Medical physics

09

Unit questions
What benefits and ethical issues are associated with the applications of physics to medicine?

Significant concepts
There is increasing application of physics-based technology to medical care. The properties of waves The difference between ionising and non-ionising radiation How radiation interacts with human tissue Uses and dangers of radiation

Area of interaction: Health and social education

In this unit, you will study how the development of new imaging techniques and radiation treatments is improving the quality of health care. You will also consider the wider ethical and economic implications of the use of such expensive technology.

Unit

Physics 4/5 UNiT 9

Medical physics

Introduction
More and more developments and discoveries in physics are used to help in the diagnosis and treatment of patients in hospitals. Doctors can now look inside our bodies without the need for surgery. X-rays have been used for over 100 years to detect bone fractures. Other forms of medical imaging of the human body use ultrasound, gamma radiation and visible light involving optical fibres. Cancerous tumours can be treated with gamma rays and X-rays. The pulse rate and oxygen saturation in the blood can be monitored using light from lightemitting diodes. These are only a few of the applications of physics in medicine. In this unit, you will learn about the properties of waves and how they interact with human tissues, the difference between non-ionising and ionising radiation and some of their medical uses. You will learn about the benefits and limitations of different imaging techniques and treatments using waves. You will be asked to consider the risks involved in the use of ionising radiation and how medical physicists make decisions about what level of radiation dose is safe.

Reflection about learning

With a partner, spend 5 minutes discussing what you already know about waves. Write down any names of different waves that you can remember. Do you know where these waves come from and if they can be dangerous to us? Do you know the answers to these questions? 1 How does an ultrasound scan work? 2 Can ultrasound be harmful to the developing foetus? 3 How are X-rays produced? 4 Is there a limit to the number of X-rays you should have? 5 How does an endoscope work? 6 Gamma rays are dangerous; so how can they be used to cure disease? Add five questions of your own that you would like answered by the end of this unit.
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About waves
Wave motions are caused by vibrations. Put your fingers on your throat and make a noise you can feel your vocal cords vibrating and this is what produces the sound wave. In a ripple tank, a dipper vibrates up and down, setting the water molecules vibrating in the same way. One whole vibration of the dipper produces one complete wave one crest and one trough. A water wave is a transverse wave. The direction of travel of the wave is perpendicular to the direction of the vibration of the water molecules.

Figure 9.1

A ripple tank showing circular waves

summative Assessment task 1 (criteria A and B)

You will learn over this unit about the enormous benets medical physics has brought to the quality of health care world-wide. Some of the technology involved is extremely expensive and there are economic and ethical implications for its use. For instance, PET (positron emission tomography) is a very high-resolution medical imaging technique, capable of identifying tumours in the early stages of their development. However, a full PET scanner costs around 4.2 million (US$6.6 million). How should decisions be made about whether to spend money on these machines or on providing better access to basic medicine and preventative measures? Write an essay or newspaper article that summarises the contributions medical physics is making to improving health care but also discusses the wider economic and ethical issues.

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Physics 4/5 UNiT 9

Medical physics

The amplitude of a wave is the maximum displacement of the particles from the equilibrium position. In the case of a water wave, the equilibrium position is the position of the water molecules when there is no disturbance. The wavelength of a wave is the length of one whole wave (one crest and one trough). The frequency of a wave is the number of waves formed per second.
Displacement

Wavelength Particles move up and down at right angles to the direction of the wave.

Crest

Properties of waves

Amplitude

Distance travelled

Direction of the wave

Figure 9.2

A transverse wave

The diagram in Figure 9.2 shows how far a wave has travelled in 1 s. The frequency of the vibrations producing the wave motion is 5 Hz. The wavelength is 0.2 m. The speed of a wave is defined as follows:
speed (m/s) = total distance travelled by the wave (m) time taken (s)

If five waves are produced every second and each wave has a length of 0.2 m, then the total length of wave produced in 1 second is 1.0 m. In other words, the total distance travelled by the wave in 1 second is 1.0 m. This is the speed of the wave.
speed = frequency wavelength v = f (the symbol for wavelength is the Greek letter lambda)
Period of wave 0.2 s

Displacement

0.2

0.4

0.6

0.8

1.0

Time (s)

Figure 9.3

How the displacement of the particles change with time

The time taken to produce one complete wave is called the period T. In this diagram the period is 0.2 s. 1 1 = = 5 Hz. The frequency of the wave (number of waves per second) is period 0.2
f=
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1 T

Sound waves are not transverse waves; they are longitudinal waves. The direction of travel of the wave or the direction of energy travel is parallel to the direction of vibration. Look at the diagram of the tuning fork in Figure 9.4. When the prong moves outwards, the air molecules are pushed closer together, forming a region of higher pressure called a compression. When the prongs move inwards, a region of lower pressure called a rarefaction is produced. These compressions and rarefactions move outwards through the air but the air molecules move backwards and forwards in step with the vibrations of the tuning fork prongs. When the compressions and rarefactions reach our ears, they cause our eardrums to vibrate and we hear a sound.
Compression Air molecules

Rarefaction Direction of wave travel

FIGURE 9.4

The prongs of the tuning fork vibrate, creating a sound wave in the air, which travels to the persons ear.

What do you know?

1 Explain the differences between a transverse wave and a longitudinal wave. Include the following words in your explanation: crest, trough, compression, rarefaction, vibration, parallel, perpendicular. Give an example of each type of wave. 2 Look at the wave in Figure 9.5.

6 4 Displacement (cm) 2 0 2 4 6 0.1 0.2 0.3 Time (s)

FIGURE 9.5

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Physics 4/5 UNiT 9

Medical physics

a What is the amplitude of the wave? b What is the wavelength? c If the frequency of the wave is 10 Hz, calculate the speed of the wave. d Draw a diagram of a wave with twice the amplitude and half the wavelength of the wave in Figure 9.5. e If the frequency of your wave is still 10 Hz what is its speed? 3 Calculate the speed in cm/s of a water wave if the wavelength is 2 cm and the frequency is 50 Hz. What is the speed in m/s? 4 A sound wave has a frequency of 200 Hz and a speed of 300 m/s in air. Calculate the wavelength of the sound wave. 5 Sound travels faster in water than in air because the particles are closer together. If the speed of sound in water is 1500 m/s, calculate the wavelength of the sound wave in question 4 in water. 6 A light wave has a wavelength of 5 107 m and its frequency is 6 1014 Hz. Calculate the speed of the light wave. 7 A radio wave has a wavelength of 1 km and travels at a speed of 3 108 m/s in air. Find the frequency of the radio wave in hertz. 8 The graph in Figure 9.6 shows how the displacement of the particles varies with time as the wave passes through a medium (for example, water or air).
0.8 0.6 0.4 Displacement (cm) 0.2 0 0.2 0.4 0.6 0.8 0.5 1.0 1.5 Time (s)

Figure 9.6
a What is the period of the wave motion (the time taken to form one complete wave) in seconds? b Use your value for the period to calculate the frequency of the wave motion. 9 Draw a graph of displacement against time for a wave motion with the same amplitude as the wave in question 8 but with twice the frequency. What is the period of your wave motion?

