Pre-Röntgen observations and research
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Example of a Crookes tube, a type of discharge tube that emitted X-rays
Before their discovery in 1895, X-rays were just a type of unidentified radiation emanating from experimental discharge tubes. They were noticed by scientists investigating cathode rays produced by such tubes, which are energetic electron beams that were first observed in 1869. Many of the early Crookes tubes (invented around 1875) undoubtedly radiated X-rays, because early researchers noticed effects that were attributable to them, as detailed below. Crookes tubes created free electrons by ionization of the residual air in the tube by a high DC voltage of anywhere between a few kilovolts and 100 kV. This voltage accelerated the electrons coming from the cathode to a high enough velocity that they created X-rays when they struck the anode or the glass wall of the tube.[4]
The earliest experimenter thought to have (unknowingly) produced X-rays was William Morgan. In 1785, he presented a paper to the Royal Society of London describing the effects of passing electrical currents through a partially evacuated glass tube, producing a glow created by X-rays.[5][6] This work was further explored by Humphry Davy and his assistant Michael Faraday.
When Stanford University physics professor Fernando Sanford created his "electric photography", he also unknowingly generated and detected X-rays. From 1886 to 1888, he studied in the Hermann von Helmholtz laboratory in Berlin, where he became familiar with the cathode rays generated in vacuum tubes when a voltage was applied across separate electrodes, as previously studied by Heinrich Hertz and Philipp Lenard. His letter of 6 January 1893 (describing his discovery as "electric photography") to the Physical Review was duly published and an article entitled Without Lens or Light, Photographs Taken With Plate and Object in Darkness appeared in the San Francisco Examiner.[7]
Starting in 1888, Philipp Lenard conducted experiments to see whether cathode rays could pass out of the Crookes tube into the air. He built a Crookes tube with a "window" at the end made of thin aluminium, facing the cathode so the cathode rays would strike it (later called a "Lenard tube"). He found that something came through, that would expose photographic plates and cause fluorescence. He measured the penetrating power of these rays through various materials. It has been suggested that at least some of these "Lenard rays" were actually X-rays.[8]
In 1889, Ivan Puluj, a lecturer in experimental physics at the Prague Polytechnic who since 1877 had been constructing various designs of gas-filled tubes to investigate their properties, published a paper on how sealed photographic plates became dark when exposed to the emanations from the tubes.[9]
Helmholtz formulated mathematical equations for X-rays. He postulated a dispersion theory before Röntgen made his discovery and announcement. He based it on the electromagnetic theory of light.[10][full citation needed] However, he did not work with actual X-rays.
In 1894, Nikola Tesla noticed damaged film in his lab that seemed to be associated with Crookes tube experiments and began investigating this invisible, radiant energy.[11][12] After Röntgen identified the X-ray, Tesla began making X-ray images of his own using high voltages and tubes of his own design,[13] as well as Crookes tubes.
