Transcribed by Christina Gory 7/1/2014

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[Radiology] [1] Ionizing Radiation by Dr Friedman

[1] [Radiology]
[_________] Hello, welcome. This is your first day as a D2 student. You were D1s first.
Now from today you are D2 students. And we are going to start with a radiology
lecture. And this lecture is total 22 hours course and a 2 hours exam. And there are
two exams in this course. One is a midterm and one is a final. And each exam will
have around 30 questions. And the questions will be multiple choice with or without
diagrams. And the course in the first exam will be covered only up to the lectures we
give you til the first midterm exam. Then the second exam final exam that will cover
only from the lectures after the midterm to the final exams. So you dont have to
worry about comprehensive. And the points is both grades exam will have 50% and
30 questions so in both you have to get 70% passing. And grades are given A, A+, A-,
B+, B, B-, C+, and C. And passing and those who dont pas get D grades F grades. And
of all the exams everybody has to be on time and those who miss the exams they will
they may they go for uh the second chance okay make up exam. And the grades for
the make up exam will be same okay but you cannot (something? Idk what he says?)
Unless you have a genuine reason. So you have to come and tell me what is exam.
Im _______ coordinator of your course and Dr Friedman will give you lectures today.
And he has many lectures with you. And then the course lectures all faculty-
radiology faculty will be giving you one or two lectures. So youve got familiar with
the faculty also. Any questions? And I have a syllabus on the learn service okay and
we have the slides there and you can check it. Any questions? And at the end of the
class I would like to see your representatives and the class president in 1a radiology
clinic. Now Dr Friedman will give you the course. And I didnt mention one of the
books that everything is written on the syllabus.

[2] Ionizing Radiation and Basic Principles of X-Ray generation.
[Dr Friedman]- Okay let me just give you a little uh additional information about the
course. -------- mentioned the exams. Uh multiple choice questions. The exam
questions will come directly out of the lectures. Were not going to find some
obscure place in the book that we didnt talk about. So its very important to come to
lecture. Another thing about multiple choice exams in this course in particular. Dont
memorize large list and numbers. Were not going to ask you to list 14 things related
to radiology. All right most of the material we cover at least the material I cover I try
to make it relevant to the clinic. Were not going to make anybody physicists or
chemists were not trying to do that. Youre going to be doctors youre going to be
working with the machine. You have to know how the machine works how the
machine produces x-rays and the effects of those x-rays on the patient. So were
going to keep it on that level. For those of you that have some time I know you have
a long weekend. This is the textbook, this is one of the textbooks, uh Radiology for
the Dental Professional. And youll notice that most of the slides in the lectures come
directly our of this textbook. So if you need any additional information do that. If
anybody wants to go further and is interested in becoming an oral-maxillofacial
radiologist there is another textbook that you can use. Thats the farrow and white
textbook. Thats on your list there as well. Its also a very good book goes into a lot of
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details if you want to learn about corks and physics be my guest. But for clinical
radiology its not absolutely necessary. Okay so uh wheat I like do to when I give a
lecture at least the last lecture before the exam, Ill have some information about the
exam because I would have seen it. And I would encourage you to come to that
lecture because we have something called the review sessi0on okay its a review
session. Its a little more than a review session. It allows you to ask us any questions
if you have any questions. We are available at least Im available in the clinic
Tuesday Thursday and Friday if anybody wants to come see me they have any
particular question or you can email me please do so. Okay so thats important. Uh I
apologize I dont have any pictures of teeth for you to look at. I know this is dental
school. The teeth will come later in the course. Once we learn about production of x-
rays and how to aim the x-rays and how to place the film then well actually show
you the results So if youre looking for color slides you dont have any. In radiology
everything is all black and white. This is not going to be like pathology where you
see all the colors and stains and things like that. Okay so what were gonna do were
gonna start with the basic principles and if anybody wants to go ahead and read the
textbook you can go ahead and do that. The first thing were going to talk about is
actually ionizing radiation and the basic principles of x-ray generation. Now were
sitting in the room right now. Were being bombarded with radiation. Okay. The
light thats hitting you is a form of radiation. Its a form of electromagnetic radiation.
X-rays fall into that spectrum. One of the and were going to show you slides of that
in a moment. So there is radiation in the room. If you were to open a radio youd
have a radio signal. There is radiation uh radio waves. That is another form of
radiation. So the definition of radiation is the emission and propagation of energy
through space in the form of waves or particles. When we talk about x-rays were
gonna some parts of the course will talk about waves with wavelengths or bundles
of energy called photons. So those are synonymous- photons and energy waves. Uh
energy waves have no mass. There is no mass in the energy wave. And radiology is
basically the study of radiation and the effects of radiation. Uh before we start on
the actual radiology were gonna look a little bit about the history of x-rays. The x-
rays were first found by Wilhelm C Roentgen, who was a German physicist. And he
was a professor at the University of Wurzburg. And like many inventions or
discoveries he was working in his laboratory late at night and what they were doing
at the turn of the century is they were working with these glass tubes- vacuum
tubes. A vacuum mean the air has been removed from the glass tubes and they had
electrodes- positive and negative- anode and cathodes- hooked up and they shot
electricity through these glass tubes and they were gases in the tubes and they
noticed that when they shot electricity through the tubes certain lights were
forming. Different form, different color lights were forming. Thats the concept of
neon lights if you go to Vegas or in New York you see that there are different colored
lights. They were interested in the reaction of electricity and gases. And what was
actually happening well see in a few minutes- is when the electricity hit the gas it
caused ionization of the gas. Ionization of the gas, ionization is the loss of an electron
when that electron is lost another electron when into that position and there was a
loss of energy and that energy was in the form of light. He was working in the
laboratory and he noticed on the other side of the laboratory opposite of his cathode
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ray tube or crooks tube. That started glowing. There was a photographic plate there
and it started glowing. And he said well something is coming out of here so he
covered these tubes with black paper. Something was coming out the glass tube that
was striking that and was causing it to glow. And as well see in a little while, one of
the properties of radiation, it has the ability to cause glowing of certain types of
chemicals, fluorescent chemicals. He then moved, he moved that plate closer to the
tube and he noticed the glow was even stronger. It was glowing more. It was
something coming out of the x-ray tube that was causing that to glow. He had no
idea what it was and hence the name x-radiation. X is the symbol, the algebraic
symbol, for I dont know. An unkown radiation. And for many years after his paper
he actually won the Nobel prize for this. It was called the Roentgen ray. Named after
him. So if you ever see an old textbook it says Roentgenology, that is radiology. It
was named after him. Uh he then proceeded to call his wife down uh middle of the
night. And his wifes name was Bertha. And he said Bertha, do me a favor, could you
put your hand, he didnt put his hand for whatever reason I dont know. He said
Bertha, do me a favor, put your hand over here next to the tube. And he noticed the
fingers, the bones of her hand were on the photographic plate. Something was
coming out of that x-ray, well that wasnt an x-ray tube. It was a glass tube called a
crooks tube. Something was coming out of there that had the ability 1- to cause
glowing, 2- it had the ability to penetrate an opaque object. It had enough energy
and well talk about how x-rays modern day. It had enough energy to penetrate
Berthas hand and she actually saw the fingers of her bones on the photographic
plate and that laid the foundation for modern radiology. Okay then proceeded to uh
well when she saw that she said in German. Does anyone speak German here? She
said [he says something in German but unfortunately I am monolingual soooooo
sorry no clue what he said]. Which means uh Wilhem youre working hard, lets go
upstairs. No, it doesnt mean that (students laugh). It means literally it means I have
seen my death. She saw, ya know, skeleton, dead person. No meat on the body. Just
bones. This was unbelievable. He then proceeded to take his shotgun, whatever he
had around. Lets x-ray this. Took his shotgun- and that led to industrial use of the x-
ray. In many industrial situations they take x-ray of steel beams, of concrete, to see if
there are any breaks or fractures in there. He also then took a box, put something in
the box. And he x-rayed the box and he was able to see what was inside the box. And
that led to the modern, go to the airport, and you stand in there and you do all kinds
of things and they were able to see what was on your body .So that was the
beginning of uh modern radiology. He is called the father od radiology. He wrote his
paper. He got a Nobel prize for it. And just to show you how dentists are very uh ya
know, I say smart, okay. Somebody heard about it and the guys name was Otto
Walkhoff, he was German dentist. Hes the person who actually took the first dental
radiograph. It was a lower premolar of his own mouth. He didnt call his wife. He
laid down on the floor for 25 minutes and he blasted himself with radiation for 25
minutes. Okay not good in todays uh but he is credited with doing the first
radiograph. And then the next guy on the list is Dr Kells, he was a New Orleans
dentist. He was the first one in the USA to take a radiograph. William Rollins is very
very, a man after my own heart, he was the first person to notice, I dont know how
he did that, but he surmised that something is dangerous is going on here.
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Something is not right. And there may be harmful effects to this. So he is actually the
father of radiation protection. What he said was lets take this glass tube, which was
exposed to the air, and lets put some lead shielding around it. And lets make a little
opening so the x-rays come out of that little opening instead of flying all over the
room and radiating everything in the room. So he is the father of radiation
protection. And he actually uh he actually suggested that if you take a radiograph on
a patient put a lead apron on to protect the patient. He surmised that idea if you do a
radiograph of the face you dont need to rest of the body radiated. So he is the father
of radiation protection. And the last guy on the list. He is the guy that is credited
with the prototype of the x-ray machine we use today. And many many respects, its
almost exactly like we use today. Before there were this ionization of gases. We
werent able to control the amount of electrons ionized. He was the first one who
developed something called a hot filament tube. Hot filament tube. Uh Dr Cooliges
coolige tube, hot filament tube, where instead of randomly hitting gases he put a
piece of metal in there and he struck that with electrons and were going to go over
that. That is basically the same design that we use now in our modern x-ray
machines even today. So that is a little bit of a history.

