, namely totally diffuse density and specu-
lar density. In the case of the totally diffuse density,
the incident flux is inc ident normally and the whole
of the light transm itted is collected and measured, or
the incident flux is diffused (I.e. incident in all direc
tions) and the tramsined lIux emerging normal to the
sample is measured. In the case of specular density
(parallel light density) the incident flux is normal and
the transmitted flux emergi ng normal to the sample
is measured.
photographiC unit - Each step, in a film, representing a
100% of exposure variation.
photography - Photography is the art or process of
obtaining images on sensitiZed surfaces by the action
of light or other radiant energy.
photomultiplier tube - An electron-multiplier tube in
which the in itial electron curren.t is derived from pho-
toelectric emission.
photon - An individual electromagnetic ray: a .. bundle-
or - packet,. of electromagnetic energy (quantum) thai
travels at the speed of light. Same as a quantum.
The energy of the phOton (quantum) determines the
type of rad iation that it is. Thus, a red light photon
has a small amount of energy, a violet light photon
more, and an X ray photon still more. A beam of
light or X-rays may be considered as a stream 01
photons.
photon fluence - (Digital Rad.) - Number of X-ray
photons per square centimeter present in Image at
various stages of production . Photon fluence which
reaches image plane dictates statistical quality of im-
age.
photo-sensitivity - Of a photographic emu lsion. A pro-
perty by virtue of which electomagnetic or corpusco-
lar radiation may produce chemical or physical chan-
ges in the emulsion.
photoradlography - The technic of photographing the
X-ray fluorescent screen image on 35 or 70 mm roll
fi lm or 4 x 10" cut film.
physical scale of atomic weights - see Atomic weights.
physical scale of.
physics, healt - see Healt physics.
p'ezoelectrtc effect - (U.S.) - The characteristic of cer-
tain materials to generate electrical charges when
subjected to mechanical vibrations, and conversely to
generate mechanical vibrations when subjected to
electrical pulses.
pile, atomic - see Nuclear reactor.
pile, nuclear - see Nuclear reactor.
pi lines - Lines formed on film during automatic pro-
cessing which were not intended to appear on the
finished radiog raph.
pin and arc - see Beam direction indicator.
pinhole camera system - Device for the measurement
of the form and size of tube focal spot. It consists of
a box with a lead or tungsten diaphgram with a hole
of about 0,1 mm. If the diaphragm is placed exactly
half way between focus and film , image shape and
dimensions are equal to those of the focus. Geomet-
rical considerations indicate that focal spot dimensions
are increased by twice the pinhole diameter. (That is:
with 0,1 mm diameter hole the focus image is en-
larged by 0,2 mm; with 0,2 mm diameter hOle the
focus image is enalarged by 0,4 mm, etc.).
GILAROONI. R,f,OIQt.OGY - EL.ECTROMEO\CINE
pltch-catch - (U.S.) - see Two-crystal method.
pixel (picture element) - (Digital Rad.) - Location in
computer memory that represen ts specific region of
X-ray image. Typical digital radiographic system con-
tains 512 x 512 pixel elements.
pixel value - (Digital Rad.) - Corresponds 10 intensity
of radiation transmitted through specific pixel of pa-
tient image.
.,.acentography - The radiological examination of the
placenta with or without a contrast medium.
planar Imaging - (NMR) - Class of NMR Imagi ng me-
thods in which spin-density information is gathered
from the whole of a selected plane simultaneously.
planar Implant - An implant arranged in one or more
planes; hence sigle plane implant. two plane implant
etc.
Plank's constant - see Quantum.
plane, crystal - see Crystal plane.
plane, parametral - see Miller indices.
.,.ane. implant - see Planar implant.
planigraphy - see Tomography.
plaque. beta ray - see Radium plaque.
plaque. radium - see Radium plaque.
plaster barium - see Barium plaster.
plate penetrameter - A plate of similar material to the
specimen under exami nation, having a thickness of 1
a 2 per cent 01 the specimen thickness, and havi ng
holes of different diameters.
plateau - Of a Geiger-Mulier counter. The range of
applied potential difference over which the counting
rate varies relatively little under constant conditions
of irradiation.
pteurography - The radiological examination of the pleu-
ral cavity following the Injection of air or other con-
trast medium.
pneumoarthrography - Injection of air as a contrast
medium into a joint space for the purpose of visualiz-
ing cartilaginous structures radiographically.
penumoencephalography - The radiographic examina-
tion of the ventricles of the brain after removal of
varying amounts of cerebrospinal fluid and reptacing
it with air as contrast medium.
pneumoperltoneography - The radiographic examination
of the peritoneum and intra-abdominal organs by
means of an injection of air as a contrast medium.
pneumothorax - The presence of air or gas in the
pleural cavity may occur spontaneously or be caused
by trauma.
point-group - see Crystal class.
point scanned radiography (flying spot radiography) -
(Digital Rad.) - Radiographic imaging system which
uses high-sensitivity stationary detector system from
which images are generated by scanning pencil beam
of radiation over patient.
point scanning - (NMR) - Class of NMR imaging me-
thods in which spin-density distribution is interrogat-
ed one point at a time. Point is scanned sequentially
through the sample to obtain a complete image. (Al-
so called sensitive point.. imaging).
pointer back - see Beam direction indicator.
G ILARDONI. RAOlot.OG'f - ELECTfiOMEOICINE
polarized beam - 1. Of electromagnetic radiation. A
beam in which the vibrations are partially or com-
pletely suppressed in certain directions. 2. Of corpus-
colar radiation. A beam in which the individual parti-
cles have non-zero spin and in which the distribution
of the values of the spin components are measured .
pole - Magnetic. The paint at which magnetic lines of
force emerge from or enter into a ferromagnetic
material.
polymorphism - The occurrence of a chemica l com-
pound with more than one crystal structure.
portal, entry - see Entry portal.
portal, exit - see Exit portal.
positive charge - That electric charge which is left
when electrons are removed from a natural body. A
poSitive charge attracts negative charges but repels
other positive charges. See Negative charge.
positive Ion - see Ion.
positron - A lundamental particle of nature having a
mass equal to that 01 the electron and possessing a
positive charge equal to the negative charge of the
electron. The mass 01 the positron is therefore 9.107
x 10- 28 gm; the electrical charge carried by the posi-
tron is equal to 4.802 x 10- 10 statcoulomb (electros-
tatic unit of charge) .
postprocessing - (Digital Rad.) - Manipu lation of image
data after recording to allow optimization of image
quality, such as edge enhancement.
potential, constant - see Constant voltage.
potential. ionization - see Ionization potential.
potential. saturation - see Saturation potential.
potential barrier - A region of high potential energy in
the field surrounding a nucleus or a nuclear particle.
It results from repulsive (cou lomb) forces acting eith-
er alone or in combination with attractive nuclear
forces.
potential difference - The difference in electrical pres-
sure or voltages between two points in circuit.
poHar-bucky diaphragm - see Bucky.
powder camera - An X-ray camera in which the di f-
fraction haloes produced in the powder method are
photographically recorded, usually on an equatorially
placed strip of film.
powder method - The examination of the di ffraction
haloes produced when a crystalline powder specimen
is irradiated in a monochromatic beam of radia tion.
The random orientation of the powder particles ena-
bles Bragg reflections to occur from all crystal planes
having interplanar spacings greater than one-half 01
the wavelenght used.
practical range - see Range.
preservative - In a developer. The constituent (e.g. so-
dium sulphite) which minimizes exhaustion of the de-
veloper caused by aerial oxidation and also serves to
remove oxidation products which migth otherwise re-
tard development or produce stain.
pr&aet apparatus - X-ray equipment in which the value
of such variables as voltage, current and time can be
accurately set before the exposure is made.
pressure mark - A variation in photographic density
caused by the application of local pressure to the
emulsion. The pressure mark may be light or dark
according to circumstances. The crescent-shaped pres-
sure mark due to severe local bending of a film is
often called a crimp mark.
4()1
primary - The part of any electrical device or circuit.
attached directly to the source, as distinguished from
the secondary which means parts depending directly
on the primary In place of the source. Also a source
that produces electricity for further action such as
mechanical or chemical action.
primary extinction - see Extinction.
primary factors - The primary radiographic factors to
be considered when making an X-ray exposure are:
,. kilovolt peak (kVp) ; 2. milliamperage (mA) ; 3. ex-
posure time (sec); and 4. focal-film distance (FFD) .
These four primary factors can be adjusted on a X-
ray machine to control the quality and quantity of
radiation striking the film .
primary radiation - 1. Radiation arising directly Irom
the target of an X-ray tube or from a radioactive
source. 2. In an absorption process. Radiation which
is incident on the absorber or which continues unal-
tered in photon energy and in direction after passing
through the absorber.
primary rectifier - see Negative half-cycle suppressor.
probe - (NMR) - Collective name for the RF coils (and
sometimes gradient coils) of an NMR spectrometer or
imaging system.
probe - (U.S.) - Transducer or search unit.
probe unll - A form of head amplifier having a low-
impedance output and su itable lor use with a Geiger-
Muller counter. It may also shape the pulse from the
counter, and assist in quenChing the discharge.
processing - A series of operations, such as develop-
ing, fixing and washing, associated with the conver-
sion of a latent image into a stable visible image.
proeessing hanger - A stainless steel frame containing
film clips at each corner that hold the X-ray film dur-
ing the processi ng procedure.
procHslng unit - A series of tanks form ing a single
unit for holding chemical solutions suitable for pro-
cessing.
product(s). decay - see Radioactive decay.
product(s). end - see Radioactive series.
product(s,. fission - see Fission products.
projection profile - (NMR) - NMR absorption spectrum
broadened by application of a field gradient. In its
simplest form, it corresponds to a one-dimensional
projection of nuclear spin density on to the frequen-
cy axis.
proportional counter - A gas filled counter, operated
under such conditions that the magnitude of each
pulse depends on the number of ions initiating it,
enabling for istance, heavily ionizing particles to be
distinguished from other ionizing radiations.
propagation - (U.S.) - Advancement o f a wave through
a medium.
prostatography - The radiographic examination of the
prostate gland .
protection lead - see Lead protection.
protective apron - see Lead-rubber apron.
protecUve gk'es - see Lead-rubber gJowes.
protecttve lead glan - Glass containing a high propor-
tion of lead compounds. It is used as a transparent
protective material.
protective material - Material which is used to provide
protection against ionizing rad iation .
protective value - see Lead equivalen t.
proton - A nuclear particle of unit mass number hav-
ing a charge equal and opposite to that of an elec-
tron and having a mass of 1.672 x 10- ZI gramme.
The nucleus of the lightest hydrogen isotope is a
proton .
proton synchrotron - An apparatus for accelerating pro-
tons by means of the synchrotron principle.
protracted treatment - 1. A course of treatment having
a prolonged overall time. 2. Treatment at low dose
rate.
protraction - see Protracted treatment.
pseudo-image - A shadow cast by an irradiated object
of smaller width than the source, in the region be-
yond the point of convergence of the umbra.
pseudoscopic view - A reserved stereoscopic view in
wh ich near objects appear to be distant and vice
versa.
pulsating voltage - A voltage which undergoes periodic
variations in magnitude, generally at a frequency re-
lated to that of the supply. The term is usuaUy con-
fined to unidi rectional vOltage.
pulse-echo method - (U.S.) - A single crystal ultrasonic
test method that both generates ultrasonic pulses and
receives the return echo.
pulse lenght (width) - (NMR) - Time for which RF ra-
diation is applied to the sample in a pulsed NMR
experiment. For a 90" pulse, pulse lenght is just suf-
ficient to tip the magnetization vector away from its
eq uilibrium position along the z-axis into the x, y
plane. Pulse lenghts of goo typically range from a few
microseconds to several mill iseconds, depending on
various methodological and instrumental factors.
pulse lenght - (U.S.) - Time duration of the pulse from
the search unit.
pulse method - (U.S.) - An ultrasonic test method us-
ing equipment which transmits a series of pulses se-
parated by a constant period of time, i.e. energy is
not sent out continuously.
pulse rate - (U.S.) - For the pulse method number of
pulses transmitted in a unit time (also called pulse
repetition rate) .
pyelography - The radiological examination of the
upper urinary tract fOllowing the injection of a con-
trast medium (intravenous pyelography or excretion
pyelography) or the direct introduction of a constrast
medium (retrograde pyelography).
a
ODE - see Quantum Detection Efficiency.
quality - Of a beam of ionizing radiation . An expres-
sion used to describe the penetrating power o f the
beam. For a heterogenous X-ray beam it is common-
ly measured in terms of half-value thickness.
quality - Radiographic. A radiograph may be said to
possess radiographic quality when by reason of exist-
ing contrast and definition all required anatomical de-
tails within the body part being examined become
visible in the image.
quantity of radiant energy - The time integral of inten-
sity. It is the total energy which has passed through
unit area, the area being normal to the direction of
propagation of the radiation.
quantum - Of energy. The smallest quantity of energy
that can be associated with a given phenomenon.
The quantum of electromagnetic radiation of a par-
ticular frequency is given by the product of the fre-
quency and Planck's constant h. (h = 6.624 x 10- 27
erg-second) .
GllARDON!, RADIOLOGY - ELECTROMEDIC! NE
quantum detection efficiency - (Digital Rad.) - Fraction
of radiation detected by imaging detector. Low ODE
leads to loss of information in final image or necessi-
tates increased radiation dose to compensate. OOEs
of about 0.50 or 50% are common with imaging de-
tectors.
quantum limit - see Boundary wavelenghf.
quantum sink - (Otgltal Rad.) - In statistical process 01
image generation, each point of image transfer or
transformation is subject to loss of information by
statistical process. Point in chain of image transfers
at which image has largest statistical uncertainty is
called quantum sink. In OSA this usually occurs at
input phosphor of image intensifier.
quantum voltage - The voltage through wh ich an elec-
tron must be accelerated to acquire the energy cor-
responding to a particular quantum .
quenching - The act 01 terminating a pulse of ioniza-
tion current in a Geiger-Muller counter. This may be
effected internally (internal quenching or self quench-
ing) by the use for example 01 an appropriate gas or
vapour filling. or externally (external quenching) by
momentary reduction of the apptied potential differ-
ence.
a -factor - see Callier coefficien t.
R
rad - Radiation Absorbed Dose. The unit of absorbed
radiation dose equal to 100 ergs of energy absorbed
per 1 gram of absorbing tissue.
radiant energy, quantity of - see Quantity of radiant
energy.
radiation - The propagation of energy through mailer
or space in the form of waves. In atomic physics the
term has been extended to include fast-moving parti-
cles (alpha and beta rays, free neutrons, etc.). Gam-
ma rays and X-rays, of particular interest in atomic
physics, are electromagnetic radiation in which energy
is propagated in packets called photons.
radiation, annihilation - see Annihilation radiation.
radiation. background - see Background radiation.
radlaUon, corpuscular - see Corpuscular radiation.
radiation, cosmic - see Cosmic radiation.
radiation, direct - see Primary radiarion.
radlatkH1. electromagnetlc - see Electromagnetic radia-
tion.
radiation, hard - see Hard radiation.
radiation, heterogenous - see Heterogeneous radiation.
radiation, Ionizing - see Ionizing radia tion.
radiation, primary - see Primary radiation.
radiation, remnant - see Remnant radiation.
radlatkH1, secondary - see Secondary radiation.
radiation, soft - see Soft radiation.
radiation. white - see Heterogenous radiation.
radiation area - Any area, accessible to personnel. in
which there exists radiation, originating in whole or
in part within licensed material, at such levels that a
major portion of the body could receive in anyone
hour a dose in excess of 5 miUirem or In any 5
consecutive days, a dose in excess of 100 miUirems.
radlation bum - A burn caused by over-exposure to
radiant energy.
QIl./<AOONI. RADlOt.OGV - ElE~EDICINE
radiation contrast - The effect of radiation quality on
contrast. A measure of this is given by the absorp-
tion coefficient of the radiation in an irrad iated ob-
ject.
radiation damage - A general term for the alteration of
properties of a material arising from radiation expo-
sure to X rays, gamma rays, neutrons, heavy-particle
radiation or fission fragments in nuclear fuel material.
radiation danger zone - A zone within which the max-
imum permissible constant dose rate or concentration
is exceeded .
radiation hazard - The danger to health arising from
exposure to ionizing radiation. It may be due to ex-
ternal irradiation or to radiation from radioactive mate-
rials within the body.
radiation maze - see Radiation trap.
radiation monitor - A device for measuring radiation in
order to assess the radiation hazard .
Radiation Protection Guide - The total amounts of io-
nizing radiation dose over certain periods 01 time
which may safely be permitted to exposed industrial
groups. These standards, established by the Federal
Radiation Council (USA). are equivalent to what was
formerly called the ..maximum perm issi ble exposure,
radiation safety officer - An individual engaged in the
practices of providing radiation protection. He is the
representative appointed by the licensee for liaison
with the Atomic Energy Commission.
radiation slcknass - A condition, following irradiation,
characterized by early malaise, vomiting and blood
changes of varying severity.
radlatlon survey - An investigation of thOse factors as-
sociated with an installation or process which could
give rise to a radiation hazard.
radiation trap - An indirect means 01 access to a room
containing an installation which gives rise to radiation
hazard, It is intended to permit freedom of access
while ensuring that workers in adjacent regions can
not be exposed to more than the maximum perm iSS-
ible constant dose rate.
radiation tube - see Air-cooled tube.
radioactive - A term referring to atoms which have un-
stable nuclei. As these atoms change to a more sta-
ble form they emit energy from the nucleus as alpha
rays, beta rays, or gamma rays.
radioactive contamination - The presence of unwanted
radioactive material, usually in circumstances which
may be dangerous to health or which may interfere
with the normal use of measuring equipment.
radioactive decay - The spontaneous change of a nu-
cleus resulting in the emission of a particle or a
photon. The atom containing the orginal nucleus is
sometimes called the Parent atom and the resulting
atom the Decay product or Daughter atom. The term
rad ioactive decay is also applied to the decay of
neutrons and mesons. For a definite quantity of a
nuclide, the rate of decay is usually expressed in
terms of half-life.
radioactive disintegration - see Radioactive decay.
radioactive emanation - A gaseous radioactive decom-
position product, e.g. radon. of a solid radioactive
element.
403
radloacttve equilibrium - The condition reached by a
radioactive series, or part thereof. when the relative
proportions of the various radioactive nuclides pres-
ent remain sensibly constant. When the parent (e.g.
22f1Ra) of the series In Question has such a small de-
cay constant that there has been no appreciable
change in the Quantity present by the time the decay
products have reached rad ioactive equilibrium the
equilibrium is relerred to as Secular equilibrium. When
the parent (e.g. m Rn) has such a large decay con-
stant that the Quantity present decreases before ra-
dioactive equilibrium is reached, the condition is re-
ferred to as TransIent equilibrium.
radioactive family - see Radioactive series.
radioactive material - Includes any such material whe-
ther or not subject to licensing control by the Atomic
Energy Commission.
radioactive series - A sequence of nuclides form ed by
successive radioactive disintegrations until a stable
(non radioactive) decay product, the End product, is
reached.
radioactive tracer - A radioisotope used to trace the
movements or behaviour of an element under given
experimental conditions, and traceable by virtue of
the radia tions it emits.
radioactive transformation - see Radioactive decay.
radioactive waste - Equipment and materials (from nu-
clear operations) which are radioactive and for which
there is no further use.
radioactivity - Spontaneous nuclear disintegration with
emission of corpuscular or electromagnetic radiations.
The principal types of rad ioactivity are alpha disinte-
gration. beta decay (electron emission, positron emis-
sion, and electron capture). and isometric transition.
radioactivity, artificial - see Induced radioac tivity.
radioactivity. Induced - see Induced radioactivity.
radioautography - see Autoradiography.
radiobiology - That branch of science devoted to the
study of the effects of radiation upon living tissue.
radioetement - An element which is radioactive.
radinfrequency - (NMR) - That part of the electromag-
netic spectrum associated with transmission of radio
waves. More specifically. electromagnetic radiation in
the approximate wavelenght band 10- 1 meters to 1()'4
meters and beyond. (Corresponding frequency band
is - 1()9 Hz to - 1()'4 Hz) . Resonance frequencies re-
Quired in NMR experiments faU In this region.
radiograph - The record on a film which represents
anatomical details of the part examined and which is
formed by the differential absorption of X-rays within
the part.
radiographer - Any individual who performs or who, in
attendance at the site where the sealed source or
sources are being used, personally supervises radio-
graphic operations and who is responsible to the li-
censee for assuring compliance with the requirements
of these regulations and the conditions of the licenses.
radiographer. therapy - see Therapy radiographer.
radIographer's assistant - Any individual who under the
personal supervision of a radiographer, uses radio-
grapher exposure devices. sealed sources or related
handling tools, or survey instruments in radiograhpy.
radiographer's exposure device - Any instrument con-
taming a sealed source fastened or contained therein,
in which the sealed sou rce or shielding thereof may
be moved. or otherwise changed. from a shielded to
unshielded positions for purposes of making a radio-
