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De rntgenstralen en hun toepassing voor het maken van (medische)

beelden van het lichaam werden ontdekt in 1895 door Wilhelm Conrad
Rntgen en hebben heden nog steeds het grootste aandeel als generator
van beelden.
De RX beeldvorming bestaat technisch uit een X-stralen buis en een
beelddrager, waar het beeld zichtbaar wordt.
De patient bevindt zich tussen beiden in.

De ingredinten:
X-stralen buis
patint
detector: hard copy film of digitale detector

X-radiation (composed of X-rays) is a form of electromagnetic radiation. X-rays

have a wavelength in the range of 0.01 to 10 nanometers, corresponding to
frequencies in the range 30 petahertz to 30 exahertz (3 ! 1016 Hz to 3 ! 1019 Hz)
and energies in the range 120 eV to 120 keV. They are shorter in wavelength than
UV rays and longer than gamma rays. In many languages, X-radiation is called
Rntgen radiation, after Wilhelm Conrad Rntgen, who is generally credited as its
discoverer, and who had named it X-radiation to signify an unknown type of
radiation.
X-rays from about 0.12 to 12 keV (10 to 0.10 nm wavelength) are classified as
"soft" X-rays, and from about 12 to 120 keV (0.10 to 0.01 nm wavelength) as "hard"
X-rays, due to their penetrating abilities.
Hard X-rays can penetrate solid objects, and their most common use is to take
images of the inside of objects in diagnostic radiography and crystallography.

An X-ray tube is a vacuum tube that produces X-rays. They are used in X-ray
machines. X-rays are part of the electromagnetic spectrum, an ionizing radiation
with wavelengths shorter than ultraviolet light. X-ray tubes evolved from
experimental Crookes tubes with which X-rays were first discovered in the late 19th
century, and the availability of this controllable source of X-rays created the field of
radiography, the imaging of opaque objects with penetrating radiation. X-ray tubes
are also used in CAT scanners, airport luggage scanners, X-ray crystallography, and
for industrial inspection.

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.[1]
In many applications, the current flow (typically in the range 1mA to 1A) is able to
be pulsed on for between about 1ms to 1s.
Electrons from the cathode collide with the anode material, usually tungsten,
molybdenum or copper, and accelerate other electrons, ions and nuclei within the
anode material. About 1% of the energy generated is emitted/radiated, usually
perpendicular to the path of the electron beam, as X-rays. The rest of the energy is
released as heat.
The range of photonic energies emitted by the system can be adjusted by changing
the applied voltage, and installing aluminum filters of varying thicknesses.
Aluminum filters are installed in the path of the X-ray beam to remove "soft" (nonpenetrating) radiation. The number of emitted X-ray photons, or dose, are adjusted
by controlling the current flow and exposure time.
Simply put, the high voltage controls X-ray penetration, and thus the contrast of the
image. The tube current and exposure time affect the dose and therefore the darkness
of the image.

X-ray penetrate objects in a varying degree.

The degree of penetration is dependent on the amount of absorption and spreading/
defelction.
This absorption/weakening is correlated with :
- The type of material through which they penetrate: material composed of atoms
with high atomic number cause more weakening
- The density of the material: the higher the density the stronger the weakening
- The thickness of the material: the ticker the more weakening
- The weakness of the emitted X-ray beam: the higher the frequency(-spectrum)
of the emitted beam (higher voltage field between anode and cathode, harder
beam) the better they penetrate. Lower frequency X-Rays penetrate less: they are
softer and more dampened by the tissue.

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Left: Glass bottle filled with water and air bubbles.

Middle: apple carved with in injection needle. Injection of air (darker tubes) or
contrast media (Barium-sulfate) in the lighter tubes.
Rigth: Glass botlle filled with contrast agent composed of Barium-sulfate.
Barium is a chemical element with the symbol Ba and atomic number 56. Barium
sulfate is used for its density, insolubility, and X-ray opacity. It is used as an
insoluble heavy mud-like paste when drilling oil wells, and in purer form, as an Xray radiocontrast agent for imaging the human gastrointestinal tract. Soluble barium
compounds are poisonous.

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High absorption (bone): White or hyperdense

Few absorption (air): Black or hypodense
Intermediate absorption: Gray

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Example of increased absorption: swallowed battery in the stomach of an infant.

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Example of increased absorption:

1/ operation clips
2/ textile / fabric retained after a chest operation

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Projection radiology relies on absorption differences

maximise differences absorption are maximsed when the X-ray bundle is tangential
to the tissues with different absorption.

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Left: AP-view of the abdomen in supine (lying down) position

Right: AP-view of the abdomen in erect position (standing up)
Due to the erect position an air-fluid interface becomes visible in a patient with
bowel obstruction.