[3]- Wilhelm Conrad Roentgen
[Dr Friedman]- Okay this is. I carry a picture of him in my wallet. No I dont. But that
is the guy. He discovered x-rays.

[4]- Atomic Structure and Ionization
[Dr Friedman]- Okay now you have to understand that whatever happens in
radiology happens at an atomic level. You cant see what is going on. There are
electrons and atoms and protons and atoms of body tissue and atoms of metal that
are involved. So were just going to basically cover a few topics in atomic structure
and well talk about ionization in a moment. Atomic structure. What do we have? We
have things called molecules. And what are molecules? Smallest particle of a
substance that retains the property of the substance. So for example H2O is a
molecule. Okay. Sodium chloride is a molecule. Smallest particle of a substance that
retains the property of the substance. The atom is the basic unit of matter. Okay so
each element has its own atom. And uh, the atom contains subatomic particles.
Subatomic particles- you have a nucleus, which contains protons and neutrons. So
protons are the positively charged subatomic particles. And neutrons have no
charge. So a neutron walks into a bar and orders a drink. And he says to the
bartender after he is done- how much do I owe you? And he says, no charge. Very
good. Okay. How about two atoms walking down the street and one atom says to the
other, I dont feel so good today, I think I lost an electron. He says, are you sure? He
says, Im positive. Okay. So thats about it. Okay. How could you make a joke about
atoms, I dont know. But I have a hundred of them. If youre interested come to the
clinic Ill let you have a couple of them. Okay. All right and then surrounding the
positive, surrounding the nucleus, which is positively charged, we have the electrons
which are rotating. And the electrons have specific shells. Theres certain numbers
of electrons. I know this is all ya know so Im gonna go over this very quickly .Uh
what keeps the electrons in the orbit. Because the electrons are spinning at very
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high speeds. So there has to be a balance between the centrifugal force of the
electron, the spinning of the electron, and the positive charge. The electrons are held
onto the atom by the nucleus. The nucleus is positive so others an attraction and
that keeps the atoms where theyre supposed to be.


[5]- The Atom
[Dr Friedman]- Okay so this is a diagram of the atom. Number one are the protons,
which are positively charged. And then the electrons are rotating. And you have the
uh positively charged, thats the nucleus. And then you have the electrons. Theres
something called binding energy. The electrons, the amount of energy necessary to
remove an electron is called a binding energy. The amount of energy. So where do
you think, which one would have a higher binding energy? The inner shell or the
outer shell? Inner shell. Because it is closer to the nucleus. As a matter of fact an
inner shell electron, in order to remove an inner shell electron, requires 69000
volts, energy volts, electron volts of energy. 69000. Thats gonna come up later when
we talk about radiation. The outer shell of electrons, the further you get away from
the nucleus, the less binding energy. So the K shell is the inner shell that has the
most binding energy. As you go further away less and less binding energy. Which
means you can ionize an atom, a large atom, with a lot of outside electrons, without
radiation. You can do that with electricity. You can even do it with heat. You will see
in a moment. If you heat a large atom like tungsten you will get boiling off of the
electrons.

[6]-Atomic Structure and Ionization
[Dr Friedman]- Okay so just very quickly. So the atomic number is called Z. Thats
the number of protons. The atomic mass is the protons and neutrons, thats the
letter A. Electrons have very very little, very very little mass. Negligible amount of
mass. What is a neutral atom? A neutral atom is the one we just saw [he goes back a
slide to show the image]. It has an equal number of protons in the nucleus as
electrons. If we knock one of those electrons off we have caused ionization.
Ionization. Ionizing energy is that energy that has enough energy to remove an
electron. So if I hold my hand up to a light, light is not harmful. Its not ionizing. It
doesnt have enough energy to cause damage. X-rays, however, will penetrate but
they also cause ionization of the atoms of the body. And that ionization of the atoms
of the body, youll learn, causes harm. Potential harm to the patient .So the basic
theme in the course is the least amount of radiation, the best possible film with the
least amount of radiation to the patient. Okay so we got that. Ionization. The
definition of ionization is loss of an electron causing the production of a positive ion
and a negative ion. The negative ion is that electron that shoots off, its hanging out.
the positive ion is the remainder of that atom and well see diagrams of that. There
are different types of photons, or energy waves, or bundles of energy. Light. Radio
waves are not ionizing. Radar is not ionizing. Well see a whole group of them and
well discuss that in a moment.


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[7]-Ionization
[Dr Friedman]- And this is basically what ionization is. You have two electrons and
you have two protons. Notice the squiggly line says x-ray. [Dr Friedman has a
problem with a pop-up constantly coming up on the screen and then he asks a
student to help him with it. Fixed!] Okay so what do we have down here? This
squiggly line says x-ray photon because as you notice it is knocking out an inner
shell electron. You cant do that with light. You cant do that with heat. The x-ray
photon has a certain wavelength, a very short wavelength. Short wavelengths have
high energy. So when you cause ionization, what you are doing you are knocking out
an electron. Again, you can cause ionization of larger atoms without the energy
because there is less binding energy. Okay.

