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Radiography is an imaging technique using
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
s, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeutic") and
industrial radiography Industrial radiography is a modality of non-destructive testing that uses ionizing radiation to inspect materials and components with the objective of locating and quantifying defects and degradation in material properties that would lead to the ...
. Similar techniques are used in airport security (where "body scanners" generally use backscatter X-ray). To create an image in
conventional radiography Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images ...
, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector (either photographic film or a digital detector). The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography (CT scanning) an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes (axial, coronal, and sagittal) which can be further processed to produce a three dimensional image.


Medical uses

Since the body is made up of various substances with differing densities, ionising and non-ionising radiation can be used to reveal the internal structure of the body on an image receptor by highlighting these differences using
attenuation In physics, attenuation (in some contexts, extinction) is the gradual loss of flux intensity through a medium. For instance, dark glasses attenuate sunlight, lead attenuates X-rays, and water and air attenuate both light and sound at var ...
, or in the case of ionising radiation, the absorption of X-ray photons by the denser substances (like
calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar ...
-rich bones). The discipline involving the study of anatomy through the use of radiographic images is known as
radiographic anatomy File:Chest.jpg File:Chestxp illustrated.jpg, Human chest radiographic anatomy. Radioanatomy (x-ray anatomy) is anatomy discipline which involves the study of anatomy through the use of radiographic films. The x-ray film represents two-dimens ...
. Medical radiography acquisition is generally carried out by
radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of pathology. Rad ...
s, while image analysis is generally done by
radiologist Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiati ...
s. Some radiographers also specialise in image interpretation. Medical radiography includes a range of modalities producing many different types of image, each of which has a different clinical application.


Projectional radiography

The creation of images by exposing an object to
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
s or other high-energy forms of
electromagnetic radiation In physics, electromagnetic radiation (EMR) consists of waves of the electromagnetic (EM) field, which propagate through space and carry momentum and electromagnetic radiant energy. It includes radio waves, microwaves, infrared, (visib ...
and capturing the resulting remnant beam (or "shadow") as a latent image is known as "projection radiography". The "shadow" may be converted to light using a fluorescent screen, which is then captured on photographic film, it may be captured by a phosphor screen to be "read" later by a laser (CR), or it may directly activate a matrix of
solid-state Solid state, or solid matter, is one of the four fundamental states of matter. Solid state may also refer to: Electronics * Solid-state electronics, circuits built of solid materials * Solid state ionics, study of ionic conductors and their ...
detectors (DR—similar to a very large version of a CCD in a digital camera).
Bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
and some organs (such as lungs) especially lend themselves to projection radiography. It is a relatively low-cost investigation with a high
diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
yield. The difference between ''soft'' and ''hard'' body parts stems mostly from the fact that carbon has a very low X-ray cross section compared to calcium.


Computed tomography

Computed tomography or CT scan (previously known as CAT scan, the "A" standing for "axial") uses ionizing radiation (x-ray radiation) in conjunction with a computer to create images of both soft and hard tissues. These images look as though the patient was sliced like bread (thus, "tomography" – "tomo" means "slice"). Though CT uses a higher amount of ionizing x-radiation than diagnostic x-rays (both utilising X-ray radiation), with advances in technology, levels of CT radiation dose and scan times have reduced. CT exams are generally short, most lasting only as long as a breath-hold,
Contrast agents A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radioph ...
are also often used, depending on the tissues needing to be seen. Radiographers perform these examinations, sometimes in conjunction with a radiologist (for instance, when a radiologist performs a CT-guided biopsy).


Dual energy X-ray absorptiometry

DEXA Dual-energy X-ray absorptiometry (DXA, or DEXA) is a means of measuring bone mineral density (BMD) using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtracted ...
, or bone densitometry, is used primarily for osteoporosis tests. It is not projection radiography, as the X-rays are emitted in 2 narrow beams that are scanned across the patient, 90 degrees from each other. Usually the hip (head of the
femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates ...
), lower back ( lumbar spine), or heel (
calcaneum In humans and many other primates, the calcaneus (; from the Latin ''calcaneus'' or ''calcaneum'', meaning heel) or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock. S ...
) are imaged, and the bone density (amount of calcium) is determined and given a number (a T-score). It is not used for bone imaging, as the image quality is not good enough to make an accurate diagnostic image for fractures, inflammation, etc. It can also be used to measure total body fat, though this is not common. The radiation dose received from DEXA scans is very low, much lower than projection radiography examinations.