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Ultrasound and ultrasound scans

The range of human hearing is 2020 000 Hz. You can test this yourself by using a signal generator and a loudspeaker. Some animals, such as dogs, bats and dolphins, can hear higher frequencies than we can. Sound with a frequency above 20 000 Hz is called ultrasound. Ultrasound can be used to form images of organs inside the human body and is used to examine the developing foetus in the mothers uterus. The frequency of ultrasound used for an ultrasound scan is between 2 and 18 MHz (1 MHz = 1 000 000 Hz) depending on which part of the body is being imaged. When waves strike the boundary between two substances of different densities, some of the wave is reflected and some is refracted. The amount of reflection and refraction depends on the difference in the densities of the two substances. A total of 99% of ultrasound waves travelling through air are reflected at an air/skin boundary. This would make this imaging technique useless because we would see an image of the skin! To reduce the amount of reflection, doctors introduce a gel between the ultrasound probe and the skin. This gel has a density similar to that of water and so there is much less reflection at the gel/skin boundary and the ultrasound waves pass into the body. When the ultrasound waves reach another boundary such as the edge of an organ, again some of the waves are transmitted and some are reflected. The reflected waves travel back to the ultrasound probe. The length of time it takes for the echo to return and the intensity of the echo are measured. The ultrasound scanner uses this information to build up an image in varying shades of grey on a computer screen. Waves that are transmitted through the body tissues are also partially absorbed. In the case of ultrasound waves, the energy of the waves absorbed is transferred to heat energy. However, for two-dimensional ultrasound images, this heating effect is small and in the 50 years that ultrasound scans have been in use, no harm to patients has been observed. Four-dimensional ultrasound can be used to image movement such as a beating heart. This is a new technique and requires ultrasound waves of a higher energy. The tissues, therefore, receive more heat energy. However, it is still considered to be safe.
Area of interaction

Health and social education Some clinics will provide keepsake 4D ultrasound videos of the developing foetus in the womb for parents. The ultrasound scans can last up to 30 minutes and are not for diagnostic purposes. Would you recommend this? Explain your opinion.

work on the web Go to www. cengage.com.au/ PIS45 and click on ultrasound. Find out about other medical uses of ultrasound.

9.1 Lets use technoLogy

Click on the icon to learn more about ultrasound technology.

Figure 9.7

Two- and three-dimensional ultrasound scans of a 20-week old foetus

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Physics 4/5 UNiT 9

Medical physics

Area of interaction

Community and service In groups of four, discuss the use of the ultrasonic teen repellent. Are shop owners justified in using such a device? Are there other ways that antisocial behaviour can be tackled? Can you see any problems with its use for other people besides teenagers? Decide in your group whether you are for or against the mosquito. Give your reasons.

Ultrasound scans are often performed on pregnant women during their first visits to the doctor and then again between 18 and 22 weeks. Doctors check if the foetus appears to be developing normally, if the blood supply to the foetus via the umbilical cord is functioning correctly and if the position of the placenta is normal.

The ultrasonic teen repellent

The ultrasonic teen repellent or mosquito is a device that produces a high-pitched, irritating sound that can only be heard by people under the age of about 20. Above the age of 20, adults start to suffer gradual hearing loss. Although this is not usually significant until about the age of 65, hearing loss begins with the loss of the ability to hear very high sounds (1820 Hz). Some shop owners have installed the mosquito outside their shops in order to drive away loitering teenagers. They feel that the teenagers drive away customers and can be involved in antisocial behaviour such as graffiti and vandalism. The device has a range of between 15 and 20 metres. The manufacturers advertise the mosquito as being completely harmless. The Times newspaper in the UK reports that the device was first used at a small supermarket in Barry, South Wales, where the owner was enthusiastic about the devices success in driving away the local youths.
BLM 9.1 The upper limiTs of hearing

What do you know?

wow!

1 What is the range of frequencies of human hearing? 2 Adults above the age of about 20 cannot hear as high frequencies as younger people. Why do you think this might be? 3 Table 9.1 shows the densities of air, water and different tissues within the human body.

Bats can emit and detect ultrasound waves up to a frequency of 100 000 Hz. They use these ultrasound waves for echolocation. The bat emits an ultrasound wave, which is reflected back to the bat by any object in its path. The bats ears pick up the reflected wave and its brain processes the information. The time taken for the echo to return tells the bat how close an object is and the intensity of the echo indicates how big the object is. Contrary to popular belief, their eyesight is actually quite good. 292

Table 9.1
Material Water Bone Blood Air Muscle Fat Skin Density (kg/m3) 1000 1900 1100 1.3 1060 900 1060

At which of these boundaries would there be most reflection: blood/bone, fat/muscle or blood/muscle? Explain why. 4 Explain why doctors introduce a gel between the ultrasound probe and the skin. 5 Why is ultrasound imaging of the inside of the lungs not possible? 6 Is there any evidence that the heating effect caused by the absorption of ultrasound is harmful?

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Electromagnetic waves and the human body

The electromagnetic spectrum is a family of transverse waves. They do not need a medium to travel as sound waves do but can travel through a vacuum. They all travel at the same speed in a vacuum (300 000 000 m/s). However, the different parts of the spectrum have different frequencies and wavelengths. As the frequency of the wave increases, the energy it carries also increases. Electromagnetic waves are also called radiation. Radiation is the word used in physics to describe any form of energy that spreads out from a source. The term radiation also includes sound, ultrasound and alpha and beta particles emitted from radioactive sources.
Frequency (Hz)

104 Wavelength (metres) Radio 103

108

1012

1015

1016

1018

1020

Microwave 10 2

Infrared 10 5

Visible 0.5 10 6

Ultraviolet 10 8

X-ray 10 10

Gamma ray 10 12

About the size of

Buildings

Humans

Honey bee

Pin point

Protozoans

Molecules

Atoms

Atomic nuclei

FIGURE 9.8

The electromagnetic spectrum

Infrared, visible, ultraviolet, X-rays and gamma rays are all used in the treatment and/or diagnosis of disease.