graphic exposure.
radiographic code - A code for specifying minimum
slandards related to radiographic practices.
radiographic contrast - The measure of difference in
the film blackening resulting from various X-ray in-
tensities transmitted by the object and recorded as
density differences in the image. Thus, difference in
film blackening from one area to another is contrast.
Contrast is directly influenced by the applied kilovol-
tage, the proportion of secondary radiation and the
character of the tissues being examined.
radiographic exposure - The subjection of an emulsion
to radia tion for the purpose of producing a latent
image. Radiographic exposure is commonly expressed
in terms of milliampere-seconds or millicurie-hours.
radlographk: Image - A radiographic image is a pictor-
ial record of the internal structural elements of a part
of the body as projected by X-rays on an X-ray film .
It consists of deposits of black metallic silver of vary-
ing concentration on the radiograph.
radiographic Interpretation - The determination of the
cause and significance of subsurface discontinuities
indicated on the radiograph. The evaluation as to the
acceptability or rejectability of the material is based
upon the judicious application of the radiographic
specification and standards governing the material.
radiographic negative - A radiograph or a print in
which the darker areas correspond to regions of
lower radIations opacity in the object radiographed.
radiographic putty - see BlockIng medium.
radiographic qualtflcatton test - A procedure for deter-
mining the optimum value of the d/ t ratio, or the
proper wO\'1(ing distance of an X-ray tube or a ra-
dioactive source.
radiographic range - The maximum range of thickness
of a specified homogenous material. or of radiation
opacity of an object, which can be recorded satisfac-
torily in a single radiograph with a specified tech-
nique.
radiographic screens - Metattic or fluorescent sheets
used to intenSify the radiation effect on film.
radiographic sensitivity - see Pene/rameter sensitivity.
radiographIc stereometry - The process of finding the
position and dimensions of details within and object
by measurements made on radiographs taken from
different directions.
radkgraphy - The production of radiographs.
radiography, auto - see Autoradiography.
radiography, cine - see Cine-radiography.
radiography. digital - see Digital radiography.
radiography. doubkt film - see Double-film radiography.
radiography. electron - see Electron radiography.
radiography, flash - see Flash radiography.
radiography. gamma - see Gamma radiography.
radiography. mass miniature - see Miniature-film radio-
graphy.
radiography, micro - see Micro-radiography.
radiography. miniature film - see Miniature-film radio-
graphy.
radiography, neutron - see Neutron radiography.
radiography, serial - see Serial radiography.
radiography. tele- - see Teleradiography.
radiography, tube-shiH - see Radiographic stereometry.
GllAROONI. AAOIOt.OGY - ELECTAOMEOtCINE
radioisotope - An unstable isotope of an element that
decays or disintegrates sponteneously, emitting radia-
tion. More than 1300 natural and artificial radioiso-
topes have been identified.
radioisotope concentration - The concentration of a
radioactive substance in inactive material, expressed
as the ratio of the number of radioisotope atoms to
the total number of atoms of the same element pres-
ent.
radiological technician - A technical assistant, other
than a radiographer, trained and engaged in tech-
niques of radiology.
radiologist - A specialist in radiology, e.g. Medical ra-
diologist (a registered medical practitioner), or Indus-
trial radiologist.
radiology - The science and application of X-rays, gam-
ma-rays and other penetrating ionizing radiations.
radiolucent - That property of a material which allows
it to be readily penetrated by X-rays.
radiopaque - That property of a material which causes
it to absorb a relatively large amount of the X-rays
passing through it.
radiophosphorus applicator - see Applicator.
radiotherapist - A medical radiologist specializing in
radiotherapy.
radiotherapy - The use of ionizing radiations (except
ultra-violet) for medical treatment.
radiotherapy technician - see Therapy radiographer.
radium - A radioactive element with the atomic number
88 and an atomic weight of 226. In nature, radium is
found associated with Uranium , which decays to ra-
dium by a series of alpha and beta emissions. Radi-
um is used as a radiation source.
radium applicator - see Applicator.
radium beam unit - see Te/eradium unit.
radium cell - A sealed radium container in the form of
a thin-walled tube, usually of metal, normally loaded
into other containers such as tubes or need les.
radium container - A container for holding radium, us-
ually sealed to retain decay products.
radium content - The quantity of radium in any radium
container expressed in terms of the mass of radium
element present.
radium content, effective - see Effective radium (radon)
content.
radium content, equivalent - see Equivament radium
content.
radium content, estimated actual - see Estimated actual
radium (radon) content.
radium gramme unit - see Teleradium unit.
radium needle - A radium container in the form of a
needle, usually of platinum-iridium or gold alloy, de-
signed primarily for insertion into tissue.
radium plaque - A radium container in which the radi-
um is distributed over a surface. The screenage is
usually small in one direction so as to permit the
transmission of beta as well gamma rays.
radium therapy - Radiotherapy by the use of the radia-
tions from radium.
radium tube - A radium container in the form of a
bluntended tube.
radius, grid - see Grid radius.
radon container - A sealed container for holding rad-
on. Th is may in general be of any of the external
forms taken by a radium container.
G ILARDONI. RADiOlOGY - ELECTROMEO ICINE
radon content - The quantity of radon in any radon
container, normally expressed in miUicuries.
radon content, effective - see Effective radium (radon)
content.
radon content, estimated actual - see Estimated actual
radium (radon) content.
radon seed ~ A short tube of small diameter contain-
ing radon. It may be of metal or of glass.
RAM - (Digital Rad.) - Random Access Memo ry. Main
memory of computer. Informations and programs are
stored in RAM and may be retrieved of changed by
program . AU cells are equally well (randomly) access-
ible.
range - Of an ionizing particle. The maximum thick-
ness of a given medium wh ich can be penetrated by
such a particle. II may be either the total path leng ht
(Integrated range) or the rectili near distance between
the ends of the path (Practical range).
range, radiographic - see Radiographic range.
range, subject - see Subject range.
rapid developer - A rapid developer is one in which a
strong alkali such as Kodalk or potassium hydroxide
is employed as the accelerator.
raster - (Digital Rad.) - Scanning pattern of lines in
television image.
rate, background counting - see Background counting
rate.
rate, counting - see Counting rate.
rale meier - see Countingrate meter.
raling, tube - see Tube rating .
ralio, branching - see Branching ratio.
ralio, contrast - see Con trast ratio.
ratio, grid (Radiography) - see Grid ratio (Radio -
graphy).
ratio, grid (Therapy) - see Grid ratio (Therapy).
ratio of transformer - The ratio of the number of turns
in the primary winding of a transformer to the num-
ber of turns in the secondary winding.
ratios, axial - see Axial ratios.
Rayleigh wave/ sur1ace wave - (U.S.) - A wave that tra-
vels on or close to the surface and readily fol lows
the curvature of the part being examined. Reflections
occur only at sharp changes of direction of the sur-
face.
rays, alpha (a) - see Alpha rays.
rays, beta (.8) - see Beta rays.
rays, cathode - see Cathode rays.
rays, cosmic - see Cosmic radiation.
rays, gamma ( y ) - see Gamma rays.
rays, Grenz - see Grenz rays.
rays, hard - see Hard radiation.
rays, soH - see Soft radia tion.
rays, X - see X-rays.
RBE dose - RBE stands for Relative Biological Effec-
tiveness. An RBE dose is the dose measured in
REMS. (This is discussed in the report of the Inter-
national Commission on Radiological Units and Mea-
su rements, 1956, NBS handbook 62 p. 7).
reaction, chain - see Chain reaction.
reaction, nuclear - see Nuclear reaction.
reactor, nuclear - see Nuclear reactor.
405
real-time imaging - (Digital Rad.) - imagi ng system
which acquires and displays images essentially as
fast as they are generated; there is no deiay before
images can be viewed.
real-lime video image - (Digital Rad.) - Television im-
age of dynamic process produced by presenting eye
with rapid sequence of changing video fields.
reciprocal laHice - A mathematical device much used
in the interpretation of diffraction problems in three
dimensional structures. Any set of crystal planes of
spacing d is represented by a pa int, whose distance
from an arbitrary origin is inversely proportional to d,
in a direction parallel to the plane normal.
reciprocity failure - The departure from the rec iprocity
law of any given emulsion under specified cond itions
(e.g. when salt screens are used).
reciprocity law - see Bunsen-Roscoe reciprocity law.
recoil electron - see Compton absorption.
recovery time - Of a Geiger-Muller counter. The min-
im um time interval after a count before the next vol-
tage pu lse of normal size.
rectification - Any method by which a unidi rectional
voltage can be obtained from an alternating supply.
rectification, full wave - see Full-wave rectification.
rectification, half wave - see Half-wave rectification.
rectified alternating current - By means of a device
called a recti fier, which permits current to fl ow in
one direction on ly, alternating current can be con-
verted to direct or uni-direct ional current. This differs
from direct current in that the current value va ries
from a steady level. This variation may be extreme,
as in the case of half-wave rectified single-phase ac,
or Slight, as in the case of three-phase rectified ac.
rectified three-phase circuit - see Generator of high
voltage (six-valve circuit) .
rectifier - A tube or circuit capable of converting the
high voltage alternating wave form into a usable uni -
directional voltage wave form.
rectifier, mechanical - see Mechanical rectifier.
rectifier, metal - see Metal rectifier.
rectifier, primary - see Negative half-cycle suppressor.
rectifying valve - A discharge tube which is used to
permit the flow of current in one direction on ly.
reduction - The process of changing a compound by
adding one or more electrons to an atom, ion, or
molecu le. Reduction signifies the gain of an electron.
reduction, photographic - see Photographic reduction.
reduction coefficient - see Effective absorption coeffi-
cient.
reference standard - A reference used as a base for
comparison.
reflection - (U.S.) - The characteristic of a surface to
change the direction of propagating acoustic energy;
the return of sound waves from surfaces.
reflection, Bragg - see Bragg reflection.
reflection, Integrated - see Integrated reflection.
reflection, selective - see Laue equations.
reflection density - The common logarithm of the ratio
of the brightness of a non-absorbing perfect diffuser
to that of the sample, both being ill uminated at an
ang le of 45 to the surface, the direction of mea-
surement being normal to the surface.
reflection target - A target so arranged that the useful
X-ray beam emerges from the surface on which the
electron stream is incident.
406
reflectograph - (U.S.) - A recording or chart made of
either the signals transmitted through a part or re-
flected back from defects within a part, or both.
refracted beam - (U.S.) - A refracted beam in one
which has been changed both in velocity and direc-
tion as a resu lt of its having crossed an interface be-
tween two different media and having initially been
directed at an acute angle to that interface.
refraction - (U.S.) ~ The characteristic of a material to
change the di rection of acoustic energy as it passes
through an interface into the refracting material. A
change in the direction and velocity of acoustic ener-
gy after it has passed at an acute angle through an
interface into the refracting material.
refractive index - (U.S.) - The ratio of the velocity of
a wave in one medium to the velocity of the wave in
a second medium is the refractive index of the se-
cond med ium with respect to the first. It is a mea-
su re of the amount a wave wi ll be refracted when il
enters the second medi um after leaving the first.
regular developer - A regular developer is one in which
sodium carbonate is employed as the accelerator. It
possesses less developing speed than rapid developer
and tends to produce gas when neutralized by the
fixing bath.
regulator, voltage - see Stabilizer.
relation, dose-effect - see Dose-effect relation.
relative abundance - The proportion of a given isotope
in a particu lar specimen of an element, usually ex-
pressed as a percentage,
Relative Biological Effectiveness - RBE - The relative
effectiveness of a given kind of ionizing rad iation in
producing a biological response as compared with
250.000 electron volt gamma rays.
relative stopping power - see Atomic stopping power.
relaxation times - (NMR) - Characteristic NMR parame-
ters, of which most frequently mentioned are T 1. T2
and T:i . T1 (spin lattice) is a measure of the time
requi red for the spin system to return to thermal
equilibrium with its surroundings (lattice) foll owing per-
turbation (e.g. by an RF pu lse). T2 (spinspin) is a
measure of the decay time of the transverse (x,Y)
component of magnetization . T2 relaxa tion therefore
contributes to the decay of the NMR signal (FlO).
Magnitude of T2 depends on magnetic interactions
between nuclear spins. Oecay time constant for FlO
depends also on magnetic field inhomogeneities and
is then denoted Ti .
relaxation rates (NMR) - Inverse of relaxation times.
Spin-lattice relaxation rate A1 = (1IT,). Sim ilary, R2 =
(l IT2 ), and so forth .
reluctance - Reluctance refers to the degree of diffi-
cu lty or resistance of a material to magnetize.
rem - Rontgen- Equivalent-Man. The absorbed dose of
any ionizing radiation which has the same biolog ical
effectiveness as one rad of X-radiation with average
specific ionization of 100 ion pairs per micron of wa-
ter, in terms of its air equivalent, in the same region.
r-meter - An ionization-type instrument designed to
measure radiation dose.
remnant magnetism - This is the term applied to the
magnetism remaining in a magnetic circuit after the
magnetizing force is removed .
GILAROON I. RADIOLOGY - ELEClllOMED1C INE
remnant radiation - Remnant radiation (RR) is the emer-
gent radiation from a body part wh ich has been se-
lectively dimi nished in intensity by the various tissues
traversed by the primary radiation. It is the rad iation
that produces the rad iographic image and is influ-
enced largely by the absorption characteristics of the
tissues examined.
rep - Rontgen-Eq uivalent-Physical. The dose of rad ia-
tion which, when delivered to a given mass of tissue,
produces the same real energ y conversion as one
rontgen delivered to the same mass of air (approx.
64 ergs per gramme). This unit may be used for ra-
diations other than X--or gamma radiation, and for X-
or gamma rad ialion when electronic equilibrium has
not been achieved.
repetition rate - (U.S.) - The rate at which the individ-
ual pulses o f acoustic energy are generated; also
Pulse Rate.
replenisher - A modified form 01 the original developer
which, when added to partially exhausted developer,
restores its efficiency.
replenishment system of deveJopment - In the replen-
ishment system of development, a constant develop-
ing time can be maintained by frequent addition of
small quantities of replenisher solution. A replenished
developer should be discarded when 125, 14 to 17
inch films per gallon of solution have been passed
through it- or, at the end of three months. The ex-
cess developer from the film must be drained to the
waste.
residual field - This is the field left in a piece of fer-
romagne tic material when the magnetizing force is
reduced to zero.
reslslance - The opposition offered by a substance or
body to the passage through it of an electric current,
which is measured in ohms.
resolution - The smallest distance between recogniza-
ble images on a film or screen. It may be expressed
as the number of lines per millimetre which can be
seen as discrete images.
resolution time - Of an electronic ci rcuit, mechanical
recording device or counting system, etc. The min-
Imum time interval that can elapse between the regis-
tering of two successive voltage pulses.
resotvlng power - (U.S,) - The measure of the capabili-
ty of an ultrasonic system to separate in time two
discontinuities at slightly different distances or to se-
parate the multiple reflections from the back surface
of flat plates.
resolving time - see Resolution time.
resonance - (NMR) - Response of physical systems to
stimulation by vibrations of specific frequency. In
NMR , vibrations are provided by RF waves, which in-
teract strongly with the nuclear spin system only when
the resonance condition of the Larmor equation is
met.
resonance Iransformer - A highvoltage transformer in
which the secondary circuit is tuned to resonate with
the supply frequency.
rest mass - Mass in the classical or Newtonian sense,
which excludes the relativistic addition due to motion.
restrainer - In a developer. The constituent (e.g. potas-
sium bromide) which reduces the activity of the de
veloping agent but enhances its preferential action by
reducing the rate of development of unexposed grains
to a greater extent than it does that of exposed
grains. In thus tends to reduce chemical fog.
G ILAROONI . RAD iOlOGY ELECTROMEDICINE
retentivity - Retentivity is the property of a given mate-
rial of retaining, to a greater or lesser deg ree some
amount of residual magnetism.
reticular - Having the appearance of a network.
reticulation - An effect due to rupture of an emulsion
coating, usually caused by rapid changes of tempera-
ture or of chemical condition of the emulsion when
wet. It gives an appearance simi lar to the grain of
leather.
retrograde pyeklgraphy - see Pyelography.
reversal - The production of a positive instead of a
negative image in an em ulsion or vice versa.
rheophore - A wire or tape which is kept tau t by a
spring-urged drum, and is used for making electrical
connections in high-voltage circuit.
rhm - see R6ntgen -per-hour-at-one-meter.
ring, film - see Film ring.
ripple voltage - see Constant voltage.
rodanode tube - An X-ray tube in which the target is
situated near the end of a long tubular anode.
ROM - (Digital Rad.) - Read On ly Memory. This m&-
mary contains programs which are fixed and are
therefore used repeatedly.
r~ ntgen - A unit of dose, defined internationally as
..the quantify of X- or gamma rad iation such that the
associated corpuscular emission per 0.001293 gramme
of air produces, in air, ions carrying one electrostatic
unit of quantity of electricity of either sign. Note
that 0.001293 gramme is the mass of 1 cu. cm of
dry atmospheric air at OOC and 760 mm of mercury
pressure. Abbreviation: A.
r~ntgen , gramme - see Gramme-r6ntgen.
r~ntgen , neutron - see N-unlr.
r~ntgen, tissue - see rep.
r~ntgen-equivalent-man - see rem.
r~ntgen-eq u lvalent-physlcal - see rep.
rOntgenogram - see Radiograph.
rtk'Itgen-per-hour-al-one-meler - A unit 01 effective stren-
ght of a gamma-ray source, under specified condi-
tions of shield ing, such that, at a distance of one
metre in air, its gamma rays prod uce a dose rate of
one rontgen per hour. Abbreviation: RHM .
Rose phantom - (Digital Rad,) - Phantom constructed
on theory of Rose (1948); a step wedge in which
each step has twice thickness of preceding step. Wi-
thin each step are sveral holes, each twice diameter
of preceding hole. Rose pred icted that threshold of
perception would occur at constant product of con-
trast and diameter.
rotallng-anode tube - An X-ray tube in which the target
constantly rotates during exposu re, thus permitting
the heat to be distributed over a much larger area
with a correspond ing increase in X-ray producing ca-
pacity. The axis of rotation is offset from the axis of
the electron stream, so that the focus ties on a circle
on the rotating surface.
rolatlng crystal method - The examination of the dif-
fracted beams from a single crystal irradiated by mo-
nochromatic radiation , the crystal being usually rotated
about an axis perpendicular to the incident beam, in
order to satisfy the conditions for Bragg reflection
from various crystal planes in turn .
407
rotating reference frame (NMR) - Alternative frame of
reference (as distinct from ..laboratory frame) from
wh ich to observe the behaviour of the magnetization
vector, M. System is then considered from the point
of view of an observer rotating with M usually at the
resonance frequency. The rotating magnetic field then
appears stationary.
rotational therapy - see Moving-field therapy.
rubber, lead - see Lead rubber.
Rutherlord scaHering - see Coulomb scattering.
s scattering, Coulomb - see Coulomb scattering.
safelighl - A source of filtered light which gives a
maximum of visibility in the darkroom whilist produc
ing a minimum of fog in the emulsion for which it is
designed. The term safelight is also used to mean
the filter alone.
salpingography, hystero - see Hystero-salpingography.
salt screen - see Intensifying screen.
sandwich Irradiation - The irradiation of tissues from
opposite sides. The t issues may be treated by a mul-
tiple-plane implant, or by two surface applicators or
moulds (in such sites as the lip or the ear) or by a
combination 01 techniques.
saturation - Of an ionization chamber. The condition
reached when the potential difference between the
electrodes is such that all the ions formed by the
radiation are collected and none produced by colli-
sion.
satu ration - Refers to that degree of magnetization
where a further increase in H produces non further
Increase in the lield in a given material other than is
produced in air.
satu,.tion current - The ionization current at satura-
tion.
saturation potentlal - The minimum potential difference
between the electrodes of an ionization chamber ne-
cessary to establish saturation.
scale of contrast - see Contrast scale.
scaling circuit - A device in which the counts may be
recorded in grou ps of predetermined size (e.g. scale
of 2, scale of 10), and in which provisions may be
made for observing at any instant the total number
of counts.
scanned protection radiography (SPR) - (Olgital Rad.)
- Digital radiography performed by scanning with fan
beam system. Patient is rapidly transversed through
fan beam with X-ray tube stationary. (System is used
to produce planar images with computed tomogra-
phy) .
scanning (manual & automatic) - (U.S.) - The moving
of the search unit or units along a test surface to
obtain complete testing of a material.
scatter - Secondary radiation which is emitted in all
directions.
scatter, back - see Back scatter.
scatter, coherent - see Coherent scatter.
seaHer, Compton - see Compton absorptiOn.
scatter, forward - see Forward scatter.
scatter, Incoherent - see Incoherent scatter.
scatter, modified - see Compton absorption.
seaHer, multiple - see Multiple scatter
scatter, unmodified - see Unmodified scatter.
40B
scatter, unsharpness - Unsharpness due to radiation
scattered by an irradiated object, intenSifying screen
or fluorescent screen.
scattering - A process that c hanges a particle's or
photon's trajectory. Scattering is caused by collisions
with atoms, nuclei, and other particles. If the scat-
tered particle's energy is unchanged by the COllision,
