Principles of X-Ray Imaging
Already a few weeks after the discovery of X-rays in 1895
by Wilhelm Conrad R€ ontgen the first medical images with
photographic plates and fluorescent screens were made. This
was the origin of projection radiography and fluoroscopy.
The greatest steps forward in X-ray diagnostic radiology
since Roentgen’s observations were the development of the
image intensifier systems and then above all the announce-
ment of computed tomography (CT) in a clinical environment
by Hounsfield at the 1972 British Institute of Radiology
annual conference. A further important step was the introduc-
tion of digital image receptors in projection radiography
during the last years. Compared to conventional film-screen
systems these receptors allow the separate optimisation of
photon detection and image processing, resulting in signifi-
cant advantages for image quality and dose.
Although today projection radiography is still the most
frequent examination with X-rays the use of computed tomo-
graphy increases rapidly, and – because it involves larger
radiation doses than the conventional imaging procedures
(cf. Table 10.1) – contributes significantly to the annual
collective dose (see Fig. 1.1). Therefore CT also obtains
growing attention in radiation protection (Brenner and
Hall 2007).
In X-ray diagnostic radiology the image is generated by
the interaction of X-ray photons, which have transmitted the
patient, with a photon detector. These photons can either be
primary photons, which have passed through the tissue with-
out interacting, or secondary photons, which result from an
interaction along their path through the patient. The second-
ary photons will in general be deflected from their original
direction and result in scattered radiation.
The basic principles of projection radiography/fluoroscopy
and CT are shortly explained in Sects. 1.1 and 1.2 respec-
tively. Although totally different in image character, both
imaging systems have in common certain features, which
can be recognised in Fig. 1.2:
1. X-rays are produced in an X-ray tube.
2. The energy distribution of the photons is modified by
inherent and additional filtration.
H. Aichinger et al., Radiation Exposure and Image Quality in X-Ray Diagnostic Radiology,
DOI 10.1007/978-3-642-11241-6_1, # Springer-Verlag Berlin Heidelberg 2012
3. The X-rays are attenuated differently by the various body
tissues.
4. Scattered radiation, which impairs image contrast, is
reduced.
5. The transmitted photons are detected.
6. The image is processed and – in the case of CT –
reconstructed.
This makes it possible to discuss the aspects of image
quality and radiation exposure for both systems together in
the main parts of the book (cf. Chap. 2).
In radiography/fluoroscopy with digital image receptors
and in computed tomography the digital image consists of a
(typically square) matrix of picture elements (pixels) which
represent the corresponding volume elements (voxels) and –
after the exposure – carry the local intensity information (gray
scale value). Quality of digital images depends primarily on
the image matrix size, i.e. the pixel size (cf. Chap. 9). As the
matrix size is increased resolution improves but the number
of photons in each pixel must be increased in order to maintain
a certain minimum noise level.
1.1 Projection Radiography
and Fluoroscopy
In projection radiography and fluoroscopy the image is a
two-dimensional projection of the attenuating properties of
all the tissues along the paths of the X-rays. The components
of a typical radiographic/fluoroscopic system are shown in
Fig. 1.3.
The photons emitted by the X-ray tube are collimated by
a beam-limiting device. Then they enter the patient, where
they may be scattered, absorbed or transmitted without
interaction. The primary photons recorded by the image
receptor form the image. The secondary photons create a
certain amount of background radiation which degrades
contrast. If necessary, the majority of the scattered photons
can be removed by placing an anti-scatter device between
the patient and the image receptor. This device can simply be
3
4 1 Principles of X-Ray Imaging

Remainder Dental
CT 0.7% 0.2%
Angiography and 7%
intervention Remainder 1% 3% Thorax
2%
Mammography 9%
4% Skeleton
GI and urogen
3% Dental and bile tract
GI and urogen 8%
37%
and bile tract
1%
Mammo-
graphy

CT 18%
Skeleton 60% Angiography
33% and
intervention
Thorax
13%

Fig. 1.1 Contribution of various examination types to total frequency (left) and to collective effective dose (right) in 2006 for Germany adapted
from BMU (2009)

X-ray tube
x
Collimation

Production of X-rays

Filtration

Object transmission

Patient
Scatter reduction

Photon detection

Patient support
Anti-scatter device
AEC system
Image reconstruction and processing
Image receptor

