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THE ESSENTIAL PHYSICS OFMEDICAL IMAGING

SECOND EDITION

J E R R O L D ~ BUSHBERG, PHDClinical Professor ofRadiologyUniversity ofCalifOrnia, Davis

Sacramento, CalifOrnia

J. ANTHONY SEIBERT, PHDProfessor ofRadiology

University ofCalifOrnia, DavisSacramento, CalifOrnia

EDWIN M. LEIDHOLDT, JR., PHDAssociate Clinical Professor ofRadiology


JOHN M. BOONE, PHDProfissor ofRadiology


4 ~ LIpPINCOTT WILLIAMS & WILKINS A Wolters Kluwer Company

Philadelphia Baltimore New York LondonBuenos Aires Hong Kong Sydney Tokyo


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CONTENTS

Preface xvAcknowledgments xviiForeword xix

G SECTION I: BASIC CONCEPTS 1Chapter 1: Introduction to Medical Imaging 3

1.1 The Modalities 41.2 Image Properties 13

Chapter 2: Radiation and the Atom 172.1 Radiation 172.2 Structure of the Atom 21

Chapter 3: Interaction of Radiation with Matter 313.1 Particle Interactions 313.2 X- and Gamma Ray Interactions 373.3 Attenuation ofX- and Gamma Rays 453.4 Absorption of Energy from X- and Gamma Rays 523.5 Imparted Energy, Equivalent Dose, and Effective Dose 56

Chapter 4: Computers in Medical Imaging 614.1 Storage and Transfer of Data in Computers 614.2 Analog Data and Conversion between Analog and Digital Forms 664.3 Components and Operation of Computers 704.4 Performance of Computer Systems 784.5 Computer Software 794.6 Storage, Processing, and Display of Digital Images 82

SECTION II: DIAGNOSTIC RADIOLOGY 95Chapter 5: X-ray Production, X-ray Tubes, and Generators 97

5.1 Production ofX-rays 97


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viii Contents5.2 X-ray Tubes 1025.3 X-ray Tube Insert, Tube Housing, Filtration, and Collimation 1135.4 X-ray Generator Function and Components 1165.5 X-ray Generator Circuit Designs 1245.6 Timing the X-ray Exposure in Radiography 1325.7 Factors Affecting X-ray Emission 1355.8 Power Ratings and Heat Loading 1375.9 X-ray Exposure Rating Charts 140

Chapter 6: Screen-Film Radiography 1456.1 Projection Radiography 1456.2 Basic Geometric Principles 1466.3 The Screen-Film Cassette 1486.4 Characteristics of Screens 1496.5 Characteristics of Film 1576.6 The Screen-Film System 1636.7 Contrast and Dose in Radiography 1646.8 Scattered Radiation in Projection Radiography 166Chapter 7: Film Processing 1757.1 Film Exposure 1757.2 The Film Processor 1787.3 Processor Artifacts 1817.4 Orher Considerations 1837.5 Laser Cameras 1847.6 Dry Processing 1847.7 Processor Quality Assurance 186

Chapter 8: Mammography 1918.1 X-ray Tube Design 1948.2 X-ray Generator and Phototimer System 2048.3 Compression, Scattered Radiation, and Magnification 2078.4 Screen-Film Cassettes and Film Processing 2128.5 Ancillary Procedures 2198.6 Radiation Dosimetry 2228.7 Regulatory Requirements 224


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ixontents

~ P t e r 9: Fluoroscopy 2319.1 Functionality 2319.2 Fluoroscopic Imaging Chain Components 2329.3 Peripheral Equipment 2429.4 Fluoroscopy Modes ofOperation 2449.5 Automatic Brightness Control (ABC) 2469.6 Image Quality 2489.7 Fluoroscopy Suites 2499.8 Radiation Dose 251

Chapter 10: Image Quality 25510.1 Contrast 25510.2 Spatial Resolution 26310.3 Noise 27310.4 Detective Quantum Efficiency (DQE) 28310.5 Sampling and Aliasing in Digital Images 28310.6 Contrast-Detail Curves 28710.7 Receiver Operating Characteristics Curves 288