elastic scattering prevails: if there is a change in
energy, the process is called inelastic scattering.
scattering - (U.S.) - Dispersion of ultrasonic waves in a
med ium due to causes other than absorption.
scattering, Bragg - see Ordered scattering.
scattering, diffuse - see Disordered scattering.
scattering, disordered - see Disordered scattering.
scaHerlng, elastic - see Elastic scattering.
scaHerlng, Inelastic - see Ine/astfc scattering.
scaHerlng, ordered - see Ordered scattering.
scattering, Rutherford - see Coulomb scattering.
scattering absorbtlon coefficient - see Absorption coef-
ficient.
scaHering angle - The angle between the direction of
propagation of the primary and scaHered radiation.
scattering cross-section - see Cross-section.
scattering factor, atomic - see Atomic scattering factor.
scattering lenght - see Atomic scattering factor.
Schottky effect - see FIeld emission.
scout film - A preliminary or survey fi lm of a part, us-
ually taken prior to the administration of opaque ma-
dia: also to check technical factors.
Schwarzschlld exponent - A mathematical index which
may be applied to one of the variables in order to
correct for the failure of the reciprocity law over a
limited range.
scintillation - Localized luminescence arising from the
impact of a sing le ionizing particle or photon .
scintillation counter - A counter in which the scinti lla-
tions produced in a flu orescent material by an ioniz-
ing radiation are detected by a photomultiplier tube.
screen, fluorescent - see Fluorescent screen.
screen, Intensifying - see IntenSifying screen.
screen, metal - see Intensifying screen.
screen, sail - see Intensifying screen.
screen, viewing - see Film illuminator.
screenage - The filtration afforded by a container of
radioactive material. It is expressed quantitatively in
terms of the thickness and material of the wall, or
the equivalent th ickness of a specified material.
screening - see Fluoroscopy.
screens, combination - see CombInation screens.
screen-type film - X-ray film designed for use with sal!
screens. I! is sensitive to the fuorescent light emitted
by such screens under the action of X-rays.
secondary extinction - see Extinction.
secondary radiation - X-rays which are produced as
the result of the interaction of primary radiation and
the absorbing material of the part being examined.
Secondary rays go in all directions and may produce
an overall density (fog) on the fi lm .
secular equilibrium - see Radioactive equilibrium.
seed, radon - see Radon seed.
GILAAOONI. RADIOlOGY ELfCTFlOMfDlClNE
 selective absorption - The concentration of a particular
substance in an organ or specified tissue to a grea-
ter extent than would be accounted for by diffusion.
selective irradlatlon - (NMR) - NMR technique employ ,
ing special RF pulses designed to irradiate only se-
lected regions of the sample. Pulse is sometimes
shaped or "'tailored" to achieve this end.
selective reflection - see Laue equations.
seH-absorption - The decrease in beta-ray or gamma
ray output resulting from aborption in the radioactive
material itself, or in any non-radioactive material with
which it may be mixed.
self-protected tube - An X-ray tube the construction
01 which includes protection against excessive emis-
sion of radiation outside the useful beam.
seH quenching - see Quench ing.
selt-rectlfylng tube - The name given to any bot-ca-
thode X-ray tube to describe its property of permit-
ting current to flow one way only, when the anode
is kept cool.
seend-recelver transducer - (U.S.) - A transducer con-
taining two crystals mounted side by side separated
by an acoustic barrier; one generates the acoustic
energy , the other receives it.
sensitive line - see Line scanning.
sensitive point - see Point scanning.
sensitivity - The size of the smallest discontinuity de-
tectable by a nondes tructive test method ; same as
"'process attainment".
sensitivity - (U.S.) - The level of ampli fication at which
the receiving circuit In an ultrasonic instrument is set.
Also the ability to detect small discont inuities .
sensitivity, contrasl - see Contrast sensitivity.
sensitivity, flaw - see Flaw sensitivity.
senslttvlty, penetrameter - see Penetrameter sensitivity.
sensitivity, radiographic - see Penetrameter sensitivity.
sensitometry - Measurement 01 the properties of emul-
sions by examination of the changes in phoptogra-
phic density produced under different conditions of
exposure and processing.
sequestrlng agent - A constituent (e.g. sodium hexame-
taphospate) which is sometimes added to a devetoper
to prevent the formation of scum from hard water.
serial radlograhpy - A technique for mak ing a number
of radiographs of the same subject in succession.
series, radioactive - see Radioactive series.
shade of gray - (Digital Rad.) - Level of film density
or gray tevel which is detectabte. Depending on
background Illumination and complexity, and method
of experiment. eye can separate from ten to perhaps
as many as 80 different shades of gray or brightness.
shear wave - (U.S.) - The wave in which the particles
of the medium vibrate in a direction perpend icular to
the direction of propagation.
shell electron - see Orbital electron.
sh~ld - A layer or mass of material used to reduce
the passage of ionizing radiation .
shletd, cannon tube - see Cannon tube shield.
shield, tube - see Tube shield.
shift. chemical - see Chemical shift.
shock- proof - A term applied to those components of
the high-voltage circuit of X-ray equipment which are
entirely surrounded by earthed metal enclosures. e.g.
shock-proof tube, shock-p roof cable.
G ILAAOONI . RAOIOlOG Y _ ELECTROMEOICINE
shock-proof cable - see Shock-proof.
shock- proof tube - An X-ray tube surrounded by an
earthed shield.
short circuit - An accidental connection of low resi-
stance between the two sides of a circuit so that Ut-
tie or no current flows through the current-consum-
ing device in the circuil.
short-scale contra .t - Short-scale contras t charac terizes
an image produCed by long wave length X-radiation.
The transition between densities as to silver content
is large and exaggerated. The range of densities is
small. Silver deposits (details) representative of both
thick and thin parts are seldom shown. Detail visibili-
ty in these image areas is diminished and in most
instances is diagnostically worthless. Opacities and
absence of image silver denotes short-scale contrast.
shutter, tube - see Tube shutter.
sialography - The rad iologica l examination of the sali-
vary ducts and alveoli following the injection of a
contras t medium .
sickness, radiation - see Radiation sickness.
Sievert unit - A unit of gamma-ray dose, being the
dose 01 radiation delivered in one hour at a distance
of 1 cm from a pOint sou rce of 1 mg of radium
element encfosed in platinum 0.5 mm thick. It is nu-
merically equal to about 8.4 rontgen.
signal-to-noise ralio (SNR) - (Digital Rad.) - Ratio of
magnitude of signal to that of fluctuations of signal.
Noise figure Is usually taken as rms (root-mean-
square) value.
slgnal-Io-nolse ratio (SNR) - (U.S.) - The ratio of am-
plitudes of indications from the smallest defect con-
sidered significant and those caused by random fac-
tors, such as heterogeneity in grain size, etc.
sliver halide - A compound of sliver with one of the
halogen elements, e.g. si lver bromide.
simultaneous multi-field theraphy - see Converging-
beam theraphy.
sine wave - A mathematical curve which is used to di-
agrammatically represent the flow of an alternating
current or the change in magnetic and electric fieldS
of electromagnetic radiations.
single crystal camera - An X-ray camera in which sin-
gle crystal s are examined by the Laue, the rotating
crystal or the osci llating crystal method . The diffract-
ed beams are usually recorded on a cylindrical film
placed coaxially with the axis of rotation of the crys-
tal.
,Ingle-phase altemallng current - Th is term refers to a
Simple current alternating in direction. Commercial
single-phase current follows a sine wave. Such a cur-
rent requires only two conductors for its circuit. Most
common commercial frequencies are 25, SO, and 60
cycles per second.
Single plane Implant - see Planar Implant.
sinography - The radiological examination of the large
intracranial venous sinuses following carotid or other
ang iog raphy.
six-valve circuit - see Generator of high voltage (six-
valve circuit).
skiagraph - see Radiograph.
skln-deplh - (NMR) - Depth to which RF radiation is
able to penetrate a conduct ing medium . In NMA im-
aging context, RF must be of a sufficiently low fre-
quency that is not significantly attenuated by body
tissues .
409
skin dose, total - see Total skin dose.
skin tollerance dose - see Tolerance dose.
silt radlograhpy (Dlgltal Rad.) - Technique wh ich
uses slit collimator aligned to array of detectors to
transverse patient rapidly. It is very efficient at rejec t
ing scattered rad iati on but can lead to kind of mo
tion distortion.
slow neutrons - Neutrons 0 1 low energy. The upper
limit 0 1 energy is often taken as 1 eV.
SNR - see Signal-to-noise ratio.
soH radiation - A term used to describe qualitatively
the less penetrating types of Xrays, beta rays and
gamma rays.
soft tissue radiograhpy - A special radiog raphic tech
nique to demonstrate anatomical details of soft tis
sue.
solarization - The di minution in density produced by
exposu re additional to that requ ired to give maximum
density on development. Th is may result in reversal.
solenoid - A solenoid is a coil consisting of a number
of loops of wire or cable to carry electric current
with the pu rpose of moving an enclosed core.
Son8g11 - Ultrasonic apparatus for medical inspections
made by Gilardoni S.p.A.
source - The origin of radiation; an X ray tube or a
radioisotope.
source, gamma ray - see Gamma-ray source.
source, Ion - see Ion source.
source container, gamma-ray - see Gamma-ray source
container.
source material - In atom ic energy law, any material,
except special nuclear material , which contains 0,05%
or more of uranium , thorium, or any combination of
the two.
source strenght, gamma-ray - see Gamma-ray source
strenght.
source-to-lilm distance - The distance from a source
of radia tion to a film set up for a radiographic expo
sure. Abbreviation: s.t.d.
space charge - The effecl ive charge carried at any in-
slant by a localized aggregation of ions or electrons
in a diSCharge tube. In a hotcathode tube the elec-
trostatic field due to the space charge of the elec-
trons may restrict the tube current.
space-group - A mutually consistent infinite group of
si mmetry elements, usually in three dimensions, by
which are determi ned the relative pOSitions in which
atoms or sets 01 atoms can occu r in a unit cell.
There are 230 three-dimensional spacErgroups.
space-group extinctions - see EKtinction.
space-lattice - An assemblage of points in space such
that each point has the same environment. A space-
lattice can be relerred to one or other of the seven
crystal systems. II is a geometrical concept and not
a structure, and therefore cannot scatter rad iation.
There are 14 space-lattices of different kinds of
symmetry.
spacing, Inlerpianar - see Interplanar spacing.
spallation - A nuclear reaction in which the energy of
the incident particle is so hig h that several particles
or nuclei are em itted from the target nucleus, which
is thus reduced both in mass number and atomic
number by several units.
410
special nuclear material - In atomic energy law, in-
cludes pl utoniu m, uranium-233, uranium contain ing
more than the natural abundance of uranium-235, or
any material artificially enriched by any of these sub
stances.
specific absorption - see Selec/ive absorption.
specific acoustic impedance (U .S.) - A characteristic
which arcs to determine the amount of reflection
which occurs at an interlace and represents the pro-
duct of lhe density of the medium in which the wave
is propagating and the wave velocity.
specific activity - The activity of a material containing
a rad ioactive substance expressed in any convenient
units, e.g. curies per gramme or per cubic centime-
tre.
specific ionization - Number of ions pairs per unit
length of path of the ion izing particle in a medium,
e.g., per cm of air per micron of tissue.
specific strenght - The gamma-ray strenght per unil
volume of a rad ioactive sou rce. This may be expres-
sed in rhms per cU.mm.
spectrograph, mass - see Mass spectrograph.
spectrometer, mass - see Mass spec/romeler.
spectrometer, neutron - see Neutron spectrome ter.
spectrometer, Xray - see X- ray spectrometer.
spectroscopy, X-ray - see X-ray spectroscopy.
spectrum - The orderly separation of the com ponents
of a beam of radia tion accord ing, lor example, to
their wavelenghts, frequencies or quantum energies.
spectrum (NMR) - In NMR, the diplay of absorption
peaks, which are plotted as a functi on of their re-
sonant frequency.
spectrum, continuous - see Continuous spectrum.
specular density - see Photographic transmission densi-
ty.
speed - Of an X-ray emu lsion. The characteristic of an
emulsion which determines the exposu re requi red
under any given set of conditions.
speed factor - see Intensifying factor.
spheregap voltmeter - A device to measure peak vol-
tage by observation of the distance at which spark ing
begins between two metallic spheres of specified di-
ameter.
spin (NMR) - The angular momentum associated with
the axial rota tion of a su b-atomic particle. Also used
ad a term for an NMR-sensitive nucleus.
spin echo - (NMR) - Reappearance 01 an NMR signal ,
ariSing from refocusing or rephasi ng of the various
components of magnetization in the x,y plane. Usual-
ly elicited by applying a 180> pulse after decay 01
the initial FlO. It ma y be used to determine T 2 with-
out contamination from inhomogeneity effects of the
magnetic field . More accurate T2 measurement Is
made by applying a string of 180" pulses. (See Carr-
Purcell sequence).
spin-warp Imaging (NMR) - A planar imaging method
employing time-dependent magnetic field grad ients to
encode the NMR signal with both phase and intensi-
ty information. The image is generated via a sing le
two-dimensional Fourier transformation rather than via
reconstruction of many one-dimensional projections.
spinning top - A disc of dense material having an ec-
centric aperture, which, when spun above a film , ena-
bles a record to be made of variations of the X- ray
output during an exposure; generally used to mea-
sure exposure time when the frequency of the mains
supply is known.
GllARDONI. RADIOLOGY - ELECTl'lOMEDlCINE
spinthariscope - A simple device for viewing scintilla-
tions.
spot, local - see Focus.
spot, high - see High spot.
spot, hot - see High spot.
spot film - A radiograph made of small isolated areas
during fluoroscopy.
SPR - see Scanned pro;ection radiography.
spurious counts - Counts caused by any agency other
than the passage into or through a counter of phot-
ons or particles to wh ich it is sensitive.
stabilizer - An automatic device to compensate for va-
riation of mains voltage and/or frequency in an elect-
ric ci rcuit. A well-known example is the stabilization
of filament heating current, and therefore the anode
cu rrent, in an X-ray tube. A stabilizer which keeps
the voltage constant is sometimes called a voltage
regu lator.
stable Isotope - A non-radioactive nuclide of a particu-
lar element.
stable tracer Isotope - A stable isotope used as a
tracer. Detection and measurement are in terms of
nuclear mass. for example by the use of a mass
spectrometer.
static electricity - Static electricity is stationary electrici-
ty as opposed to electricity in motion as an electric
current.
sialic marks - Artifact s produced on a film due to dis-
charges of static electricity. They may appear as ir-
regularly shaped lines resembling trees. streaks. or
smudges.
static video Image - (Digital Rad.) - Television image
of static recording, produced by presenting sequence
of identical video fields.
stationary grid - A grid In which the opaque strips are
so thin and so close together that it can remain sta-
tionary without the shadows of the strips interfering
with the in terpretation of the film (e.g. Lysholm grid).
steady-state-free precession - (NMR) - SSFP or SFP.
Method of NMR excitation in wh ich strings of AF
pulses are applied regularly and rapidly. wi th inter-
pulse spacings short as compared with T, and T2
step-down transformer - see Transformer.
step-up translormer - see Transformer.
step-wedge - A block of material in the form of a ser-
ies of steps used to compare the radiographic effects
of X-rays under various conditions.
step-wedge penetrameter - A penetrameter of similar
material to the specimen under examination, having
steps ranging usually from 1 to 5 per cent of the
specimen thickness. Each step may contain one or
more drilled holes for the assessment of definition.
stereoftuoroscopy - A lIuoroscopic technique which ena-
bles screen images to be viewed three-dimensionally.
stereogram - Any type of stereoscopic rad iograph,
photograph or picture.
stereogram, auto - see Auto-stereogram.
stereogram, parallax - see Parallax stereogram.
stereography - The production of stereograms.
stereogratlcule - A scale which enables direct measu-
rements in the direction of viewing to be made dur-
ing stereoscopic examination.
stereometry, radiographic - see Radiographic stereome-
try.
GllAAOONI. RADIOlOGY - B.ECTROMEOtCINE
stereoscopy - The three-dimensional visual effect result-
ing from binocular vision.
stop bath - An acid bath to arrest development and to
neutralize alkaline developer in an emulsion before
transfer to the fixing bath.
stopping power - Of a material for a particle. The
energy loss suffered by the particle per unit lenght
of its path in the material. It is usually expressed as
MeV per em and although often treated as constant,
it does, in fact, vary along the path of the particle.
stopping power, atomk - see Atomic stopping power.
stopping, power, relative - see Atomic stopping power.
storage capacity - A term referring to the maximum
quantity of heat measured in heat units which may
be stored within an X-ray tube without burning out
the tube.
stratigraphy - see Tomography.
strenght, gamma ray source - see Gamma-ray source
strengh t.
strenght, specific - see Specific strenght.
strip penetrameter - see Plate pene/rameter.
stripping emulsion - A photographic emu lsion, for use
in autoradiography, which can be removed from its
base and placed In contact with a speCimen contain-
ing radioactive material.
structure, crystal - see Unit cell.
structure, mosaic - see Mosaic structure.
structure factor - The amplitude, measured at unit dis-
tance, of the wave scattered in any chosen direction
by a unit cell, for an Incident plane wave of unit
amplitude. For X-rays this amplitude is expressed rel-
ative to that for a single classical electron. The phase
may be stated with respect to that of the contribu-
tion from an atom at the origin of the unit cell.
subject contrast - Contrast arising from variation in ra-
diation opacity within an irradiated object .
subject range - The range of thickness or radiation
opaci ty of material in an object which is to be exam-
ined .
subjective contrast - Qualitative contrast in a radio-
graph or fluorescent screen reproduction as estimated
visually.
superficial X-ray theraphy - X-ray theraphy (usually by
soft radiation produced at less than 140 kVp) of the
skin or of any surface of the body which has been
made accessible.
superlattice - A new space-lattice which may be pro-
duced (as in alloy systems) in a structure, when the
original space-Ianice points cease to be identical.
supervoltage theraphy - see Supervoltage X-ray thera-
phy.
supervottage X-ray theraphy - X-ray theraphy by means
of very hard X-rays usually generated at one million
volts or more.
suppressor, negative half-cycle - see Negative half-cy-
cle suppressor.
suppressor, surge - see Surge suppressor.
surface, lsocount - see /socoun t surface.
surface, Isodose - see Isodose surface.
surface dose - see Field dose.
surface Irradiation - Irradiation of a part of the body
by applying a mould or applicator loaded with ra-
dioactive malerial to the surface of the body.
411
surface Irregularity - An image on a radiograph film
that corresponds to an irreg ularity visible on the sur-
face of an object being tested.
surface wave - see Rayleigh wave.
surge suppressor - A device for minimizing surges. It
may incorporate, for example, resistors, capacitors,
inductors, gas tubes or semiconducting discs.
sUre'ey. radiation - see Radiation survey.
sUre'ey meter - A portable instrument which measures
dose rate of exposure of radiation intensity.
swallow examination, barium - see Barium swallow ex-
amination.
swHch, h~h voltage change-over - see High-voltage
change-over switch.
switch valve - A thermionic valve used as an ON-OFF
switch in the high-voltage ci rcuit of an X-ray equip-
ment.
synchro-cyclotron - A development of the cyclotron in
which relativistic limitations are overcome by frequen-
cy modu lation of the electric field to permit the at-
tainment of higher particle energies.
synchronizing pulse - (Digital Rad.) - Pulse created in
television camera and transm itted to monitor to keep
electron beams in camera and monitor scanning same
portion of picture at same time.
synchronous timer - A timer which IS operated by a
synchronous motor.
synchrotron - An apparatus for accelerating electrons
III a on::ular Ofbtl of constant radius by means of the
betatron pnnople, a synchronous oscillating electric
5etd befng empk)yed in addition to permit the al-
ta nment of higher energies.
synchrotron, proton - see Proton synchrotron.
')'$tem, cry.tal - see Crystal system.
T tic purposes.
target - The surface of the anode of an X-ray tube on
which the electron stream impinges and from which
the main beam of X-rays is emitted.
target, reflection - see Reflection target.
target, transmission - see Transmission target.
targel-skln distance - The distance from the target of
the X-ray tube to the skin; this is a necessary con-
sideration in determ ining absorbed dose by a patient
in radiation therapy.
technique. cross-tire - see Cross-lire technique.
technique, double-contrast enema - see Double-contrast
enema technique.
telecurletherapy nozzle - see Applicator.
telecurletherapy unit - Apparatus contai ning a large
quantity of radioactive material (usually several cur-
ies) which is designed to emit a beam of gamma
rays suitable for external irradiation .
teleradiography - Radiography employing large source-
to-object and source-to-film distances.
teleradlum unit - A telecurie therapy unit containing
radium.
television lines - (Digital Rad.) - Horizontal lines used
to make up raster.
temperature factor - The factor which expresses the
reduction of intensity of a rellection due to the ther-
mal vibrations of the atoms in a crystal.
temporal resolution - (Digital Rad.) - Ability of imaging
system to resolve events occurring in time.
412
tenth-value thickness - The thickness of a specified
su bstance which, when introduced into the path of a
given beam of radiation, reduces its effect to one
tenth.
tesla - (NMR) - Unit of magnetic fietd streng ht. (Strict-
ly magnetic flux density). 1 tesla = 10,000 gauss.
Symbol: T.
therapy - A term used in radiology to indicate treat-
ment with radium, radioactive isotopes, and/or X-rays.
therapy, contact X-ray - see Contact X-ray therapy.
therapy, converging beam - see Converging-beam the-
raphy.
therapy, converging fietd - see Moving-field therapy.
therapy, deep X-ray - see Deep X-ray therapy.
therapy, grid - see Grid therapy.
therapy, intracavitary X-ray - see Intracavitary X-ray
therapy.
therapy, Isotope - see Isotope therapy.
therapy, megavoltage - see Supervoltage X-ray therapy.