The interaction of electromagnetic waves with human tissue

Radio waves have the longest wavelengths and are used for communications. The human body is quite transparent to low-frequency radio waves. Just as these waves pass through the walls of your house, they also pass straight through your body (they are transmitted). Microwaves have wavelengths in the order of a few centimetres. Microwave energy is absorbed by matter, especially water and fat, but the amount of absorption is small. The energy of the microwaves is converted to heat (movement energy of the molecules). In a microwave oven high-intensity microwaves pass through the food millions of times in order to heat the food to a high temperature. Infrared, or heat radiation, is absorbed more strongly by our tissues than microwaves. Again it causes an increase in the kinetic energy of the molecules. As it penetrates further than visible light, it can be used to form images of blood vessels under the skin.
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PHYSICS 4/5 UNIT 9

Medical physics

Assessment Task 2 (Criteria A, B and C)

There is no such thing as a safe tan. Many people sunbake in order to acquire a suntan but excessive exposure to ultraviolet light can be dangerous. Find out about the dangers of ultraviolet radiation from the Sun. Who is most at risk and where is the risk greatest? What is the difference between UV A, UV B and UV C? What harm can be caused to our skin and our eyes? Suggest how people can protect themselves from damage from ultraviolet radiation. You could include information about the effectiveness of different sorts of sunscreen. Present your ndings as a poster or PowerPoint presentation that will warn people against excessive sunbathing.

Visible light is absorbed strongly by our tissues our bodies are almost completely opaque to waves of this frequency. The energy of the absorbed light is converted to heat energy of our molecules. However, for small thicknesses such as a nger both infrared and red light are partially transmitted; this is used in pulse oximetry. Low ultraviolet frequencies are absorbed strongly by the outer layer of our skin. As the frequency of the ultraviolet light increases, the energy of the waves increases and can cause ionisation of the atoms in the tissues. This ionisation can cause harmful effects such as sunburn and skin cancer. Fortunately the ozone layer in the upper atmosphere absorbs most of the harmful ultraviolet radiation from the Sun. In medicine ultraviolet light is used to sterilise rooms and equipment as it kills microorganisms. It can also be used to treat some skin diseases. X-rays and gamma rays are the highest frequency and most energetic waves. Two waves can have the same frequency but one can be an X-ray and the other a gamma ray. The difference is in the source of the radiation. X-rays are produced when electrons travelling at a very high speed strike a target metal such as tungsten and are rapidly decelerated. Gamma rays are emitted from radioactive atoms. X-rays and gamma rays are highly penetrating and pass straight through most materials. However, the absorption of these waves increases as the thickness and the density of the material increases. They are, therefore, very useful for making images of inside the human body but their absorption by our tissues ionises the atoms, and in high doses they can be harmful. X-rays and gamma rays are used to treat cancer. This is called radiotherapy.

Ionisation
In a neutral atom, the number of negatively charged electrons equals the number of positively charged protons. The atom, therefore, has an overall charge of zero. If electrons are added or removed from an atom, the atom becomes an ion (see Unit 8 and Chemistry 4/5 for the international student, Unit 2). High-frequency ultraviolet radiation, X-rays and gamma rays are ionising forms of radiation. If electrons in atoms absorb the energy of these radiations, they have enough energy to escape from the atom. This leaves the atom positively charged. The electrons that have been released can then collide with other atoms and create more ions.
The electron absorbs the energy from the gamma ray and escapes from the atom. Gamma ray

+ + +

A positive lithium ion is formed.

7 3

Li
FIGURE 9.9

7 3

Li

How gamma rays can cause ionisation of atoms

This ionisation of the atoms in our cells can lead to abnormal chemical reactions and can break DNA chains in the cell nuclei. Damaged cells may die or they may mutate. If a large number of cells die, the body cannot replace them fast enough and it may develop
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diseases (radiation sickness). Mutated cells can become cancerous and the cancer may spread. Mutations in sex cells can lead to infertility or birth defects in babies. The developing foetus and young children are most at risk from the damage caused by radiation as their cells are dividing rapidly. However, for low doses of ionising radiation, our bodies remove, repair and replace damaged cells and the body usually suffers no long-term effects.

What do you know?

1 Copy and complete Table 9.2, using the words below.

Knowledgeable about learning: Memory

Table 9.2
Name of radiation Radio waves Microwaves 102 Approximate Source wavelength (m) Radio transmitters Very weakly absorbed Absorption Ionising or Dangers by human non-ionising tissue radiation? Non-ionising None Medical uses None

There is some None debate about the dangers if any of microwaves used for mobile phone networks. Non-ionising Can cause burns

Infrared Visible

105 5 107

The Sun, your body Absorbed strongly by skin The Sun and ultraviolet lamps X-ray machines Weakly absorbed

Non-ionising Does have a heating effect on the body Higher frequencies only are ionising Ionising Can damage DNA and cause cancer Imaging body functions and radiotherapy Sterilising Treating skin diseases

Ultraviolet

108

Complete Table 9.2 as a summary to help you remember the different parts of the electromagnetic spectrum and their properties. Another useful and fun way to help you remember things is to sing. On YouTube you will find the Electromagnetic Spectrum song by Emerson Foo and Wong Yann (Singapore). Why do you think music is helpful for memorising things? Why does hearing an old favourite song bring back such strong memories for people?

X-rays

Gamma rays 1012

Ionising

Microwave transmitters 103 Imaging bones and radiotherapy Not absorbed The nuclei of radioactive atoms Endoscopy Pulse oximetry and thermography

Can damage DNA and cause cancer 1010 Weakly absorbed Non-ionising Medium absorption The Sun, light bulbs

Higher frequencies cause sunburn and can cause skin cancer Lower frequencies are absorbed strongly by outer skin
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Physics 4/5 UNiT 9

Medical physics

Assessment task 3 (criteria D, e and F)

Investigation 9.1 Intensity of radiation

Your challenge
Investigate how the intensity of radiation from a source changes as you move further away from the source.