[8] Properties of Radiation
[Dr Friedman]- Okay so now lets talk about some of the properties of radiation. For
example, x-rays, energy waves with no mass. Its a bundle or wavelengths of energy-
no mass. Electromagnetic radiation, which is a grouping of radiations, such as light
and ultraviolet, are basically movement of energy through space as a combination of
electric and magnetic fields. That is all I need you to know. Ill say it again. Movement
of energy through space as a combination of electric and magnetic field. Were
actually picking out x-rays from that electromagnetic spectrum. A spectrum is a
grouping of energies from one end to the other. We have low energy all the way to
high energy and well talk about that. They all have in common, light and x-rays,
have in common the speed of travel, they travel at the speed of light. Okay x-rays
and light. A lot of students say to me, I just took a radiograph, when can I go back
into the room? Uh those x-rays are gone. You cant go in there fast enough. Theyre
dissipated. So you can go directly into the room because of the speed of travel. Light
also travels.. Figure this out, light travels at the speed of light. Oh. Okay. All right.
And of course, weightlessness. Light has no mass. What are the differences? What
makes light different than x-rays? Their wavelength. And well see in a moment, x-
rays have very short wavelengths. Short wavelengths, high energy. Light has longer
wavelengths. Some wavelengths are even measured in meters. Uh radio waves can
be miles and miles. Each wave can be a mile long. And the frequency and penetrating
ability. Differences? Light cannot, light will penetrate a piece of paper okay but it
wont penetrate the human body. Okay penetrating ability. And well see.

[9]- Properties of Radiation
[Dr Friedman]- Okay so what do we have in a wavelength? We have a crest. Ill show
you a diagram of that in a second. Crest is the top of the wavelength, Ill point this
out. Trough is the bottom of the wavelength. We have short wavelengths, which are
high energy wavelengths, and we have long wavelengths.

[10]- Wavelengths
[Dr Friedman]- So these are wavelengths. The top is the short wavelength. The
distance from the two crests is called the wavelength, or lambda. All right. And these
are longer wavelengths. As far as frequency- frequency is the amount of waves per
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unit of time. So which one do you think has higher frequency? Which one has more
bumps? The top one. The shorter frequencies have higher wavelengths. They
contain more energy and those are the one that can penetrate and cause harm.
Longer wavelengths, less energy.

[11]- Properties of Radiation
[Dr Friedman] Okay so properties of radiation. Of all electromagnetic radiation
including x-rays and light and well see the whole spectrum. No mass. Neutral
polarity. Travel at the speed of light- 186,000 miles per second. Propagate an
electric field at right angles to their path of travel.

[12]-Electromagnetic Spectrum
[Dr Friedman]- And here is our electromagnetic spectrum. On this side we have very
very long long wavelengths. These are measured in meters. On this side, we have
short wavelengths such as x0rays, gamma rays. This is the guy were going to be
looking at. Dont memorize any of these numbers here. You dont need to know that.
You just need to know these are all electromagnetic radiations. They have
similarities. The differences between each one have to do with he wavelength.
Shorter wavelengths are damaging and have the ability to penetrate. Longer
wavelengths will not penetrate. SO we have television and radio and radar on this
side. Then we have microwaves, which really are not ionizing. When you put
something in there it causes heating of the water molecules, but its not really
ionization. The ionizing radiations are the gamma rays and the x-rays. Okay. And in
that group are ultraviolet rays as well.

[13]- Properties of Radiation.
[Dr Friedman]- Properties of radiation. X-rays specifically. Theyre odorless. So if you
come down basically you can see all of these things if you come into 1A and you
watch us take x-rays. Uh theyre odorless. If you smell anything its not the x-rays. I
would look at maybe the patient. Tasteless. Whoever tasted these things. Theyre
invisible. We had students today coming down to the clinic from upstairs. Uh Dr.
Friedman I want you to look at my x-rays. You see I cant look at your x-rays. The x-
rays are invisible. There an invisible form of electromagnetic radiation. After having
said that everybody in the clinic upstairs is gonna say put your x-rays on the view
box let me see, go develop your x-rays. The correct term is radiographs or films. But
everyones gonna say x-ray- go take an x-ray. Its invisible where I cant see it, what
do I do? Okay so thats invisible. How do I know that? Because if Im in the cubicle in
1A I dont see anything coming out of the machine. Im aiming at the patient and I
dont see anything. Its invisible. So some of these things you can see just by looking
into the room. Uh travel in straight lines .Why do I know they travel in straight lines?
Because if this is the tooth that I want to take a picture of I take my collimator,
which I have a whole collection of here, and I aim it straight at the patient. I dont uh
I dont do something like that. I aim it straight. So they travel in straight lines. Travel
the speed of light. They have the ability to ionize atoms. Why do they have the ability
to ionize atoms? They have very short wavelength. Short wavelengths contain a lot
of energy.
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[14]- Proper of Radiation
[Dr. Friedman]- Uh produced by an electrical current. Electric current. How do we
know x-rays are produced by an electrical current? Because theyre plugged into the
wall. The machine is plugged into the wall. So the electrical energy somehow when
you push these buttons is converted to x-rays. And were gonna show you how that
actually works. But it is produced by an electric current that penetrates opaque
tissue. How do I know? I put a film behind the tooth. I send the x-rays through.
Process the film and I see the tooth. I see an image of the tooth. So it has the ability
to penetrate opaque tissues and structures. Now of course in a tooth, there are
different densities of the material. You have the enamel, which is very dense, you
have the dentin, you have the pulp So x-rays will go through, and some of them will
go through further than others. For example, the pulp tissue, which is soft tissue,
will appear black on an x-ray because the x-rays penetrate. The enamel or if the
patient has a crown, ever see a picture of a crown? A radiograph of a crown? Itll be
white because the x-rays have not penetrated. They have been absorbed by the
crown metal. And well see that later on when we talk about formation of the image.
Right now were talking about the x-rays coming out of the x-ray tube. How do we
produce them? And how do we control the penetrating ability? Can affect
photographic emulsion. The film that is in the patients mouth is a photographic
emulsion. The x-rays penetrate, theres an image, a latent image that is produced on
the film, when you process it you can see that. That is going to be covered in the
lecture of processing film. It is given by Dr Jane. Good luck.

[15]- Uses of X-rays in Dentistry
[Dr Friedman]- Okay uh very nice. Okay uses of x-rays in dentistry. Okay. One of the
uses, the main use of radiographs is for diagnosis obviously. The patient comes in-
doc Im having pain when I have something cold. So the patient has pain when
theyre having something cold, what would you suspect? Anybody? You didnt learn
this yet? Okay. Uh they may have a cavity. A cavity is a hole in the tooth. So when the
cold goes into that cavity it goes into the dentin and nerve and I feel it .okay what
else could be? Well if the patient has a large amalgam filling, a silver filling, and they
have something cold, guess what happens? The cold is conducted by the metal right
into the tooth and theyll feel a momentary sensitivity. Okay. Another way patients
can have sensitivity to cold? They have gum recession. So the gum is covering the
root surface which has nerve endings in them and if the gum recedes guess what
happens? The cold goes right there and they feel the pain. Now youre going to
diagnose that how do you know what to do? Do I drill the tooth? Do I change the
filling? Do I send the patient to a periodontist? Anything like that. So youll need a
film to diagnose that. If the patient says I feel sensitivity to cold but then it goes right
away. It only lasts for a few seconds. Do you know what that means? That means its
a healthy tooth. Its a hypersensitive tooth but the tooth has a nerve. its responding
to the stimulus, the cold, the tooth says oh. But then a few seconds later it doesnt
hurt. So what does that mean? It means that the nerve has the ability to shut off the
response. Now if the patient walks in and says doc Im having pain for two days and
its not stopping- that nerve is bad. Youre gonna have to do something like root
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canal therapy. But in order to know all of this information you cant tell by looking at
the tooth. Diagnosis ya know. Theres a thousand different things you can do with
that. Legal evidence? You have to have appropriate radiographs in the patients
chart. And they have to be good quality radiographs. If youre ever summoned to
court, god forbid, and you have lousy films, you probably lost the case right there. So
its very important to have good radiographs. Also, theres a situation where a fellow
came down came up from Florida to a dentist in New York, this was written in the
journal. And they had a bad toothache and they went to the dentist. The dentist said
that tooth has to be extracted. Oh but doc I dont want any x-rays I just had x-rays,
can you just extract the tooth? The tooth was broken down from decay to the gum
line the dentist took the tooth out without a radiograph. Patient healed there were
no problems, no post-operative complications and then a month or two later gets a
letter from an attorney that the patient is sewing the dentist. Why is the patient
sewing the dentist? Because that tooth couldve been saved. Okay whats the
defense? You have no defense. So before you do anything take a radiograph. Very
important. Its called the CYA principle. Cover Your. Im not gonna say because.
Okay so you always need to have good radiographs in case of something like hat
occurring. Therapy well radiation therapy, god forbid the patient has some type of
cancer in the mouth or in the head, they use radiation therapy. What does that have
to do with radiology? Well patients who undergo radiation therapy what happens
to their teeth? Anybody know? They have severe caries in their teeth. Anybody
know why? Any guesses as to why a patient undergoing radiation therapy will have
severe caries especially near the roots? Near circumferential caries. Anybody?
Because the radiation kills the tumor but it also destroys the salivary gland tissue
and theres no production of saliva. No production of saliva caries. Xerostomia. Dry
mouth. Okay and the last one is forensic use. I was here in the school 911. And uh it
was a horrible situation. People were running uptown and we were called in at the
time. Dr. Fromer, who was the author r that textbook, and myself to the morgue to
take radiographs of the body parts and the teeth and see if we could identify
patients that way. You may get a call in your office. Did you have a patient named so
and so? Do you have their radiographs? We need to see them so we can match the
body to that. Okay a little morose but that is what uh another use of dental
radiographs are. Okay. Lets go to the next one.