Fluoroscopy

Fluoroscopy is a term invented by Thomas Edison during his early X-ray studies. The name refers to the fluorescence he saw while looking at a glowing plate bombarded with X-rays. The technique provides moving projection radiographs. Fluoroscopy is mainly performed to view movement (of tissue or a contrast agent), or to guide a medical intervention, such as angioplasty, pacemaker insertion, or joint repair/replacement. The last can often be carried out in the operating theatre, using a portable fluoroscopy machine called a C-arm. It can move around the surgery table and make digital images for the surgeon. Biplanar Fluoroscopy works the same as single plane fluoroscopy except displaying two planes at the same time. The ability to work in two planes is important for orthopedic and spinal surgery and can reduce operating times by eliminating re-positioning.


Angiography

Angiography is the use of fluoroscopy to view the cardiovascular system. An iodine-based contrast is injected into the bloodstream and watched as it travels around. Since liquid blood and the vessels are not very dense, a contrast with high density (like the large iodine atoms) is used to view the vessels under X-ray. Angiography is used to find aneurysms, leaks, blockages ( thromboses), new vessel growth, and placement of catheters and stents.
Balloon angioplasty Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atheroscleros ...
is often done with angiography.


Contrast radiography

Contrast radiography uses a radiocontrast agent, a type of
contrast medium A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radio ...
, to make the structures of interest stand out visually from their background. Contrast agents are required in conventional angiography, and can be used in both projectional radiography and computed tomography (called '' contrast CT'').


Other medical imaging

Although not technically radiographic techniques due to not using X-rays, imaging modalities such as PET and MRI are sometimes grouped in radiography because the radiology department of hospitals handle all forms of imaging. Treatment using radiation is known as radiotherapy.


Industrial radiography

Industrial radiography Industrial radiography is a modality of non-destructive testing that uses ionizing radiation to inspect materials and components with the objective of locating and quantifying defects and degradation in material properties that would lead to the ...
is a method of
non-destructive testing Nondestructive testing (NDT) is any of a wide group of analysis techniques used in science and technology industry to evaluate the properties of a material, component or system without causing damage. The terms nondestructive examination (NDE), n ...
where many types of manufactured components can be examined to verify the internal structure and integrity of the specimen. Industrial Radiography can be performed utilizing either X-rays or gamma rays. Both are forms of
electromagnetic radiation In physics, electromagnetic radiation (EMR) consists of waves of the electromagnetic (EM) field, which propagate through space and carry momentum and electromagnetic radiant energy. It includes radio waves, microwaves, infrared, (visib ...
. The difference between various forms of electromagnetic energy is related to the wavelength. X and gamma rays have the shortest wavelength and this property leads to the ability to penetrate, travel through, and exit various materials such as carbon steel and other metals. Specific methods include industrial computed tomography.


Image quality

Image quality will depend on resolution and density. Resolution is the ability an image to show closely spaced structure in the object as separate entities in the image while density is the blackening power of the image. Sharpness of a radiographic image is strongly determined by the size of the X-ray source. This is determined by the area of the electron beam hitting the anode. A large photon source results in more blurring in the final image and is worsened by an increase in image formation distance. This blurring can be measured as a contribution to the modulation transfer function of the imaging system. The memory devices used in large-scale radiographic systems are also very important. They work efficiently to store the crucial data of contrast and density in the radiography image and produce the output accordingly. Smaller capacity memory drives with high-density connectors are also important to deal with internal vibration or shock.