These may help

Source of electromagnetic radiation and a detector; for example, a light source and a photometer or light-dependent resistor and multimeter to measure the resistance, or a microwave transmitter and receiver or a heat source and an infrared detector Metre ruler to measure the distance

Safety
Show your plan to your teacher and ask for guidance on safety. Never look directly at a source of radiation. In the case of infrared and microwaves, do not expose your tissues to the radiation.

Things to think about

How will you control any radiation not coming from your source? Will you need to repeat your findings?

Extension
Investigate the relationship between the thickness of glass placed in front of a light source and the intensity of radiation. Note: Both these investigations can be carried out using gamma radiation but not by you! Your teacher would have to do the experiments. The absorber to investigate for gamma radiation would be lead.

Assessment task 4 (criteria e and F)

Experiment 9.1 Critical angle

What is the critical angle for glass or Perspex for visible light? When does total internal reflection take place?

Materials
Semicircular glass or Perspex block Ray box Power pack Ruler, pencil and protractor Primary colour filter red, blue or green Plain white paper
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Procedure
1 Draw around the semicircular glass block on a piece of plain paper with a pencil. 2 Measure and mark the midpoint of the diameter of the block. 3 Shine a ray of coloured light through the curved side of the block to the midpoint so that the ray passes into the air. Mark the incident and refracted rays with three crosses each as shown below. 4 Increase the angle of incidence of the ray of light in the block. Take care that the ray still passes through the midpoint. You should see that the refracted ray moves closer and closer to the edge of the glass. What else do you observe?
Midpoint Midpoint Air

Refracted ray

Perspex

Incident ray

Figure 9.10

Critical ray

5 When almost all the ray of light appears to be refracted along the edge of the block, mark the incident ray with three crosses. 6 Increase the angle of incidence in the block even further. What do you see? 7 Mark the incident and reflected rays with three crosses.
Incident ray

Figure 9.11

Analysis of results
1 Join up the crosses to show the paths of the different light rays you can use different colours for each different incident ray. 2 Draw the normal (the perpendicular) to the face at the midpoint using a protractor as shown in Figure 9.12. 3 Measure the angles that each ray you have drawn makes with the normal in the Perspex and in air.

Normal

Figure 9.12

Conclusion
Describe carefully what you have found out in your investigation. Look back at work you have already completed on waves to explain why the light refracts when it travels from one medium to another. What value have you determined for the critical angle of your substance? What are the conditions for total internal reflection? Does the totally internally reflected light obey the law of reflection?

Evaluate your experiment

How accurate was your experiment? What problems did you have? How could the experiment be improved?

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Physics 4/5 UNiT 9

Medical physics

Experiment 9.2 Total internal reflection: using prisms

Materials
Ray box Power pack Ruler, pencil and protractor Plain white paper 45, 45, 90 prisms

Procedure
1 Shine a ray of light through your prism. 2 Move the prism so that the ray is turned through an angle of 90o as shown in Figure 9.13. 3 Draw around the block and mark the incident and reflected rays. 4 Remove the block and complete the path of the rays. 5 Draw a normal to the face where the ray reflects. 6 Measure the angle of incidence and angle of reflection. 7 Record your results.
Reflected ray Incident ray

45

Figure 9.13

Analysis of results
1 Why does the ray reflect? 2 You can use the same prism to turn the ray through 180o. Try this (see Figure 9.14). This is how bicycle reflectors work.
45

Incident ray

Reflected ray

Figure 9.14

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Optical bres and endoscopes

Light travels in straight lines but we can make light change direction so that we can see around corners by using total internal reection in optical bres. This has led to the development of endoscopes that allow doctors to look inside the body without carrying out major surgery. An optical bre consists of a very thin, exible glass tube surrounded by a cylinder of less optically dense glass. The bre is then covered in black plastic to prevent light entering from outside. Light shone into the optical bre hits the boundary between the two different layers of glass at an angle above the critical angle and so is reected. In this way, the light travels down the optical bre.
Inner core of more optically dense glass Optical bres

Air

Normal Black plastic Outer cladding of less optically dense glass

FIGURE 9.15

Total internal reection through an optical bre

Illumination bundle

Endoscope Image bundle Oesophagus Illumination bundle

Image bundle

Stomach

Light has reached the inside of the patients stomach by total internal reflection.

FIGURE 9.16

How endoscopy uses total internal reection

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Medical physics

Medical uses of endoscopy

Endoscopes are used to see images of inside the body. In an endoscope there are two bundles of fibres. One bundle carries the light from a strong light source to the part of the body the doctor wishes to examine. The light is reflected and travels back through the image bundle of optical fibres. The doctor observes the image formed by the reflected light by using an eyepiece or on a computer screen. Endoscopes also enable doctors to take small tissue samples (biopsies), remove foreign objects and carry out minimally invasive surgery, often called keyhole surgery. In keyhole surgery, the surgeon makes about three or four tiny incisions into which a tube is inserted. The endoscope is passed into the tube and the image from the endoscope is displayed on a TV screen. The surgeon can pass specially designed miniature surgical instruments through the tube and operate the instruments from outside the body by observing the images on the TV screen.
An image of the inside of a persons colon obtained using an endoscope

Figure 9.17

wow!
The Lindbergh operation
On 7 September 2001, a team of surgeons in New York carried out keyhole surgery to remove the gall bladder of a patient in Strasburg, France. The surgeons operated the surgical equipment in France from New York through high-speed fibre optics connected to a TV monitor provided by France Telecom. This was the first trans-Atlantic, remotely performed surgical procedure. The operation was named after the American aviator Charles Lindbergh, who was the first person to fly solo non-stop across the Atlantic.

There are many benefits to the patient of keyhole surgery over conventional open surgery. These include a quicker post-operative recovery, less scarring, less pain and fewer possibilities of infection after the operation.

Some procedures performed by keyhole surgery are hernia repairs, removing gall bladders, appendixes and ovarian cysts and treating ulcers. Keyhole surgery is sometimes referred to as the greatest surgical advancement since the anaesthetic.

Figure 9.18

Keyhole surgery

What do you know?

