Lecture №1
Introduction to
Roentgenology
Compiled by: Prof. Kulayev Michael Timofeevich – Chair of
Oncology with course of radiation diagnostics and radiation
therapy, Saransk city

The discovery of X rays in 1895 was the
beginning of a revolutionary change in
our understanding of the physical
world.

Issues:
1.History of X-ray detecting;
2.Biography of Wilhelm Conrad Roentgen;
3.Development of roentgenology in Germany and
Austria;
4.Development of roentgenology in Russia;
5.X-ray tube. Construction and principles of working;
6.Properties of X-rays;
7.Principles of radiation protection;
8.Radiology (X-ray) department;
9.Construction of x-ray apparatus.

Medical abbreviations
1. R (Ro)– roentgenological, roentgenology
2. Ca – cancer
3. Bl – blastoma (usually meaning cancer)
4. Tr – (tumor)
5. Neo – neoplasma
6. Sa – sarcoma
7. Ds – diagnosis
8. Met (Mts) – metastasis
9. Susp. – suspicion
10. Tbc - tuberculosis

In the winter of the year of his fiftieth birthday,
and the year following his appointment to the
leadership of the University of Würzburg,
Rector Wilhelm Conrad Roentgen noticed a
barium platinocyanide screen fluorescing in
his laboratory as he generated cathode rays in a
Crookes tube some distance away. Leaving
aside for a time his duties to the university and
to his students, Rector Roentgen spent the
next six weeks in his laboratory, working
alone, and sharing nothing with his colleagues.

It was at this point that Röntgen noticed a faint
shimmering from a bench a few feet away from the
tube. To be sure, he tried several more discharges
and saw the same shimmering each time. Striking
a match, he discovered the shimmering had come
from the location of the barium
platinocyanide screen he had been intending to
use next. Röntgen speculated that a new kind of
ray might be responsible. 8 November was a
Friday, so he took advantage of the weekend to
repeat his experiments and make his first notes.

 In the following 6 weeks he ate and slept in his
laboratory as he investigated many properties of
the new rays he temporarily termed "X-rays",
using the mathematical designation ("X") for
something unknown. The new rays came to bear
his name in many languages as "Röntgen Rays"
(and the associated X-ray radiograms as
"Röntgenograms").

Nearly two weeks after his discovery, he took the first
picture using X-rays of his wife Anna Bertha's
hand. When she saw her skeleton she exclaimed "I
have seen my death!"
Signature
of Röntgen
Bertha’s hand
radiogram

Philipp Edward von Lenard (1862-1947).
Nobel Prize winner on physics for his
work on cathode rays (1905).
He hated W.C. Roentgen due to the fact
that the whole world’s glory went to
Roentgen but not to him.

Roentgen’s
laboratory

Crooks tube.

Würzburg.
Roentgen's museum.

Würzburg. Roentgen’s museum.

Roentgen’s report in the Society of physics and
medicals. Würzburg, 23.01.1896.

Stamps for the 100
anniversary of X-ray
discovery.
First X-ray made in public. Hand of the
famed anatomist, Albert von Kölliker,
made during Roentgen's initial lecture
before the Würzburg Physical Medical
Society on January 23, 1896.

Wilhelm Conrad Röntgen was born on March 27,
1845, at Lennep in the Lower Rhine Province of
Germany, as the only child of a merchant and
manufacturer of cloth. His mother was Charlotte
Constanze Frowein of Amsterdam, a member of an
old Lennep family which had settled in Amsterdam.
House where Wilhelm
Conrad Röntgen was
born at Lennep.

When he was three years old, his family moved to
Apeldoorn in the Netherlands, where he went to a
boarding school. He did not show any special
aptitude, but showed a love of nature and was fond
of roaming in the open country and forests.
He was especially apt at making mechanical
contrivances, a characteristic which remained with
him also in later life. In 1862 he entered a technical
school at Utrecht, where he was however unfairly
expelled, accused of having produced a caricature of
one of the teachers, which was in fact done by
someone else.