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A medical contrast medium (or contrast agent) is a substance used to enhance the
contrast of structures or fluids within the body in medical imaging. It is commonly
used to enhance the visibility of blood vessels and the gastrointestinal tract.
Several types of contrast media are in use in medical imaging and they can roughly
be classified based on the imaging modalities where they are used. Although other
types exist, most common contrast agents work based on X-ray attenuation and
magnetic resonance signal enhancement.
X-ray attenuation
Iodine and barium are the most common types of contrast medium for enhancing xray based imaging methods. Various sorts of iodinated contrast media exist, with
variations occurring between the osmolarity, viscosity and absolute iodine content of
different media. Non-ionic dimers are favored for their low osmolarity and toxicity,
but have a correspondingly higher price attached to their use[2].
MR signal enhancing
This would include gadolinium for use in magnetic resonance imaging as a MRI
contrast agent. In the 3+ oxidation state the metal has 7 unpaired f electrons. This
causes water around the contrast agent to relax quickly, enhancing the quality of the

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Air is a NEGATIVE contrast agent: low density: black on X-ray

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Positive X-ray contrast agents will increase the absorption of X-rays, thus less Xrays will penetrate through the object: the areas with contrast agent will be
visualized as hyperdense (white) areas.
Visualisation of the joints of the wrist after injection of Iodine.

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Left: non contrast enhanced

Right: X-ray after filling of the thick bowel (colon) with Barium contrast agent.

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X-ray computed tomography (CT) is a medical imaging method employing

tomography created by computer processing. Digital geometry processing is used to
generate a three-dimensional image of the inside of an object from a large series of
two-dimensional X-ray images taken around a single axis of rotation.

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There are several advantages that CT has over traditional 2D medical radiography.
First, CT completely eliminates the superimposition of images of structures outside
the area of interest. Second, because of the inherent high-contrast resolution of CT,
differences between tissues that differ in physical density by less than 1% can be
distinguished. Finally, data from a single CT imaging procedure consisting of either
multiple contiguous or one helical scan can be viewed as images in the axial,
coronal, or sagittal planes, depending on the diagnostic task. This is referred to as
multiplanar reformatted imaging.

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Nle anatomy of the skull and brain:

White matter, gray matter
Ventricles
Eye, lens, optic nerve, muscles of the eye
Sectional anatomy: internal orientation le/ri/anter/post
On a static projective image of the skull:
High detail of the bony structures
Projective
No information of the soft tissues and skull content (brain, eye)
Not enough contrast resolution/slight differences in
absorption are not detected

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CT:
Static
X-rays
No more projective : sectional imaging/ no disturbing superposition
superior contrast resolution:
Surface of the skin
Eye with lens
Optic nerve and muscles
Retrobulbar fat tissue
Air in ethmoid cells
Bony skull
Brain tissue

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There are several advantages that CT has over traditional 2D medical radiography.
First, CT completely eliminates the superimposition of images of structures outside
the area of interest. Second, because of the inherent high-contrast resolution of CT,
differences between tissues that differ in physical density by less than 1% can be
distinguished. Finally, data from a single CT imaging procedure consisting of either
multiple contiguous or one helical scan can be viewed as images in the axial,
coronal, or sagittal planes, depending on the diagnostic task. This is referred to as
multiplanar reformatted imaging.

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CT has a higher contrast resolution than conventional X-ray.

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The Hounsfield scale, named after Sir Godfrey Newbold Hounsfield, is a

quantitative scale for describing radiodensity.
Radiodensity is the property of relative transparency to the passage of X-rays (and
other radiation) through a material. Radiolucent indicates greater transparency or
"transradiancy" to X-ray photons. Radiodense indicates greater opacity to X-ray
photons.
The Hounsfield unit (HU) scale is a linear transformation of the original linear
attenuation coefficient measurement into one in which the radiodensity of distilled
water at standard pressure and temperature (STP) is defined as zero Hounsfield units
(HU), while the radiodensity of air at STP is defined as -1000 HU.
Scale: 4096 CT numbers (proportional to the X-ray absorption characteristics)
Water: 0 HU
Bone: +++ HU
Air, fat: --- HU
Image display: 256 gray values

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Left: axial CT cut before administration of Iodine contrast

Right: same, after before administration of Iodine contrast

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Administration of contrast agent allows to acquire dynamic CT images:

Left upper: before the injection of Iodine
Right upper: during the arterial passage of the Iodine agent. The parenchyma of the
kidney is highly perfused
Left down: capillary phase
Right down: venous phase: most of the contrast agent is within the veins.