therapy, moving-field - see Moving-field therapy.
therapy, pendulum - see Moving-field therapy.
therapy, radium - see Radium therapy.
therapy, rotational - see Moving-field therapy.
therapy. simultaneous multi-field - see Converging-beam
therapy.
therapy, superficial X-ray - see Superficial X-ray the-
rapy.
therapy, supere'oltage X-ray - see Supervoltage X-ray
therapy.
therapy, X-ray - see X-fay therapy.
therapy radiographer - A technical assistant, trained
and engaged under the direction of a radiotherapist
in the practical applications of radiation for therapeu-
therapy tube - An X-ray tube designed for use in X-
ray therapy.
thermal, capacity of the anode - see Anode thermal
capacity.
therm'" neutrons - Neutrons in thermal equilibrium with
their surroundings. At 150 C their mean energy is
about 0.025 eV.
thermionic emission - The emission of electrons from
the surface of a hot body by virtue of their thermal
energy.
thermlons - Electrons liberated by thermionic emission .
thickness, half-value - see Half-value thickness.
thickness, tenth-value - see Tenth-value thickness.
thimble Ionization chamber - A common form o f ioni-
zation chamber, of appropriate material and dimen-
sions, in which the outer electrode has the shape of
a thimble.
Thoraeus filter - see Composite filter.
three-phase altemating current - Commercial electricity
is commonty transmitted as three Single-phase cur-
rents, that is, three separate currents following separ-
ate sine curves, each at 50 or 60 cycles (or other
frequencies) per second , but with the peaks of their
individual curves one-third of a cycle apart. At least
three (sometimes four) conductors are required for
three-phase alternating current.
three-phase circuit, rectified - see Generator of high
voltage (six-va/ve circuit).
GILARDONI. RADIOLOGY ELECTRQMEOICINE
threshold dose - The smallest dose of radiation that
will prod uce a specified result.
Thulium-170 - A radioisotope of the element Thu liu m.
TID - see Time interval difference imaging.
time, dead - see Dead rime.
time, recovery - see Recovery time.
time, resolution - see Resolution time.
time, resolving - see Resolution time.
time, temperature developement - A method of film
development in which the time or duration of devel-
opment is dependent upon the temperature of the
developer.
time Interval diHerence imaging - (Digital Rad.) - Com-
puterized imag ing tech nique where successive televi-
sion frames are subtracted at real-time flu oroscopy
rates. Resulting subtracted im ag es (which contain
contin ually updated masks) correspond to time varia-
tions in X-ray attenuation in object. Approach shows
areas of object which are changing in time with re-
gard to X-ray attenuation.
time mode (mask) subtraction - (Digital Rad.) - Type
of image subtraction in digital radiography which uses
time dependency of contrast medium injection to de-
fi ne anatomy. Mask image is acquired before contrast
agent reaches target site, and subsequent images are
acquired and subtracted from mask after contrast
medium has arrived. Other types of SUbtraction in-
clude time interval difference imaging, energy sub-
traction , and K-edge subtraction.
timer - The device used on an X-ray machine to com-
plete the electrical ci rcuit so that X-rays will be pro-
duced for a limited period of time.
timer, ciockwork - see Clockwork timer.
timer, electronic - see Electronic timer.
timer, exposure - see Exposure timer.
timer, Impulse - see Impulse timer.
timer, phased - see Impulse timer.
timer, photoelectric - see Photoelectric timer.
timer, synchronous - see Synchronous timer.
tissue contrast - Tissue contrast refers to the relative
differences in tissue density and thickness of the
components of an anatom i~ part with respect to their
X-ray absorbing properties. Rad iographically. tissue
contrast is evidenced by the variat ions in rad iogra-
phic densities caused by the differences in absorbing
power of the different kinds of tissue traversed by an
X-ra y beam resulting in reduced intensities that reach
the film.
tissue equivalent material - see Phantom material.
tissue rtSntgen - see Rep.
tolerance dose - The maximum dose that can safely
be delivered to a specified tissue in a course of
treatment, e.g. Skin tolerance dose, Bone tolerance
dose. See also Maximum permissible dose.
tomography - The radiography of a predetermined lay-
er of a body. In one method the X-ray tube and the
film are moved simultaneously in opposite directions
about a pivotal point in the plane of the layer. Also
termed planigraphy, laminagraphy, stratigraphy, and
body-section radiography.
GILARDONI, RA.D IOLOGY _ ELECTRO~EDICINE
tone - A tone (or brightness) value represents the
amount of light transm itted through a radiograph ic
density from a conventional X-ray illuminator; all tones
are transl ucent. The X-ray absorption differences of
tissues are rendered as differences in density or
tones. The lig ht transmission is dependent upon the
silver concentration in the image.
total absorption - Absorption arising from all causes.
total cross-section - see Cross-section.
total electron binding energy - The energy requi red to
remove all the o rb ital electrons from an atom to in-
finte distance from the nucleus and from each other.
total field dose - The sum of the field doses given to
a si ngle specified area during a whole course of
treatment.
total nuclear binding energy - The energy requ ired
com pletely to dissociate a nucleus into its constituent
nucleons. It is the energy equivalent of the mass de-
fect of the nucleus. The quotient of the total nuclear
binding energy and the mass number is the Average
binding energy per nucleon and is indicative of the
work requi red to remove one nucleon from the nu-
cleus.
total skin dose - The dose of radiation received from
all sou rces by a specifi ed surface area during a
cou rse of treatment.
totally diffuse denSity - see Photographic transmission
density.
tracer, radioactive - see Radioactive tracer.
tracer Isotope, stable - see Stable tracer isotope.
track - Of an ionizing particle. The path of an ionizing
particle as revealed, for example. in a cloud chamber
or a photographic emulsion.
transducer - Any device which is capable of converting
energy from one form to another.
transducer - (U .S.) - An assembly consisting basically
of a housing, piezoelectric element, backing material,
wear plate (optional) and electrical leads for convert-
ing electrical im pulses into mechanical energy and
vice versa.
transformation, radioactive - see Radioactive decay.
transformation constant - see Decay constant.
transformer - An electrical device which changes an al-
ternating cu rrent of a given voltage and amperage in-
to another alternating current of a different voltage
and amperage. A step-down transformer decreases
voltage and increases amperage. A step-up transfor-
mer increases voltage and decreases amperage.
transformer, filament - see Filament transformer.
transformer, resonance - see Resonance transformer.
transformer, tripler - see Tripier transformer.
transient currents - Currents of short duration, gener-
ated by sudden changes in the electrical or magnetic
conditions existing in an electrical or magnetic cir-
cuit.
transient equilibrium - see Radioactive equilibrium.
tranSition, forbidden - see Forbidden transition.
transition, Isomeric - see Isomeric transition.
translation group - see Space-lattice.
translucent - A material that is translucent admits the
passage of light, but does not permit objects to be
distinctly seen through it.
transmission angle - (U.S.) - The incident angle of the
transmitted ultrasonic beam . It is zero degrees when
the ultrasonic beam is perpendicular to the test sur-
face.
413
 transmission target - A target so arranged that the
useful X-ray beam emerges from the surface remote
from that on which the electron stream is incident.
transmutation - The transformation of one nuclide to
another 0 1 a d ifferent element by means of a nuclear
reaction .
transparent - A material is transparent when it has the
propert y of transmitting rays of light so that objects
can be seen through it.
tansverese wave - see Shear wave.
trap, radiation - see Radiation trap.
treatment, fractionated - see Fractionated treatment.
treatment, protracted - see Protracted treatment.
treatment cone - see Applicator.
treatment time, overa" - see Overall treatment time.
Trende lenburg positio n - A supine position In which
the pelvis is higher than the head of the patient. For
radiographic purposes, the body may be tilted as
much as 45.
tripier, frequen cy - see Tripier transformer.
trlpler transformer - A static transformer for converting
a three-phase supply to a single-phase supply of
three times the frequency. it usually consists 01 three
similar transformes, having an abnormally low iron
conten t so as to introdu ce a strong third harmon ic.
The primaries are star-co nnected to the three-phase
supply, wh ile the secondaries are connected In open
delta. The normal mains-frequency voltages cancel out
round the delta, but the third harmonic voltages are
in phase and add together.
true absorption - The part of the total absorption which
arises from the complete or partial loss of energy of
photons of the primary beam.
tube, air cOOed - see Air-coofed tube.
tube, cascade - see Cascade tube.
tube, contac t - see Contac t tube.
tube, Coolidg e - see Coolidge tube.
tube, diagno stic - see Diagnostic tube.
tube, dlscharge - see Discharge tube.
tube, double-focus - see Double -focus tube.
tube, ektclro n multipl ier - see Electron multiplier.
tube, flash - see Flash tube.
tube, gas - see Gas tube.
tube, Geiger- MOIler - see Geiger -Muller counter.
tube, Grenz - see Grenz tube.
tube, grid - see Grid tube.
tube, hot-cathode - see Hot-cathode tube.
tube, Insert - see Insert tube.
tube, line-focus - see Line-focus tube.
tube, oll-cooled - see Oil-cooled tube.
tube, oil-Immersed - see Oil-immersed tube.
tube, photom ultiplier - see Photomultiplier tube.
tube, radiator - see Air-COOled tube.
tube, radium - see Radium tube.
tube, rod-anode - see Rod-anode tube.
tube, rotating -anode ~ see Rotatinganode tube.
rube, sell-protected ~ see Self-pro tected tube.
tube, self-reclltying - see Self-rectifying tube.
lube, shock-proof - see ShOCk-proof tube.
kbe. therapy - see Theraphy tube.
tube, water-cooled - see Water-cooled tube.
tube, X-ray - see X-ray tube.
tube diaphra gm - A device, normal ly fixed to a tube
shield or head, to limit the d ivergence of the emer-
gent X-ray beam.
tube filter - A filler wh ich can be attached to the X-
ray tube shield.
tube head - A type of tube shield which In additio n to
the X-ray tube may contain part of the high-voltage
generator.
tube rating - The maxim um electrical load that can be
safely applied to an X-ray tube for a specified period .
tube shield - The shock- prool housing of an X-ray
tUbe.
tube-shift radiography - see Hyposcopic view.
tube shutter - A device attached to a tube shield,
generally of lead and usually remotely operated, used
to permit or to prevent the emergence of the X- ray
beam.
tube stand - A support, often In the form of one or
more vertical pillars with adjustable attachments, for
holding an X-ra y tube in position.
tumour dose - The depth dose at the tumour under
treatment. The term is normal ly used to denote the
dose in rontgen s received by the tumour during the
whole course of treatment. When used In this sense
it is usual also to slate the overall time of treatment,
e.g. 3000 r in three weeks.
tungsten alloy - A protective material contain ing tungs-
ten, copper and nickel, and having a density about
50 per cent greater Ihan that of lead.
turbidit y - Unsharpness due to radiation scattered by a
phOtog raphic emulsion.
two-cry stal method - (U.S.) - Use of two transdu cers
for sending and receiving . May be send-receive or
through -transmission method .
two- film techniq ue - A procedure wherein two films
of different relative speeds are used simultaneously to
radiograph both the th ick and the thin sections 01 an
item.
two plane Implant - see Volum9 Implant.
u
ultraso nic absorption - (U.S.) - A dampe ning of ultra-
sonic vibrations that occurs when the wave trans-
verses a medium .
ultraso nic spectrum - (U.S.) - The frequency span of
elastic waves greater than the highest audible fre-
quency , generally regarded as being higher than 2.0
x lQ4 cycles per second , to approx imately 1()Q cps.
umbra - A region behind an obiect in a beam of radi-
ation such that a straight line drawn from any point
in this region to any pOint in the source passes
through the object. The umbra is sometimes referred
to as the region of total shadow.
under-development - Develo pment which is less than
that required to produce the optimu m results in a
particular radiograph. It may arise from development
for too short a time, or at too Iowa temperature, or
from the use of exhausted developer.
underexposure - The result of exposing the X-ray film
to an insufficient amoun t of X-rays.
undlrec llonal current - Curren t that flows oniy in one
direction.
GILAIlDON I , RADIOLOGY - ElECffiOM EDICINE
undlrectlonal voltage - A voltage of which the polarity,
but not necessarily the magnitude, is constant.
unit, atomic mass - see Atomic mass unit.
unit, energy - see Energy unit.
unit, n - see n-unit.
unit, Sievert - see Sievert unit.
unH, X - see X-unit.
unit cell - A unit parallelepiped of structure, which
when repeated in three dimensions produces the ex-
tended crystal structure. The smallest un it which will
do this is often chosen.
unlt-cell parameters - The lenghts of the edges of the
unit cell , together with the interaxial angles.
unmodified scatter - Radiation scattered without change
of photon energy.
unsharpness - A quantitative measure of lack of defini-
tion. It is usually expressed as the width of the band
of changing density or brightness ariSing from a
sudden change in the intensity of the radiation inci-
dent on the fi lm or fluorescent screen.
unsharpnell, geometric - see Geometric unsharpness.
unsharpnesl, sea"tr - see Scatter unsharpness.
ureterography - The radiographic examination of the
ureters after the injection of a contrast med ium.
urography - The radiological examination of the uri-
nary tract following (a) the intravenous injection and
subsequent excretion 01 a contrast medium or (b)
the introduction 01 a suitable catheter.
uterosalp'ngography - The radiographic examination of
the uterus and Fallopian tubes alter introduction of
contrast med ia. Also called hysterosalpingography.
uselul den" ty range - The range of density over wh ich
the grad ient Is adequate for the recognition of image
details. The upper density limit is determined mainly
by the brightness available In the film illuminator,
and the lower density limit by the sensitivity required .
v voltage, Inverse - see Inverse voltage.
vacuum tube - Any type 01 sealed tube which has a
very low gas pressure and will allow an electric cur-
rent to flow through it. X-ray tubes and valve tubes
are examples of vacuum tubes.
valence - The valence of an element (or radical) is
measured by the number 01 atoms of hydrogen with
which it can combine, or by the number of atoms of
hydrogen that it can replace by reaction with an
acid.
vatve, gal - see Gas valve.
vatve, hot-cathode - see Hot-cathode valve.
vatve, rectHylng - see Rectifying valve.
vatve, switch - see Switch valve.
vatve electrometer - see Electrometer.
Van de Graaff generator - see Electrostatic generator.
velocity - (U.S.) - The speed at which sound waves
travel through a medium.
veiling glare ( Digital Rad.) - Spurious light level
measurable under radiopaque lead disk imaged with
image intensi fier. Amount of brightness is due to lat-
eral transmission of light in glass of output phosphor.
Veiling glare will cause video signal to be artificially
high for that region.
venography - see Phlebography.
GILAROONI. FlAOIOt.OG Y EUCTROMEDICINE
venography, portal - The radiographic examination of
the liver following injection of a contrast medium di-
rectly into the portal vein.
ventriculography - The radiological examination of the
intracranial ventricles following direct introduction of
air.
ve" culograhpy - The radiological examination of the
lumen of the seminal vesicles, vas deferens and ejac-
ulatory duct following the injection of a contrast me-
dium.
video detector system - (Digital Roo.) - Radiographic
imaging system which uses conventional X-ray image
intensifier in combination with high-quality television
camera. Distinct advantages are high frame rate and
very efficient use of X-ray tube power loading.
video signal composite - see Composite video signal.
vldeotluorolCopy (Digital Rad.) - X-ray fluoroscopy
using television to view final image. Also. recording
of spot films during X-ray fluoroscopy, by means of
multlformat camera, from video signal.
view, hyperscoplc - see Hyperscopic view.
view, hyposcoplc - see Hyposcopic view.
view, orthoscopk: - see Orthoscopic view.
view, pseudoscoplc - see Pseudoscopic view.
viewing screen - see Film illuminator.
Villard circuit - see Generator of high voltage (Villard
circuit).
visual examination - see Fluoroscopy.
volt - The unit of electrical pressure or electromotive
force. One volt is that amount of electrical pressure
which is required to force one ampere 01 current
through one ohm of resistance.
volt, electron - see Electron volt.
voltage - The electrical pressure which causes electrici-
ty to move measured In volts.
voltage, constant - see Constant voltage.
voltage, crest - see Peak voltage.
voltage, peak - see Peak voltage.
voltage, pulsating - see Pulsating voltage.
voltage, quantum - see Quantum voltage.
voltage, rtpp'e - see Constant voltage.
voltage, unidirectional - see Unidirectional voltage.
voltage regulator - see Stabilizer.
vottmeter - An instrument for measuring electromotive
force in units deSignated as volts.
vottmeter, sptwre-gap - see Sphere-gap voltmeter.
volume dose - see Integral absorbed dose.
volume Implant - A type of implant used when the vo-
lume to be treated approximates to a regular solid
form. Sources are distributed both within the volume
and on its periphery.
w
wall absorption - The decrease in beta-ray or gamma-
ray output resulting from absorption in the walls of
the container.
wall effect - The contribution to the ionization in an
ionization chamber by electrons liberated from the
walls.
41 5
water-cooled lube - An X-ray tube in which the heat
produced on the target is dissipated , directly or indi-
rectly, by means of water.
watt - The practical un it of electric power. One watt is
produced when one volt pushes a current of one
ampere.
wavelenghl, boundary - see Boundary wavelenght.
wavelenght, critical absorption - see Critical absorption
w8velenght.
wavelenght, effective - see Effec tiv~ wavelenght.
wedge filter - A filter so constructed that its thickness
varies continuosly or in steps from one edge to the
other. Wedge filters may be used to Increase the uni-
formi ty of radiation in certain types of treatment.
weights, atomlc-chemlcal scale 01 - see Atomic weights,
chemical scale of.
weights, atomic-physical scale of - see Atomic weights,
physical scale of.
Weissenberg camera - see Moving-film camera.
wetting agent - A substance used in processing to re-
duce surface tension. When used in a pre-develop-
ment bath is promotes the subsequent uniform diffu-
sion of developer into the emulsion . It may also be
used in final bath to assist in rapid and uniform
drainage of the film and so to reduce the occu rrence
of marks due to uneven drying (drying marks) .
white radlallon - see Heterogeneous radiation.
Wilson chamber - A device in which the ionization is
visualized during a rapid rarefaction of ai r in the
chamber that, leaving a trail of condenSed water dro-
plets, reveals the trajectory of ionizing pa rticles. The
ionization trajectory outside the central path of rays
is determined by scattered air radiation.
wire penetrameter - A penetrameter incorporating a
series of wires graded in diameter and usually of
sim ilar material to the specimen under examination .
Wltka circuit - see Genera tor of high VO ltage (Witks
circuIt).
workload - The output of a radiation machine or a ra-
dioactive source integrated over a suitable time and
expressed In appropriate units.
x z
X-radiation characterisUc see Characteristic X-radia-
tion.
X-radiation, fluorescence see Charactaristic X-radia -
tion.
X-ray analysis - see Diffraction analysis.
X-ray bath - X-ray therapy by means of very large
fields irradia ting, for example, the whole abdomen, or
the whole tru nk.
X-ray camera - An apparatus for obtaining a photo-
graphic record, for subsequent measurement of posi-
tion and intensity, of the diffracted beams produced
when a crystalline specimen is irradiated in a beam
of X-rays.
X-ray crystallography - The study of crystals by X-ray
diffraction.
X-ray diffractometer - An instrument used in diffraction
analysis for measu ring with a beam of X-rays, fre-
quently monochromatic, the intensities of the diffract-
ed beams at different ang les. An ionization chamber
or a cou nter may be used.
X-ray film - A film base which is coated (usually on
both sides) with an emulsion designed for use with
X-rays.
416
X-ray paper - White paper coated with emulsion for
use with or without an intensifying screen. It is suit-
able for some purposes as an alternative to X-ray
film.
X-ray spectrometer - An instrument for measuring an
X-ray spectrum . It is used for determining the wave-
lenghts of X-rays and the relative intensities of differ-
ent wavelenghts in an X-ray beam.
X-ray spectroscopy - The study of X-ray spectra and
their interpretation .
X-ray therapy - Radiotherapy by means of X-rays.
X-ray therapy, contact - see Conract X-ray therapy.
X-ray therapy, deep - see Deep X-ray therapy.
X-ray therapy, intracavitary - see Intracavitary X-ray
therapy.
X-ray therapy, superficial - see Superficial X-ray ther-
apy.
X-ray therapy, supervoltage - see Supervoltage X-ray
therapy.
X-ray therapy applicator - see Applicator.
X-ray tube - A glass vacuum tube which decelerates
the high velocity electrons, and produces X-rays.
X-rays - Penetrating electromagnetic radia tion emitted
when the inner orbital electrons of an atom are ex-
c ited and release energy. Thus, the radiation is non-
nuclear in origin and is generated in practice by
bombarding a metallic target with high-speed elec-
trons.
X-unit - A unit of lenght. The X-unit is defined by as-
sig ning the value 3029.45X to the spacing of the
(200) planes of calcite at 18<'C. One X-unit equals
(1 .00202 0.00003) x 10- 11 cm. Symbol X.
xenon detector array - (Digital Rad.) - One type o f
linear detector array used in digital radiography is
xenon-fi lled detector (presently used in computed
tomograp hy scanners) . Detector consists of two
plates separated by gap and is filled with high-pres-
sure xenon gas. One plate Is high-voltage electrode;
other is circuit board etched to give array of metal
collecting strips focused on X-ray tube. These detec-
tors are stable and have wide dynamic range.
zero potential - Having neither positive nor negative
voltage or pressu re.
zeugmatography - (NMR) - Name coined by Lauterbur
for the NMR imaging technique. In regarding the
specimen as a medium which couples the RF field to
the mag netic field gradient, he derived the term from
the Greek "fWYIJ(J'I>: that which joins together.
Presen t Glossary was built up on the base of following
ones:
1. British Standard Institution - UK
2. Departments of the Ai r Force, the Army and Navy
Medical Service - USA
3. E.E. Weismantel - Aerospace Industries Association -
USA
4. Applied Radiology - USA - Digital radiography Glos-
sa",
5. Radiology - USA - Nuclear Magnetic Resonance
GlOSsary
To them go our best thanks.
GILARDONI. RAOIOLOGY - ELECTROME'OICINE
 PART 19