He then entered the University of Utrecht in 1865 to
study physics. Not having attained the credentials
required for a regular student, and hearing that he
could enter the Federal Polytechnic Institute at
Zurich by passing its examination, he passed this
and began studies there as a student of mechanical
engineering. He wasn’t always sedulous student. He
attended the lectures given by Clausius and also
worked in the laboratory of Kundt. Both Kundt and
Clausius exerted great influence on his development.
In 1869 (24 y.o.) he graduated Ph.D. at the
University of Zurich, was appointed assistant to
Kundt and went with him to Würzburg in the same
year, and three years later to Strasbourg.

In 1874 he qualified as Lecturer at Strasbourg
University and in 1875 he was appointed Professor
in the Academy of Agriculture at Hohenheim in
Württemberg. In 1876 he returned to Strasbourg as
Professor of Physics, but three years later he
accepted the invitation to the Chair of Physics in the
University of Giessen.

After having declined invitations to similar positions
in the Universities of Jena (1886) and Utrecht
(1888), he accepted it from the University of
Würzburg (1888), where he succeeded Kohlrausch
and found among his colleagues Helmholtz and
Lorenz. In 1899 he declined an offer to the Chair
of Physics in the University of Leipzig, but in 1900
he accepted it in the University of Munich, by
special request of the Bavarian government.

Here he remained for the rest of his life, although he
was offered, but declined, the Presidency of the
Physikalisch-Technische Reichsanstalt at Berlin and
the Chair of Physics of the Berlin Academy.
Röntgen's first work was published in 1870, dealing
with the specific heats of gases, followed a few years
later by a paper on the thermal conductivity of
crystals. Among other problems he studied were the
electrical and other characteristics of quartz etc.

Röntgen's name, however, is chiefly associated with his
discovery of the rays that he called X-rays. In 1895
he was studying the phenomena accompanying the
passage of an electric current through a gas of
extremely low pressure. Previous work in this field
had already been carried out by J. Plucker (1801-
1868), J. W. Hittorf (1824-1914), C. F. Varley (1828-
1883), E. Goldstein (1850-1931), Sir William
Crookes (1832-1919), H. Hertz (1857-1894) and Ph.
von Lenard (1862-1947).

By the work of these scientists the properties of
cathode rays - the name given by Goldstein to the
electric current established in highly rarefied gases
by the very high tension electricity generated by
Ruhmkorff's induction coil - had become well
known. Röntgen's work on cathode rays led him,
however, to the discovery of a new and different
kind of rays. He was the first in the world, who won
the Nobel Prize in physics (1901).

Numerous honors were showered upon him. On the
13th of January (1896), Roentgen presented himself
to the Kaiser and was awarded the Prussian Order
of the Crown, Second Class. In several cities, streets
were named after him, and a complete list of Prizes,
Medals, honorary doctorates, honorary and
corresponding memberships of learned societies in
Germany as well as abroad, and other honors would
fill a whole page of this book. In spite of all this,
Röntgen retained the characteristic of a strikingly
modest and reticent man.

Throughout his life he retained his love of nature and
outdoor occupations. Many vacations were spent at
his summer home at Weilheim, at the foot of the
Bavarian Alps, where he entertained his friends and
went on many expeditions into the mountains.

He was a great mountaineer and more than once got
into dangerous situations. Amiable and courteous by
nature, he was always understanding the views and
difficulties of others. He was always shy of having
an assistant, and preferred to work alone. Much of
the apparatus he used was built by himself with
great ingenuity and experimental skill.

Röntgen married Anna Bertha Ludwig of Zürich,
whom he had met in the café run by her father. She
was a niece of the poet Otto Ludwig. They married
in 1872 in Apeldoorn, The Netherlands. They had no
children, but in 1887 adopted Josephine Bertha
Ludwig, then aged 6, daughter of Mrs. Röntgen's
only brother. Four years after his wife, Röntgen died
at Munich on February 10, 1923, from carcinoma of
the intestine.