Discovery by Röntgen
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Wilhelm Röntgen
On 8 November 1895, German physics professor Wilhelm Röntgen stumbled on X-rays while experimenting with Lenard tubes and Crookes tubes and began studying them. He wrote an initial report "On a new kind of ray: A preliminary communication" and on 28 December 1895, submitted it to Würzburg's Physical-Medical Society journal.[14] This was the first paper written on X-rays. Röntgen referred to the radiation as "X", to indicate that it was an unknown type of radiation. Some early texts refer to them as Chi-rays, having interpreted "X" as the uppercase Greek letter Chi, Χ.[15][16][17] The name X-rays stuck, although (over Röntgen's great objections) many of his colleagues suggested calling them Röntgen rays. They are still referred to as such in many languages, including German, Hungarian, Ukrainian, Danish, Polish, Czech, Bulgarian, Swedish, Finnish, Portuguese, Estonian, Slovak, Slovenian, Turkish, Russian, Latvian, Lithuanian, Albanian, Japanese, Dutch, Georgian, Hebrew, Icelandic, and Norwegian. Röntgen received the first Nobel Prize in Physics for his discovery.[18]
There are conflicting accounts of his discovery because Röntgen had his lab notes burned after his death, but this is a likely reconstruction by his biographers:[19][20] Röntgen was investigating cathode rays from a Crookes tube which he had wrapped in black cardboard so that the visible light from the tube would not interfere, using a fluorescent screen painted with barium platinocyanide. He noticed a faint green glow from the screen, about 1 meter (3.3 ft) away. Röntgen realized some invisible rays coming from the tube were passing through the cardboard to make the screen glow. He found they could also pass through books and papers on his desk. Röntgen threw himself into investigating these unknown rays systematically. Two months after his initial discovery, he published his paper.[21]
Hand mit Ringen (Hand with Rings): print of Wilhelm Röntgen's first "medical" X-ray, of his wife's hand, taken on 22 December 1895 and presented to Ludwig Zehnder of the Physik Institut, University of Freiburg, on 1 January 1896[22][23]
Röntgen discovered their medical use when he made a picture of his wife's hand on a photographic plate formed due to X-rays. The photograph of his wife's hand was the first photograph of a human body part using X-rays. When she saw the picture, she said "I have seen my death."[24]
The discovery of X-rays generated significant interest. Röntgen's biographer Otto Glasser estimated that, in 1896 alone, as many as 49 essays and 1044 articles about the new rays were published.[25] This was probably a conservative estimate, if one considers that nearly every paper around the world extensively reported about the new discovery, with a magazine such as Science dedicating as many as 23 articles to it in that year alone.[26] Sensationalist reactions to the new discovery included publications linking the new kind of rays to occult and paranormal theories, such as telepathy.[27][28]
Advances in radiology
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Taking an X-ray image with early Crookes tube apparatus, late 1800s. The Crookes tube is visible in center. The standing man is viewing his hand with a fluoroscope screen. The seated man is taking a radiograph of his hand by placing it on a photographic plate. No precautions against radiation exposure are taken; its hazards were not known at the time.
Surgical removal of a bullet whose location was diagnosed with X-rays (see inset) in 1897
Röntgen immediately noticed X-rays could have medical applications. Along with his 28 December Physical-Medical Society submission, he sent a letter to physicians he knew around Europe (1 January 1896).[29] News (and the creation of "shadowgrams") spread rapidly with Scottish electrical engineer Alan Archibald Campbell-Swinton being the first after Röntgen to create an X-ray (of a hand). Through February, there were 46 experimenters taking up the technique in North America alone.[29]
The first use of X-rays under clinical conditions was by John Hall-Edwards in Birmingham, England on 11 January 1896, when he radiographed a needle stuck in the hand of an associate. On 14 February 1896, Hall-Edwards was also the first to use X-rays in a surgical operation.[30]
Images by James Green, from "Sciagraphs of British Batrachians and Reptiles" (1897), featuring (from left) Rana esculenta (now Pelophylax lessonae), Lacerta vivipara (now Zootoca vivipara), and Lacerta agilis
In early 1896, several weeks after Röntgen's discovery, Ivan Romanovich Tarkhanov irradiated frogs and insects with X-rays, concluding that the rays "not only photograph, but also affect the living function".[31] At around the same time, the zoological illustrator James Green began to use X-rays to examine fragile specimens. George Albert Boulenger first mentioned this work in a paper he delivered before the Zoological Society of London in May 1896. The book Sciagraphs of British Batrachians and Reptiles (sciagraph is an obsolete name for an X-ray photograph), by Green and James H. Gardiner, with a foreword by Boulenger, was published in 1897.[32][33]
The first medical X-ray made in the United States was obtained using a discharge tube of Puluj's design. In January 1896, on reading of Röntgen's discovery, Frank Austin of Dartmouth College tested all of the discharge tubes in the physics laboratory and found that only the Puluj tube produced X-rays. This was a result of Puluj's inclusion of an oblique "target" of mica, used for holding samples of fluorescent material, within the tube. On 3 February 1896, Gilman Frost, professor of medicine at the college, and his brother Edwin Frost, professor of physics, exposed the wrist of Eddie McCarthy, whom Gilman had treated some weeks earlier for a fracture, to the X-rays and collected the resulting image of the broken bone on gelatin photographic plates obtained from Howard Langill, a local photographer also interested in Röntgen's work.[34]
1896 plaque published in "Nouvelle Iconographie de la Salpetrière", a medical journal. In the left a hand deformity, in the right same hand seen using radiography. The authors named the technique Röntgen photography.