SUBJECT INDEX
 PAAT 19 B
CHAPTER 19.1 ALPHABETICAL CLASSIFICATION a-mode display (US) 190
Back, scattered radiation 109
- reinforcement effect (US) 200
Balanced Gilardonl HSU (screens) 44
Balistic Efficiency 104
Beam, geomelry (US) 183
- particle therapy (Rad. Protect.), ICRP 307
- reflection (US) 185
- therapy (Aad. Protect.), ICPR 306
A - therapy, sealed source (Rad. Protect.), ICRP 307, 308
- ultrasonic, visualization of 189
A-mode display (US) 189 Becquerel discovery 31
Abdominal, aorta 171 Benign diseases, bone 247
-scanning (US) 201 Beryllium window tubes 129
Abducent nerve (Ana!.) 275 Beta, counters 231
Absorbed dose (Aad. Protecl.) 300 - decay 222
Absortion, coefficient 39 - rays 31
- con trast 45 Betatron 297
- grid 56 Bioelectricity 33
- law (X-ray) 38 Bi-plane Cinefluorography 86
- muscle/bone ratio loa, 111 Blackening 50
- of painting components 335 - saturation 50
- photoelectric effect 40 Blood, cells (Anal.) 255
- ultrasound 186 - circulation of 273
Acoustic, Impedance (US) 182 - composition 271
- intenSity (US) 183 - Pool imaging (Nucl. Mad.) 248
- nerve (Anal.) 275 Body, fundamental tIssues (Anal.) 255
- Tomography, computed (US) 197 - regions (Anal.) 254
Adrenal gland (Anat.) 277 - types (Anal.) 254
Alpha, decay 222 - types of movement 256
- rays 31 Bomb. Cobalt 296
Aluminium, and copper tilters 71 - X-TV 105
- fillers 74 Bone (s), abnormal pattern 247
Amphiarthroses 256 - classIfication (Anal.) 256
Analogical scan conversion tube (US) 190 - benign diseases 247
Anatomical, drawings by Leonardo da Vinci 277 - descriptive terms (Anatom.) 257
- phantoms 144 - facial (Anatom.) 283
- planes 253 - imaging (Nucl. Mad.) 246
- postures 253 - neoplastic diseases 247
- terms 253 - normal pattern 247
Anatomy 253 - physiology 246
Angiocardiography, First Pass Nuclear 244 Bremsstrahlung 41
- Equilibrium Gates Blood Pool (Nucl. Moo.) 244 BronChi (Anal.) 286
Angiography, digital 169 Bucky 55
Angstrom 29 - stand 154
Ankle (anal.) 259 - table 153
Anode rays 31 - threegrids 61
Annual dose limits 300 Build-up, (maximum ionization depth) 108, 111
Antlnfiammatory therapy 110
AntiSC8tt.erOO grids 53. 147
Anti-terrorism equipment 91
Aorta, abdominal 171
Aortic valve, US inspection 206
Arm (Anat.) 258
Art-Gil 337
Arteries (Anat.) 273
Arthrology 225
Arthrosic therapy 110 C
Artificial , and natural radioactivity 223
- radioactive elements 31 Cables, high voltage 130, 132
Artistlcal radiology 335 Camera (5), gemma, response 237,238
Atomic, mass 30 - scintillation 235
- theory 30 - television 81
Automatic, control desks 134 Capillaries (Anal.) 273
- dose rate control 83 Cardiac cycle 272
- .gain con trol circuits (X-ray television) 83 CardiologIcal scanning (US) 205
Autonomic nervous system 275 Cardiology, nuclear 243