O, Röntgen, then the news is true,
And not a trick of idle rumor,
That bids us each beware of you,
And of your grim and graveyard humor.
We do not want, like Dr. Swift,
To take our flesh off and to pose in
Our bones, or show each little rift
And joint for you to poke your nose in.
We only crave to contemplate
Each other’s usual full-dress photo;
Your worse than “altogether” state
Of portraiture we bar in toto!
The fondest swain would
scarcely prize
A picture of his lady’s
framework;
To gaze on this with yearning
eyes
Would probably be voted tame
work!
No, keep them for your epitaph,
these tombstone-souvenirs
unpleasant;
Or go away and photograph
Mahatmas, spooks, and Mrs. B-
s-nt!
—Punch, January 25, 1896

Christmas time.
Würzburg

Photo of Roentgen and his wife Bertha.

Wilhelm Conrad von Röntgen

Monument
devoted
to Roentgen
Giessen where Roentgen was buried.
Monument on his grave.

After the opening of R-rays Germany
became a kind of "Mecca" for all those who
would like to learn a new discovery. A year after
discovery of X-rays, company “Siemens” starts
commercial production of X-ray machines. Of
course, in Germany radiology became most
developed. It began to form the so called “Berlin
School” of radiologists. Its feature was the
preferring of X-ray radiograms versus to
fluoroscopy. However, there was the last
method in their arsenal too.

The first medically indicated radiograph was
taken on January 1896 together by E. Haschek at
the physics institute. The patient’s hand showed
trauma to the middle phalanx.
S. Exner presented a second x-ray image on
January 17 (1896), which was important to the
development of radiology. The anatomist
Tandler placed the hand of a corpse at the
disposal of Haschek at the physics institute. The
arterial vessels were filled with iodine solution.
After 57 minutes of exposure, the first
angiogram was created.

In 1936 the German Roentgen Society erected
a monument to the x-ray and radium martyrs of
all nations. The monument stands beside the
radiological department of St. George’s
Hospital, Hamburg – the hospital of Albers-
Schoenberg, the German radiology pioneer who
succumbed to his radiation injuries in 1921.
Much of the martyrs’ Memorial is inscribed
with the names of 169 x-ray and radium martyrs
from 15 countries, who by then had died; the
highest tolls recorded were 14 British, 20
German, 39 American, and 40 French citizens.
Many other names were later added.

Heinrich Ernst Albers-
Schönberg (January 21, 1865 – June 4,
1921) was the “king” of German
Röntgenology. He was among the first
scientists to explore the clinical
possibilities of x-rays. He was appointed
the first professor of radiology in
Germany in 1919. He co-founded the still
existing journal “Fortschritte auf dem
Gebiet der Röntgenstrahlen“ in 1897 and
was the initiator and co-founder of the
Deutsche Röntgengesellschaft in 1905.

Painting “X-Ray
examining”

Privet doctor examines a patient.
(No any protection).
Development of roentgenology in Germany

 Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931)
Development of Roentgenology in Austria
Die röntgenologische Diagnostik der
Erkrankungen der
Brusteingeweide (1901).
Holzknecht was introduced to x-rays by
Vienna's first radiologist Gustav Kaiser
(1871-1954). In 1899, Holzknecht was
offered working in the department of H.
Nothnagel, a professor of medicine in
Vienna. Holzknecht set to work, and he
particularly devoted himself to the study
of the chest.
His first major observation was on
bronchial obstruction; he made the
classic observation that the
mediastinum shifted on expiration
secondary to the air-trapping. He made
measurements of the cardiac contour,
and emphasized the usefulness of the
oblique views.
On the basis of this work, in 1901 he
published the first book devoted to
radiology of the chest.

Radioscopy (fluoroscopy) of the
chest in times of W.C. Roentgen
(painting).
Fluoroscopy of the chest
in the early 20th century
(photo).

Development of Roentgenology in Austria
Whilst his apparatus looks primitive to us today, it was the high-
tech equipment of his time. As can be seen, there is an absence
of protection, with no shielding around the x-ray tube seen
centrally, and also no protection around the fluorescent screen.
The operator would be exposed to both primary and secondary
radiation, and this is why there were so many injuries in this first
generation of radiologists. There was also the pernicious habit of
using one's own hand to test the quality of the x-ray beam.

 Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931)
Development of Roentgenology in Austria
As was the case in those days, Holzknecht was
interested in both diagnosis and therapy, and in 1902
he described his well-known chromoradiometer, which
was the first device designed to measure radiation
dose. This was a major advance.
In addition, Holzknecht was probably the first person
to suggest that radiology should be a medical specialty
in its own right. In 1903, along with his Viennese
colleague R. Kienböck, he proposed that there was
more to radiology than just simply the use of a helpful
technique.

 Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931)
Development of Roentgenology in Austria
He was actively involved in the training of young
radiologists and emphasized the need for radiologists
in training to be familiar with physiology, anatomy,
and pathology, as well as the clinical features of the
disease, in order to make an accurate and helpful
radiological diagnosis. The Viennese school of
radiology became hugely influential and attracted
many foreign students.
Holzknecht was also the first to describe gastric cancer
using radiology.

 Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931)
Development of Roentgenology in Austria

 Wien, A. Karlsson’s Park. Monument
 in honor of Guido Holzknecht
Development of Roentgenology in Austria
The urn with his ashes
and three more victims
of radiolody.
There is
poignancy
about the
figure, with
his poor
damaged
hands held in
front of him.

Development of Roentgenology in Austria
Antoine Béclère said of Holzknecht that, "No one
brought more passionate ardor and inspiration to the
pursuit of a good and high ideal, no one had a deeper
zeal, was more indefatigable, had more courage,
dedication or selflessness.“
As we remember this amazing pioneer, may we all
have a similar dedication in our daily service to our
patients.
The retro-cardiac space is also known as the
Holzknecht’s space.

 France has made enormous contributions to
world culture and science, and one of the
greatest of her sons is the doctor and
radiologist Antoine Béclère (1856-1939).

Development of Roentgenology in France

His father was a physician, and it was
therefore natural that in 1873 he entered the
Hôpital Lariboisière to start his studies.
 In 1897 he created first laboratory of radiology
in Paris. He organized library on
roentgenology consisting of more than 400000
volumes. Béclère is one of the greats of
radiology.
Development of Roentgenology in France
A commemorative medal from
1936. The International Society
of Radiology still awards the
Béclère Medal.

The first X-ray apparatus in Russia were
delivered from Germany by physicians who
managed to practice in Germany. A.S. Popov
(inventor of radio) has built the working
X-ray machine - according to the drawings of
the magazine - in February 1896 (St.
Petersburg). Soon, the military understood
the exceptional value of this discovery, and
many large warships were equipped with X-
ray apparatus.
St. Petersburg. Military
cruiser AURORA.
A.S. Popov

Thus, on the military cruiser "Aurora" X-ray
examinations were performed in more than 100
of the patients and the wounded. Before the
October Revolution radiology was developed
poorly. It was dealt with enthusiasts or private
practitioners.
Prof. P.N. Lebedev showed a picture with the
preparation of an ectopic pregnancy in
February 1, 1896. Two weeks later V.N. Tonkov
(author of a textbook on anatomy) said about
the possibilities of bone study in vivo.

Ioffe Abram (1880-1960)
technical director of
world’s first institute of
roentgenology in Saint
Petersburg (1918 г.).
He was an assistant of
Roentgen in 1903-1906.
Nemionv Mikhail (1880-
1950) – co-founder of above
mentioned institute.
Development of roentgenology in Russia

Scheme X-ray tube.
Cathode (К) has a split
where is filament of
heating.
The electrons are rushing
to positively charged
anode (А).
Cathode and anode are
charged with high
voltage up to 30 000-
120 000 volts and more.
The anode is edged and
rotated around its own
axis.
(kv)
(rays)

Simplified picture of the X-ray tube.

Picture of the X-ray tube.

Modern X-ray tube.
Coolidge X-ray tube, from
around 1917. The heated
cathode is on the left, and the
anode is right.
The X-rays are emitted
downwards.

Simplified schematic of a rotating anode X-ray tube envelope and
housing. The rotating anode (A), spins via the rotor (R) and its bearings,
creating a focal area of X-ray production around the anode target (T).
The cathode (C), is shown with the filament circuit in green. All of these
components are contained within the evacuated tube envelope (E). Just
outside of the envelope is the stator (S), which induces rotation of the
rotor. The tube envelope is surrounded in a dielectric cooling oil (O),
with an expansion bellows (B). X-ray beam leaves through the tube
window (W), typically Aluminum or Beryllium while the rest of the
housing will be lead or copper to attenuate stray X-rays.