Many experimenters, including Röntgen himself in his original experiments, came up with methods to view X-ray images "live" using some form of luminescent screen.[29] Röntgen used a screen coated with barium platinocyanide. On 5 February 1896, live imaging devices were developed by both Italian scientist Enrico Salvioni (his "cryptoscope") and William Francis Magie of Princeton University (his "Skiascope"), both using barium platinocyanide. American inventor Thomas Edison started research soon after Röntgen's discovery and investigated materials' ability to fluoresce when exposed to X-rays, finding that calcium tungstate was the most effective substance. In May 1896, he developed the first mass-produced live imaging device, his "Vitascope", later called the fluoroscope, which became the standard for medical X-ray examinations.[29] Edison dropped X-ray research around 1903, before the death of Clarence Madison Dally, one of his glassblowers. Dally had a habit of testing X-ray tubes on his own hands, developing a cancer in them so tenacious that both arms were amputated in a futile attempt to save his life; in 1904, he became the first known death attributed to X-ray exposure.[29] During the time the fluoroscope was being developed, Serbian American physicist Mihajlo Pupin, using a calcium tungstate screen developed by Edison, found that using a fluorescent screen decreased the exposure time it took to create an X-ray for medical imaging from an hour to a few minutes.[35][29]
In 1901, U.S. President William McKinley was shot twice in an assassination attempt while attending the Pan American Exposition in Buffalo, New York. While one bullet only grazed his sternum, another had lodged somewhere deep inside his abdomen and could not be found. A worried McKinley aide sent word to inventor Thomas Edison to rush an X-ray machine to Buffalo to find the stray bullet. It arrived but was not used. While the shooting itself had not been lethal, gangrene had developed along the path of the bullet, and McKinley died of septic shock due to bacterial infection six days later.[36]
With the widespread experimentation with X‑rays after their discovery in 1895 by scientists, physicians, and inventors came many stories of burns, hair loss, and worse in technical journals of the time. In February 1896, Professor John Daniel and William Lofland Dudley of Vanderbilt University reported hair loss after Dudley was X-rayed. A child who had been shot in the head was brought to the Vanderbilt laboratory in 1896. Before trying to find the bullet, an experiment was attempted, for which Dudley "with his characteristic devotion to science"[37][38][39] volunteered. Daniel reported that 21 days after taking a picture of Dudley's skull (with an exposure time of one hour), he noticed a bald spot 5 centimeters (2 in) in diameter on the part of his head nearest the X-ray tube: "A plate holder with the plates towards the side of the skull was fastened and a coin placed between the skull and the head. The tube was fastened at the other side at a distance of one-half-inch [1.3 cm] from the hair."[40] Beyond burns, hair loss, and cancer, X-rays can be linked to infertility in males based on the amount of radiation used.