Chapter 11: Digital Radiography 29311.1 Computed Radiography 29311.2 Charged-Coupled Devices (CCDs) 29711.3 Flat Panel Detectors 30011.4 Digital Mammography 30411.5 Digital versus Analog Processes 30711.6 Implementation 30711.7 Patient Dose Considerations 30811.8 Hard Copy versus Soft Copy Display 30811.9 Digital Image Processing 30911.10 Contrast versus Spatial Resolution in Digital Imaging 315

Chapter 12: Adjuncts to Radiology 31712.1 Geometric Tomography 31712.2 Digital Tomosynthesis 32012.3 Temporal Subtraction 32112.4 Dual-Energy Subtraction 323


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X Contents

Chapter 13: Computed Tomography 32713.1 Basic Principles 32713.2 Geometry and Historical Development 33113.3 Detectors and Detector Arrays 33913.4 Details ofAcquisition 34213.5 Tomographic Reconstruction 34613.6 Digital Image Display 35813.7 Radiation Dose 36213.8 Image Quality 36713.9 Artifacts 369

Chapter 14: Nuclear Magnetic Resonance 37314.1 Magnetization Properties 37314.2 Generation and Detection of the Magnetic Resonance Signal 38114.3 Pulse Sequences 39114.4 Spin Echo 39114.5 Inversion Recovery 39914.6 Gradient Recalled Echo 40314.7 Signal from Flow 40814.8 Perfusion and Diffusion Contrast 40914.9 Magnetization Transfer Contrast 411

Chapter 15: Magnetic Resonance Imaging (MRI) 41515.1 Localization of the MR Signal 41515.2 k-space Data Acquisition and Image Reconstruction 42615.3 Three-Dimensional Fourier Transform Image Acquisition 43815.4 Image Characteristics 43915.5 Angiography and Magnetization Transfer Contrast 44215.6 Artifacts 44715.7 Instrumentation 45815.8 Safety and Bioeffects 465

Chapter 16: Ultrasound 46916.1 Characteristics of Sound 47016.2 Interactions of Ultrasound with Matter 476


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Contents xi

16.3 Transducers 48316.4 Beam Properties 49016.5 Image Data Acquisition 50116.6 Two-Dimensional Image Display and Storage 51016.7 Miscellaneous Issues 51616.8 Image Quality and Artifacts 52416.9 Doppler Ultrasound 53116.10 System Performance and Quality Assurance 54416.11 Acoustic Power and Bioeffects 548

Chapter 17: Computer Networks, PACS, and Teleradiology 55517.1 Computer Networks 55517.2 PACS and Teleradiology 565

, SECTION III: NUCLEAR MEDICINE 587Chapter 18: Radioactivity and Nuclear Transformation 589

18.1 Radionuclide Decay Terms and Relationships 58918.2 Nuclear Transformation 593

Chapter 19: Radionuclide Production and Radiopharmaceuticals 60319.1 Radionuclide Production 60319.2 Radiopharmaceuticals 61719.3 Regulatory Issues 624

Chapter 20: Radiation Detection and Measurement 62720.1 Types of Detectors 62720.2 Gas-Filled Detectors 63220.3 Scintillation Detectors 63620.4 Semiconductor Detectors 64120.5 Pulse Height Spectroscopy 64420.6 Non-Imaging Detector Applications 65420.7 Counting Statistics 661

Chapter 21: Nuclear Imaging-The Scintillation Camera 66921.1 Planar Nuclear Imaging: The Anger Scintillation Camera 67021.2 Computers in Nuclear Imaging 695


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xii ContentsChapter 22: Nuclear Imaging-Emission Tomography 703

22.1 Single Photon Emission Computed Tomography (SPECT) 70422.2 Positron Emission Tomography (PET) 719

SECTION IV: RADIATION PROTECTION, DOSIMETRY, ANDBIOLOGY 737Chapter 23: Radiation Protection 739