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X-radiation (composed of X-rays) is a form of electromagnetic radiation. X-rays

have a wavelength in the range of 0.01 to 10 nanometers, corresponding to
frequencies in the range 30 petahertz to 30 exahertz (3 ! 1016 Hz to 3 ! 1019 Hz)
and energies in the range 120 eV to 120 keV. They are shorter in wavelength than
UV rays and longer than gamma rays. In many languages, X-radiation is called
Rntgen radiation, after Wilhelm Conrad Rntgen, who is generally credited as its
discoverer, and who had named it X-radiation to signify an unknown type of
radiation.
X-rays from about 0.12 to 12 keV (10 to 0.10 nm wavelength) are classified as
"soft" X-rays, and from about 12 to 120 keV (0.10 to 0.01 nm wavelength) as "hard"
X-rays, due to their penetrating abilities.
Hard X-rays can penetrate solid objects, and their most common use is to take
images of the inside of objects in diagnostic radiography and crystallography.
The main source of x-ray radiation is from outer space (e.g. the sun, black holes, and
supernovae). Man-made X-rays are generated by an X-ray tube, a vacuum tube that
uses a high voltage to accelerate the electrons released by a hot cathode to a high
velocity. The high velocity electrons collide with a metal target, the anode, creating
the X-rays.

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Ionizing radiation consists of subatomic particles or electromagnetic waves energetic

enough to detach electrons from atoms or molecules, thus ionizing them. The degree
and nature of such ionization depends on the energy of the individual particles or
waves, and not on their number. An intense flood of particles or waves will not cause
ionization if these particles or waves do not carry enough energy to be ionizing.
Roughly speaking, particles or photons with energies above a few electron volts
(eV) are ionizing.
Examples of ionizing particles are energetic alpha particles, beta particles, and
neutrons. The ability of an electromagnetic wave (photons) to ionize an atom or
molecule depends on its frequency. Radiation on the short-wavelength end of the
electromagnetic spectrumhigh frequency ultraviolet, x-rays, and gamma raysis
ionizing. Lower-energy radiation such as visible light, microwaves, and radio waves
are not.
Ionizing radiation is ubiquitous in the environment, and also comes from radioactive
materials, x-ray tubes, and particle accelerators. It is invisible and not directly
detectable by human senses.

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The biological effects of radiation are thought of in terms of their effects on living
cells. For low levels of radiation, the biological effects are so small they may not be
detected in epidemiological studies. The body repairs many types of radiation and
chemical damage. Biological effects of radiation on living cells may result in a
variety of outcomes, including:
Cells experience DNA damage and are able to detect and repair the damage.
Cells experience DNA damage and are unable to repair the damage. These cells
may go through the process of programmed cell death, or apoptosis, thus
eliminating the potential genetic damage from the larger tissue.
Cells experience a nonlethal DNA mutation that is passed on to subsequent cell
divisions. This mutation may contribute to the formation of a cancer.
Cells experience "irreparable DNA damage." Low level ionizing radiation may
induce irreparable DNA damage (leading to replicational and transcriptional
errors needed for neoplasia or may trigger viral interactions) leading to premature aging and cancer

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Natural background radiation!

Natural background radiation comes from four primary sources: cosmic radiation,
solar radiation, external terrestrial sources, and radon.!
!
Cosmic radiation!
The Earth, and all living things on it, are constantly bombarded by radiation from
outside our solar system. This cosmic radiation consists of positively-charged ions
from protons to iron nuclei. The energy of this radiation can far exceed that which
humans can create even in the largest particle accelerators. This radiation interacts in
the atmosphere to create secondary radiation that rains down, including x-rays,
muons, protons, alpha particles, pions, electrons, and neutrons.!
The dose from cosmic radiation is largely from muons, neutrons, and electrons, with
a dose rate that varies in different parts of the world and based largely on the
geomagnetic field, altitude, and solar cycle. !
!
External terrestrial sources!
Most materials on Earth contain some radioactive atoms, even if in small quantities.
Most of the dose received from these sources is from food containing radioactive
isotopes, gamma-ray emitters in building materials, or rocks and soil when outside.
The major radionuclides of concern for terrestrial radiation are isotopes of

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Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI),

or magnetic resonance tomography (MRT) is a medical imaging technique used in
radiology to visualize detailed internal structures. The good contrast it provides
between the different soft tissues of the body make it especially useful in brain,
muscles, heart, and cancer compared with other medical imaging techniques such as
computed tomography (CT) or X-rays.
Unlike CT scans or traditional X-rays MRI uses no ionizing radiation. Instead it uses
a powerful magnetic field to align the magnetization of some atoms in the body, then
uses radio frequency fields to systematically alter the alignment of this
magnetization. This causes the nuclei to produce a rotating magnetic field detectable
by the scannerand this information is recorded to construct an image of the
scanned area of the body.
Magnetic resonance imaging is a relatively new technology. The first MR image was
published in 1973 and the first cross-sectional image of a living mouse was
published in January 1974. The first studies performed on humans were published in
1977. By comparison, the first human X-ray image was taken in 1895.

