The document provides guidelines on medical radiology. It discusses the key components of a radiology system including the patient positioner, X-ray source, high voltage generator, and image receptor. It describes the physical principles behind X-rays and how radiological exams work. The document also outlines different radiology work techniques like parameter settings and anatomic programs.

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Villa Sistemi Medicali SpA
Guide lines: Medical radiology

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• Introduction To Radiology
• Key Components
• Work Techniques
• Types Of Exams
• Types Of Devices
Contents

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• The radiology is used as diagnostic instrument to visualize anatomical structures,
that can not be seen from outside and it is a part of a bigger discipline, called
“Diagnostic Imaging”
• The X-rays were discovered accidentally by Wilhelm Conrad Röntgen (German)
in 1895
• In the course of the century, technologies, means and materials have become
refined and have brought the radiology (or better the Diagnostic Imaging) 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
• 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
Introduction To Radiology

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• With the progress of knowledge and of technologies, radiologists have
developed a strong specialization in their competences
• Thanks to X-rays, specialized products were designed, addressed
directly to clinical specialist in different fields: Mammography,
Interventistic, Angiography, Mineralometry, etc.
• Each clinical specialty is equipped with devices, which, limiting the
application field, increase the diagnostic efficacy of the product
• Radiological competence can be found also in other specializations as,
for 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.
Introduction To Radiology

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• Radiology is based on the use of X-rays, electromagnetic radiations with
wave-length of about 10-10
m
• X-rays can easily cross each kind of material: they practically go into the
object and come out in the opposite side. When X-rays cross an object, they
are attenuated by the object itself: the more dense is an object, the higher is
its attenuation
- 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)
• In the human organism there are: elements that are not very dense (soft
tissue, muscles, internal organs) and elements very dense (bones)
Physical principle
Introduction To Radiology

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• X-rays, after having crossed the body, “go out” and hit a film which is very similar to a
normal photographic film
• The radiographic film is not very sensitive to X-ray , but it’s much more sensitive to
common light: that’s why it is always positioned inside a
“cassette”, which has several purposes:
- Protect the film from the light
- Increase the sensitivity of the film, getting it in touch with “screens” that
transform X-rays into visible light
- Increase the mechanical resistance
• The X-rays are noxious for the organism so 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 is a century “old”, continues to be used
Physi cal pr i nci pl e
Introduction To Radiology

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• Introduction To Radiology
• Key Components
• Work Techniques
• Types Of Exams
• Types Of Devices
Contents

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• X-rays are the most popular technology for diagnostic imaging in a wide
spectrum of application (bucky tables and remote controlled RF systems)
• A radiological system is mainly made up of the following elements:
- Patient positioner - Table
- X-ray source - Tube
- High voltage Generator
- Image receptor - Film, Image Intensifier, DR
• In addition, there are:
- Grid
- Collimator
- High tension cables
Key Components

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• The table is the element which is mainly useful for support and the
positioning of the patient
• Typically the table is also provided with a column, which supports the
X-ray tube and allows its positioning as needed
MoviplanApollo
Table
Tube
Column
Tube
Column
Key Components

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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 and it is typically used for bone exams
(Moviplan, chest stands)
• The most sophisticate system is called Spot Film Device and it is typically used for
Gastro-Intestinal exams on R/F tables (Apollo, Vision)
Table
Spot Film Device
Potter Bucky
Key Components

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• 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 to 150 kV
• There are several models of tube, in function of the kind
of the system, of the application and of workflow
• The models are different as a function of several
parameters:
- Power
- Focal spot size
- Heat storage capacity
Tube
Key Components

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• 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 with Moviplan for bones applications
• The R/F generators are used with remote controlled tables (Apollo) and tilting tables (Vision
and Viromatic) in gastro-intestinal (GI) and angiographic applications
• With the console it is possible to set three main parameters:
- kV (Kilovolt): from 40 to 150
- mA (milliampere): from 10 to 1000
- s (seconds): from 0.001 to 20
• Changing those three parameters it is possible to adapt X-ray emission to the organ
in exam and to the kind of image that the operator wants to obtain
Generator
Key Components

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Image receptor
• The radiographic film, similar to a photographic film, is hit by the
X-rays and an image with the crossed tissue density can be
obtained
• The Image Intensifier subsystem is used to operate in fluoroscopy
mode to convert x-rays into a bright visible light
• Digital X-ray sensors are used in Digital Radiography, instead of
traditional film, and are called Flat Panel Detectors. They can be
fixed or portable and contain a layer of scintillator material
commonly made by Caesium Iodide (CsI) or Gadolinium
oxysulfide (Gadox)
Key Components

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• Inside the Potter Bucky or the SFD a component called
grid is present and it 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
Grid
Key Components

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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
Collimator
Collimator
Key Components

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• 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)
HT cables
Key Components

