x-ray 3

Detectors

Main article: X-ray detector

X-ray detectors vary in shape and function depending on their purpose. Imaging detectors such as those used for radiography were originally based on photographic plates and later photographic film but are now mostly replaced by various digital detector types such as image plates or flat panel detectors. For radiation protection direct exposure hazard is often evaluated using ionization chambers, while dosimeters are used to measure the radiation dose a person has been exposed to. X-ray spectra can be measured either by energy dispersive or wavelength dispersive spectrometers.

Medical uses

Main article: Medical imaging

A chest radiograph of a female, demonstrating a hiatus hernia

Since Röntgen's discovery that X-rays can identify bone structures, X-rays have been used for medical imaging. The first medical use was less than a month after his paper on the subject.^[23] Up until 2010, 5 billion medical imaging studies have been conducted worldwide.^[24] Radiation exposure from medical imaging in 2006 made up about 50% of total ionizing radiation exposure in the United States.^[25]

Radiographs

Main article: Radiography

An arm radiograph, demonstrating broken ulna and radius with implanted internal fixation.

A radiograph is an X-ray image obtained by placing a part of the patient in front of an X-ray detector and then illuminating it with a short X-ray pulse. Bones contain much calcium, which due to its relatively high atomic number absorbs x-rays efficiently. This reduces the amount of X-rays reaching the detector in the shadow of the bones, making them clearly visible on the radiograph. The lungs and trapped gas also show up clearly because of lower absorption compared to tissue, while differences between tissue types are harder to see.

Radiographs are useful in the detection of pathology of the skeletal system as well as for detecting some disease processes in soft tissue. Some notable examples are the very common chest X-ray, which can be used to identify lung diseases such as pneumonia, lung cancer or pulmonary edema, and the abdominal x-ray, which can detect bowel (or intestinal) obstruction, free air (from visceral perforations) and free fluid (in ascites). X-rays may also be used to detect pathology such as gallstones (which are rarely radiopaque) or kidney stones which are often (but not always) visible. Traditional plain X-rays are less useful in the imaging of soft tissues such as the brain or muscle.

Dental radiography is commonly used in the diagnoses of common oral problems, such as cavities.

In medical diagnostic applications, the low energy (soft) X-rays are unwanted, since they are totally absorbed by the body, increasing the radiation dose without contributing to the image. Hence, a thin metal sheet, often of aluminium, called an X-ray filter, is usually placed over the window of the X-ray tube, absorbing the low energy part in the spectrum. This is called hardening the beam since it shifts the center of the spectrum towards higher energy (or harder) x-rays.

To generate an image of the cardiovascular system, including the arteries and veins (angiography) an initial image is taken of the anatomical region of interest. A second image is then taken of the same region after an iodinated contrast agent has been injected into the blood vessels within this area. These two images are then digitally subtracted, leaving an image of only the iodinated contrast outlining the blood vessels. The radiologist or surgeon then compares the image obtained to normal anatomical images to determine if there is any damage or blockage of the vessel.

Computed tomography

Head CT scan (transverse plane) slice -– a modern application of medical radiography

Computed tomography (CT scanning) is a medical imaging modality where tomographic images or slices of specific areas of the body are obtained from a large series of two-dimensional X-ray images taken in different directions.^[26] These cross-sectional images can be combined into a three-dimensional image of the inside of the body and used for diagnostic and therapeutic purposes in various medical disciplines.

Fluoroscopy

Fluoroscopy is an imaging technique commonly used by physicians or radiation therapists to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an X-ray image intensifier and CCD video camera allowing the images to be recorded and played on a monitor. This method may use a contrast material. Examples include cardiac catheterization (to examine for coronary artery blockages) and barium swallow (to examine for esophageal disorders).

Radiotherapy

The use of X-rays as a treatment is known as radiation therapy and is largely used for the management (including palliation) of cancer; it requires higher radiation doses than those received for imaging alone. X-rays beams are used for treating skin cancers using lower energy x-ray beams while higher energy beams are used for treating cancers within the body such as brain, lung, prostate and breast.^[27][28]