In August 1896, H. D. Hawks, a graduate of Columbia College, suffered severe hand and chest burns from an X-ray demonstration. It was reported in Electrical Review and led to many other reports of problems associated with X-rays being sent in to the publication.[41] Many experimenters including Elihu Thomson at Edison's lab, William J. Morton, and Nikola Tesla also reported burns. Elihu Thomson deliberately exposed a finger to an X-ray tube over a period of time and suffered pain, swelling, and blistering.[42] Other effects were sometimes blamed for the damage including ultraviolet rays and (according to Tesla) ozone.[11] Many physicians claimed there were no effects from X-ray exposure at all.[42] On 3 August 1905, in San Francisco, California, Elizabeth Fleischman, an American X-ray pioneer, died from complications as a result of her work with X-rays.[43][44][45]
Hall-Edwards developed a cancer (then called X-ray dermatitis) sufficiently advanced by 1904 to cause him to write papers and give public addresses on the dangers of X-rays. His left arm had to be amputated at the elbow in 1908,[46][47] and four fingers on his right arm soon thereafter, leaving only a thumb. He died of cancer in 1926. His left hand is kept at Birmingham University.
20th century and beyond
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A patient being examined with a thoracic fluoroscope in 1940, which displayed continuous moving images. This image was used to argue that radiation exposure during the X-ray procedure would be negligible.
The many applications of X-rays immediately generated enormous interest. Workshops began making specialized versions of Crookes tubes for generating X-rays and these first-generation cold cathode or Crookes X-ray tubes were used until about 1920.
A typical early 20th-century medical X-ray system consisted of a Ruhmkorff coil connected to a cold cathode Crookes X-ray tube. A spark gap was typically connected to the high voltage side in parallel to the tube and used for diagnostic purposes.[48] The spark gap allowed detecting the polarity of the sparks, measuring voltage by the length of the sparks thus determining the "hardness" of the vacuum of the tube, and it provided a load in the event the X-ray tube was disconnected. To detect the hardness of the tube, the spark gap was initially opened to the widest setting. While the coil was operating, the operator reduced the gap until sparks began to appear. A tube in which the spark gap began to spark at around 6.4 centimeters (2.5 in) was considered soft (low vacuum) and suitable for thin body parts such as hands and arms. A 13-centimeter (5 in) spark indicated the tube was suitable for shoulders and knees. An 18-to-23-centimeter (7 to 9 in) spark would indicate a higher vacuum suitable for imaging the abdomen of larger individuals. Since the spark gap was connected in parallel to the tube, the spark gap had to be opened until the sparking ceased to operate the tube for imaging. Exposure time for photographic plates was around half a minute for a hand to a couple of minutes for a thorax. The plates may have a small addition of fluorescent salt to reduce exposure times.[48]
Crookes tubes were unreliable. They had to contain a small quantity of gas (invariably air) as a current will not flow in such a tube if they are fully evacuated. However, as time passed, the X-rays caused the glass to absorb the gas, causing the tube to generate "harder" X-rays until it soon stopped operating. Larger and more frequently used tubes were provided with devices for restoring the air, known as "softeners". These often took the form of a small side tube that contained a small piece of mica, a mineral that traps relatively large quantities of air within its structure. A small electrical heater heated the mica, causing it to release a small amount of air, thus restoring the tube's efficiency. However, the mica had a limited life, and the restoration process was difficult to control.
In 1904, John Ambrose Fleming invented the thermionic diode, the first kind of vacuum tube. This used a hot cathode that caused an electric current to flow in a vacuum. This idea was quickly applied to X-ray tubes, and hence heated-cathode X-ray tubes, called "Coolidge tubes", completely replaced the troublesome cold cathode tubes by about 1920.
In about 1906, the physicist Charles Barkla discovered that X-rays could be scattered by gases, and that each element had a characteristic X-ray spectrum. He won the 1917 Nobel Prize in Physics for this discovery.
In 1912, Max von Laue, Paul Knipping, and Walter Friedrich first observed the diffraction of X-rays by crystals. This discovery, along with the early work of Paul Peter Ewald, William Henry Bragg, and William Lawrence Bragg, gave birth to the field of X-ray crystallography.[49]
In 1913, Henry Moseley performed crystallography experiments with X-rays emanating from various metals and formulated Moseley's law which relates the frequency of the X-rays to the atomic number of the metal.