As with any vacuum tube, there is
a cathode, which emits electrons into the vacuum
and an anode to collect the electrons, thus
establishing a flow of electrical current, known as
the beam, through the tube.
A high voltage power source, for example 30 to
150 kilovolts (kV), is connected across cathode
and anode to accelerate the electrons.
The X-ray spectrum depends on the anode
material and the accelerating voltage.

Properties of X-rays
X-rays are the type of wave energy (0,00001-1000
nm) with spectrum between ultraviolet and
gamma-rays. It is their nature and main property.

Properties of X-rays

Properties of X-rays

Properties of X-rays
Physical properties:
1. X-rays are electromagnetic radiation having a wavelength
between 10 A to 0,01 A and speed – 300000 km/sec (same
as that of visible light)
2. In free space they travel in a straight line, invisible to Eye
3. Showing effects of Interference, Diffraction and Refraction
4. They produce electric and magnetic field at right angles to
their path of propagation; don’t require any medium for
propagation
5. They can penetrate liquids, solids and gases
6. They cause Ionization
7. They cause effect of Fluorescence ( method of
Fluoroscopy)
8. They have Heating effect
9. The X-Rays have the property of Attenuation, Absorption
and Scattering

Properties of X-rays

Three of the most basic and easy to follow
principles of radiation protection are time,
distance, and shielding.
Time: As the length of time a tech is exposed
increases, the dose received increases in direct
proportion. During fluoroscopic exams a
technologists should only be in the room when
needed to assist.

Otherwise they should be behind the lead
wall, dressed in lead apron and thyroid collar in
case their assistance is needed. In most cases this
is not feasible but there are some exams; such as
modified barium swallows that the techs
assistance during the exam is rarely needed.
Another way to reduce the time we are exposed
is to avoid holding patients during exams if
possible. If there is another person available to
hold such as a patient relative or even a nurse
who is rarely exposed utilize them in restraining
a patient.

Distance: The most effective of the principles
is distance. The further a person is from the
source the less intense the radiation source is.
When the distance from the source is doubled
the intensity at the new distance is only 1/4 the
original intensity. When performing portable x-
ray exams a tech should be at least six feet from
the source of the radiation.

Shielding: When the use of the time and distance
principles are not possible shielding should always be
used. Wearing protective lead shielding and thyroid
collars can protect the radiosensitive areas of the body
when it is required for the technologist to be near the
source of radiation. Protective aprons, gloves and
thyroid collars are usually made of lead impregnated
vinyl. The most widely used and recommended is a 0.5
mm lead equivalent for protective apparel.

Radiology is a specialty that uses Medical
imaging to diagnose and treat diseases seen within the
body. A variety of imaging techniques such as X-
ray radiography, ultrasound, computed
tomography (CT), nuclear
medicine including positron emission
tomography (PET), and magnetic resonance
imaging (MRI) are used to diagnose and/or treat
diseases. Interventional radiology is the performance
of (usually minimally invasive) medical procedures
with the guidance of imaging technologies.

The acquisition of medical images is usually
carried out by the Radiographer, often known as a
Radiologic Technologist. Depending on location,
the Diagnostic Radiologist, or Reporting Radiographer,
then interprets or "reads" the images and produces a
report of their findings and impression or diagnosis. This
report is then transmitted to the Practitioner who
requested the imaging, either routinely or emergently.
Imaging exams are stored digitally in the picture
archiving and communication system (PACS) where they
can be viewed by all members of the healthcare team
within the same health system and compared later on
with future imaging exams.

Every X-ray department consists of:
1.X-ray machines rooms
2. Control panel room.
3.X-ray staff room (doctor’s room) with
light boxes and monitors.
4. Photo laboratory.
5. WC
6. Waiting room.

1. X-ray tube (usually two – for roentgenography and fluoroscopy)
2. The stand with table
3. X-ray generator
4. Control panel
5. Transformer
6. Fluoroscopic
screen

First X-ray device (schematic). Photo of Roentgen’s X-ray device.

Modern X-ray devices.

Thanks for your attention!

Some
questions?