GILAADONI. R/U)IOlOOV - ELECTROMeOICiNe

419
CAT (US) 197 - proportional 226
Cathode, rays 31 - scintillation 95
- screen tube 126 - well 232
CCDs (scanning radiogreph iC detector) 90 Coolidge tube (s) 36, 120
Ceiling tube stand 153 - additional information 122
Cerebellum (Anal.) 274 - rolating anode 36, 128, 129
Cerebrospinal fl uid 274 Cranial nerves (Ana!.) 275
Cerebrum (Anat.) 274 Crookes-HiUort voltage multipliers 11 6
Charge Coupled Devices {scanning rad. delector) 90 Crystal counters 227
Chemical cells 33 CuHVl 108
Chest Changer 154 Curie point 182
Chronogil 147
Cine Film Marking 87
Cinefluorography 85
- BI-plane 86
- film-for 87
- pulsed 86 D
Circula tory system 271
Clavicle (Anat.) 259 Daily dose limits 300
Clean-up (grid) 54 Darkroom processing 74
Cobalt bomb 296 Deep, dose 109
CoUar bone (Anat.) 259 - therapy 104
Collimation (scintillation cameras) 238 - tumor, radiotherapy 298
Compensating filtration (in radiography) 45 - tumor radiotherapy equipment 296
Compton effect 4{) Defecation 271
Computed, Acoustic Tomography (US) 197 Deflnilion and contrast 45
- control unit (logi)!;) 134 Densitometer 51
Computed Tomography lsa, 165 51
- pocket comparison
- acoustic (US) 197 Densltomelric curve 50
- detectors 161 Densitometry 50
- image reconstruction 16' Density, evaluation (film) 51
- Image quality 183 (film) 50
- images, mathemallcal evaluation 165 (grid) 54
- ionizalion chambers 161 limit (film) 50
- mathematical fi lters 165 (US) 182
- numbers 162 - useful range (film) 52
- scanners, spatial resolution 183 Derlsogil 51
Compuler, (NMR) 219 Oefllal radiography (Rad. Protect.), ICRP 305, 310
- (Nucl. Mect) 24{) Oermotheraphy, equipment for 294
Computerized, echotomography (US) 193 Detector (s), compu ted Tomography 161
- radiology 167 - gas filled 225
Condenser-Gil 119 - lithium drift 227
Conductors, bodies 32 - scintillation 161, 227
Connective, tissue (Anat.) 255 - solid state 143
Contact theraphy 109 - surface-junction (Nucl. Med.) 227
Contagll 95 - X-ray output 143
Contamination (Nucl. Med.) 250 Development (film) 52
Conlinuos Spectrum 41
Diagnostic (s), dose volume 102
- current Inftuence 42
- equipment 149, 152
- filter influence 42 - generator output 10'
Contrast, absorption 45 - Installation (Rad. Protect.), ICRP 303
- and definition (sharpness) 45 - ultrasound 181, 199, 201
- evaluation 68 Diameter selection, probe (US) 196
media 45 Diarthroses 256
- resolution (CT) 164 Diastole 272
- photographic 50 Diffraction (US) 186
Control desks 132, 134 Digestive system 264
Constant potential equipment output 117 Digital, angiography 169
Conversion factor (Image Intensifier) 79 - dual energy subtraction .66
Copper Half Value l ayer 108 - echotomography (US) 197
Cosmic rays 31 - filtering techniques 168
Count-rate, meters 229 - fluoroscopy 147
- performance (gamma-camera) 236 - hybrid subtraction 166
Counters, beta 231 - Image archiving 179
- crystal 227 - Optical Recording 179
- for large sim ple volume 232 - radi ology 168
- gamma 232 - Scan Converter (US) 191
- geiger 94, 301 - Subtraction Angiography 169
- Geiger-Muller 226 - Subtraction Angiography applications 170

