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The atoms in the anode of an X-ray tube are ionized by an incoming beam of high energy electrons. Those electrons streamed off the cathode and were accelerated by the high voltage across the tube's elements. The high energy electron beam slams into the specially alloyed anode and ionizes the atoms there. The ionized atoms have their outer electrons torn out to very high energy levels, and when they de-ionize, they do so by emitting a high energy photon - an X-ray. The anode gets hot as heck, too.

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Q: How are atoms in an X-ray tube anode ionized?
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