Radiation dose

The dosage of radiation applied in radiography varies by procedure. For example, the effective dosage of a chest x-ray is 0.1 mSv, while an abdominal CT is 10 mSv. The
American Association of Physicists in Medicine The American Association of Physicists in Medicine (AAPM) is a scientific, educational, and professional organization of Medical Physicists. In 2011, it absorbed the American College of Medical Physics Their headquarters are located at 1631 Prin ...
(AAPM) have stated that the "risks of medical imaging at patient doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be nonexistent." Other scientific bodies sharing this conclusion include the International Organization of Medical Physicists, the UN Scientific Committee on the Effects of Atomic Radiation, and the International Commission on Radiological Protection. Nonetheless, radiological organizations, including the Radiological Society of North America (RSNA) and the
American College of Radiology The American College of Radiology (ACR), founded in 1923, is a professional medical society representing nearly 40,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists. ...
(ACR), as well as multiple government agencies, indicate safety standards to ensure that radiation dosage is as low as possible.


Shielding

Lead is the most common shield against X-rays because of its high density (11340 kg/m3), stopping power, ease of installation and low cost. The maximum range of a high-energy photon such as an X-ray in matter is infinite; at every point in the matter traversed by the photon, there is a probability of interaction. Thus there is a very small probability of no interaction over very large distances. The shielding of photon beam is therefore exponential (with an attenuation length being close to the radiation length of the material); doubling the thickness of shielding will square the shielding effect. Table in this section shows the recommended thickness of lead shielding in function of X-ray energy, from the Recommendations by the Second International Congress of Radiology.


Campaigns

In response to increased concern by the public over radiation doses and the ongoing progress of best practices, The Alliance for Radiation Safety in Pediatric Imaging was formed within the Society for Pediatric Radiology. In concert with the American Society of Radiologic Technologists, the
American College of Radiology The American College of Radiology (ACR), founded in 1923, is a professional medical society representing nearly 40,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists. ...
, and the
American Association of Physicists in Medicine The American Association of Physicists in Medicine (AAPM) is a scientific, educational, and professional organization of Medical Physicists. In 2011, it absorbed the American College of Medical Physics Their headquarters are located at 1631 Prin ...
, the Society for Pediatric Radiology developed and launched the Image Gently campaign which is designed to maintain high quality imaging studies while using the lowest doses and best radiation safety practices available on pediatric patients. This initiative has been endorsed and applied by a growing list of various professional medical organizations around the world and has received support and assistance from companies that manufacture equipment used in radiology. Following upon the success of the Image Gently campaign, the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine, and the American Society of Radiologic Technologists have launched a similar campaign to address this issue in the adult population called Image Wisely. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
and International Atomic Energy Agency (IAEA) of the United Nations have also been working in this area and have ongoing projects designed to broaden best practices and lower patient radiation dose.


Provider payment

Contrary to advice that emphasises only conducting radiographs when in the patient's interest, recent evidence suggests that they are used more frequently when dentists are paid under fee-for-service.


Equipment


Sources

In medicine and dentistry, projectional radiography and computed tomography images generally use X-rays created by X-ray generators, which generate X-rays from X-ray tubes. The resultant images from the radiograph (X-ray generator/machine) or CT scanner are correctly referred to as "radiograms"/"roentgenograms" and "tomograms" respectively. A number of other sources of
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
photons are possible, and may be used in industrial radiography or research; these include betatrons, and
linear accelerators A linear particle accelerator (often shortened to linac) is a type of particle accelerator that accelerates charged subatomic particles or ions to a high speed by subjecting them to a series of oscillating electric potentials along a linear b ...
(linacs) and synchrotrons. For gamma rays, radioactive sources such as 192Ir, 60Co or 137Cs are used.


Grid

An anti-scatter grid may be placed between the patient and the detector to reduce the quantity of scattered x-rays that reach the detector. This improves the contrast resolution of the image, but also increases radiation exposure for the patient.