420 GILAAOONI. RAOIOt.OGY - El..ECTI'IOMEOICINE

Digitization, benefits 166 Enlargement 38,129
- principle 166 Epicardium (Anat.) 272
DIN-Wire Quality Indicator 67 Epithelial, tissue (Anal.) 255
DiSCharge, transversal 141 Equilibrium Gates Blood Pool Angiocardiography 244
Display (NMRJ 21. Esophagus (Anat.) 266
Distance inverse square law 37 Excretory system 270
Dogil 94 Exponential absorption law 38
Doppler effect (US) 200 Exposure, and contamination (Nucl. Med.) 250
DOA 179 - data for human body 71, 73
Dose (5) 37, 91 - factors 66
- absorbed (Rad. Protect.) 300 - Gllardoni system 337
- annual, limits 300 - latitude 50
- deep 109 - radiographic, electrical factors 135
- equivalent (Rad. Protect.) 300 - radiographic, in art radiology 335
- in radiotherapy 110 - radiographic, timing fa ctors 135
- limits for different organs, ICRP 311 - (Rad. Protect.) 300
- limits for individuals 300 - time control 137
- palient (Nucl. Med.) 248 - limer 133
- Radiation Absorbed (RAD) 91 Extraorganic abscesses 202
- radiographic 67 Eye (Anal.) 276
- rate automatic control (X-ray television) B3
- skin (fluoroscopy, radiography) 100, 101
- skin, erythema 111
- tumor/dose tissue 104
- volume lOll, 101, 111
- volume (diagnostics) 102
- volume (Gllardoni relati ons) 102
- volume (Mayneord relation) 102
- volume (Therapy) 102, 110 F
- weekly limits 300
Dosimeter, GUardoni 94.301 Facial, bones (Anat.) 283
- principle 91
- nerve (Anal.) 275
- scintillation 9S Fallopian tubes (Anal.) 270
- Victoreen 94 Farad-Gil 119, 152
Dosimetric control of film 53 Femur (Anal.) 260
Dosimetric output, X-ray diagnostic generators 101 Ferroelectrlclty 181
- X-theraphy equipment 109 Fibula (Anat.) 260
Double grid rad iography 58, 59 Field intensity, electric 139, 140
DSA 169 Film (5) , badges 301
Dual energy SUbtraction (digital radiology) 166 - cine marking 87
Dynamic, angled fluoroscopy 90 - density 50
- focusing (US) 193 - dosimetric control 53
- for Cinefluorography 87
- handling 74
- in art radiography 335
- overdevelopment 52
- processing 75
- radiographic 71
E - sensitivity 50
- sensitometric curve 50
Ear (anat.) 276 - ,peed 50
Echotomographic equipment selection (US) 193 - storing 74
Echotomography, computerized (US) 193 - underdevelopment 52
- digital (US) 197 - unsharpness 43
E.F. (Nucl. Card .), determination 244 - with blackening dose printed 53
- left and right ventricles 244 Filter (5), aluminium 74
Electric, field intensity 139, 140 - aluminium and copper 71
- mains resistance, measure of 118 - Inlluence (Continuos Spectrum) 42
- power (X-ray equipment) 117 - mathematical (CT) 165
Electricity generators 32 First Pass Nuclear An giocardiography 244
Electromagnetic generators 33 Flash radiography (tubes lor) 129
- ,peed 29 Fluorescent screens l or Fluoroscopy 147
- waves spectrum 29 Fluorography, spot film 87
Electron capture (Nucl. Med.) 223 Fluoroscopic image 75
Electronic instrumentation (Nuel. Med.) 229 Fluoroscopy, digital 147
Endocardium (Anat.) 272 - dynamic angled 90
Endocavitary therapy (tube for) 129 - (Rad.Protect.), ICRP 304, 310
Endocrine system 276 Flying spot solid state scanner 90
Energy attenuation (US) 185 Focal range (grid) 54

G ILAROONI. RADIOLOGY - ELECTROMEDICINE 421

Focal spot 122 - exposure system 337
- formation 126 - film badge 301
- in linear focus tubes 126 - graphs (Ind.) 31.
- measurement 38 - high voltage generators 149
- size 129 - Logix System 134
Focus-grid distance limits 55 - Multilogix System 134
Focusing, dynamic (US) 193 - proleximeter 301
- geometrical (grids) 54 - relations (dose volume) 102
- selection, probe (US) 196 - rule for steel (Ind .) 319
F06tUS, US inspection 203 - tank. (US) 188
Fog, inherent 50 - Total Body Radiography (GTBR) 48
Forearm (Anal.) 257 - ultrasonic probes (medical) 189
Four rectifier equipment 116 - X-ray tubes 120
Fourier Transform Imaging (NMR) 21. Gland (5), (Ana!.). adrenal 277
Free precession (NMR) 214 - intestinal 277
Frequency (US) , constant ,.2 - parathyroid 277
- selection, probe 196 - pineal 'ZT7
- spectrum (probes) 187 - pituitary 277
Fundamental pillars (X-diagnostlcs) 147 - sallvary 265
- 50' 277
- thyroid 276
Glass processing (tube sealing) 121
Glossopharyngeal nerve (Anal.) 275
Gonioscopy 90
Gradient system (NMR) 219
Gray-scale (US) 191
Grey scale 162
Grid (5 ) 53, 60
G - absorption 56
- anliscanered 53, 147
Gain (Image Intensifier) 79 - acceptance standard 61
- automatic Circuits (X ray TV) - characteristics 54
aJ
- density 54
Gall bladder (Ana!.) 267
- double (radiography) 58, 59
Gamma, camera respon se 237
- efficiency (clean up) 54
- camera sensitivity 237
- focal range 55
- counters 232
ray equipment (Ind,) 320 - 322 - graph 54
- invisible stationary 55, 56, 58, 50, 61
- ray spectroscopy 230
- optimum 56
- rays 31
- quality 60
Gas lillecl delectors 225
- ratio 54
Gastric secretion 266
- 150 lines practical utilization 58
Geiger, counters 94, 301
Gridgll 61, 62
- MOiler counters 226
Grounded anode tube 129
Geometrical, focusing (grids) 54
,.7 GTBR 48
- parameters evaluation (probes), (US)
Gynaecological, masses (US) 204
- Therapeutic Elliciency 110, 111
- unsharpness 38,44 - scanning (US) 203
Generator (5), chemical (cells) 33
- condenser 126
- electromagnetic 33
- high frequency 117
- of electriCity 32
- 01 high voltage 115, 152
- photoelectric (cells)
- piezoelectric 33, ,.,
33

- pulse (Image Intensifier) .2

-X-<y 38 H
- X-.f1I)' (output) 101
GenlaI organ (Anal.), male and female 269 Half Value Layer 40, 108, 302
Gestanonal age, US inspection 204 Hand (Anat.) 257

--
""""
GoIIrocn baIanoed HSU (screens)

- c:.er.ered Tet3pix
-
-
-
OJldei . . generator
: ..... ,MJter
oagriOltlC equipment
122
44
96, 301
112
126
51
149, 152
Hard ray (5)
Hardware (Computer, Nucl. Med.)
Heart (Anal.)
Heating characteristic of anode (tube)
Hepatobiliary imaging (Nucl. Moo.)
High, definition screens
- frequency generators
63,66
240
271
127
247, 248
44
117
-~, 94, 301 - kilovoltage technique 45
.....a""" Iof radiotherapy 105 - speed screens 44

GILAIlDONI. RAD IOLOGY - ELECTA O ~ E OICINE

High voltage 115, 139. 141 , 147 K
- cables 130, 132
- circui ts 115 Kerma (Rad, Protect.) 300
- generators 11 5, 152 Kidney(s). (Anat) 269
- Gilardoni generators 149 - Lithotrlpten 155
- rectifiers 115 - US inspection 202
- terminals 132 Kinescopy 84
- timer 133 Kinetic unsharpness 44
- transformer 115 Kraft paper 141
Hip (Anal) 261 KV, control 135
Human, body exposure dala 71 , 73 - evaluation 136
- body organization 254 - regulation 133
- development 254
HVL 40, 108, 302
Hybrid subtract ion (Digital Rod.) 166
Hypoglossal nerve (Anal.) 275

Large field image intensifier 88

Lo rmor relationship (NMR) 213
ICRP recommendations 303 Laryn)( (Anat) 268
Ilium (Anal.) 261 Laser disc 179
Image, dlgitlzaUon and processing 169 Latitude, exposure 50
- electronic processing (US) 196 Leonard-Gil 48
- intensifier 75, 77, 78, 147 Left ventricle (EF, TD)-(Nucl. Med.) 244
- intensilier conversion factor 79 Leg (Anal.) 260
- Intensifier, large field 88 Leonardo da Vinci, anatomical drawings 277
- quality (US) 194 Llebenow-Greinacher voltage doublers 116
- Quality Indicator 68 Light. velocity of 29
- quality factors 66 Linear, Accelerator 297
Immersion tank (probes characterization 187 - array (US) 192
Impendance, acoustic (US) 182 - intensified scanner (radiography) 90
In vitro, measurements, Instruments lor 231 - scanners (Nucl. Mad.) 234
- thyroid function studies 243 - tomography 157
In vivo, diagnostic application 242 Lines spectrum 41
- measurements, Instruments for 223 Lith ium drill detectors 227
- thyroid function studies 242 Liver, (Ana!. ) 267
- tracer studies, probes lor 223 - Imaging (Nucl. Mad.) 247
Industrial, radiographs e)(omples 323- 325 - scintiangiograpny 248
- radiOlogy 317 - ultrasound inspection 201
Inherent fog 50 Load (tube), limits 130
Inorganic solid sclntiflators 228 - radiographic ratings 127
101, Gil Indicator 68 - specific area 125
Insulating, materials 139 Long scale 45
-. 1~ Longitudinal waves (US) 183
Insulators, bodies 32 Lung (s) (Anal.) 268
Intensification factors (screens) 43 - capacity 268
Intensifying screens, radiographic 147 Lymphatic system (Anat.) 273
Intensity, X-ray 91
In!. Comm. on Roo. Protect. (ICRP) recommeodations 303
Intestinal glands (Ana!.) 277
Intestine (Anal.), large 266
- small 266
Invisible, stationary grids 55, 56, 60, 61
Ionization 40
- chamber prote)(imeters 301
- chambers 225
- chambers (Computed Tomography) 161
- maximum depth (Build-up) 108,111 M
- viewing 91
Ischium (Anal.) 261 M-G il 337
Isodose curves, applications (radiotherapy) 294 mA, control 136
- Neodermo Be 295 - emission curve 126
Isomeric 'tran sitions (Nucl. Med .) 223 - regulation 133

GILAA[)()oNI . RA.OIOLQGY - ELECTROMEOIClNE 423

Magnet (NMR) 218 - trigeminal 275
Magnetic, particle test equipment (Ind.) 330 - trochlear 275
- resonance 213 - vagus 275
- Testing (Ind.) 328 Nervous. autonomic system 275
- Testing examples (Ind .) 33' - system 27'
Magnification techniques
Mains resistance, measure of 11..7 - tissue (Anal.), composition of
Neurology, US inspection
27'
207
Mammographic phantom '44 Noise (CT scanners) '64
Mammography (tubes for) '29 Non, imaging radiocardiog raphy 243
Mass Screening '56 - linear Tomography '57
Mathematical, evaluation (CT) '65 Normal pattern (Nucl. Med.) 247
- filters (CT) '65 Nose (Ana!.) 267
Maximal intensity waveleng ht 43 Nuclear, cardiology 243
Maximum, Electric Power (tube) '22 - medicine, instrumentation 229, 231
- ionization depth (Build-up) ,oa, - rays 30
- operatin g temperature (US) "'
182 Nuclear Magnetic Resonan ce 212
- tube voltage 122 - future perspectives 220
Mayneord relation (Dose Volume) '02 - imaging 21.
Mediastinal vessels 170 - imaging techniques 216
Medium deep therapy equipment 296 - risk for pa ti ents 219
Medulla oblongata (Ana!.) 274 - system 218
Metal, ceramic. rotatin g anode tubes '29 Nuclei (atomiC), in a magnetic field 212
- glass, rota ti ng anode tubes 128 Nucleus (atomiC) 30, 212
Metatarsal (Ana!.) 259
Microfocus (tubes) '29
MlCtunctlOO
,.,
270
.......... oils
.,
--
Wu .... 'i

--
lib ......

......,.....&/
205
250
250
250
'29
265
'35
Obstetri cal scanning (US)
o
203
1+, ; '29
Oculomotor nerve (Ana!.) 275
'**"!I.a I!XaII"IpIes 338-344 Oil (s). insulating 14'
~1kInII amorptJOn f3bO loa, 111 - mineral 14'
Muscle cells (AnaL) 255 - synthetic 14'
MyocardIal acute infarct imaging (Nucl. card.) 245 Olfactory nerve (Ana!.) 275
Myocardium (Anal.) 272 One-rectifier equipment '16
- perfusion imaging (Nucl. Card.) 245 Optic nerve (Ana!.) 275
Organic scintillators 229
Orthicon 88
Orthoscope '53
Osteology '56
Ovaries (Anat.) 270
Overdevelopment (film) 52
Overexposed radiographs 66
Overload protection (tubes) '33
Overloading (tubes) 125, '33
N
Output (X-ray equipment) 117

Natural, and artificial radioactivity 223

- radioactive background 300
- radioactive elements 31
NOT processes (Ind.). comparison and selection 333
Neck vessels 170
Neoplastic diseases (Bone) 247
Nerve (s) (Ana!.), abducent 275
- acousti c 275
- cells 275 p
- cran ial 275
- facial 275 PACS '79
- glossopharyngeal 275 - storage capacity '79
- hypoglossal 275 Painting (s), components 335
- oculomotor 275 rad iographs (examples) 338, 344
- olfactory 275 radiography, equipments for 337
- optic 275 radiological investigation 335
- spinal 275 X-ray absorption of components 335

