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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 (Figure) and (Figure).) X rays are also used to inspect our luggage at airports, as shown in (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.

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 chapter 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 chapter.

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. (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 (Figure). G. Hounsfield (UK) and A. Cormack (US) won the Nobel Prize in Medicine in 1979 for their development of computed tomography.

X-Ray Diffraction and Crystallography

Since x-ray photons are very energetic, they have relatively short wavelengths. For example, the 54.4-keV \({K}_{\alpha }\) x ray of (Figure) has a wavelength \(\lambda =\text{hc}/E=0\text{.}\text{0228 nm}\). Thus, typical x-ray photons act like rays when they encounter macroscopic objects, like teeth, and produce sharp shadows; however, since atoms are on the order of 0.1 nm in size, x rays can be used to detect the location, shape, and size of atoms and molecules. The process is called x-ray diffraction, because it involves the diffraction and interference of x rays to produce patterns that can be analyzed for information about the structures that scattered the x rays. Perhaps the most famous example of x-ray diffraction is the discovery of the double-helix structure of DNA in 1953 by an international team of scientists working at the Cavendish Laboratory—American James Watson, Englishman Francis Crick, and New Zealand–born Maurice Wilkins. Using x-ray diffraction data produced by Rosalind Franklin, they were the first to discern the structure of DNA that is so crucial to life. For this, Watson, Crick, and Wilkins were awarded the 1962 Nobel Prize in Physiology or Medicine. There is much debate and controversy over the issue that Rosalind Franklin was not included in the prize.

(Figure) shows a diffraction pattern produced by the scattering of x rays from a crystal. This process is known as x-ray crystallography because of the information it can yield about crystal structure, and it was the type of data Rosalind Franklin supplied to Watson and Crick for DNA. Not only do x rays confirm the size and shape of atoms, they give information on the atomic arrangements in materials. For example, current research in high-temperature superconductors involves complex materials whose lattice arrangements are crucial to obtaining a superconducting material. These can be studied using x-ray crystallography.

Historically, the scattering of x rays from crystals was used to prove that x rays are energetic EM waves. This was suspected from the time of the discovery of x rays in 1895, but it was not until 1912 that the German Max von Laue (1879–1960) convinced two of his colleagues to scatter x rays from crystals. If a diffraction pattern is obtained, he reasoned, then the x rays must be waves, and their wavelength could be determined. (The spacing of atoms in various crystals was reasonably well known at the time, based on good values for Avogadro’s number.) The experiments were convincing, and the 1914 Nobel Prize in Physics was given to von Laue for his suggestion leading to the proof that x rays are EM waves. In 1915, the unique father-and-son team of Sir William Henry Bragg and his son Sir William Lawrence Bragg were awarded a joint Nobel Prize for inventing the x-ray spectrometer and the then-new science of x-ray analysis. The elder Bragg had migrated to Australia from England just after graduating in mathematics. He learned physics and chemistry during his career at the University of Adelaide. The younger Bragg was born in Adelaide but went back to the Cavendish Laboratories in England to a career in x-ray and neutron crystallography; he provided support for Watson, Crick, and Wilkins for their work on unraveling the mysteries of DNA and to Max Perutz for his 1962 Nobel Prize-winning work on the structure of hemoglobin. Here again, we witness the enabling nature of physics—establishing instruments and designing experiments as well as solving mysteries in the biomedical sciences.

Certain other uses for x rays will be studied in later chapters. X rays are useful in the treatment of cancer because of the inhibiting effect they have on cell reproduction. X rays observed coming from outer space are useful in determining the nature of their sources, such as neutron stars and possibly black holes. Created in nuclear bomb explosions, x rays can also be used to detect clandestine atmospheric tests of these weapons. X rays can cause excitations of atoms, which then fluoresce (emitting characteristic EM radiation), making x-ray-induced fluorescence a valuable analytical tool in a range of fields from art to archaeology.