The Coolidge X-ray tube was invented the same year by William D. Coolidge. It made possible the continuous emissions of X-rays. Modern X-ray tubes are based on this design, often employing the use of rotating targets which allow for significantly higher heat dissipation than static targets, further allowing higher quantity X-ray output for use in high-powered applications such as rotational CT scanners.
Chandra's image of the galaxy cluster Abell 2125 reveals a complex of several massive multimillion-degree-Celsius gas clouds in the process of merging.
The use of X-rays for medical purposes (which developed into the field of radiation therapy) was pioneered by Major John Hall-Edwards in Birmingham, England. Then in 1908, he had to have his left arm amputated because of the spread of X-ray dermatitis on his arm.[50]
Medical science also used the motion picture to study human physiology. In 1913, a motion picture was made in Detroit showing a hard-boiled egg inside a human stomach. This early X-ray movie was recorded at a rate of one still image every four seconds.[51] Dr Lewis Gregory Cole of New York was a pioneer of the technique, which he called "serial radiography".[52][53] In 1918, X-rays were used in association with motion picture cameras to capture the human skeleton in motion.[54][55][56] In 1920, it was used to record the movements of tongue and teeth in the study of languages by the Institute of Phonetics in England.[57]
In 1914, Marie Curie developed radiological cars to support soldiers injured in World War I. The cars would allow for rapid X-ray imaging of wounded soldiers so battlefield surgeons could quickly and more accurately operate.[58]
From the early 1920s through to the 1950s, X-ray machines were developed to assist in the fitting of shoes[59] and were sold to commercial shoe stores.[60][61][62] Concerns regarding the impact of frequent or poorly controlled use were expressed in the 1950s,[63][64] leading to the practice's eventual end that decade.[65]
The X-ray microscope was developed during the 1950s.
The Chandra X-ray Observatory, launched on 23 July 1999, has been allowing the exploration of the very violent processes in the universe that produce X-rays. Unlike visible light, which gives a relatively stable view of the universe, the X-ray universe is unstable. It features stars being torn apart by black holes, galactic collisions, and novae, and neutron stars that build up layers of plasma that then explode into space.
Phase-contrast X-ray image of a spider
An X-ray laser device was proposed as part of the Reagan Administration's Strategic Defense Initiative in the 1980s, but the only test of the device (a sort of laser "blaster" or death ray, powered by a thermonuclear explosion) gave inconclusive results. For technical and political reasons, the overall project (including the X-ray laser) was defunded (though was later revived by the second Bush Administration as National Missile Defense using different technologies).
Phase-contrast X-ray imaging refers to a variety of techniques that use phase information of an X-ray beam to form the image. Due to its good sensitivity to density differences, it is especially useful for imaging soft tissues. It has become an important method for visualizing cellular and histological structures in a wide range of biological and medical studies. There are several technologies being used for X-ray phase-contrast imaging, all using different principles to convert phase variations in the X-rays emerging from an object into intensity variations.[66][67] These include propagation-based phase contrast,[68] Talbot interferometry,[67] refraction-enhanced imaging,[69] and X-ray interferometry.[70] These methods provide higher contrast compared to normal absorption-based X-ray imaging, making it possible to distinguish from each other details that have almost similar density. A disadvantage is that these methods require more sophisticated equipment, such as synchrotron or microfocus X-ray sources, X-ray optics, and high resolution X-ray detectors.
