Monday Case of the Day History: During acceptance testing of a new general radiographic room, tube output measurements differed between the small and large focal spot. Slit and pinhole camera imaging to verify the small focal spot size produced the images shown below. Author: Ryan Fisher, Ph.D. Cleveland Clinic, Cleveland, OH Physics Figure 2: Pinhole image of small focal spot The likely explanation is: A. Inadequate erasure of the CR cassette used for imaging B. Metal filings on the collimator exit window C. Current in both x-ray tube filaments D. Focal spot blooming due to high imaging technique Figure 1: Slit camera image of small focal spot

Findings: 1.The tube output per mAs for the small focal spot was found to be approximately 30% higher than for the large focal spot. 2.Slit camera images of the large focal spot appeared normal and focal spot size measurements were within tolerances. 3.Slit camera and follow up pinhole camera images of the small focal spot showed a lower intensity ghosted shadow artifact, seen in Figures 1 & 2. Measurements of the darker areas of each were within tolerances for the small focal spot size. 4.Measurements showed the ghosted shadow size corresponded to the measured size of the large focal spot Figure 2: Pinhole image of small focal spot Figure 1: Slit camera image of small focal spot Small focal spot Ghosted shadow artifact

Findings: Figure 3: SFS pinhole image with current to large focal spot shut off 5.The service engineer was consulted and the small focal spot pinhole images were repeated with the filament current to the large focal spot completely shut off, producing the image seen in Figure 3 below. 6.The tube output per mAs for the small focal spot was re-measured with the current to the large focal spot filament cut off, and results were in line with what was previously measured with the large focal spot. Figure 4: Original SFS pinhole image

Diagnosis: C. Current in both x-ray tube filaments

While inadequate erasure of a CR cassette can lead to image artifacts, it is not likely that they would correspond so well with the actual focal spot images. This choice would also not explain the tube output discrepancy between the large and small focal spots. Therefore, choice A, “inadequate erasure of the CR cassette used for imaging,” is incorrect. Focal spot blooming can lead to inaccurate focal spot size measurements to the extent that NEMA recommends testing focal spot size for general radiographic equipment at 50% of the maximum tube current rating allowed during a 0.1 sec exposure (NEMA). All images in this case were acquired with such a technique and focal spot blooming would not explain the ghosted artifacts in both the pinhole and slit camera images. Choice D, “Focal spot blooming due to high imaging technique” is also incorrect. While debris on either the x-ray tube or collimator exit window have been shown to cause inverse pinhole effect artifacts (Cowart), such a scenario would not create the ghosted line artifacts seen in the slit camera images. Thus, choice B, “metal filings on the collimator exit window,” is also incorrect. Discussion: With the small focal spot selected, the generator was still supplying enough current to the large focal spot filament to cause electron emission and subsequent x-ray production. This additional x-ray production caused the higher tube output per mAs measured with the small focal spot, as well as the ghosted shadows visible in the slit and pinhole camera images. After all current was physically cut off from the large focal spot, the output and focal spot images for the small focal spot returned to normal. Replacement of faulty generator components corrected the issue.

References/Bibliography: Cowart, RW. An investigation of the inverse pinhole camera. Thesis. University of Texas Health Science Center at Houston. Graduate School of Biomedical Sciences. Houston, TX. June pages. National Electrical Manufacturers Association. (1992). Measurement of dimensions and properties of focal spots of diagnostic x-ray tubes (NEMA XR ). Washington, D.C.: National Electrical Manufacturers Association.