Detectors

Detectors can be divided into two major categories: imaging detectors (such as photographic plates and X-ray film ( photographic film), now mostly replaced by various
digitizing DigitizationTech Target. (2011, April). Definition: digitization. ''WhatIs.com''. Retrieved December 15, 2021, from https://whatis.techtarget.com/definition/digitization is the process of converting information into a digital (i.e. computer- ...
devices like image plates or flat panel detectors) and dose measurement devices (such as ionization chambers, Geiger counters, and
dosimeter A radiation dosimeter is a device that measures dose uptake of external ionizing radiation. It is worn by the person being monitored when used as a personal dosimeter, and is a record of the radiation dose received. Modern electronic personal d ...
s used to measure the local radiation exposure, dose, and/or dose rate, for example, for verifying that radiation protection equipment and procedures are effective on an ongoing basis).


Side markers

A radiopaque anatomical side marker is added to each image. For example, if the patient has their right hand x-rayed, the radiographer includes a radiopaque "R" marker within the field of the x-ray beam as an indicator of which hand has been imaged. If a physical marker is not included, the radiographer may add the correct side marker later as part of digital post-processing.


Image intensifiers and array detectors

As an alternative to X-ray detectors,
image intensifiers An image intensifier or image intensifier tube is a vacuum tube device for increasing the intensity of available light in an optical system to allow use under low-light conditions, such as at night, to facilitate visual imaging of low-light proces ...
are analog devices that readily convert the acquired X-ray image into one visible on a video screen. This device is made of a vacuum tube with a wide input surface coated on the inside with caesium iodide (CsI). When hit by X-rays material phosphors which causes the
photocathode A photocathode is a surface engineered to convert light (photons) into electrons using the photoelectric effect. Photocathodes are important in accelerator physics where they are utilised in a photoinjector to generate high brightness electron be ...
adjacent to it to emit electrons. These electron are then focus using electron lenses inside the intensifier to an output screen coated with phosphorescent materials. The image from the output can then be recorded via a camera and displayed. Digital devices known as array detectors are becoming more common in fluoroscopy. These devices are made of discrete pixelated detectors known as thin-film transistors (TFT) which can either work ''indirectly'' by using photo detectors that detect light emitted from a scintillator material such as CsI, or ''directly'' by capturing the electrons produced when the X-rays hit the detector. Direct detector do not tend to experience the blurring or spreading effect caused by phosphorescent scintillators of or film screens since the detectors are activated directly by X-ray photons.


Dual-energy

''Dual-energy'' radiography is where images are acquired using two separate
tube voltage An X-ray tube is a vacuum tube that converts electrical input power into X-rays. The availability of this controllable source of X-rays created the field of radiography, the imaging of partly opaque objects with penetrating radiation. In contras ...
s. This is the standard method for
bone densitometry Dual-energy X-ray absorptiometry (DXA, or DEXA) is a means of measuring bone mineral density (BMD) using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtract ...
. It is also used in
CT pulmonary angiography A CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. Its main use is to diagnose pulmonary embolism (PE). It is a preferred choice of imaging i ...
to decrease the required dose of iodinated contrast.