[16]- The Dental X-ray and Its Components
[Dr. Friedman]- Now were actually going to talk about whats in the x-ray machine
that you hanging in all the clinics. When you look at he x-ray machine youre going
to see something like this sticking out of it connected to a machine. Thats called the
tube head. Part of the machine that you see is called the tube head. Inside the tube
head is a little glass tube, remember Roentgen with the glass tube and Coolige. Glass
tube. And were gonna talk about that. And there are different components to the
glass tube. Im gonna give you some terms and then were going to show you
diagrams and were going to relate the term to the diagrams. There are two parts to
the x-ray tube. The x-ray tube is about 6 inches long, its wired up with electrical
wires and well talk about the wiring system. And thats where the x-rays are
produced. They come out of the x-ray tube and they go through the position and
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something? (43:29 not sure what he said) and they hit the patient. Okay, the first
component of the x-ray tube is the anode. Which is the positive part of the x-ray
tube. The anode is the positive part. And I actually have a piece of anode here for
display purposes but were gonna see that in a minute. What the anode contains is a
stem or a sleeve, this copper device, its made out of copper. And Ill show you
diagrams of that. It has a little piece of tungsten. White metal, right here on the
sleeve, tungsten. So what happens well see in a moment. Electrons will strike the
tungsten. Focal spot. This tungsten is called the target or the focal area. So the target
or the focal area is synonymous, same thing, but theres one sport right in the center
where the x-rays are focused to. That is called the focal spot. So the focal spot is a
small part on here the entire is called the focal area or target. Primary radiation.
What is primary? There is primary and secondary radiation. Primary radiation is
defined as the radiation in the air before hitting the patient. So when you aim that
collimator the x-rays coming out of the collimator, or position-indicating device, is
called primary radiation. When that primary radiation hits the patient or hits an
object its converted to secondary radiation. Thats for a later lecture. Uh then you
have the negative part of the x-ray tube, the glass tube. The negative part is called
the cathode and the cathode contains a little tungsten filament. So tungsten is in
anode and in the cathode. Its a little thin wire like in a light bulb. And then theres
something called the focusing cup, which is made out of molybdenum. Its hard to
say but thats what it is. Its molybdenum. And that focuses the electrons from the
cathode over to the anode. Remember electricity flows from the negative to the
positive so well see that in a moment. Well see in a diagram. Well put all of this
together in a second.

[17]- The Dental X-ray and Its Components
[Dr Friedman]- Uh then you have the glass envelope, which is the glass tube, and a
little opening in the glass tube where the x-rays come out of is called the porte. The
porte is the opening in the glass tube. Then we have an aluminum filter. Well look at
that and well talk about that in a minute. And then you have a diaphragm okay. The
aluminum filter I can show you. So remember this is screwed into the tube head.
Theres a little glass x-ray tube, the x-rays come out, the first thing that theyre going
to encounter is a piece of aluminum, a very thing strip of aluminum. And then when
you go past the aluminum youll actually see something made out of lead. This
particular one, Im sorry, I wont show you pictures of that. Anyone is welcome to
see that later. Then you have lead. The purpose of the lead is to collimate the x-rays.
We dont want the x-rays hitting the entire patients face. So theres a little hole
where the x-rays come through so all the other x-rays are stopped by the lead. Okay
so were gonna talk about what the purpose is. Why do we put these things in here?
And the answer is to protect the patient. And youll see how these devices protect
the patient.

[18]- The Dental X-ray Tube
[Dr. Friedman]- Okay so this is just a diagram of the x-ray, dental x-ray tube, which is
in the tube head. There is no air. Its a vacuum tube. The air has been removed. Why
do we remove the air? Two reasons. 1- we want electrons to shoot across to form
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11
radiation. We dont want any air to prevent the movement. Theres no air? We have
freer movement of electrons. The faster the electrons move, the more kinetic energy
they have, and the more radiation, the better quality x-rays are produced. The low
wavelengths. (2) The air is also removed because also you dont want oxidation of
the tungsten filament and well see that in a moment. So the air is removed for those
two reasons.

[19]- X-ray Production
[Dr. Friedman] Okay heres a few terms. Were gonna talk about all of these things
when I show you a diagram. Thermionic Emission Effect. Okay now I dont know
how we can do this. I can try my best but uh what happens is is heat generated in
the x-ray machine when you turn the x-ray machine on and it heats a little filament
and the filament by being heated produces electrons. The electrons are needed for
production of radiation. Theres an Electron Cloud, which hangs out at the cathode
by the filament. The cathode ray is When the x-ray, the electrons shoot across the
tube. Kilovoltage controls the amount of voltage in the circuit. And Head Leakage
just means when x-rays are coming out of the tube head thats a dangerous situation
and you want to avoid it.

[20]- The Dental X-ray Tube
[Dr Friedman]- Aha finally a picture and now lets put all these terms together for
you. There is a negative end called a cathode, which contains a little filament of
tungsten, a thing filament of tungsten. Surrounding that is a focusing cup made out
of molybdenum. Okay so that is the negative end. This is the positive end, which has
a little piece of tungsten, called a tungsten target, which is embedded in copper.
Why? A lot of heat is produced and tungsten is not a good dissipater of heat. So we
cant to remove the heat so we dont burn out the tube so we put it into a copper
sleeve that is going into a cooling mechanism outside. Well talk about that. This is
the anode, the positive end, again, contains the sleeve, a copper stem, and a tungsten
target. Notice the tungsten target is angled, it has an angulation. Well talk about that
in a little while. The x-rays are produced and they come out through a little opening
called a porte. Just get the terms down because were going to go step by step. Thats
called the porte. And of course you have the aluminum filter and the diaphragm The
aluminum filter and the diaphragm. Again, the aluminum filter well discuss. Purpose
is the diaphragm is used to collimate to aim the x-rays at the most pin point area.
Okay so.

[21]- Rotating Anode
[Dr. Friedman]- Okay so. Okay this is a machine that has a rotating anode instead of a
fixed anode. In large machines, panoramic machines, they will have a rotating anode
so that it doesnt burn out the tube.