1 Explain carefully how light is transmitted in an optical fibre. 2 Look at the diagram of light travelling down an optical fibre (Figure 9.15). Why does the light change direction when it enters the fibre? Which way should it bend when it leaves the fibre? 3 Why must the light source used in endoscopes be very intense? 4 Why is keyhole surgery considered to be such a major advancement?

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X-rays
X-rays were discovered by German physicist Wilhelm Roentgen in 1895. He called the penetrating rays X-rays because no-one at the time knew what they were. We now know that they are electromagnetic waves just as light waves are. The first X-ray photograph taken was of Roentgens wifes hand (Figure 9.19). In this X-ray photograph you can clearly see the bones of her hand and her wedding ring. That X-rays could have important medical applications was realised immediately and the first images of broken bones were being made by early 1896. In 1901 Roentgen received the first Nobel Prize in Physics for his discovery. To take a traditional X-ray of the bones, a photographic film is placed under the part of the body being examined and a short pulse of X-rays is directed at the precise area. The X-rays are mostly absorbed by the bones but they pass through the soft tissue because it is less dense. The transmitted X-rays strike a photographic film placed underneath the patient, turning that part of the photographic film from white to black. An X-ray image, therefore, shows a white shadow of the bones against a black background. Nowadays, photographic film has been replaced by computed and digital radiography, which captures the image on a screen.

Figure 9.19 X-ray of Roentgens wifes hand the first X-ray ever taken

Figure 9.20

A chest X-ray

How are X-rays produced?

An X-ray machine consists of an electron gun and a tungsten alloy target in a vacuum. In the diagram in Figure 9.21, a current flows through a tungsten filament (a high-resistance coil). Due to the heating effect of the current, the filament becomes white hot and heats up the metal plate (cathode). Some of the electrons in the cathode have enough energy to escape from the surface of the metal and form an electron cloud. This process is called thermionic emission.
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Physics 4/5 UNiT 9

Medical physics

Lead case Oil bath Cathode Electron beam X-ray beam

Vacuum Tungsten anode

Filter

A very high voltage (between 20 and 150 kV) is connected across the metal plate and a tungsten alloy target. This causes the metal plate to become very negative (the cathode) and the target to become very positive (the anode). The electrons are repelled from the cathode and attracted to the anode. They accelerate across the gap to a very high speed. When the electrons strike the target, they are decelerated rapidly and in most cases the kinetic energy of the electrons is converted to heat (infrared) but some of the electrons orbiting the tungsten atoms absorb the electrons energy and then emit this energy as X-rays. The higher the accelerating voltage, the higher the frequency of the X-rays produced. To produce more X-rays of the same frequency, the current in the tungsten filament must be increased so that more electrons are released from its surface.

Figure 9.21
An X-ray machine
Motor

Because most of the energy of the electrons is actually converted to heat, the tungsten target becomes very hot and so a cooling mechanism is required. The target is rotated by a motor so that the beam of electrons hits different points and the target is prevented from melting. The kinetic energy of the electrons comes from the accelerating voltage across the anode and cathode. The voltage across two points in a circuit is defined as the energy in joules gained per coulomb of charge as it travels between those two points:
voltage (volts) = energy (joules) charge (coulombs)

energy = charge voltage kinetic energy gained by each electron (J) = charge of each electron (C) voltage (V)

We can write this equation in symbols:

E = eV

where e is the charge on one electron and is equal to 1.6 1019 C. The formula for kinetic energy is:
KE = 1 mv2 2

where m is the mass (kg) and v is the velocity (m/s) and so:
1 mv2 2

= eV

The accelerating electrons between the anode and the cathode constitute an electric current although they are flowing through a vacuum not a conducting wire. Current is defined as the charge in coulombs flowing past a point in a circuit per second:
current =
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charge time

We can write this in symbols as follows:

I= Q t

The charge of each electron is e and the number of electrons passing a given point in time t is n. The total charge Q flowing in time t is equal to the number of electrons multiplied by the charge of each electron:
Q = ne I= ne t

SkillS

Worked example
In an X-ray tube, the accelerating voltage is 500 kV. If the charge on each electron is 1.6 1019 C, what is the energy acquired by each electron? Energy = eV = (1.6 1019) 500 103 = 8.0 1014 J If the current flowing is 2 A, what is the number of electrons flowing per second? I= = n= ne t n(1.6 1019) 1

2 1.6 1019 = 1.25 1019 electrons

CT scans
The development of computer processing technology has led to the development of computerised tomography (CT). In a CT scan, a ring-shaped apparatus rotates around the patient. An X-ray tube in the ring emits a beam of X-rays, which pass through the patient at different angles as the ring rotates. The transmitted beams are incident on an array of detectors. The computer constructs images of different slices through the body from different angles. A CT scan gives the doctor more diagnostic information than a traditional X-ray. Patients often swallow radiocontrast agents when they have a CT scan. The radiocontrast agent absorbs more X-rays and this helps to show up the tissues and organs. However, CT scans expose patients to a higher dose of ionising radiation than a traditional X-ray. The X-rays used have a lower frequency and so are more easily absorbed. Also, the exposure time is longer.

Figure 9.22 A CT scan of a horizontal slice through the abdomen

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The dangers of X-rays

When X-rays were first discovered, it was not realised that although they had great diagnostic benefits they could also be harmful. Many early radiologists worked with no protection and suffered burns and in some cases malignant tumours. Thomas Edisons assistant died from cancer caused by exposure to X-rays. These days, X-ray rooms are lined with lead and radiologists operate the equipment in a separate lead-lined room with lead-plastic windows.

Figure 9.23 This photograph taken in 1971 is of the hand of a radiologist many years after over-exposure to X-rays.
BLM 9.2 X-ray quiz

Activity How mucH leAd iS needed to Stop x-rAyS?

Lead is used to line the walls in X-ray rooms because of its high density (11.34 g/cm3). The thicker the lead, the more X-rays are absorbed. Table 9.3 shows the thicknesses of lead needed to absorb X-rays of different energies.

Table 9.3

Thicknesses of lead needed to absorb X-rays of different energies X-rays (kV) 75 100 125 150 175 200 225 300 400 500 600 900 Thickness of lead (mm) 1.0 1.5 2.0 2.5 3.0 4.0 5.0 9.0 15.0 22.0 34.0 51.0

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Plot a graph of lead thickness (y-axis) against the accelerating voltage (x-axis). You can do this on graph paper or copy the data into an Excel spreadsheet and use the program to plot the graph for you. Draw the line of best fit. Are there any points that do not fit on your line? Describe how the minimum thickness changes as the energy of the X-rays increases. Is the thickness of lead needed proportional to the energy of the X-rays? Explain your answer. All radiation spreads out as it travels. Can you use this fact to explain why the thickness of the lead needed to absorb the X-rays does not increase proportionally to their energy.

