THE RADIOLOGY:

introductory course

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 Application
• The radiology is used as diagnostic instrument to
visualize anatomical structures, that can not be seen
from outside
• The radiology is a part of a bigger discipline, called
“Diagnostic Imaging”

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 The history
The X-rays are been discovered accidentally by

Wilhelm Conrad Röntgen

(German) in 1895

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 The evolution

• In the course of the century, technologies, means

and materials have become refined and have
brought the radiology (or better the Diagnostic
Iaging be a particular branch of the medicine.
• A significant evolution of the radiology has been the
CT (Computerized Tomography) (Hounsfield et Al.,
1972) which still uses collimated X-rays and allows
the study of body sections.

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 The evolution
• Progressively other diagnostic modalities have been
improved, as:
• Ultrasound, nuclear medicine, magnetic resonance
which use different physical principles from X-rays
and allow to obtain different information compared to
ones given by radiographic images

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 The “different” radiologies

• With the progression of knowledge and of technologies, a

strong specialization has developed in the Radiologists
competence.
• Thanks to X-rays, “specialized” products were designed,
addressed directly to clinical specialist in different specialties:
• Mammography, Interventistic, Angiography, Mineralometry,
etc.

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 The “different” radiologies
• Each clinical speciality is equipped with devices, which, limiting
the application field, increase the diagnostic efficacy of the
product
• The Radiologist figure has not only one meaning anymore
• Radiological competence can be found in other specialization
as, in example, surgeon, cardiologist, breast specialist,
dentists , etc. They use radiological images, but each of them
with very specific purpose and needs, that must be
understood and supported.

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 The physical principle
The radiology is based on the using of X-RAY
X-rays are an electromagnetic radiation with wave-
length of about 10-10 m
X-rays can easily cross each kind of material
Practically X-rays “go into” the object and “come out” in
the opposite side.

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 The physical principle
When X-rays cross an object, they are attenuated by
the object itself.

The more DENSE is an object, the higher is its

attenuation.

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 The physical principle
• Air is not very dense: X-rays cross it easily
• Water has a middle density: only a part of X-rays
can cross it
• Lead has a very high density: practically X-rays don’t
cross it (this is the reason for which the lead is used
as protective barrier)

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 The physical principle
• In the human organism there are:
• elements that are not very dense (soft tissue, muscles,
internal organs)
• elements very dense: the bones

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 The physical principle
• X-rays, after having crossed the body, “go out” and
hit a “FILM” which is very similar to a normal
photographic film, but with a bigger size (up to 35x43
cm)
• An image with the crossed tissue density is obtained,
which is the classic radiography

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 The“Cassette”

• The radiographic film is not very sensitive to X-ray , but it’s

much more sensitive to common light.
• The film is always positioned inside a “cassette”, which has
several purposes:
• To protect the film from the light
• To increase the sensitivity of the film, getting it in touch with
“Screens” that transform X-rays into visible light
• To increase the mechanical resistance
• There are different sizes in function of the kind of exams

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 Radio-protection
• The X-rays are noxious for the organism ! They are
bring to cancer
• It is necessary to limit the exposure of both patients
and operators
• Obviously the relation risks/benefits is very favorable,
in fact the radiological technique, even if a century
“old”, continues to be used

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 X-ray systems

• X-rays are the most popular technology for

diagnostic imaging
• Dedicated systems (mammo, C-arms, Panoramic)
• Wide spectrum of application (bucky tables, remote
controlled RF systems)

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 Composition of a system

A radiological system is made up of following

elements:
• Patient positioner (table)
• X-ray source (tube)
• High voltage Generator
• Image receptor (film, Image Intensifier, CR, DR)

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 The table
• The table is the element which is mainly useful for
support and positioning of the patient

APOLLO MOVIPLAN
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 Tha table

• Typically the table is also provided with a

COLUMN, which supports the X-ray tube and
allows its positioning as needed

TUBE

COLUMN

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 The table

• The table is equipped with a device to support and

position the cassette
• The most simple system is called Cassette Holder and is
not used frequently
• A middle system is called “Potter Bucky”. It is typically
used for bone exams (Moviplan, chest stands)
• The most sophisticate system is called Spot Film Device
and is typically used for Gastro-Intestinal exams on R/F
tables such as Apollo or Vision

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 SFD and Potter Bucky

Spot Film Device Potter Bucky

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 The grid

• Inside the Potter Bucky or the SFD a component

called GRID is present which has the purpose of
eliminating the “Scattered radiation”, that is a sort of
“fog” generated by the subject in exam, which affect
the image quality
• The grid is a sort of filter which “cleans the image”

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 The tube
• The X-ray tube is the component which emits the X-
rays
• To emit the X-rays, the
tube must be supplied
with a voltage from
40.000 to 150.000 Volt
(40-150 kV)