[22]- Activated Filament Circuit
[Dr Friedman]- Okay so lets start. And the way were going to start is you walk into
your office in the morning and youre ready to work. The first thing you do is turn on
your x-ray machine. Its on. Are x-rays being produced? No. What happens when you
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12
turn your x-ray machine on? What happens is there are two circuits in there. In the
tube. One is called the filament circuit that goes to the filament, or the cathode. And
the other one is the high-tension circuit which goes to the anode. Okay so this is
what happens. You turn your machine on, that causes heating of the tungsten
filament. Youre heating the tungsten filament. When you heat the tungsten filament
what happens? Electrons are boiled off. Theyre ionized from the heat. The tungsten
you look has a lot of electrons. The outer electrons can be boiled off. We need those
electrons. Theyre just hanging out right there minding their own business and
thats an electron cloud at that point. Theyre not going anywhere because theres no
positive charge. Okay so then when you go ahead and put the film in the patients
mouth and aim and then you walk out of the room and press the exposure switch,
that is when you are setting up the positive charge. The electrons will then shoot
across, hit the tungsten target, and that is how x-rays are produced. So you come in
the morning, what you are doing is you are opening your machine; you are heating
the filament circuit. How much voltage is necessary to heat the filament circuit? 2-5
Volts. But we just said that the x-ray machine is plugged into the wall. How many
volts of electricity are in the wall circuit? About 120 something like that 110. Okay
how do we get 2-5 volts into that circuit? Theres something called a transformer.
There are two transformers in the x-ray machine. One is a step down transformer
and Im not going to talk about how the wires are. Step down transformer. So when
you turn your machine on you are activating the step down transformers taking 110
volts of electricity and stepping it down to 2-5. What happens if you use more than
2-5? You burn it out. So you need. Thats called the filament circuit or long-voltage
circuit. Its synonymous. A filament circuit, a low voltage circuit, or low-tension
circuit. Those are all synonymous. Okay so you have that electron cloud, you turned
your machine on, 2-5 volts of electricity are heating the filament, electrons boil off,
what do you think that effect is called? When the electrons are boiling off?
Thermionic Emission Effect. Why? Therm means heat, producing ions, emission of
electrons. So you have a bunch of electrons hanging out there ready. How do we
control the number of electrons? Milliamperage. Well talk about that in a little while.
So you got the picture? So you have the electrons hanging out there. You then go and
put the film in the patients mouth, take your collimator and aim it at the patient,
what do you then do? Youve activated the high-tension circuit. This circuit is now
closed. And so doing that becomes positive. The anode becomes positive and only
when you press the exposure switch, that causes the anode to become positive.
When the anode becomes positive what happens to the electrons that were hanging
out there? They shoot across the tube at very, very high speeds. Now how many
volts of electricity are in the high tension or high voltage circuit? Anywhere from 50-
100 kilovolts. Kilovolts. 70,000. The machines we have run at 70,000 volts of
electricity. 70,000. Ill explain why you need that much. But thats 70,000 kilovolts.
How do we get 70,000 kilovolts, which is 110 volts? Transformer. A step up
transformer. Step up transformer. The more kilovolts you have, the higher the
kilovolts, think about this. The higher the kilovolts, the higher the kinetic energy, the
energy of those electrons shoot across. The higher the kinetic energy, the shorter
the wavelengths are going to be. So if you have a patient who has a large skeletal
build. Thats a patient for a guy with a big head. Okay large skeletal build. You want
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13
to increase the kilovoltage to get more penetration. Because the kilovoltage controls
the penetrating ability of the x-rays. So 70,000 volts you press the button, the
electrons shoot across from the cathode to the anode and you get in a moment you
see this is called the cathode ray. The electrons shooting across is called the cathode
ray.

[23]- X-ray Production
[Dr Friedman]- Okay this is x-ray production. You press the exposure switch you
close the switch here, the circuit is now closed the electricity flows through there
causes that target area to become positive. The electrons strike, they strike at very
very high force. So what do you need to produce x radiation? You need a source of
electrons, which we have over here. Thermionic emission effect. We have to
accelerate the electrons by using a very high kilovolt potential or peak and you have
to have a target to stop the electrons. When the electrons strike the target, radiation
is produced. And well show you how in a minute Okay. Anybody have nay questions
about that?

[24]- Types of X-rays Produced At The Tungsten target
[Dr. Friedman]- Okay So when the electrons come across and they strike the target,
three things can happen. 1- the electron can go into the tungsten target. Were gonna
pick out one atom of tungsten. This happens millions of times. Were gonna pick out
one atom of tungsten. One of the things that can happen is the electron can shoot
right through and hit the nucleus and give up all of its energy and then no radiation
is produced. Another thing that can happen is called Bremsstrahlung- that is the
major source of radiation coming out of the tube. Caused by Bremsstrahlung,
literally meaning breaking radiation. And then we have something called
characteristic x-ray. So these are the two forms of x-rays coming out of the x-ray
tube- Bremsstrahlung and characteristic. And both of them combined are used to
produce the image. Most of them will be the Bremsstrahlung.

[25]- Bremsstrahlung and Characteristic X-rays
[Dr. Friedman]- Okay so we have an atom this is an atom of tungsten. Remember we
shot the electrons across, they hit the tungsten target, this is one atom of the
tungsten target. So. You have two different electrons lets say this is electron A, this is
electron B. The electron goes into the target, into the tungsten atom, and gets close
to the nucleus. What happens when it gets close to the nucleus? It gets ejected
because the nucleus is positive and this electron gets positive and you end up with A
prime. The energy that slows down the electron and causesdoes anybody drive a
racecar? When youre going very fast and then you get to a curve you have to slow
down, there is a loss of energy. This is almost like a racecar. When the electron is
coming at very high speeds it comes into the tungsten and strikes the tungsten atom
and it gets close to the nucleus. When it gets to the nucleus actually the electrons, I
misspoke before. And then electrons, you can correct me if Im, and the electrons
will actually eject because the negative chargers the similar charges. So as if gets
close to the nucleus, the inner shell electrons will repel that. And the slowing down
and the veering off course, the change in direction, the breaking, produces energy in
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14
the form of Bremsstrahlung radiation. Okay. Now what do you think happens to that
A prime? The A prime goes its a million atoms. That A prime goes into the next
atom. And the same reaction occurs. But what do you think happened? Which one
will have more energy? This one of the second one where the electron has been
slowed down? This one will have more energy. The other one the electron is already
slowed down. It goes into another atom, more bremsstrahlung radiation is
produced. So in effect what do we have? We have a heterogeneous formation of x-
rays and some of the radiation will have short wavelengths and longer wavelengths,
longer are whole different group of wavelengths. Which of the wavelengths that we
need for our patients to get the best possible image? Short wavelengths, those are
the ones that penetrate. What would happen if the long wavelengths hit the patient?
Its gonna bombard them with radiation, cause damage, ionization. But theyre not
useful. Theyre not going to form an image so we dont want those there. How do we
get rid of the Aluminum filtration? What the aluminum filter does, it removes the
long wavelengths that are non-penetrating. Those will be harmful to the patient. The
short wavelengths will penetrate the aluminum. Okay that is one way of forming
radiation. The other way is the electron goes into the atom, strikes the inner shell
electrons, and actually knocks it out of its orbit. Remember we said what the binding
energy of an inner shell electron is? 69,000 volts. 69,000 volts or 69 kilovolts. The
only way we can get a high-speed electron to be able to do that is if we use our x-ray
machines from 70-90 kilovolts of energy. Done by the step-up transformer. So the
high-speed electron hits the inner shell, it knocks out that k shell electrons, which
requires 69000 volts of energy, and what happens? The other electrons cascade into
the inner shell. And when an outer shell electron goes into an inner shell electron,
into the inner shell, theres a formation of energy. Energy is given off just like when
there is ionization, light is given off. This is in the form of something called
characteristic radiation. Without getting into detail its characteristic to the atom
used. Tungsten we have characteristic radiation. Very small amount of the radiation
however is in this form. But those are the two ways that radiation are formed.
Bremsstrahlung , high speed electron veers off course loses energy. The other way is
it knocks out the inner shell electron, the electron from the outer shell coming in has
to give up a lot of energy to give up the inner shell and that is given off in the form of
characteristic radiation.