424 G ILARDONI . RAD iOlOGY - ELECTRO MED ICINE

Pancreas (Anal.) 267, 277 Protection, against rad iation (ICRP) 303
- US inspection 202 - (Nuc!. Med.) 24'
Panel Electron Tube (Fluoroscopy) 88 - of the palient (ICRP) 308
Paranasal sinuses (Ana!.) 267 - radiological 300
Parathyroid gland (Anal.) 277 Proteximeters (ionization chamber) 301
Particle beam therapy (Rad. Protect.). ICRP 307 Proteximetric, bottle 96
Patient (s), dose (Nucl. Med.) 248 - calculation 302
- EqUivalent Phantom 144 - control instruments 301
- protection (ICRP) 308 Proteximetry 143
- risk (NMR) 219 Pubis (Anal.) 261
Peak voltage 139 Pulse, generator (Image Intensifier) 82
Pelvic girdle (Anal.) 262 - height analysis system (Nucl. Med.) 229
Penetrant Testing (Ind.) 332 Pulsed, Cinefluorography 86
- equipment 333 - tubes (liash radiography) 129
- examples of applications 333
Penis (Anal.) 269
Penumbra 38
PEP 144
Pericardium (Anal.) 272
Peripheral vessels 171
PET-Scope 88
Phalanges (Ana!.) 259
Phantom (5), anatomical 144
- mammographic 144
- tomographic 144, 157
Pharynx (Anat.) 266
Photodlodes Image Detectors 88
Photoelectric. celis 33
- ellect <0
Photolluorography (Rad. Protect.). ICPA 305
a
Photographic, contrast 50
- unit 71 Quality Indicator, DIN 67
Photomultiplier (tubes) 228 - 101 Gil 68
Picture Archiving and Communlcalion Systems 179
Piezoelectric, constants 183
- generators 33
- materials 182
Piezoelectricity 181
Pineal gland (Ana!.) 277
Pituitary gland (Anal.) 277
Placenta, US inspection 204
Planning of radiological departments 312, 313, 315
Plesio therapy 104, 109
Plumblcon 82
Pocket comparison densitometer 51
Pons (Anal.) 274
Positron emission tomography (NucL Med.) 239
Post processing operation (image), (US) 197 R
Practical, evaluation of density (film) 51
- eICposure data (for human body) 71 , 73 AAD
- focal range (grid)
- hints for good rad iographs
54
74
Radiation (s), Absorbed Dose
- effect on human body
""
100
- utilization of 150 lines grids 58 - intensity (ou tput) 37
Pre, amplifier (Nuc!. Med.) 229 - protection (ICRP) 303
- degasing (tubes) 121 - protection (NucL Med.) 24'
- processing operations (image). (US) 196 - quantity (dose) 37
- zoom (image). (US) 196 - scattered 40. 53. 56, 57
Primary scattered radiations <0 - scattered, back 109
Probe (s) (US), characterization 186, 328 Radioactive, background, natural 300
- diameter selection 196 - decays 222, 223
- electrical para meters 186 - elements 31
- focusing selection 196 - substances, diagnostic use (Rad. Protect.), ICRP 306
- frequency selection 196 - tracers (thyroid) 242
- frequency spectrum 187 - wastes 251
- geometrical parameters evaluation 187 Radioactivity 222
- performance checking 194 - counting statistic 225
- resolution capability 195 - measurement of 225
Projection reconstruction method (NMR) 216 - natural and artificial 223
Proportional coun ters 226 - units of 224

GILAROON I. RADIOI..OOY - ELECTROMEOICINE 425

Radiocardiography, non imaging (Nucl. card.) 243 RBE 105, 111
Radiographic, dose 67 Real time, display (US) 192
- exposure, electrical factors 135 - waveform (US) 187
- exposure In art radiology 335 Receiver (NMR) 219
- exposure timing factors 135 Rectifiers, high voltage 11 5
- fi lm 71 Rectum (Anat.) 267
- inteflsifying screens 147 Reinforcement effect, back (US) 200
- load tube ratings 127 Relative Biological Elliclency 105, 111
- optimum "8 Relaxati on (NMR), process 215
- power 1 t 7, 122 - time differences in tissues 216
- quality 66 - time, spin-lattice 215
- techniques 66 - time, spin-spin 215
- testing (Ind.), examples 317, 323 REM 91
- unit 71 Renal procedures (Nucl. Mad.) 245
Radiog ra phS, atlas, projections and Reproduction 254
exposure data (Med. examples) 282-292 Resolution evaluation (film) 68
- industrial examples 323 - 325 Resonance. condition of (US) 183
- of stamps, mummies, pain tings (examples) 338344 Respiration 266
- overexposed (information recovery) 66 Respiratory system 267
- practi cal hints 74 RF (NMR) , coils 219
- unsatisfactory 76 - fie ld 213
Radiog raphy, art pieces of interest 335 R.I. (thyroid) uptake test 243
- denial (Rad. Protect.), ICRP 305, 31 0 Ribs (Anat.) 264
- double grid 58, 59 Right ventricles (EF), (Nucl. Mad.) 2
- extra short 126 Risk for patients (NMR) 219
- of paintings, equipment for 337 Room monitori ng (Nucl. Med.) 250
- of piece of art 335 Roentg en 91
- (Rad, Prolect). ICRP 305, 310 - discovery 29
Radioisolopes, handling (N ucl. Mad.) 250 - Equivalent Man 91
Radiological. contrast 45 - Gil 153, 167
- departments, planning of 312, 313, 315 Rotating anode tube (s) 36, 37, 128. 129
- examslyear per 1000 Inhabllants 313 - metal ceramic 129
- investigalion 01 paintings 335 - metal glass 128
- protection 300 - with grid 129
- protection (ICRP) 303 Rule, ultrasonic (Ind.) 328
- units 300 - X-rad iograph ic exposure (Ind.) 319
Radiology, artistical 335 - R.W.M. analysis (Nucl. Mad.) 244
- computerized 167
- digital 166
- industrial 317
Radionuclide (s), for medical use 224
- storage 249
Radiotherapy, apparatus characteristics 104
- Betatron 297
- Cobalt Bomb 296
- deep tumor 298
- deep tumor, equipment 296
- dermo-equlpment 294
- doses 110
- equipment, guide-line selection
- fundamental equipment
315
294
s
- Gilardonl equipment 105
- isodose curves applications Salivary glands (Anal.) 265
294
Linear Accelerator 297 Saturation, blackening 50
- medium deep equipment 296 Scale, gray (US) 191
- (Rad. Protect.), ICRP 311 - grey 162
- techniques 109 - long 45
Rain effect (US) 200 - short 45
Rare earth screens - standard 45
Ratio,(grid) 54 Scalers 229
- tumor dose/tissue dose 104 Scan Conversion Tube, analogical, (US) 190
Ratog il 94 Scanner (s), Flying spot 90
Rays, Alpha 31 - intensified linear 90
- Anode 31 - linear (N ucl. Moo.) 234
- Beta 31 Scanning (US), abdominal 201
- cathode 31 - cardiological 205
- Gamma 31 - gynaecological 203
- nuclear 30 - obstetrical 203
- >oft 63.66 - thyroId 207
- standard 66, 71 Scapula (Anal.) 258

426 G ILAROONI. RACIOLOGY - ELECTROM EOICI NE

Scattered radiations 40, 53, 56, 57 Spin-spin relaxation time (NMR) 215
- back 109 Spinal (Ana!.), accessory nerve 275
- of human parts 58 - column 263
Scattering 40 - cord 274
- US 186 - nerves 275
Scintiangiography, liver 248 Spinning top method (time control) 137
Scintigraphic pattern (Nucl. card.) 245 Spleen (Anal.) 274
Scintillation. cameras 235 - US inspection 202
- counters 95 Spot. Film Fluorography 87
- detectors 161 , 227 - lIying solid slate scanners 90
- dosimeter 95 Stamps, radiographs (examples) 338-344
Scintillator (s), inorganic 228 Standard, rays 66, 71
- organic 229 - seale 45
Screen (s), balanced GUardoni HSU 44 Stationary grid , invisible 55, 56, 58, 60, 61
- fl uorescent for Fluoroscopy 147 Sternum (Anal.) 264
High Definition 44 Stomach (Anal.) 266
High Speed 44 Storage, capaci ty (PACS) 17.
intensification factors 43 - of radlonuclides 24.
intensifying, radiographic 147 Structure of matter 30
- quality, con trol of 44 Superfi cial X-ray therapy (Rad. Protect.). ICRP 307
rare earth 44 Surface (Nucl. Med .). junction detectors 227
- resolution, control of 44 - monitoring 250
- unsharpness 43 Synarthroses 255
Sealed source beam therapy (Rad. Protect.) ICPR 307, 308 Synthetic oils 141
Secondary scattered radiations 40 Systole 272
Sector scan (US) ,.2
Self-reclilier equipment 116
- output 117
Semiconductors 115
Sensitivity, (film) 50
- (gamma camera) 237
Sensitometric curve (film) 50
Sex (Anat.), cells 254
- glands 277
Shielding requirements (selected sources) 302
Short scale 45 T
Shoulder blade (Anat.) 258
Simulator 105 T l (NMR ) 215
Single photon, Iongitudinal-section imaging 23. T2 (NMR ) 215
- transverse-section imaging 23. - measure me net 216
Six-rectifier equipment 11 6 TO lell ventricle volume (Nucl. Mad.) 244
Skin dose, erythema 111 Techniques of radiotherapy 109
- In fl uoroscopy 100, 101 Teeth (Ana!.) 265
- in radiography 100, 101 Teleradiog raphy 154
- typical radiographies 100 Television 80, 81
Skull (Ana!.) 282 - AGC circuits 83
Soft, Gil 63 - automatic dose rate control 83
- rays 63, 66 - camera 81
Software (Computer, Nucl. Med.) 241 - image format ion 81
Solid state. detectors 143 - technique 77
- high voltage rectifiers 115 Tenth Value Layer 40
- intensified linear scanner 90 Therapeutic Efficiency. geometrical 11 0, 11 1
- X-ray output detector 143 Therapeutical Optimum (TO) 112
Sonagll 208 Therapy, antinfiammatory 110
Source (s), sealed. beam therapy (ICAP) 307, 308 - arthrosic 110
- shielding requirements 302 - beam (Rad. Protect.), ICRP 306
Spark gap 135 - contact 109
Spatial. linearity (gamma camera) 238 - conven tional X-ray (Rad. Protect.). ICRP 306
- resolu tion (CT scanners)
- resolution (gamma camera)
- vision (FluOroscopy)
Specific area load (tube)
.,
163
237

125
- deep
- dose volume
- medium deep. equipment
- particle beam (Rad . Protect.) ICRP
104
102
296
307
Speed (film) 50 - plesio 104. 109
Spectroscopy, gamma ray 230 - sealad source beam (Red. Protect.), ICRP 307. 308
Spectrum, con tinuos 41 - superficial X-ray (Rad. Protect), ICRP 307
- electromag netic waves 29 - tumor 11 0
- lines 41 - X-ray, conven tional (Rad . Protec!.), ICRP 306
Sphere spark gap 135 - X-ray tube housing 130
Spin lattice relaxation time (NMR) 215 Thermocouples 33

G ILARDO ~ 1. RAOIOLOGV - ELECTROMEDICINE 427

T high (Anat.) 200 - microlocus 129
THVL 108 - monostage 129
Thymus (Anat.) 277 - multifocus, compu ter operated 135
Thyroid, fun ction studies (in vitro) 243 - multistage 129
- func ition studies (in vivo) 242 - overload safety device 133
- gland (Anal.) 276 - overloading 125, 133
- radioaclive Iracers 242 - phOtomultiplier 228
- scanning (NucL Med.) 242 - power 122
- scanning (US) 207 - pre-degasing 121
Tibia (Anat.) 260 - pulsed (fl ash radiography) 129
Til ting table 153 - rotating anode 36, 37, 126, 129
Time control 137, 138, 139 - sealing (glass processing) 121
- spinning top method 137 - specific area load 125
- with dosimeter 139 - vacuum 122
Time, Gain Compensation (US) 196 Tumor, deep rad iotherapy 298
- motion display (US) 193 - deep rad ioteraphy, equipment 296
Timer, exposure 133 - doseltlssue dose (ratio) 104
- high vol tage 133 - therapy 110
Tissue (s), connective (Anal.) 255 Twelve rectifier equipment 116
- characterization (US) 199 Two (or three) dimensional Fou ri er
- characterizat ion (NMA) 215 Transform imaging 218
- epithelial (Anal.) 255
- Hall Value Layer 108
- nervous (Anal.), composi tion of 274
- of the body (Anat.) 255
- photonlc and elec tronic transmission curves 298
TM-mode (US) 193
Tomographic phantom 144, 157
Tomography 59, 156
- acoustic, computed (US) 197
- computed 158
- detectors In CT 161
- linear 157
- non linear 157
- positron emission (Nucl. Med.) 239 u
Tongue (Anal.) 266
Tonsils (Anal.) 266 U ltrasonic, beam, visualization of 189
Total unsharpness 44 - Images collection 208
Tracheas (Ana!.) 268 - probes 166, 326
Transmitter (NMA) 219 - probes (electrical parameters) 186
Transformer, high voltage 115 - probes (geometrical parameters) 187
Transversal discharge 141 - rule (Ind,) 328
Trigeminal nerve (Anal.) 275 - waves 153
Trochlear nerve (Anat.) 275 Ultrasound, absorption 186
Tube (s), analogical scan conversion (US) 190 - diagnostics, application field 201
- Beryllium window 129 - diagnostics, phlsycal concepts 199
- bifocal rotating anode 37 - diffraction 186
- cathode screen 126 - energy attenuation 185
- ceiling stand 153 - equipment (Ind.) 327
- characteristic 126 - equipment performance checking 208
- Coolidge 36, 120, 122, 126, 129 - generation 181
- efficiency (ou tput) 127 - industrial utilization (examples) 226
- failures 130 - medical diagnostics 181
- focal spot 126, 129 - scattering 186
- for endocavltary terapy 129 - techniques 189
- for flash radiography 129 - testing (Ind.) 326
- for mammography 129 Underdevelopment, film 52
- grounded anode 129 U nils of radioactivity 224
- heating characteristic 127 Unsharpness, film 43
housing 129, 130 - geometrical 36, 44
life 125, 130 - kinetic 44
load limits 130 - screen 43
load specifiC area 125 - lotal 44
- load rad iographic ratings 127 Ureter (Anal.) 269
- manufacturing 120 Urethra (Ana!.) 269
- max voltage 122 Urinary bladder (Anat.) 269
- maximum electric power 122 - US inspection 202
- metal ceramic 129 Urogenital system 268
- metal glass 128 Uterus (Anal.) 270

428 GILARDONI. RADIOLOGY - ElECTAOMEDIC INE

 v x
Vagi na (Ana!.) 270 X-diagnostics, equipment, guide-line for the selection 3'3
Vagus nerve (Anal.) 275 - fundamental pillars '47
Veins (Ana!.) 273 - high voltage cables '32
Velocity (US waves) 182, 183 - section planning 3'3
Ventricles, left (EF, TO) . (Nuel. Mad.) 244 X-Gil 149
- right (EFI, (Nuel. Med.) 244 X-ray (s), absorption of painting components 335
Vertebral column (Anal.) 263 - anatomical phantoms 144
Victoreen dosimeter 94 - departments, planning of 315
Video tape record ing 84 - diagnosis (Rad. Protect.), ICRP 308
Vidicon
Villard voltage doublers
B1
116
- diagnosti c generators output
- diagnostic installation (Rad. Protec\.), ICRP
'0'
303
Vol ta-Gil 152 - discovery of 29
Vol tage. doublers (liebenow-Greinachef) 116 - dose and intensity 9'
- doublers (Villard ) 116 - equipment (Ind.) 320-322
- multipliers (Crookes-Hittorf) 116 - equipment, electric power 117
Vulva (Ana!.) 270 - equipment, o utput 117
- exams/year per 1000 inhabitants 3'3
- exponential absortion law 38
- generator 38
- Intensitimer (M-Gil) 337
- ionization 40
- production of 29
- solid state output detector 143
w - superficial therapy (Rad. Protect.), ICRP 307
- television, AGC circu its 63
Wastes, rad ioacti ve 251 - television, aut. dose rate control 63
Wave (s), longitudinal (US) '63 - test patterns 143
- propagation velocity (US) 182. '63 - therapy (Rad. Protect. ), ICRP 306
- u Itrasen ie '63 - tube emission spectrum 41
Wavelenght, max. intensity 43 - tube fa ilures '30
- minimum 42 - tube housing 129, 130
- (US)
Weekly dose limits
'63
300
- tubes manufacturing
X-therapy, equipment, dosimetric ou tput
,'"
,og
Well-(:ounlers 232 Gilardoni Centered Therapix ' 12
Wilson chamber 9' High vo ltage cables ' 32
Workes monitoring (Nuel. Mad.) 250 Types ' 04
Wr ist (Anal.) 257 X-TV bomb '05

GlLAADONl, RA.OfOlOOV - ElCTROMEOICIN 429