Medical and Other Diagnostic Uses of X-rays

Medical and Other Diagnostic Uses of X-rays

All of us can identify diagnostic uses of x-ray photons. Among these are the universal dental and medical x rays that have become an essential part of medical diagnostics. (See this figure and this figure.) X rays are also used to inspect our luggage at airports, as shown in this figure, and for early detection of cracks in crucial aircraft components. An x ray is not only a noun meaning high-energy photon, it also is an image produced by x rays, and it has been made into a familiar verb—to be x-rayed.

An x-ray image reveals fillings in a person’s teeth. (credit: Dmitry G, Wikimedia Commons)

This x-ray image of a person’s chest shows many details, including an artificial pacemaker. (credit: Sunzi99, Wikimedia Commons)

This x-ray image shows the contents of a piece of luggage. The denser the material, the darker the shadow. (credit: IDuke, Wikimedia Commons)

The most common x-ray images are simple shadows. Since x-ray photons have high energies, they penetrate materials that are opaque to visible light. The more energy an x-ray photon has, the more material it will penetrate. So an x-ray tube may be operated at 50.0 kV for a chest x ray, whereas it may need to be operated at 100 kV to examine a broken leg in a cast. The depth of penetration is related to the density of the material as well as to the energy of the photon. The denser the material, the fewer x-ray photons get through and the darker the shadow.

Thus x rays excel at detecting breaks in bones and in imaging other physiological structures, such as some tumors, that differ in density from surrounding material. Because of their high photon energy, x rays produce significant ionization in materials and damage cells in biological organisms. Modern uses minimize exposure to the patient and eliminate exposure to others. Biological effects of x rays will be explored in the next tutorial along with other types of ionizing radiation such as those produced by nuclei.

As the x-ray energy increases, the Compton effect (see Photon Momentum) becomes more important in the attenuation of the x rays. Here, the x ray scatters from an outer electron shell of the atom, giving the ejected electron some kinetic energy while losing energy itself. The probability for attenuation of the x rays depends upon the number of electrons present (the material’s density) as well as the thickness of the material. Chemical composition of the medium, as characterized by its atomic number \(Z\), is not important here. Low-energy x rays provide better contrast (sharper images). However, due to greater attenuation and less scattering, they are more absorbed by thicker materials. Greater contrast can be achieved by injecting a substance with a large atomic number, such as barium or iodine. The structure of the part of the body that contains the substance (e.g., the gastro-intestinal tract or the abdomen) can easily be seen this way.

Breast cancer is the second-leading cause of death among women worldwide. Early detection can be very effective, hence the importance of x-ray diagnostics. A mammogram cannot diagnose a malignant tumor, only give evidence of a lump or region of increased density within the breast. X-ray absorption by different types of soft tissue is very similar, so contrast is difficult; this is especially true for younger women, who typically have denser breasts. For older women who are at greater risk of developing breast cancer, the presence of more fat in the breast gives the lump or tumor more contrast. MRI (Magnetic resonance imaging) has recently been used as a supplement to conventional x rays to improve detection and eliminate false positives. The subject’s radiation dose from x rays will be treated in a later tutorial.

A standard x ray gives only a two-dimensional view of the object. Dense bones might hide images of soft tissue or organs. If you took another x ray from the side of the person (the first one being from the front), you would gain additional information. While shadow images are sufficient in many applications, far more sophisticated images can be produced with modern technology. This figure shows the use of a computed tomography (CT) scanner, also called computed axial tomography (CAT) scanner. X rays are passed through a narrow section (called a slice) of the patient’s body (or body part) over a range of directions.

An array of many detectors on the other side of the patient registers the x rays. The system is then rotated around the patient and another image is taken, and so on. The x-ray tube and detector array are mechanically attached and so rotate together. Complex computer image processing of the relative absorption of the x rays along different directions produces a highly-detailed image. Different slices are taken as the patient moves through the scanner on a table. Multiple images of different slices can also be computer analyzed to produce three-dimensional information, sometimes enhancing specific types of tissue, as shown in this figure. G. Hounsfield (UK) and A. Cormack (US) won the Nobel Prize in Medicine in 1979 for their development of computed tomography.

A patient being positioned in a CT scanner aboard the hospital ship USNS Mercy. The CT scanner passes x rays through slices of the patient’s body (or body part) over a range of directions. The relative absorption of the x rays along different directions is computer analyzed to produce highly detailed images. Three-dimensional information can be obtained from multiple slices. (credit: Rebecca Moat, U.S. Navy)

This three-dimensional image of a skull was produced by computed tomography, involving analysis of several x-ray slices of the head. (credit: Emailshankar, Wikimedia Commons)