23.1 Sources of Exposure to Ionizing Radiation 73923.2 Personnel Dosimetry 74723.3 Radiation Detection Equipment in Radiation Safety 75323.4 Radiation Protection and Exposure Control 75523.5 Regulatory Agencies and Radiation Exposure Limits 788

Chapter 24: Radiation Dosimetry of the Patient 79524.1 X-ray Dosimetry 80024.2 Radiopharmaceutical Dosimetry: The MIRD Method 805

Chapter 25: Radiation Biology 81325.1 Interaction of Radiation with Tissue 81425.2 Cellular Radiobiology 81825.3 Response of Organ Systems to Radiation 82725.4 Acute Radiation Syndrome 83125.5 Radiation-Induced Carcinogenesis 83825.6 Hereditary Effects of Radiation Exposure 85125.7 Radiation Effects In Utero 853

SECTION V: APPENDICES 863Appendix A: Fundamental Principles of Physics 865

A.l Physical Laws, Quantities, and Units 865A.2 Classical Physics 867A.3 Electricity and Magnetism 868

Appendix B: Physical Constants, Preftxes, Geometry, Conversion Factors, andRadiologic Data 883

B.l Physical Constants, Prefixes, and Geometry 8838.2 Conversion Factors 884


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Contents xiii

8.3 Radiological Data for Elements 1 through 100 885Appendix C: Mass Attenuation Coefficients and Spectra Data Tables 887

C1 Mass Attenuation Coefficients for Selected Elements 887C2 Mass Attenuation Coefficients for Selected Compounds 889C3 Mass Energy Attenuation Coefficients for Selected Detector Compounds 890C4 Mammography Spectra: Mo/Mo 891C5 Mammography Spectra: Mo/Rh 893C6 Mammography Spectra: RhfRh 895C7 General Diagnostic Spectra: W/Al 897

Appendix D: Radiopharmaceutical Characteristics and Dosimetry 8990.1 Route of administration, localization, clinical utility, and other characteristics ofcommonly used radiopharmaceuticals 900D.2 Typical administered adult activity, highest organ dose, gonadal dose, and adult

effective dose for commonly used radiopharmaceuricals 908D.3 Effective doses per unit activity administered to patients age 15, 10, 5, and 1

year for commonly used diagnostic radiopharmaceuticals 9100.4 Absorbed dose estimates to the embryo/fetus per unit activity administered to

the mother for commonly used radiopharmaceuticals 911Appendix E: Internet Resources 913Subject Index 915


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PREFACE TO THESECOND EDITION

The Erst edition of this text was developed from the extensive syllabus we had created for aradiology resident board review course that has been taught annually at the University ofCalifornia Davis since 1984. Although the topics were, in broad terms, the same as in thecourse syllabus, the book itself was written de novo. Since the Erst edition of this book wascompleted in 1993, there have been many important advances in medical imaging technology. Consequently, in this second edition, most of the chapters have been completely rewritten, although the organization of the text into four main sections remains unchanged. Inaddition, new chapters have been added. An Introduction to Medical Imaging begins this newedition as Chapter 1. In the Diagnostic Radiology section, chapters on Film Processing, Digi-tal RadioKraphy, and Computer Networks, PACS, and Teleradiography have been added. Inrecognition of the increased sophistication and complexity in some modalities, the chapterson MRI and nuclear imaging have been split into two chapters each, in an attempt to breakthe material into smaller and more digestible parts. Considerable effort was also spent onintegrating the discussion and assuring consistent terminology between the different chapters. The ImaKe Quality chapter was expanded to provide additional details on this important topic.

In addition, a more extensive set of reference data is provided in this edition. Theappendices have been expanded to include the fundamental principles of physics, physicalconstants and conversion factors, elemental data, mass attenuation coefficients, x-ray spectra, and radiopharmaceutical characteristics and dosimetry. Web sites of professional societies, governmental organizations and other entities that may be of interest to the medicalimaging community are also provided.