[26]- The Dental X-Ray Machine and X-ray Production
[Dr Friedman]- Okay uh you guys mind if we take a five minute break? Okay. Im
sorry for these two hour lectures. I dont know how. [5 minute break] Attention.
Alright lets get back to this so we can get ya out of here. Okay. Uh do we have any
anybody from Canada here? All right! Okay you guys have a 4
th
of July in Canada?
You dont have a 4
th
of July right? Today is the 4
th
. Okay so you dont have a 4
th
of
July. You have one day less than we do in the year? No but you find that clinic 1A is a
very Canadian friendly clinic. Ya know why? We named it 1A. So explain that to a
whats that? No? Alright. [laughing] Okay. So we were talking about we were talking
about the different electrical components in the x-ray tube. We were talking about
he low voltage and the low voltage circuit and the high voltage or high tension
circuit. But basically electrical current is the flow of electrons and there the current
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15
that we use here uh is called an alternating current. Alternating current. And what
does that mean? It means the current flow from one direction and it changes and
goes to the opposite direction. Well show you examples of that. Then is goes back,
the flow. So in the x-ray tube there is some ramifications of the use of alternating
current. And youll see some of that in a moment. There is also something called
direct current. The x-ray machines we have on the 11
th
floor. If you havent had your
preclinical radiology, our direct current units. The ones we have in most dental
offices are alternating currents. Okay so were gonna talk a little bit about that.

[27]- Wavelength image
[Dr Friedman]- Okay this is what alternating current means. When you press the
exposure switch, the current starts to flow and you have the peak of electrical
current at the top, 90 KVP. KVP. P is the peak potential or the greatest amount of
current that can flow at 90. Okay so what happens is as the current goes up, you
start out with 20 40 60 80 you get a peak of 90 and then it comes back down again
btu it reaches this point. The cathode is the anode is no longer positive its anode.
And the cathode is positive. So what happens to the electrons at that point? They
dont go anywhere. At that point, where you have the reversal of the current. So at
this point, from here to here, since you have a reversal, alternating current, there are
no x-rays produced at that point. So when you press your exposure switch, and
youre using alternating current, are you getting a flow of electrons or are you
getting impulses of electrons? The answer is pulses or impulses. So if I press the
button one second, for one second there are 60 of these reversals. So in a cycle of
alternating current, you have 60 reversals. So theres only radiation produced at this
point and then when it gets here and then so on and so forth. So in one second you
are going to get 60 impulses of radiation. In one second. Okay because of the
reversal of the alternating current. Direct current doesnt work that way. Direct
current gives you continuous peaks and so theres a continuous flow of radiation. So
if you look up in the clinic well show you a picture of that. Thats measured on the
11
th
floor. We measure it in seconds. In fractions of seconds- .5 second, .32 seconds,
.16 seconds. When we measure the x-ray, the time of exposure here, in clinic 1a,
were measuring it in impulses. How many impulses of radiation is the patient
getting for that film? Well if I were to tell you that the patient is getting 30 impulses
of radiation, for this film, how many second of radiation is that? Just divide by 60. So
the answer is a half. Patients getting 10 impulses how many seconds is that? 1/6 of a
second. Remember I told you you dont have to memorize numbers? But these
numbers are the ones that they give you on board exams of conversion of impulses
to seconds. So again if they give you impulses how many seconds? Knowing that
there are 60 pulses per second due to the reversal of the current, the conversion is
very simple. Just divide by 60. So 20 impulses, 1/3 of a second. Those are the
numbers that you are going to encounter. Sometimes on our exam Ill give you more
information when it comes to that. But understand that you are getting pulses of
radiation. Oh with direct current, now how do we get direct current from an
alternating current plug? Theres a device in there called a rectifier. A rectifier. All
you need to know about rectification, were not electrical engineers. A rectifier
converts alternating current to direct current. That is a rectifier. Uh these machines
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are self-rectified. The alternating current machines are self-rectified because there
is a conversion to direct current by itself. Another term for this is halfwave
rectification. Those are synonymous- self rectify because you produce it without
anything, without any rectifier in there, and also halfwave rectification. Dont go into
more detail than that. Okay.

[28]- Comonents and Functions of the Dental X-ray Machine
[Dr Friedman]- Okay we spoke about some of the components of the dental x-ray
machine. This is just a review. Voltage, there are two voltages in the x-ray tube. This
is gonna be a little bit of a review. We have the low voltage circuit, thats the filament
circuit. When you turn your x-ray machine on, what you are doing is 2-5 volts of
electricity being converted by a step down transformer. That heats the tungsten
filament .What is the effects of the heated tungsten filament? Thermionic emission
effect. The electrons are boiled off. Theyre just hanging out there minding their own
business. Theyre not doing anything . Then theres a high voltage circuit, 70,000-
90,000 kilovolts of electricity. And that is converted to high voltage by a step up
transformer. Autotransformers are something in there to keep the line currents
steady. Youre not responsible for that. And there are certain meters when the old
machines you were able to set their kilovolts. I want 90 kilovolts, this is a large
patient. And then the next patient I had in the chair was a pediatric patient who was
5 years old. If I use the same kilovolts, kilovolts control the penetrating power, uses
the same kilovolts, what kind of film do you think I would get on a pediatric patient?
Very dark film. Unreadable because theres too much penetration. So we were able
to change the kilovolts. Youre lucky. You dont have to worry about changing
kilovoltage or milliamperage. Milliamperage as you see over here is by a step down
transformer. We want to control the heating of the filament. We want to control the
heating of the filament you change the milliamperage. The higher the milliamperage
the more electrons boil off. So you have more electrons, are those electrons going to
produce higher, greater penetrating ability? No. That is the function of the kilovolts.
So to get it straight kilovoltage controls the kinetic energy. Milliamperage then
controls the quantity of x-rays produced. The higher the milliamps, the more
electrons are boiled off. More electrons are boiled off, the more radiation you will
have. You will not give you higher quality penetrating radiation but it will give you
more radiation. And in so doing, you can cut down on the exposure time. That is
important if you are taking ct scans, the patient has to be standing there, sitting in
the machine for longer period of times. You want to have the highest milliamps.
Some of the ct scan operate at 50-100 milliamps. Our machines cant take more than
5-7. Some machines 10. Otherwise if you have so many electrons boiled off , they
will burn out the target. There will be so many electrons bombarding the target.
Thats why on those extra-oral machines, ct scans, you have a rotating anode. So the
electrons shoot across and they hit a different part of the anode in the cycle. Okay?

[29] Basic Electric Circuits of the Dental X-ray Machine
[Dr Friedman]- Uh this is just the diagram of the. Heres your x-ray tube. You have a
step down transformer, which goes into the cathode area to crank down the
kilovoltage. The voltage, the 2-5 volts. Not kilovolts, 2-5 VOLTS of electricity. And
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17
you have the step up transformer. Dont memorize this. Okay this is for someone
who is opening up the machine and wants to see all the uh schematics.