History

Radiography's origins and fluoroscopy's origins can both be traced to 8 November 1895, when German physics professor Wilhelm Conrad Röntgen discovered the X-ray and noted that, while it could pass through human tissue, it could not pass through bone or metal. Röntgen referred to the radiation as "X", to indicate that it was an unknown type of radiation. He received the first
Nobel Prize in Physics ) , image = Nobel Prize.png , alt = A golden medallion with an embossed image of a bearded man facing left in profile. To the left of the man is the text "ALFR•" then "NOBEL", and on the right, the text (smaller) "NAT•" then " ...
for his discovery. There are conflicting accounts of his discovery because Röntgen had his lab notes burned after his death, but this is a likely reconstruction by his biographers: Röntgen was investigating cathode rays using a
fluorescent Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, ...
screen painted with barium platinocyanide and a Crookes tube which he had wrapped in black cardboard to shield its fluorescent glow. He noticed a faint green glow from the screen, about 1 metre away. Röntgen realized some invisible rays coming from the tube were passing through the cardboard to make the screen glow: they were passing through an opaque object to affect the film behind it. Röntgen discovered X-rays' medical use when he made a picture of his wife's hand on a photographic plate formed due to X-rays. The photograph of his wife's hand was the first ever photograph of a human body part using X-rays. When she saw the picture, she said, "I have seen my death." The first use of X-rays under clinical conditions was by John Hall-Edwards in Birmingham, England on 11 January 1896, when he radiographed a needle stuck in the hand of an associate. On 14 February 1896, Hall-Edwards also became the first to use X-rays in a surgical operation. The United States saw its first medical X-ray obtained using a discharge tube of Ivan Pulyui's design. In January 1896, on reading of Röntgen's discovery, Frank Austin of Dartmouth College tested all of the discharge tubes in the physics laboratory and found that only the Pulyui tube produced X-rays. This was a result of Pulyui's inclusion of an oblique "target" of mica, used for holding samples of
fluorescent Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, ...
material, within the tube. On 3 February 1896 Gilman Frost, professor of medicine at the college, and his brother Edwin Frost, professor of physics, exposed the wrist of Eddie McCarthy, whom Gilman had treated some weeks earlier for a fracture, to the X-rays and collected the resulting image of the broken bone on gelatin photographic plates obtained from Howard Langill, a local photographer also interested in Röntgen's work. X-rays were put to diagnostic use very early; for example, Alan Archibald Campbell-Swinton opened a radiographic laboratory in the United Kingdom in 1896, before the dangers of ionizing radiation were discovered. Indeed,
Marie Curie Marie Salomea Skłodowska–Curie ( , , ; born Maria Salomea Skłodowska, ; 7 November 1867 – 4 July 1934) was a Polish and naturalized-French physicist and chemist who conducted pioneering research on radioactivity. She was the fir ...
pushed for radiography to be used to treat wounded soldiers in World War I. Initially, many kinds of staff conducted radiography in hospitals, including physicists, photographers, physicians, nurses, and engineers. The medical speciality of radiology grew up over many years around the new technology. When new diagnostic tests were developed, it was natural for the
radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of pathology. Rad ...
s to be trained in and to adopt this new technology. Radiographers now perform fluoroscopy, computed tomography, mammography, ultrasound,
nuclear medicine Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is " radiology done inside out" because it records radiation emi ...
and magnetic resonance imaging as well. Although a nonspecialist dictionary might define radiography quite narrowly as "taking X-ray images", this has long been only part of the work of "X-ray departments", radiographers, and radiologists. Initially, radiographs were known as roentgenograms, while ''skiagrapher'' (from the
Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic pe ...
words for "shadow" and "writer") was used until about 1918 to mean ''radiographer''. The Japanese term for the radiograph, レントゲン (rentogen), shares its etymology with the original English term.


See also

* Autoradiograph *
Background radiation Background radiation is a measure of the level of ionizing radiation present in the environment at a particular location which is not due to deliberate introduction of radiation sources. Background radiation originates from a variety of source ...
*
Computer-aided diagnosis Computer-aided detection (CADe), also called computer-aided diagnosis (CADx), are systems that assist doctors in the interpretation of medical images. Imaging techniques in X-ray, MRI, Endoscopy, and ultrasound diagnostics yield a great deal o ...
* Imaging science * List of civilian radiation accidents * Medical imaging in pregnancy * Radiation * Digital radiography * Radiation contamination *
Radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of pathology. Rad ...
*
Thermography Infrared thermography (IRT), thermal video and/or thermal imaging, is a process where a thermal camera captures and creates an image of an object by using infrared radiation emitted from the object in a process, which are examples of infrared i ...


References


Further reading

* * * * *


External links


MedPix
Medical Image Database
Video on X-ray inspection and industrial computed tomography
Karlsruhe University of Applied Sciences

* ttp://physics.nist.gov/PhysRefData/Xcom/Text/XCOM.html NIST's XCOM: Photon Cross Sections Database
NIST's FAST: Attenuation and Scattering Tables



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