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 The tube
• There are several models of tube, in function of the
kind of the system, of the application, of work flow
• The models are different on the base of several
parameters:
• Power
• Focal spot size
• Heat storage capacity

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 The collimator
The collimator is present on the tube in the point
from which X-rays are emitted, and is used to:
• Limit the size of the irradiated field
• Project on the patient a luminous
square which shows the field size.
• Reduce the stray radiation in the
environment

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 The generator

• The generator generates the high voltage to be applied to the

tube to produce X-rays.
• There are several models in function of the power and of the
application
• The rad-only generators are used with tables as Moviplan for
bones applications
• The R/F generators are used with remote controlled tables
(Apollo and Mercury) and tilting tables (Vision and Viromatic) in
gastro-intestinal (GI) and angiographic applications

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 The generator
• Through the console it is possible to set the three
main parameters:
• kV (Kilovolt): from 40 to 150
• mA (milliampere): from 10 to 1000
• s (seconds): from 0.001 to 20 sec
• Changing those three parameters it is possible to
adapt X-ray emission to the organ in exam and to the
kind of image which the operator wants to obtain

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 Parameters meaning

• kV are representative of single photons energy and

therefore of their penetration power. A radiation with
high kV can cross denser and/or thicker materials

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 Parameters meaning
• The mA are representative of quantity of emitted X-
photons and, under the same kV and object in exam,
a radiation with higher mA “makes the film darker”
• The exposure time (s) can be assimilated to emitted
photons quantity: under the same mA, if the
exposure time doubles, also the photons quantity
doubles

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 Parameters meaning
• mA and s are therefore comparable in the final effect (film
darkening)
• In fact the mAs unit is often used, that is the product mA *
s (milliampere-second)
• If 25 mAs are necessary to obtain a correct exposure, it is
possible to use 25 mA for one second, or it is possible to
use 250 mA for 0.1s
• It is preferable to use high mA and short times to reduce
the artifacts due to the movement of the patient or of the
organs
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 Work techniques

• Three points technique: the operator can set

independently kV, mA and s values
• Two points technique: the operator can set kV and
mAs values. The generator sets the highest possible
mA value for the kV value selected

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 The anatomic programs

• They allow to set exposure

parameters automatically
• The operator sets the organ to
examine,the projection (frontal
or lateral) and the patient size
• The system sets the best kV,
mA, sec values in function of the
exam

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 Automatic Exposure Control (AEC)

• Generator accessory
• Composed of two parts:
• AEC interface (it is a board, which is installed into the generator)
• Measure chamber is put in the potter bucky or in the SFD immediately
above the cassette.
• The X-rays, before hitting the cassette, cross the measure
chamber, which emits an electrical signal proportional to the
rays quantity which has crossed it

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 Automatic Exposure Control (AEC)

• The signal is sent to interface board, which elaborates it and

informs the generator to interrupt the exposure when the
radiation dose emitted is sufficient to give the correct film
darkening
• Substantially the parameter on which the AEC acts is the
exposure time
• It is called also 1 point technique, because the operator can set
only the kV value

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 Automatic Exposure Control (AEC)

• The kV value is set by operator manually or through an

anatomic program (in this case a mixed anatomic technique +
AEC is used)
• The mA value is set automatically with the max possible value
for that particular kV value

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 Conventional and HF generators
Conventional generator
The wave-shape of the high tension
is directly linked to the 50 Hz mains
frequency. The kV have a sinusoidal
shape which goes from 0 to 100 kV
(in example)

HF generator
The wave-shape of the high tension
is generated by an “Inverter” which
works with frequencies of several
kHz and it is further “levelled” so
that it is almost constant
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 Advantages of HF technology

• Higher efficiency (under the same application, it is

sufficient a lower power)
• Reduction of the patient dose
• Insensitivity to mains voltage fluctuations
• Reduction of “soft rays”, that are the rays generated in
the rising and falling portions of the wave, which don’t
contribute to the image formation, but which are
noxious for the patient
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 HF generators

• RF generators: for radiographic and fluoroscopic

applications (remote controlled and tilting tables):
• Genius HF-A
• G100 RF
• RAD only generators: for radiographic applications
(bucky systems)
• G100 RAD
• G100C RAD
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 HT Cables

• The high tension cables (HT) are used to connect the

generator with the tube
• Their length must be chosen in function of the
system composition (14/16 m cables are the most
common ones)

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 Operating modes

• Radiography: it is comparable to a photo

• Fluoroscopy: it is comparable to a movie
• Serial radiography: it is comparable to a sequence of
photo taken at very short intervals
• Digital: it allows to operate in each above-mentioned
mode in digital way, instead of with a film