[30] Other Parts of the Control Panel
[Dr Friedman]- So what are the other parts of the control panel? Well what we spoke
about previously was the x-ray tube itself. And the tube head. Theres parts of the
control panel- the on/off switch. What does that do? When you press the on switch
what are you doing? Heating the filament. Thermionic emission effect. Thats all
youre doing. Then you have the electronic timer, you set the exposure that is the
only thing that we have. Now if you are taking a full set of x-rays on a patient, do we
use the same exposure time for every tooth? Centrals, premolars and molars? What
do you think? The answer is no. Because the anterior teeth will be light. Okay the
anterior teeth, excuse me. Youre using a pre-set exposure that is good for the
anterior teeth, and you get the proper film. When you get to the posterior teeth,
those teeth are thickest, the bone is thicker, youre not going to get as much
penetration so those will come out light. So the anteriors are the correct exposure.
So what do we do to compensate for that? We only have one thing we can do. We
cant change the KVP, we cant change the milliamps. That is preset for you. Well
lets change the exposure times. And youll see when you go to the clinics. Come visit
us, Youll see a chart. Anterior, upper anterior- 10 impulses. Im just making these
numbers up. Uh premolars- 14 impulses. Molars- 18 impulses. You have to increase
the numbers of impulses so you get the proper penetration so you get a film that has
the proper density, darkness, and contrast. Well talk about that in a later lecture.
Okay and then you have the exposure switch. You place the film in the patients
mouth, you aim your collimating device at the patient, you run out of the room and
the patient says to you- are x-rays dangerous? No theyre not dangerous. So what
are you running out of the room for? Why dont you stay in here? Because Ive got to
press the button. So theres a button on the outside, a retractable cord, when you
press that buttons, two things happen. One thing, thats mandated by the federal
government, is that you need a light that goes off to show that theres an x-ray in uh
being taken at the time. Theres also an audible sound, youll here a beep as well. But
what happens inside the machine itself? You have the high tension circuit is closed.
When the high-tension circuit is closed what happens? The anode becomes positive.
The electrons shoot across. What controls the speed of the electrons shooting
across? The kilovoltage. The higher the kilovoltage, the faster the electrons shoot
across. The faster they shoot across, the more energy, the lower wavelengths they
will have. What do we do with the long wavelengths? We dont want those.
Filtration. Well talk about that in a minute. Okay.

[31]- Dental Control Panel
[Dr Friedman]- and this is the exact machine they have upstairs. Notice is says 765
DC. What do you think DC stands for? Direct Current. This machine has a rectifier in
it which convers the alternating current to direct current and so when you make the
exposure it is done in fractions of seconds. .32 seconds. Okay and we can control. We
can use the setting for adult, we can sue the setting for pediatric, we can use the
setting for film, for digital x-rays. And these are the differences. The anterior,
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18
premolars, bitewings, and different molars. When you press those buttons you
change the exposure time. Thats the only thing we have under out control.

[32] The X-ray beam
[Dr Friedman]- Okay again we used some of these terms. What is primary radiation?
Thats the radiation coming out of the x-ray machine. Before hitting the patient.
Once it hits the patient it becomes secondary radiation. Whats the useful beam?
Well the x-rays coming out of the tube have all different wavelengths in them. Why
do they have all different wavelengths? For two reasons. Number one is the multiple
bremsstrahlungs. Okay when the initial electron goes in it produces short
wavelengths, then it goes into another one and it gets longer and longer and longer.
So theres a whole, its a heterogeneous group of radiation that is produced. Another
way you can get a heterogeneous, a production of radiation, is remember the KVP. A
t the top of that peak those electrons will shot across at the highest speed.
Everywhere up the hill and down the hill you are getting less energy. So we have a
combination of long wavelengths and short wavelengths. What is the, what are the
wavelengths we want to use for the patient? SHORT wavelengths, those are
penetration. What do we want to do with the long wavelengths? We dont want to
shower the patient with unnecessary radiation. We have to remove them and those
are removed by some process called filtration. Use aluminum filters. Well talk about
that in a little while. What is the useful beam? Its actually the beam that after it has
been filtered. And after it has been uh collimated by the diaphragm. The PID is the
position indicating device. They come in all sizes. We have 8, 16. Okay and youll
learn that the loner the collimating devices the better the image. Well talk about hat
when we talk about image formation. What they have in common is that they are all
lead lined. So the x-rays dont fly out all over the room. And you have circular
collimators which give the patient an extreme amount of radiation and you have
little tiny rectangular collimators, which are exactly the size of the film. That is less
radiation. This is a 60% reduction of radiation to the patient as opposed to this one.
Okay uh as this is what we used to use many years ago, if you walk into a dental
office and the dentist has one of these pointy plastic cones, my suggestion is get out.
Get out. Because what does this do? It doesnt collimate. The x-rays are aimed this
ray. It shoots through the plastic and hits your entire face with radiation, no
filtration, no collimation, plastic cone. Okay remember the x-rays that come out of
the x-ray machine are called primary radiation. What happens when the x-rays
strike an object? That is called secondary radiation. The x-rays strike the plastic
before hitting the patient. High production of secondary or scatter radiation, which
is very harmful to the patient .So this is the plastic pointy cone, run away. Okay?
And again, secondary or scatter a radiation is defined as the radiation after hitting
the patient. Were not getting into that today. We have enough trouble with the
radiation coming out of the x-ray tube. Well talk about what happens when it strikes
an object or the patient.

[33]- The Divergent X-ray Beam
[Dr Friedman]- Uh remember that the x-ray beam coming out of the collimator
diverges. Its a divergent beam. Just like the flashlight. If I had a flashlight here and I
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19
stood next to the wall and I shined it on the wall youd have a circle. As I walk away
the circle gets larger. And that happens with x-rays, and light, and all forms of
energy. Theres a divergence of the x-ray beam. Okay so what does that mean? That
means if you have a short collimator, the x-rays are not collimated for a long period
of time, theres more divergence of the x-ray beam with a short collimator. The long
collimator, well the x0rays will travel through the center. the ones coming out are
more parallel. Whats the problem of divergence of the x-ray beam? Well we want to
take a picture of a small film. We dont want the x-rays to diverge. So which patient
is safer? This patient thats getting x-rays from here or here? Right over here (long
collimator). Okay so because of divergence, the surface area of the patient, and the
theme of this course is protect the patient. And youll see, everything I talk about I
dont know about the other lecturer, protect the patient. So because of the
divergence f the x=ray beam, the longer the collimator, the safer it is for the patient.
Were gonna talk about that when we talk about patient protection and the operator
protection in one of the later lectures. Okay and we have again, the central ray, okay
here is your anode, the electrons shoot across, the radiation is produced. Whats the
central ray? Its invisible. Its an imaginary line with the center of the x-ray. We used
to use that. We aimed the central ray and this and this and this. Its jut a term
meaning the central point of the radiation. And if you notice there are two devices
here. Theres a diaphragm. What is the diaphragm? Its either a circular piece of lead
if you are using a circular collimator. Or a rectangular piece of lead with a little hole.
And all the s-rays are blocked except those center x-rays. The enter x-rays are the
ones that are focused on the film. And after the diaphragm there is another device
that protects the patient .so how does the diaphragm protect the patient? By
collimating the beam. The diaphragms a collimating device. How does the aluminum
filter protect the patient? The long wavelengths are absorbed, they dont come
through that. So we are eliminating the long, non useful wavelengths, which are
harmful to the patient, and will not form an image, So speaking about collimating,
another term for these, these are called collimating devices. Theyre collimators. So
if you see aim the collimator at the patient, thats another device that collimates the
x-ray beam. So there are two collimators, one is a lead diaphragm, which youre
welcome to see if you come up her a little later. Theres a piece of lead with a little
tiny circle in there. X-rays just go through the center here. Okay and uh lets see what
else we got.

[34]- Secondary Radiation/Scatter Radiation
[Dr Friedman]- Okay we spoke about this plastic cone thats that pointy cone I spoke
about. Same thing happened but theres no collimation whatsoever. It goes all over
the patient . and another problem besides the fact that theres no collimation, were
not dealing with primary radiation anymore. Were dealing with secondary radiation
, which are longer wavelengths and they harm the patient. So if you see one of those
plastic cones, get out. Okay.