2 3 4 5

What do you know?

1 2 3 4 5 Explain the meaning of the term thermionic emission. How are the electrons emitted from the filament made to accelerate towards the target? Why must the inside of the X-ray machine be evacuated? What would happen to the electrons if there was air inside? What happens to the kinetic energy of the electrons when they strike the tungsten target? What would happen to the number and frequency of the X-rays produced if the: a filament voltage was increased? b accelerating voltage was increased? 6 Tungsten has the highest melting point of all metals (3140C). Why is it important that the metal target used in an X-ray machine has a high melting point? If the accelerating voltage in an X-ray machine is 50 kV, calculate the kinetic energy gained by each electron as it travels between the cathode and the anode. Calculate the current flowing between the cathode and the anode if the number of electrons flowing per second is 5 1019. If the current flowing between the cathode and the anode is 3 A, find the number of electrons hitting the target per second. Explain the difference between the image formed by conventional X-rays and the image formed by a CT scan. What is the disadvantage of a CT scan?

7 8 9 10 11

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PHYSICS 4/5 UNIT 9

Medical physics

Nuclear imaging using gamma radiation

Nuclear imaging is different from X-ray imaging as it shows body functions rather than

images of the bodys anatomy. The images obtained look quite different from an X-ray or CT scan. This procedure uses radioisotopes that are attached to a pharmaceutical to form a radiopharmaceutical. The pharmaceutical chosen depends on the part of the body under examination. The radiopharmaceutical is injected into the patient. As the radioisotope decays, it emits gamma rays that are transmitted through the patients tissues and detected by a gamma camera.

Gamma ray detectors

FIGURE 9.24 A gamma camera detecting gamma rays from a patient who has been injected with a radioisotope

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FIGURE 9.25
Detection of gamma rays

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The radioisotope used in 85% of nuclear imaging techniques is technetium-99m (where 99 is the mass number of the element). It can be used to image the skeleton, brain, thyroid, lungs, liver, kidney, bone marrow and heart muscle. To check the functioning of the heart, a small amount of the radioisotope is injected into the patients bloodstream and a gamma camera is positioned over the heart. The gamma rays emitted by the technetium as the blood flows through the heart are detected by a gamma camera, which then converts the gamma image to a visible image on a computer screen. The amount and the position of the gamma rays emitted can help doctors to determine if the heart ventricles are working correctly and can help detect blockages in the arteries which may restrict blood flow.

Figure 9.26
Gamma ray scan of brain

BLM 9.3 Medical iMaging using radioactive isotopes

Is the procedure safe?

Because the half-life of technetium-99m is low, the patient does not remain radioactive for long and the exposure to gamma radiation is low. The technetium-99 decay product is also radioactive but emits low-energy beta particles and is excreted in 24 hours from the body via the kidneys. However, pregnant women are not advised to have such a test and mothers with babies are asked to suspend breastfeeding for a while afterwards. Radioisotopes are stored in special lead-lined containers. When handling the radioisotopes, medical staff protect themselves from exposure to gamma radiation by wearing lead gloves and aprons. The syringes are made from lead-glass, which absorbs gamma rays but allows operators to see the dose that is being administered.

Production and decay of technetium-99m

Technetium-99m is the decay product of molybdenum-99. Molybdenum-99 is produced in special nuclear reactors by bombarding uranium-235 with neutrons. There are only five reactors in the world that produce molybdenum-99. The molybdenum from these nuclear reactors has to be transported to hospitals where the technetium-99m is extracted.
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In such nuclear reactions, the total number of neutrons plus protons must be conserved. In the following example, the sum of the mass numbers of the decay products must add up to 236.
235 92 U

+ 0n

236 92 U

42 Mo + 3 0 n +

99

134 50 Sn

+ 0

99 + 3 1 + 134 + 0 = 236

The atomic numbers (number of protons) must also be conserved. In this example, the atomic numbers of the decay products must add up to 92:
work on the web Go to www. cengage.com.au/ PIS45 and click on medical physics for further information about the use of physics in medicine. The Health Physics Society has some useful fact sheets. On the How stuff works website, go to the section on health.

42 + 0 + 50 + 0 = 92

Molybdenum-99 has a half-life of 66 hours and decays by emitting beta particles:

99 42 Mo

43 Tc + 1p +
1

99

0 1 e

In beta decay, a neutron changes to a proton and emits an electron:

1 0n 0 1 e

The daughter nucleus, therefore, has one more proton than the parent nucleus (but the same mass number) but charge is conserved in the reaction because of the negative charge of the emitted electron. The negative charge of the electron is represented by the subscript 1. Technetium-99m is a metastable isotope. When radioactive elements or isotopes decay by emitting alpha or beta particles, the daughter nucleus has excess energy and is said to be an excited nucleus. However, this excess energy is released from the nucleus immediately in the form of gamma radiation. But in some rare cases, the release of this energy takes longer. These isotopes are metastable isotopes and are indicated by an m after the mass number, which stands for metastable. Technetium-99m has a half-life of 6 hours. In this time, half of the atoms present emit their excess energy as gamma radiation to form technetium-99. These technetium-99 atoms have less energy but the same number of protons and neutrons.

What do you know?

1 How is nuclear imaging different from imaging by X-rays? 2 Does a patient undergoing nuclear imaging need to worry about the dose of gamma radiation received? 3 What do you understand by the term half-life? 4 What fraction of the technetium-99m will remain in the patients bloodstream after 18 hours? 5 What is a metastable isotope? 6 When uranium-235 undergoes fission, the fission products can often be different. Molybdenum is only produced by a small percentage of 235U atoms. Another fission reaction is shown below. Work out the missing mass number and atomic number by balancing the equation.
235 92 U

+ 0n

236 92 U

91

Kr + 3 0 n +

56 Ba

7 Why shouldnt pregnant mothers have a nuclear imaging test (see Ionisation, pp. 294-5)?

BLM 9.4 Balancing nuclear equations

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Radiotherapy
Radiotherapy is the treatment of cancers and other diseases with ionising radiation. X-rays and gamma rays are commonly used. The radiation can be delivered externally or internally by placing a source of radiation inside the body. The ionising radiation works by damaging the DNA of the cancer cells and causing them to die. Although the radiation damages both cancerous and healthy cells, the healthy cells are able to replace themselves.

