Get Through FRCR Part I: MCQs and Mock Examination To our families and our teachers Get Through FRCR Part I: M CQs and Mock E xamination Damian T olan MBChB MRCP(UK) Specialist Registrar in Diagnostic Radiology. Leeds Rachel Hyland MBChB Specialist Registrar in Diagnostic Radiology. Leeds Christopher Taylor BSc Head of R adiological Physics. Radiation Protection Adviser a nd Head of L eeds FRCR Physics Teaching Programme. Leeds Teaching Hospitals Trust Arnold Cowen BSc Senior L ecturer in Medical Physics. University o f L eeds 0 CRC Press cBl Taylor & F rancis Group Boca Raton London N ew York CRC Pr ess is an imprint of the Taylor & Francis G roup, an i nforma business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2004 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works This book contains information obtained from authentic and highly regarded sources. Reason- able efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Foreword VII Abbreviations IX Introduction 1 1. Fundamental properties of matter, radiation and radioactive decay 3 2. Production of x-rays 13 3. Interactions of ionising radiation with matter 29 4. Factors affecting image quality 39 5. Conventional film processing 57 6. Quality assurance and quality control 61 7. Mammography 63 8. Special radiographic techniques 69 9. Image intensifiers and fluoroscopy 73 10. Computed tomography scanning 77 11. Radionuclide imaging 81 12. Radiation protection 89 13. Patient dosimetry 101 14. UK Legislation-Statutory Requirements and Non-statutory Recommendations 107 Mock examination 115 v Taylor & Francis Taylor & Francis Group http:/taylorandfrancis.com ., Foreword 0 ~ ~ As radiologists we rely heavily on the "Aunt Minnie" pattern recognition a. approach to interpret our images. Short-cutting a careful visual analysis in this way works well most of the time, but after over 30 years in clini­ cal radiology I still see - every week - new or unfamiliar appearances which fit no clear pattern but which require explanation. In these cir­ cumstances, the question we need to ask is not "what is it?" but rather "what has happened to produce these appearances?" In part, this is an exploration of how the pathology or pathophysiology in the patient has become manifest in the image- we have to back-project the substance from the shadow. However, the other critical element to our visual analysis requires us to understand the technical aspects of image acquisi­ tion and display, and for this reason it is important for radiologists to have a firm understanding of the science and technology involved in image production. The last four decades have seen a dramatic expansion in the range of clinical imaging techniques and the role of the radiologist has evolved equally rapidly. Fortunately, the basic science remains the same as it always was. In reading through this book I was reassured to find that in an increasingly ephemeral world, protons and electrons continue to be unimpressed by politics and post-modernism. Once you have digested this book, its contents will provide you with long-term sustenance. The authors are amongst the first students and teachers to experience the revised syllabus and examination for Part 1 of the FRCR in December 2002. In a format which is clear and concise they have covered the radi­ ation physics relevant to imaging - including x-radiography, computed tomography and radionuclide imaging - also those aspects of radiation protection which are relevant to clinical applications, and all the accom­ panying legislation. This volume will be invaluable not only to candi­ dates for the FRCR part 1, but as a continuing source of reference to radiologists at a later stage of their training and experience. The authors are to be congratulated on this most valuable contribution. Philip JA Robinson Professor of Clinical Radiology StJames's University Hospital Leeds vii Taylor & Francis Taylor & Francis Group http:/taylorandfrancis.com Abbreviations > 0" 0" ~ g<: ARSAC administration of radioactive substances advisory committee o :::I Bq becquerel (disintegrations per second) 1/1 c speed of light (3 x 108ms-1) c coulomb CTDI Computed tomography dose index DAP dose area product (Gy cm2, cGy cm2) DRL diagnostic reference level eV electron volts (1 eV = 1.6 x 10-19 joules); subdivisions are keV and MeV f frequency FFD focus film distance Gy gray-a unit of absorbed dose, and of kerma; subdivisions are mGy and pGy mGycm milligray-centimetres, a unit of dose-length product h Planck's constant (6.626 x 10-34 Js) HVL half value layer HSE Health and Safety Executive IRR 1999 Ionising Radiations Regulations 1999 IRMER Ionising Radiation (Medical Exposure) Regulations 2000 kV kilovolt kVp peak electrical potential across an x-ray tube, in kilovolts kW kilowatt LAC linear attenuation coefficient lp/mm line pairs per millimetre rnA milliamperes (tube current) mAs milliampere-seconds MBq/mg megabecquerel per milligram, a unit of specific activity MTF modulation transfer function rad radiation absorbed dose (a non-SI unit of absorbed dose or kerma) SI Systeme Internationale Sv sievert - a unit of effective dose and equivalent dose; subdivisions are mSv and flSv TLD thermoluminescent dose meter z atomic number A. wavelength The text uses standard chemical symbols, e.g. Tc (technetium) and Csl (caesium iodide). Nuclides have been written with either the name or symbol of the element followed by its atomic mass number, e.g. technetium-99 or Tc-99. ix