[35] Filtration and Collimation
[Dr Friedman]- okay a little bit of a review. Filtration and collimation. What is the
purpose and function of filtration? Very simple. Its an aluminum disk that is placed
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after the x-ray tube in the collimator that absorbs the long wavelengths of radiation,
the unnecessary, harmful radiation. What are the federal regulations? Remember I
told you about numbers, you dont memorize numbers and things like that. If you
got a red pen, underline this because they have this all the time. The federal
regulation is, if your x-ray machine is operating at less than 70 KVP, from 50-70
KVP, theres a preset machine with the KVP, you need 1.5 millimeters of aluminum
filtration. 1.5 mm. On some exams theyll put 1.5 inches. MILLIMETERS. Very thin
disk of aluminum. And that will provide the proper filtration for that type of KVP.
The higher the KVP the more filtration you are going to need. So any machine thats
operating from 70 KVP and above, if you buy a 90 KVP machine, its more expensive,
you dont need to do that, because the human eye sees the best image around70
KVP. Well talk about that when we talk about image formation. 2.5 mm. 2.5 mm of
aluminum filtration is necessary in order to have the proper filtration in your x-ray
machine. What are collimation? Collimation is restricting the size of the beam. Why
do we want to restrict the size of the beam? Were aiming at a little piece of film. We
dont need the entire patients head hit with radiation. So how do we collimate the
beam? With collimating devices. What are the two collimating devices? We spoke
about the lead diaphragm. Okay which is a lead block of lead, a thin piece. There is
no federal mandate for that. You can have it as thick or as thin as you want because
the lead will absorb all of the radiation except in that little center area. That circular
or rectangular. And another collimating device is the position indicating device. Uh
its another collimator. And rectangular collimation is what you will see in every
machine in the office. If you go outside to private practices you wont see many
rectangular collimators. Anybody know why? Because when you have rectangular
collimator you have to be very precise when you take your films, otherwise you
msiss part of the film. Thats called collimated cutoff. And so part of the film will not
be diagnostic. The larger collimator, you never can miss. So when you are going into
private practice, you have to weigh patient protection vs collimated cutoff. Youll
make those decisions when you et out there. What I can tell you as the research
shows, if you use rectangular collimation, remember you are getting the same
amount of radiation coming out of the machine, the same exposure time, nothing
changes. But what you have is about a 55-60% reduction in radiation to the patient.
Okay quality and quantity and x-rays. What controls the quality of the x-rays? Which
uh which control factor controls the quality of the x-rays? So the penetrating power?
KVP. The higher the KVP, the better the quality of the x-ray, more penetrating
power. And what controls the quantity of the x-ray? Milliamperage. The higher the
milliamps, the more electrons are there and so therefore you can reduce your
exposure time, if you have a patient thats moving around a lot you want to reduce
your exposure time. If theyre moving around youre gonna get a blurry film either
way you do it so. And the last thing I need to tell you about very quickly, on this. This
is something called half-value layer (HVL). Im just piling on but okay. Half value
layer is how we actually measure the penetrating power of the x-ray beam coming
out of the tube. Now KVP will control. KVP is an electrical term, but the actual
penetrating power has to do with the HVL. And what HVL stands for is how much
thickness of aluminum is necessary to reduce the radiation by half/ How much
radiation, how much thickness of the aluminum filter is necessary to reduce the
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21
radiation by half? Im gonna tell you that in our x-ray machine, we have a half value
layer of 2.75. How do we get that? 2.5 is the actual uh is the actual aluminum filter.
Remember 2.5? Were using 70 KVP. 2.5. And theres also inherent filtration in the
machine. Whats the inherent filtration? Something else is filtering the x-ray. One of
those is the glass porte. Its not an opening but theres a little thin piece of glass the
x-rays have to go through. And also theres oil surrounding the x-ray tube. Theres
oil the x-rays have to go through this oil .So those are the inherent filtration. So if an
inspector comes to your office and you have an HVL of four that is a problem.
Patient is getting too much radiation. They should have 2.5-2.75 in that range there.
But hats the way of measuring the penetrating power. What controls the penetrating
power is the KVP.

[36] Position Indicating Device
[Dr Friedman]- These are some of the position indicating devices or collimating
devices.

[37]- Rectangular Collimation
[Dr Friedman]- Rectangular collimation.

[38]- Film Packet and Collimation
[Dr Friedman]- forget that one.

[39]- Collimation and Filtration
[Dr Friedman]- Collimation and filtration again. Just a repeat you have the lead
diaphragm and then you have the aluminum filter.

[40]- Half-Value Layer
[Dr Friedman]- Half value layer. We take a disk of aluminum and what is the
thickness of this disk of aluminum to reduce the radiation by half. Thats the half
value layer .So youre going to see on your machines when you buy them, its gonna
have the KVP setting, its gonna have the milliamps setting, the standard setting, and
its gonna have HVL, the half value layer. And what does that mean? It has to do with
the penetration of the x-ray tube coming out. And sometimes the inspector will say
to you. Your HVL is 4 and thats a fine. Theyre gonna give you a fine for that. But you
can correct it and then you get your money back. If you take another piece of
aluminum filter and you put it in there, certain thickness of aluminum filter, you can
add that, then when he tests it the HVL is 2.5-2.7, youre in business. Okay so you
dont have to get a new machine.

[41]- Milliamperage Seconds/Quantity
[Dr Friedman]- Okay and this is the last thing I want to show you very quickly only
because it shows up on exams. When we talk about exposure to the patient, we dont
talk about milliamps or exposure in seconds. We talk about milliamp seconds.
Milliamps second. So what that is is the milliamps times the exposure time is
milliamp second. That will control the total density of the film. How dark the film is.
The more milliamps, the more seconds, the denser the film is going to be. So heres
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an example, a radiograph is exposure to milliamps of 12 and a KVP of 90 and the
exposure time is 1 second. So thats the first film. Your given is 12 x the exposure
time is 1, the milliamps seconds in that case is 12! Okay a second radiograph is
exposed with a new exposure time of 2 seconds but the density remains the same.
So what is the milliamps setting? Anybody?

[41]- mAs CALCULATION
[Dr Friedman]- There it is. So its six. Because 6 x 2 is12. You have the same density.
So when when talking about calculations of density of darkness on the film, they
usually talk about milliamps second. So those are separate entities but you can
combine them into milliamps second. Uh I just want to tell you one more thing and
Ill let you go, youve had enough. Uh this process of x-ray production is very very
inefficient. For the electrons shoot across and x-ray energy is produced, 1% of the
energy, of the kinetic energy of the electron, is converted to x-rays, x-radiation. 99%
of the energy is in the form of heat. Heat energy. And that heat has to be dissipated.
So do you know what in the device, what in the x-ray tube, will dissipate the heat?
The copper stem. That little target is embedded in the copper so that when the
electrons bombard, a lot of heat is given off, the copper stem removes the heat, and
theres something else in the x-ray machine, in the tube head. Its surrounded with
oil. If youre ever working on an x-ray machine and you see oil dripping out. Call
something .The oil is an insulating material, its supposed to dissipate some 0f the
heat that he target, the tungsten, the copper sleeve cannot dissipate. Okay. What I
suggest you do, okay, for exam purposes, uh dont wait for a day or two because
these things are going to pile up on you. And uh Its going to be too much. What you
want to do, I know you guys are going to the beach and all that on the weekend, I
would uh I would take a look at the textbook and just read it. I dont want you to
memorize anything as far as diagrams. Just have a basic information what is
filtration, what it is, how does x-rays produced, what happens in the anode, at the
cathode, what controls these factors? So I through a lot out at you and if anybody
has any questions please come forward and ask me, Ill be more than happy to
answer you. But the way to do well in this course is to come to lecture, listen, and
then you youre gonna leave with a foggy head and the best way is to just get that
little textbook there. If you understand this, you dont need to textbook. If you want
to put everything together in understandable terms take a look at the textbook.
Okay? I think well see you Thursday. Okayyyy.