External beam radiotherapy

The energy of the radiation used depends on the position of the cancer. Higher energy X-rays penetrate further into the body and so can be used to destroy cancer cells deeper in the body. Several beams of radiation are focused on the target tissue at different angles. This reduces the damage done to the healthy tissue surrounding the tumour because although each beam hits the cancerous tissue, only one beam passes through each part of the surrounding healthy tissue. Small doses of radiation are usually given over a few days or weeks. This allows any healthy cells that are damaged to repair themselves or be replaced.
Normal cells

Gamma rays

Cancer cells

Figure 9.27 Gamma rays from different directions hitting a tumour

Internal radiotherapy
A radioactive implant is placed directly in a tumour or in a body cavity so that the radiation dose is concentrated in a small area. The radioisotope in the implant emits gamma radiation, which kills the surrounding cancerous cells. For temporary implants, as soon as the implant is removed the patient is no longer radioactive. For permanent implants, the half-life of the radioisotope is short so that the patient only has to stay in hospital for a few days. By this time, the amount of radiation will have reached a safe level. Internal radiotherapy is frequently used for cancers of the cervix, uterus and tongue. Caesium-137 is used to treat cancers of the cervix. Iridium-192 is used to treat cancers of the tongue.
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Systematic radioisotope therapy

This is a form of targeted therapy. The radioisotope is either delivered into the patients blood stream or swallowed. The radioisotope is specifically absorbed by the cancerous tissue because of its chemical properties. For instance, radioactive iodine-131 is used in the treatment of thyroid cancers. The iodine is absorbed by the thyroid gland but not by other body organs. The iodine has a half-life of 8 days and decays by emitting beta particles and gamma rays. The cancer cells in the thyroid gland absorb the radiation and die.
BLM 9.5 The cosT of TreaTmenT

Waste from medical uses of radioisotopes

The generation of electricity from nuclear power stations produces nuclear waste, some of which remains radioactive for thousands of years. Disposing of this waste safely is a problem we face today. The use of radioisotopes in medicine also produces nuclear waste. It is mainly low-level waste such as clothes, tools and paper. The level of radioactivity drops quickly and the waste can be buried in landfill sites after storage of a few months or years. The radioisotopes themselves also become nuclear waste when their activity has dropped below a useful level. Some radioisotopes such as cobalt-60, which is used in radiotherapy, produce intermediatelevel waste. Intermediate-level waste has a higher activity than low-level waste and remains radioactive for a long time. The most common form of disposal is solidifying the waste in concrete and burying it deep underground.
Area of interaction

Environments Try to find out if there have been any examples of environmental contamination caused by radioactive wastes from hospitals. Do you think all countries have the right to have a nuclear industry so they can make their own radioisotopes for medical uses? What do you think would happen when radioisotopes get into the food chain? Why was milk banned in certain places in Europe after the Chernobyl disaster?

What do you know?

1 In external beam radiotherapy, why are higher energy X-rays used for cancers deeper in the body? 2 How do doctors ensure that the healthy tissue is damaged as little as possible? 3 In internal radiotherapy, why is it important that the half-life of the radioisotope is short? 4 In systematic radioisotope therapy, how is a specific organ in the body targeted?

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How much ionising radiation is harmful?

We are exposed all our lives to ionising radiation. The majority (82%) comes from natural sources such as radon gas, cosmic rays, rocks and even, in small amounts, our food. The main form of artificial ionising radiation is medical (15%) and is mostly received from X-rays. The dose received from medicine has increased in recent years because of the increased use of CT scans. A small percentage of radiation comes from emissions from the nuclear industry and fall-out from nuclear testing in the 1950s and 1960s.
Consumer products Nuclear medicine 2% Other 1% Medical X-rays 11% 4%

Cosmic rays from space

8%

Rocks and soil

8%

11% Inside human body 55% Radon

Figure 9.28

Natural and man-made sources of radiation

The amount of energy from an ionising source absorbed per kilogram of tissue is called the absorbed dose. One joule per kilogram is called a gray. Radiation doses are usually expressed in sieverts or millisieverts. These units take into account the fact that different forms of ionising radiation differ in the amount of biological harm they do. For X-rays, gamma rays and beta particles 1 gray (Gy) = 1 Sv but for alpha radiation 1 Gy = 20 Sv because alpha particles do more damage for the same amount of energy. The average dose per person from natural sources is 3 mSv per year but this varies depending on location. People who live in high radon areas receive a higher dose. Exposure to cosmic rays is less for people living nearer the equator but people who fly frequently are exposed to more of these rays. Table 9.4 shows the typical effective doses for some medical procedures. The doses have been compared with the time it takes to receive an equivalent dose from the natural background. The radiation doses from these procedures are very small. It is difficult to determine the risks associated with the accumulated radiation dose (both natural and artificial) over long periods for the average person. This is because there is a long time delay between any biological damage caused by radiation and the onset of cancer. However, the risks do appear to be very small.
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Table 9.4

Typical radiation doses for some medical procedures Effective dose (mSv) 10.00 6.50 4.00 2.00 2.00 0.70 0.04 0.03 0.02 Time taken to receive an equivalent dose from the natural background 3 years 2.2 years 1.3 years 8 months 8 months 3 months 6 days 4 days 3 days

Imaging procedure

CT abdomen and pelvis Heart using gamma source Bone using gamma source CT head CT chest Mammogram (four different directions) Chest X-ray Skull X-ray Teeth X-ray

Very large doses (over 1 Sv) over a short period of time cause radiation sickness and possible death within days or weeks. Such doses were received by people close to the Hiroshima and Nagasaki nuclear bombs and by some workers and rescue workers during the Chernobyl nuclear reactor accident. Patients who receive radiotherapy to treat cancers receive exposures to their healthy tissues that are hundreds or thousands of times bigger than the doses received from medical imaging procedures. The amount of radiation given in radiotherapy depends on the type and stage of the cancer being treated. A typical dose for a tumour is 6080 Gy although this is given as 2-gray doses 5 days a week.
BLM 9.6 radiaTion levels are They safe

What do you know?