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The body is largely composed of water molecules. Each water molecule has two
hydrogen nuclei or protons. When a person goes inside the powerful magnetic field
of the scanner, the magnetic moments of some of these protons changes, and aligns
with the direction of the field.

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Protondensiteitsbeeld van de hersenen

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T1 gewogen beelden van de hersenen.

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Links: protondensiteitsbeeld
Rechts: T2 gewogen beeld van de hersenen

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MR myelogram: visualisation of the cerebrospinal fluid in the cervical spine.

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MR angiography: visualisation of bloodvessels.

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MR angiographic images (without contrast) of the vessels of the brain, due to the
fact that blood water protons move.

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Visualisation of the diffusion (amount of Brownian motion) of water molecules in

the brain.
During an acute stroke a brain infarction will become visible, since in the infarct
itself there is less diffusion of water molecules.

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Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of
human hearing. Although this limit varies from person to person, it is approximately
20 kilohertz (20,000 hertz) in healthy, young adults and thus, 20 kHz serves as a
useful lower limit in describing ultrasound.
Medical sonography (ultrasonography) is an ultrasound-based diagnostic medical
imaging technique used to visualize muscles, tendons, and many internal organs, to
capture their size, structure and any pathological lesions with real time tomographic
images. Ultrasound has been used by radiologists and sonographers to image the
human body for at least 50 years and has become one of the most widely used
diagnostic tools in modern medicine. The technology is relatively inexpensive and
portable, especially when compared with other techniques, such as magnetic
resonance imaging (MRI) and computed tomography (CT). Ultrasound is also used
to visualize fetuses during routine and emergency prenatal care. Such diagnostic
applications used during pregnancy are referred to as obstetric sonography.
As currently applied in the medical field, properly performed ultrasound poses no
known risks to the patient.

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Typical diagnostic sonographic scanners operate in the frequency range of 2 to 18

megahertz, though frequencies up to 50-100 megahertz has been used
experimentally in a technique known as biomicroscopy in special regions, such as
the anterior chamber of eye. The above frequencies are hundreds of times greater
than the limit of human hearing, which is typically accepted as 20 kilohertz. The
choice of frequency is a trade-off between spatial resolution of the image and
imaging depth: lower frequencies produce less resolution but image deeper into the
body.
Sonography (ultrasonography) is widely used in medicine. It is possible to perform
both diagnosis and therapeutic procedures, using ultrasound to guide interventional
procedures (for instance biopsies or drainage of fluid collections). Sonographers are
medical professionals who perform scans for diagnostic purposes. Sonographers
typically use a hand-held probe (called a transducer) that is placed directly on and
moved over the patient.

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Sonography is effective for imaging soft tissues of the body. Superficial structures
such as muscles, tendons, testes, breast and the neonatal brain are imaged at a higher
frequency (7-18 MHz), which provides better axial and lateral resolution. Deeper
structures such as liver and kidney are imaged at a lower frequency 1-6 MHz with
lower axial and lateral resolution but greater penetration.
From sound to image
The creation of an image from sound is done in three steps - producing a sound
wave, receiving echoes, and interpreting those echoes.
1/ Producing a sound wave
A sound wave is typically produced by a piezoelectric transducer encased in a
housing which can take a number of forms. Strong, short electrical pulses from the
ultrasound machine make the transducer ring at the desired frequency. The
frequencies can be anywhere between 2 and 18 MHz. The sound is focused either by
the shape of the transducer, a lens in front of the transducer, or a complex set of
control pulses from the ultrasound scanner machine (Beamforming). This focusing
produces an arc-shaped sound wave from the face of the transducer. The wave
travels into the body and comes into focus at a desired depth.
Materials on the face of the transducer enable the sound to be transmitted efficiently

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Sonography can be enhanced with Doppler measurements, which employ the

Doppler effect to assess whether structures (usually blood) are moving towards or
away from the probe, and its relative velocity.
By calculating the frequency shift of a particular sample volume, for example flow
in an artery or a jet of blood flow over a heart valve, its speed and direction can be
determined and visualised. This is particularly useful in cardiovascular studies
(sonography of the vascular system and heart) and essential in many areas such as
determining reverse blood flow in the liver vasculature in portal hypertension.
This Doppler shift falls in the audible range and is often presented audibly using
stereo speakers: this produces a very distinctive, although synthetic, pulsating sound.

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Sonographic devices have trouble penetrating bone. For example, sonography of the
adult brain is very limited though improvements are being made in transcranial
ultrasonography.
Sonography performs very poorly when there is a gas between the transducer and
the organ of interest, due to the extreme differences in acoustic impedance. For
example, overlying gas in the gastrointestinal tract often makes ultrasound scanning
of the pancreas difficult, and lung imaging is not possible (apart from demarcating
pleural effusions).

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The method is operator-dependent. A high level of skill and experience is needed to

acquire good-quality images and make accurate diagnoses.

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