Fig. 1.2 Basic principles of radiography/fluoroscopy and CT imaging Fig. 1.3 Typical arrangement of a radiography/fluoroscopy system
1.2 Computed Tomography
an air gap or a so-called anti-scatter grid formed from a
series of parallel metal strips. An automatic exposure control
system (AEC) provides for the correct exposure of the image
receptor. Today digital image receptors predominate in radi-
ography and fluoroscopy, but film-screen systems and image
intensifiers are also still in use.
1.2 Computed Tomography
Whereas it is not possible in projection radiography to
gain any depth information from a single image, computed
tomography separates the superimposed anatomical details
and produces sectional or axial slice images with excellent
soft tissue contrast. Compared to projection radiography and
fluoroscopy computed tomography is a rather new imaging
technique. Therefore it seems to be reasonable to present its
fundamental principles in some more detail.
The principle of computed tomography is illustrated in
Fig. 1.4.
A well-collimated X-ray pencil beam is attenuated by
the tissues along its path and the transmitted radiation is
detected. In order to generate one projection the tube-detector
assembly scans the object in a linear translatory motion. This
procedure is repeated at many viewing angles (typically at
least 180 projections are received with a rotational increment
of 1
). From these projections a two-dimensional discrete
distribution of the linear attenuation coefficients mtissue is
X-ray tube
Detector
Fig. 1.4 Principle of data acquisition in CT imaging (Adapted from
Bunke 2003)
5
reconstructed as image signal by computation. In practice
CT numbers or Hounsfield units are used instead of mtissue
where the Hounsfield unit HU is defined by:
ðmtissue  mwater Þ
HU ¼ 1000  (1.1)
mwater
where mwater is the linear attenuation coefficient of water.
The experimental set-up of Hounsfield corresponded
largely to the arrangement sketched in Fig. 1.4.
This set-up was termed the ‘first generation’ of CT
(Kalender 2006). To speed up scanning and to utilise the
available X-ray power more efficiently the first commercial
scanners (the ‘second generation’) used some more detectors
and a small fan beam. The typical scan time for an 80  80
image matrix was 5 min (Kalender 2006).
Continuously rotating CT systems (‘third generation’)
according to Fig. 1.5 with a fan beam covering the total patient
cross-section and a corresponding detector array, consisting
of gas proportional detectors or scintillation detectors (cf.
Sect. 8.2), were introduced in the 1980s. Continuous rotation
was made possible by a slip-ring technology for electrical
power supply and data acquisition. Scan time was reduced
down to 2 s for a single slice with a 256  256 matrix.
A major step forward in CT technology was the introduc-
tion of spiral or helical CT by Kalender and Vock in 1989
(Kalender et al. 1989; Vock et al. 1989): Slice-by-slice
imaging was replaced by volume scanning. The principle
Fig. 1.5 Continuously rotating CT system with a fan beam and
corresponding detector array (Adapted from Bunke 2003)
6 1 Principles of X-Ray Imaging

Fig. 1.6 Principle of spiral CT

imaging (From Bunke 2003)

of this method is illustrated in Fig. 1.6: While the fan beam is [ mm ] 5 2.5 1.5 1 1 1.5 2.5 5
continuously rotating the patient is moved with constant
velocity along his body axis (the z-axis) through the gantry; 2×8
this results in a spiral track of the focal spot around the
patient and accordingly in a spiral data set. 4×5
Direct image reconstruction from these data would give
rise to image artefacts (similar to motion artefacts). This 4 × 2.5
can mostly be avoided by data interpolation. The interpolation
method developed at first was the 360
linear interpolation 4×1
(LI) algorithm, which used data from a full rotation of the
tube-detector assembly. Since for a complete interpolated data 2 × 0.5
set at a definite slice position two successive 360
rotations on
either side of the selected plane were necessary, considerable
Fig. 1.7 Adaptive array detector with detector combinations for
widening of the slice profile resulted, thus reducing image different slice thicknesses (from Bunke 2003), e.g. the uppermost
quality. Therefore the 360
LI was soon replaced by a 180
combination allows slice widths in the longitudinal direction from
LI where interpolation from opposing 180
points reduces the 1 to 5 mm at the isocentre
spiral range used for reconstruction. This is possible since
X-ray beam attenuation at a distinct rotation angle j is equiv-
alent to the X-ray beam attenuation traversing the body from The MSCT detector arrays could be divided into two
the opposite side, at 180
+ j. As the distance of the data groups: Those with detector elements of unequal width along
points is now smaller, effective slice width will be less. the z-axis (adaptive array detector) and those with elements of
In 1992 CT scanners were introduced, which used two equal width (linear or matrix detector). Figure 1.7 shows as an
parallel banks of detectors. This was followed by multirow example an adaptive array detector with the possibility of the
detector CT scanning in 1998 using solid detectors and simul- setting of different slice thicknesses.
taneously imaging four slices in each rotation of the X-ray tube At present 64-slice scanning represents the state of the art,
(Kalender 2006). A great advantage of multislice CT (MSCT) allowing the imaging of all body regions with submilli-
scanners over single section spiral CT is the opportunity for metre isotropic spatial resolution and scan times of 5–15 s
longer anatomic coverage during the same scanning time. (Kalender 2006).
References
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cardiac imaging, angiography and interventions. Dual source
CT scanners are equipped with an ultrafast dual detector
system and two X-ray tube assemblies. Cone beam CT (see
Sect. 8.2) uses a flat-panel-detector with up to 1,920 rows
and 2,480 columns (Oppelt 2005). This enables enhanced use
of X-ray quanta, but also leads to a higher fraction of scattered
radiation (see Sect. 11.2.4).
References
Brenner DJ, Hall EJ (2007) Computed tomography – an increasing
source of radiation exposure. N Engl J Med 357:2277–2284
Bunke J (2003) Computertomographie. In: Schmidt T (ed)
Strahlenphysik Strahlenbiologie Strahlenschutz. Springer, Berlin,
pp 84–98
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Kalender WA (2006) X-ray computed tomography. Phys Med Biol 51:
R29–R43
Kalender WA, Seissler W, Vock P (1989) Single-breath-hold spiral
volumetric CT by continuous patient translation and scanner rota-
tion. Radiology 173:414
BMU (Bundesministerium f€ ur Umwelt, Naturschutz und Reaktor-
sicherheit) (2009) Umweltradioaktiuit€at und Strahlenbelastung im
Jahr 2008: Unterrichtung durch die Bundesregierung http://nbn-
resolving.de/urn:nbn:de:0221-201003311019
Oppelt A (ed) (2005) Imaging systems for medical diagnostics.
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Vock P, Jung H, Kalender WA (1989) Single breathhold spiral volu-
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