1 The effective dose from a spine X-ray is 1.5 mSv. Approximately how long does it take to receive an equivalent dose from background radiation? 2 Why is it important that doctors keep up-to-date records of the treatment received by patients? 3 Why is it difficult to assess the long-term risk of exposure to radiation? Can you think of any other reasons besides the one mentioned in the text? 4 Why are you exposed to more cosmic rays when you are flying? 5 What advice would you give to pregnant women in order to reduce their exposure to ionising radiation? 6 In radiotherapy the dose of radiation received is very high. Why is this dose spread out over a period of time? 7 Use an Excel spreadsheet to plot a bar chart of the effective doses from the procedures given in Table 9.4. Add the average background. Why should this data be shown as a bar chart and not a line graph?

BLM 9.7 medical wordfind BLM 9.8 uniT checklisT

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Unit review
Review questions
Understanding 1 Describe the difference between a transverse and longitudinal wave and give examples of each. 2 Which of the equations below is correct? A B C 3 4 v = f/ f = v v = f Ultraviolet, visible, microwaves, gamma rays The following sentences all contain errors. Rewrite the sentences so they give the correct information and uses. a b c 5 Ultrasound is a transverse wave motion and is used to treat malignant tumours. X-rays have a longer wavelength than visible light and are easily absorbed by human tissue. Any dose of gamma radiation is fatal. It therefore cannot be used in medical procedures and treatments.

self test 9

Put the following electromagnetic waves in order of increasing frequency:

Explain the difference between ionising and non-ionising radiation. Why can ionising radiation be harmful?

Apply 6 If the speed of an ultrasound wave is 1550 m/s and its frequency is 1 MHz, find the wavelength of the wave. 7 If the speed of light in glass is 2 108 m/s, how long does it take a ray of light to travel a distance of 6000 km (the distance between New York and Strasbourg) through an optical fibre? Why is the time likely to be greater than the value you have calculated? In an X-ray machine sufficient X-rays are produced but their frequency is not high enough for the required medical procedure. What could the problem be? Choose from AE and explain why your answer is correct and the other answers are incorrect. A B C D E 9 The current flowing in the filament is too small. The X-ray tube isnt evacuated. The accelerating voltage is too big. The accelerating voltage is too small. The anode and cathode are connected the wrong way round.

The average effective radiation dose received from the natural background is 3 mSv per year. How much is this per day? The effective dose received from taking a nuclear image of the functioning of the kidney is 3.6 mSv. How many times greater is this dose than the daily background dose? Should a patient be worried about having this test?

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10

The equations below show some fission reactions that take place in a nuclear reactor. Balance the equations by working out the missing mass numbers and atomic numbers. a b
235 92 U 235 92 U

+ 1n 0 +
1 0n

236 92 U 236 92 U

92 Kr + 3 1 n + 0
40 Zr

31n 0

56 Ba 139

Te +

Evaluate 11 The average radiation dose received by the average American from medical procedures may now be greater than the dose from the natural background. This is mainly due to the increased use of CT scans, which are being used on a more routine basis. Some hospital websites advertise gift vouchers for CT scans as last-minute Christmas presents. One hospital charges $750 for whole body scans. Would you recommend someone to have a preventative CT scan when they feel perfectly healthy? Explain your opinion to your class. Reflection 12 As a whole class look back at the unit question. a b 13 14 Make a list of developments and discoveries in physics that are used in medicine. You can include examples not included in the unit. Make a list of what you consider to be the ethical issues in the use of these technologies.

On your own, check the questions on page 286. Do you now know the answers to these questions? What about the questions you wrote yourself? Make a note of any questions that the unit has raised for you that you would like to have answered in the future. Note down any parts of the unit that you found difficult. These are the concepts you need to concentrate on when you are revising. You could ask a friend, someone at home or your teacher to go over them again with you.

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new words
absorb to take in radiation and transform its energy to another form without transmitting or reflecting it absorbed dose the amount of radiation energy in joules absorbed per kilogram of matter activity the amount of radioactivity emitted from a source measured in bequerels per second amplitude maximum displacement of a wave cancer an abnormal growth of cells which spreads in an uncontrolled way compression to reduce the amount of space that is occupied computerised tomography medical imaging procedure using lower frequency X-rays which shows slices through the body crest the top of a wave critical angle the angle of incidence when the angle of refraction is 90 effective dose or biological dose the dose of radiation received taking into account the type of radiation endoscope a medical imaging device using the total internal reflection of light in optical fibres excited nucleus a nucleus with excess energy frequency number of waves formed per second gray (Gy) the unit of absorbed dose; 1 gray = 1 joule of absorbed energy per kilogram intermediate-level waste waste from a nuclear reactor or decayed radioisotopes that remains radioactive for tens of thousands of years ion an atom which has gained or lost electrons to become positively or negatively charged ionisation the process by which atoms become ions ionising radiation radiation which has sufficient energy to cause the atoms through which it passes to lose or gain electrons keyhole surgery minimally invasive surgery which only requires the surgeon to make small incisions in the body longitudinal waves direction of travel is parallel to direction of vibration low-level waste waste that is only slightly radioactive such as clothes and tools metastable isotope an atom of an element whose nucleus has excess energy which decays to give out gamma radiation only mutation a permanent change in a cells DNA nuclear imaging a medical procedure which uses radiation from the nucleus to image body functions period time taken for one complete wave perpendicular at right angles pulse oximeter a medical device that measures a patients blood oxygen level radioisotope an isotope of an element which is radioactive radiopharmaceutical a drug made by combining a chemical with a radioisotope radiotherapy the treatment of cancer and other diseases using ionising radiation rarefaction region of lower pressure sievert (Sv) the unit for effective dose

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sterilise destroy bacteria and viruses on an object thermionic emission the process by which electrons gain enough energy to be emitted from a the surface of a hot filament total internal reflection when a wave meets a boundary at an angle greater than the critical angle and all the wave is reflected transmitted passes through, not absorbed or reflected transverse wave a wave which travels perpendicular to the movement of the medium trough the bottom part of a wave tumour a cancerous growth ultrasound a sound wave with a frequency above the range of human hearing (>20 000 Hz) ultrasound scan the medical imaging procedure which uses the reflection of ultrasound waves to form images of inside the body vibration back-and-forth motion about an equilibrium position

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