The Eeld of radiology is in a protracted state of transition regarding the usage of units.Although the 51 unit system has been officially adopted by most radiology and scientif-1cjournals, it is hard to avoid the use of the roentgen and rem. Our ionization chambers stillread out in milliroentgen of exposure (not milligray of air kerma), and our monthly mmbadge reports are still conveyed in millirem (not millisievens). The U.S. Government hasbeen slow to adopt 51 units. Consequently, while we have adopted 51 units throughout mostof the text, we felt compelled to discuss (and use where appropriate) the older units in contexts where they are still used. Furthermore, antiquated quantities such as the effective doseequivalent are still used by the U.S. Nuclear Regulatory Commission, although the rest ofthe world uses effective dose.

We have received many comments over the years from instructors, residents, and otherstlldents who made use of the Erst edition, and we have tried to respond to these commentsby making appropriate changes in the book. Our intention with this book is to take thenovice reader from the introduction of a topic, all the way through a relatively thoroughdescription of it. If we try to do this using too few words we may lose many readers; i f weuse too many words we may bore others. We did our best to walk this fine line, but if youare in the latter group, we encourage you to read jezster.


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xvi Preface to the Second Edition

We are deeply grateful to that part of the radiology community who embraced our firsteffort. This second edition was inspired both by the successes and the shortcomings of thefirst edition. We are also grateful to those who provided suggestions for improvement andwe hope that they will be pleased with this new edition.

Jerrold T Bushbergj. Anthony Seibert

Edwin M. Leidholdt, Jr.John M. Boone


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ACKNOWLEDGMENTS

During the production of this work, several individuals generously gave their time and expertise. First, we would like to thank L. Stephen Graham, Ph.D., University of California, LosAngeles, and Mark W Groch, Ph.D., Northwestern University, who provided valuableinsight in detailed reviews of the chapters on nuclear medicine imaging. We also thankMichael Buonocore, M.D., Ph.D., University of California, Davis, who reviewed the chapters on MRI, and Fred Mettler, M.D., University of New Mexico, who provided valuablecontributions to the chapter on radiation biology. Raymond Tanner, Ph.D., University ofTennessee, Memphis, provided a useful critique and recommended changes in several chapters of the First Edition, which were incorporated into this effort. Virgil Cooper, Ph.D., University ofCalifornia, Los Angeles, provided thoughtful commentary on x-ray imaging and afresh young perspective for gauging our efforts.

We are also appreciative of the comments of Stewart Bushong, Ph.D., Baylor College ofMedicine, especially regarding film processing. Walter Huda, Ph.D., SUNY Upstate MedicalUniversity, provided very helpful discussions on many topics. The expertise of Mel Tecotzky,Ph.D., in x-ray phosphors enhanced our discussion of this topic. Skip Kennedy, M.S., University of California, Davis, provided technical insight regarding computer networks andPACS.

The efforts of Fernando Herrera, UCD Illustration Services, brought to life some of theillustrations used in several chapters. In addition, we would like to acknowledge the superbadministrative support of Lorraine Smith and Patrice Wilbur, whose patience and attentionto detail are greatly appreciated.

We are grateful for the contributions that these individuals have made towards thedevelopment of this book. We are also indebted to many other scientists whose work in thisfield predates our own and whose contributions served as the foundation ofmany of the concepts developed in this book.

]. T.B.].A.S.E.M.L.].M.B.


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FOREWORD

Can medical physics be interesting and exciting? Personally, I find most physics textbooksdry, confusing, and a useful cure for my insomnia. This book is different. Dr. Bushberg andhis colleagues have been teaching residents as well as an international review course in radi-ation physics, protection, dosimetry, and biology for almost two decades. They know whatworks, what does not, and how to present information clearly.

A particularly strong point of this book is that it covers all areas of diagnostic imaging.A number of current texts cover only one area of physics and the residents often purchaseseveral texts by different authors in order to have a complete grasp of the subject matter.Of course, medical imagers are more at home with pictures rather than text and formu-las. Most authors of other physics books have not grasped this concept. The nearly 600exquisite illustrations contained in this substantially revised second edition will make thisbook a favorite of the medical imaging community.

Fred A. Mettler Jr., M.D.Professor and Chair

Department ofRadiologyUniversity ofNew MexicoAlbuquerque, New Mexico

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