Patient undergoing an X-ray exam in a hospital radiology room
A chest radiograph of a female patient, demonstrating a hiatal hernia
Since Röntgen's discovery that X-rays can identify bone structures, X-rays have been used for medical imaging.[98] The first medical use was less than a month after his paper on the subject.[34] Up to 2010, five billion medical imaging examinations had been conducted worldwide.[99] Radiation exposure from medical imaging in 2006 made up about 50% of total ionizing radiation exposure in the United States.[100]
Projectional radiographs
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Plain radiograph of the right knee
Projectional radiography is the practice of producing two-dimensional images using X-ray radiation. Bones contain a high concentration of calcium, which, due to its relatively high atomic number, absorbs X-rays efficiently. This reduces the amount of X-rays reaching the detector in the shadow of the bones, making them clearly visible on the radiograph. The lungs and trapped gas also show up clearly because of lower absorption compared to tissue, while differences between tissue types are harder to see.[101]
Projectional radiographs are useful in the detection of pathology of the skeletal system as well as for detecting some disease processes in soft tissue. Some notable examples are the very common chest X-ray, which can be used to identify lung diseases such as pneumonia, lung cancer, or pulmonary edema, and the abdominal x-ray, which can detect bowel (or intestinal) obstruction, free air (from visceral perforations), and free fluid (in ascites). X-rays may also be used to detect pathology such as gallstones (which are rarely radiopaque) or kidney stones which are often (but not always) visible. Traditional plain X-rays are less useful in the imaging of soft tissues such as the brain or muscle. One area where projectional radiographs are used extensively is in evaluating how an orthopedic implant, such as a knee, hip or shoulder replacement, is situated in the body with respect to the surrounding bone. This can be assessed in two dimensions from plain radiographs, or it can be assessed in three dimensions if a technique called '2D to 3D registration' is used. This technique purportedly negates projection errors associated with evaluating implant position from plain radiographs.[102]
Dental radiography is commonly used in the diagnoses of common oral problems, such as cavities.
In medical diagnostic applications, the low energy (soft) X-rays are unwanted, since they are totally absorbed by the body, increasing the radiation dose without contributing to the image. Hence, a thin metal sheet, often of aluminium, called an X-ray filter, is usually placed over the window of the X-ray tube, absorbing the low energy part in the spectrum. This is called hardening the beam since it shifts the center of the spectrum towards higher energy (or harder) X-rays.
To generate an image of the cardiovascular system, including the arteries and veins (angiography) an initial image is taken of the anatomical region of interest. A second image is then taken of the same region after an iodinated contrast agent has been injected into the blood vessels within this area. These two images are then digitally subtracted, leaving an image of only the iodinated contrast outlining the blood vessels. The radiologist or surgeon then compares the image obtained to normal anatomical images to determine whether there is any damage or blockage of the vessel.
Head CT scan (transverse plane) slice – a modern application of medical radiography
Computed tomography (CT scanning) is a medical imaging modality where tomographic images or slices of specific areas of the body are obtained from a large series of two-dimensional X-ray images taken in different directions.[103] These cross-sectional images can be combined into a three-dimensional image of the inside of the body.[104] CT scans are a quicker and more cost effective imaging modality that can be used for diagnostic and therapeutic purposes in various medical disciplines.[104]
Fluoroscopy is an imaging technique commonly used by physicians or radiation therapists to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope.[105] In its simplest form, a fluoroscope consists of an X-ray source and a fluorescent screen, between which a patient is placed. However, modern fluoroscopes couple the screen to an X-ray image intensifier and CCD video camera allowing the images to be recorded and played on a monitor. This method may use a contrast material. Examples include cardiac catheterization (to examine for coronary artery blockages) and barium swallow (to examine for esophageal disorders and swallowing disorders). As of recent, modern fluoroscopy utilizes short bursts of x-rays, rather than a continuous beam, to effectively lower radiation exposure for both the patient and operator.[105]
The use of X-rays as a treatment is known as radiation therapy and is largely used for the management (including palliation) of cancer; it requires higher radiation doses than those received for imaging alone. X-rays beams are used for treating skin cancers using lower energy X-ray beams while higher energy beams are used for treating cancers within the body such as brain, lung, prostate, and breast.[106][107]