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• Introduction To Radiology
• Key Components
• Work Techniques
• Types Of Exams
• Types Of Devices
Contents

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• 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
• 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
• Exposure time (s) can be assimilated to emitted photons
quantity: under the same mA, if the exposure time doubles,
also the photons quantity doubles
Work Techniques
Parameters meaning

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• mA and s are therefore comparable in the final effect (film
darkening)
• The mAs (milliampere-second) unit, as result of the
product mA*s, is often used
• For example, 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 0.1 s
• 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
Parameters meaning
Work Techniques

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• 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
• One point technique: the operator can set only the kV value
• Zero points technique: automatic setting of kV, mA, s
Work Techniques

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• 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
Work Techniques
Anatomic programs

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• Generator accessory
• Composed of two parts:
- AEC interface (it is a board, which is installed into the
generator)
- Measure chamber is placed 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
Automatic Exposure Control (AEC)
Work Techniques

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• 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: the operator can set only the kV
value, 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
Automatic Exposure Control (AEC)
Work Techniques

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• 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
Conventional and HF generators
t
kV
t
t
kV
Conventional X-ray generator
Constant Potential (HF) X-ray
generator
X-ray pulses
Work Techniques

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• 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. They don’t
contribute to the image formation, but are noxious for
the patient
Advantages of HF technology
Work Techniques

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• Introduction To Radiology
• Key Components
• Work Techniques
• Types Of Exams
• Types Of Devices
Contents

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• Radiography: it is comparable to a photo
• Serial radiography: it is comparable to a sequence of photo taken
at very short intervals
• Fluoroscopy: it is comparable to a movie
• Pulsed fluoroscopy: it emits X-ray as a series of short pulses
instead of a continuous flow, reducing the patient dose
• Digital radiography or fluoroscopy: it allows to operate in each
type of exam in digital way
• Tomography: it make a sectional image by moving an X-ray
source and the film in opposite directions during the X-ray
exposure
Types Of Exams

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• 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) thanks to under-table SFD
- Tilting tables (Vision, Viromatic) thanks to under-table potter
bucky
Radiography
Types Of Exams

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• 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
Serial radiography
Types Of Exams

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• 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 visualized on the
monitor
Fluoroscopy
Types Of Exams

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• Study of dynamic phenomenon/district with middle/high
speed (up to 25 img/s)
• 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 I.I, a high resolution CCD camera
and a digital processing system (DIVA-D)
Digital fluoroscopy
Types Of Exams

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• 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 and other exams
• It is often replaced by Computed Tomography and Magnetic
Resonance
Tomography
Types Of Exams

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

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• It can be executed on:
- Remote controlled tables (standard)
- Tilting tables, through optional
tomographic column
- Bucky table through optional
tomographic column
• 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)
Tomography
Types Of Exams

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Types Of Exams
Exposure parameters
Parameter Radiography, serial
Radiography, digital
Fluoroscopy
kV 40 – 150 40 – 120
mA 10 – 1000 0,5 – 10
Times 1 ms – 10 sec From few
seconds to some
minutes

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• Introduction To Radiology
• Key Components
• Work Techniques
• Types Of Exams
• Types Of Devices
Contents

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Types Of Devices
• Remote controlled tables
• Conventional titling tables
• Bucky tables
• Chest stands
• Ceiling tubestands
• Mobile units
• Surgical “C” arms
• Mammographic units
• U-arm Digital Radiographic Systems

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• 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
Remote controlled tables
Types Of Devices

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• 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 Anglo-Saxon school
Conventional tilting tables
Types Of Devices

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• It is a simple device which allows to execute a wide number of exams
• The tabletop 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 tabletop 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
Bucky tables
Types Of Devices

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• 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
Chest stands
Types Of Devices

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• Useful in casualty wards to have 4-side access to the
bucky table, without the floor column
• For lateral projections on remote control tables
Ceiling tubestands
Types Of Devices

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• Mobile units: mobile radiographic systems used in trauma and surgery
rooms, at patient’s bed and also as backup unit in general diagnostic
• Surgical “C” arms: radiographic and fluoroscopy systems used in
general and vascular surgery, traumatology and orthopedics thanks to
their positioning flexibility
• U-arm Direct Digital Radiographic Systems: systems based on flat
panel detectors that can cover virtually all the applications of a modern
radiological room assuring flexibility
• Mammographic units: analog or digital, are available ready for biopsy
Other devices
Types Of Devices

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Radiological tables and applications
Kind RAD
R/F
Model
Villa
Applications
Remote control R/F Apollo Bones
Gastrointestinal (GI)
Angiography
Tomography
Chest
Conventional
Tilting
R/F Vision
Viromati
c
Bones
Gastrointestinal (GI)
Angiography (limited)
Tomography
Bucky Table RAD Moviplan Bones
Tomography
Chest stand RAD Chest
stand
Chest
Spinal column
Under load inf. extremities
Types Of Devices

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