SYLLABUS

FOR A COURSE IN "DIAGNOSTIC IMAGING - PHYSICAL AND BIOLOGICAL ASPECTS" FOR DOCTORS UNDERGOING SPECIALIST TRAINING IN RADIOLOGY

Guidelines for Training in General Radiology, recently issued by the European Association of Radiology, recommend that a formal course in basic sciences should be an essential requirement of the Core of Knowledge for general radiology.

In this Syllabus for a course in "Diagnostic Imaging - Physical and Biological aspects", the emphasis throughout is on those elements of physics and radiobiology that are relevant to the work of a radiologist, namely:

I) the mechanisms of image formation and the factors affecting image quality,

II) factors affecting the risk to both patients and staff.

Elements of the Core of Knowledge covered include

a) the physical basis of image formation for conventional X-rays, computed tomography, nuclear medicine, ultrasound and magnetic resonance imaging,

b) quality control,

c) radiation physics,

d) essential radiobiology,

e) radiation protection and the principles behind legislation.

The course is designed to be taught in no more than 40 hours, supplemented by some demonstrations (e.g. image faults caused by technical factors, radiation protection arrangements and quality assurance in practice) tutorials, revision and examination rehearsals. The number of hours suggested for each topic within the total framework of 40 hours maximum is shown in brackets. These times should be used for guidance only.

Syllabus

The more advanced topics, e.g. CT, ultrasound, MRI are only covered at an introductory level. Radiologists who specialise in these areas will be expected to take more advanced courses at a later date.

1. X-ray production (2 hours)
   Basic principles; electromagnetic spectrum; properties of X-rays; wavelength, energy, inverse square law; quantum effects, the Planck constant; excitation and ionisation; the X-ray spectrum (continuous and line spectra), factors affecting the X-ray spectrum (distinction between quantity and quality); design of a rotating anode X-ray tube; spatial distribution of X-rays (heel effect), automatic exposure control; thermal rating factors; high performance generators; quality assurance of basic X-ray sets.
    
2. Interaction of X-rays with matter (3 hours)
   Attenuation, scatter and absorption; coherent, Compton and photoelectric interaction processes; practical consequences including linear attenuation coefficient, half value thickness, tenth value thickness; broad beam and narrow beam attenuation, principles of filtration and beam hardening; absorption edges.
    
3. The image receptor (2 hours)
   Fluorescence, phosphorescence and thermoluminescence; photostimulable phosphors; X-ray film construction, characteristic curve, optical density, speed and latitude, film gamma, film screen combinations; image intensifiers; TV camera, fluoroscopy (pulsed output, image retention, noise reduction, automatic dose control); quality control of recording media and image intensifiers.
    
4. The radiological image (3 hours)
   Contrast; scatter and grids; resolution and unsharpness (focal spot size, movement); geometrical factors affecting unsharpness; assessment of image quality, response of the visual system inter-relationship of object size, contrast and perception; methods of enhancing contrast.
    
5. Radiation doses and dose reduction (3 hours)
   Absorbed dose, the Gray; principles of radiation dosimetry (ionisation chambers, dose area product meters, thermoluminescent dosimetry); Geiger-Müller tubes and other radiation detectors; mass absorption coefficient; entrance dose, exit dose, organ dose, measurement of patient doses; standard exposure criteria for radiographic examinations; typical entrance doses in radiological examinations; methods of dose reduction.
    
6. Special radiographic techniques (11 hour)
   Mobile units; high voltage radiography; macro-radiography; mammography (spectrum, filtration, special quality assurance considerations).
    
7. Digital radiology (2 hours)
   Binary numbers; formation of digital images; data manipulation; signal to noise ratio; quantum noise; subtraction radiography; flow imaging; digital mammography; multimodel image registration-, artefacts.
    
8. Radionuclide imaging (4 hours)
   Structure of the atom; binding energy of electrons; radioactivity and radionuclides; alpha, beta and gamma radiation; exponential decay, half life; units of activity, specific activity.
   
   Scintillation crystals, collimation, scatter control, the gamma camera; properties of radionuclides and radiopharmaceuticals for imaging; radionuclide generators; factors affecting the quality of radionuclide images; dynamic investigations.
    
9. Tomographic imaging with ionising radiation (3 hours)
   Longitudinal tomography; principles of computed axial transmission tomography, data collection and reconstruction, practical aspects (operator controlled variables), contrast detection limit and dynamic range, artefacts, patient doses; spiral CT; quality control; introduction to SPECT and PET.
    
10. Radiobiology and risk (4 hours)
    Stochastic and deterministic effects of radiation; evidence for radiation induced cancer in humans; linear energy transfer; relative biological effectiveness, radiation weighting factors, equivalent dose and the Sievert; tissue weighting factors and effective dose; mutagenesis; current risk factors and typical risk estimates; typical effective doses, and risk calculations; hazard from ingested radioactivity; special high risk situations.
     
11. Practical radiation protection (2 hours + 2 hours demonstrations)
    International Commission of Radiological Protection (ICRP) concepts of justification, optimisation and limitation; the ALARA (as low as reasonably achievable) principle; International Basic Safety Standards and European Directives, statutory responsibilities, relevant legislation and Codes of Practice, statutory dose limits; controlled and supervised areas, staff classification; general radiation protection procedures; special situations (fluoroscopy, CT, paediatric radiology, X-rays during pregnancy, mobile units, dental radiology, nuclear medicine); annual limit on intake; personal dosimetry; room planning for X-rays and unsealed sources.
     
12. Principles of ultrasonic imaging (4 hours)
    Basic components of an ultrasound system; types of transducer, production of ultrasound, operator controlled variables; frequencies of medical ultrasound, characterisation of ultrasound beam intensity, temporal and spatial peak and average values, interaction of ultrasound with tissue, biological effects; basic principles of A,B,M, real time and duplex scanning; basic principles of continuous wave, pulsed and colour Doppler ultrasound; common artefacts.
     
13. Principles of magnetic resonance imaging (5 hours)
    Basic principles of origin of signal; concepts of proton density, T1, T2; field gradients and the image forming process; basic imaging sequences (spin echo, inversion recovery, gradient echo); effect of contrast agents and motion; possible hazards to patients, staff and other persons.

Information: Dr. P. P Dendy <philip.dendy@mail.com>

Last update: 2001-03-19