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 Exposure parameters

Radiography, serial
Parameter Fluoroscopy
radiography, digital

kV 40 - 150 40 - 120

mA 10 - 1000 0.5 – 10

From a few seconds

Times (s) 1ms – 10sec
to some minutes
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 Radiography

• It allows to take static images (chest, bones)

• It puts in evidence fine details
• It is executed on:
•Bucky tables (Moviplan) and chest stands (for chest exams) thanks
to the Potter Bucky
•Remote controlled tables (Apollo, Mercury) thanks to under-table SFD
•Tilting tables (Vision, Viromatic) thanks to under-table potter bucky

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 Fluoroscopy

• It allows to take pictures of dynamic events (gastro-

Intestinal)
• It is not useful to put in evidence details, but to see
the evolution of a phenomenon
• It is executed on R/F (Radio/Fluoro) tables, tilting
or remote controlled and on surgical C-arm
• The image is taken by TV Chain, made up of an II
(Image Intensifier) and a CCD camera, and is
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 Serial radiography

• It is used typically for dynamic GI (gastro-intestinal)

study
• More images (from 2 to 6), called divisions, at
intervals of 0.5-1 sec. each other, are taken on the
same film
• It is executed on R/F (Radio/Fluoro) tables, tilting or
remote controlled, through the SFD

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 Digital Fluoroscopy
• Study of dynamic phenomenon/district with
middle/high speed (up to 25 img/sec)
• It is used typically for digestive and vascular
apparatus study
• It allows to execute angiographic examination with
DSA = Digital Subtraction Angiography
• The system is based on a II, a high resolution CCD
camera and a digital processing system (DIVA-D)
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 Tomography
• It is used to take internal organs sections
• It is based on the principle of “cancellation” of structures which
are outside the slice layer
• The cancellation is obtained with an “defocussing” procedure,
thanks to a relative movement between the film and the
structures which are not interesting
• For example it is used for kidney, liver, ... exams
• It is often replaced by CT and MR

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 Tomography
X-ray source
movement
The effect of “cancellation”
of the structures which are Patient body
outside the focal layer is
obtained through the Focal plane Table surface
movement in opposite
directions of the source Cassette movement
and the film respect to the Film/screen
organ

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 Tomography

• It can be executed on:

• Remote controlled tables
(standard)
• Tilting tables, through
optional tomographic
column
• Bucky table through
optional tomographic
column

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 Tomography

• The simplest systems use

a mechanical bar which
synchronizes the tube
and the potter movement
• The most sophisticated
systems use an electronic
system without bar
(electronic tomography)

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 Radiological tables and applications
RAD
Kind R/F Model Villa Applications
Remote control R/F Apollo Bones
Mercury Gastrointestinal (GI)
Angiography
Tomography
Chest
Conventional R/F Vision Bones
Tilting Viromatic Gastrointestinal (GI)
Angiography (limited)
Tomography
Bucky table RAD Moviplan Bones
Tomography

Chest stand RAD Chest stand Chest

Spinal column
under load inf. extremities
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 Remote controlled table
• It is the device which allows to execute the widest
number of R/F and RAD exams
• The control console is positioned in a separate room
• It is typical of Italian and French schools
• It allows to make the best of digital acquisition
systems

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 Conventional tilting table
• It allows to execute R/F exams
• To execute RAD exams, an under-table potter bucky and
a second tube on column or ceiling tubestand are needed
• The controls are on the table itself
• It is typical of UK school
• The use with digital acquisition systems gives some
problems

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 R/F systems
• Remote controlled table
Vs.
Conventional tilting
• Apollo

• Vision

• Viromatic

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 Bucky tables
• It is a simple device which allows to execute a wide number of
exams
• The table top is “floating” to allows a fast and precise manual
positioning
• It is often coupled with a chest stand to make a general
radiography room (general rad)
• It is often provided with vertical movement thanks to a lift,
which allows to lower the table top to about 50 cm from floor,
to facilitate the access of patients with motion difficulties
(elders or with extremities problems) since the device is often
used for first study of casualty ward
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 Chest stand
• It is an accessory which completes a radiological
system (generally based on Moviplan or
Vision/Viromatic, sometimes with remote control)
• It is used to execute chest and spinal column exams
with standing patients
• It can also be used for loaded lower extremities
studies.

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 Ceiling suspension Lem Plus

• Useful in casualty wards to have 4-side access to the

bucky table, without the floor column
• For lateral projections on remote control tables

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 Other devices
• Basic radiographic system (BRS)
Multix-S
• Mobile units
Visitor AR 30, Visitor T30, Visitor T4
• Surgical C arm
Arcovis 3000
• Mammographic unit
Melody II

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 DR Systems
• Direct Digital Radiology
• Based on “Flat panels” that replace the conventional
cassettes in radiographic systems (typically bucky
tables, chest stands, BRS systems)
• Used for RAD applications only

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