MODULE 6 Radiographic exposures Aim “To provide sufficient knowledge of exposure selection and manipulation, to enable accurate selection of ex ‘osures in order to produce mavimum information on ‘the resuitant radiographs. Objectives (n completion of this module the student wil 1m Understand the effect each exposure factor has on the resultant radiograph, Be able to use this knowledge effects, 1 Be able to select the correct exposure factors require. 18 Understand and use the step system of exposure caleultion 18 Beable tomanipulate exposure factors using the step sytem. 1 Ge abe to establish and maintain a reliable exposure chart. 18 Be able to modty an existing exposure chart, ‘Strictly speaking the term, “exposure” refers to the ‘quantity of radiation to which the patent is exposed. In practical radiography we tend to talk of *expo- sure’ as the collective exposure factors, Kv, mw and time, which together wil produce the radiation expo- sure that wil gve the required penetration density and contrast onthe radiograph. “Ther are several other factors, which influence flm ‘quality but here we will only consider KY, mA time and FFD SID) w ‘© Controls largely the penetrating power (beter described as the quality of the beam), and to a lesser degree, te intensity of radiation and there- fore fim density and patent dose. ‘© Affects contrast. The higher the kV the lower ‘the contrast. The lower the KV the higher the contrast. ntrals the Intensity of radiation and there- fore fllm density and patient dose. The higher ‘the mf, the higher the film density and patient ose, time ‘© Controls the length of time of raciation flow, and therefore film density and patient dose The longer the exposure tme Ue higher te fm density and patient dose. {The multiple of mA and time in second. Mary modern Xray units are designed to use mAs rather than mA and time separate FFD (S10) © The greater the distance an Xray beam travels the less effective it wil be, the less dlstance it ‘travels the more effective i willbe. ‘© Exposure compensation is therefore necessary vith changes in FF (SID). For the adiographer it is important to set the correct exposure factors required to produce high quality radiograph which wil ve the maximum amount of information yet minimise the dose tothe patent. IIs important to have systems in place that will hel the radiographer ta select and manipulate expo- sure factors effectively. Exposure chart Each Xray unit should have a lst of commonly used exposures for easy reference (see Appendix B,page 168) ‘This st wil of course, be limite but will at east po vide a guide. Methods of recording exposures Written chart. Notebook ‘© Computerised “chart” within the Xray unt.Here we wil dea with: (© Establishing and modifying an exposure char, {© Manipulating exposure factors using the step system, ‘© Draw up blank exposure chart ee Fla 6-2 and Append 8, page 168. Filinallthe anatomical areas tobe covered ist- ing the views foreach Divide these into groups using the same set of Conditions. .9.allextremities using etal screen, fn grid, 100 em FFD (SID) Produce a well exposed se of radiographs of an ‘extremity, €. hand. this can be done in the course of a routine exaination.) Record the expasures used against HAND on the chart. Exposure chart 2B ‘Measure the thickness ofthe patents hand in ail projections used. e.9. PA, Obique, lateral (see Morte 2. Accessory equipment, page 41 and Appendix, page 138. HMescure thickness at the level of entry of the central ry, foreach positon of the hand, Measure ll other areasfpostions in the same ‘group (these can be obtained from a colleague octrendof similar size rat the patiend, Calculate the exposures for all ther areasiposi- tions inthe group, based on the folowing chart (patient thickness related to exposure change), Using the and as your base level than incorwenience Patent thickness related to exposure change — 1.Sem increase in thickness requires a 25% increase in exposure (41 step) S.dem inerease in thickress requires a 100% Inerease in exposure (3 steos) and | i peta oat Wrist | nae a eae oa ae Lateral | 100 - Detail ms Fig 6-1.An example of a partially completed exposure chartQUALITY ASSURANCE WORKBOOK — 50cm decrease in thickness requires a 50% decrease in exposure (-3 steps) 1.5em decrease in thickness requires a 2306 decrease in exposure -1 step) Nate: The reference to“+or—steps"Is explained below The step stem, Example ‘© PA HAND (em thick) Exposure SOKV 6 mAs. ‘© Calculate an exposure fora lateral WRIST (em ‘hick. ‘© Thickness ciference between PA HAND and Lat- cal WRIST is Sem. {© Foran increase of Sem the exposure is increased by 10096 see*Patient thikness related to expo- sure change’ figures above) ‘© Therefore the lateral WRIST exposure willbe SOKV 22s, ‘9 The exposures fr al other areas af the body can be caleulated in this way The step system “The step stem i a simple, standardised form of ex posure factor manipulation, designed to remove some of the guess work and make exposure setting more accurate. Te works ona series of step charts allowing the use of standard step changes in exposure Its also related to patient thickness (see Append ‘A, pages 135 & 136) and medical condition (see Fa 5) Fig 62.1 step chart Note: Step changes can be applied to ary one of the charts or split between the chats 19 The step system provides step charts fork, mf, rs, time and FFD (SID), (se Fig 6-2, Fg 6-3, Fig 6-48 Fi 6-5. 19 Touse thestep stem to make exposure changes, This necessary to talkin terms of steps. (@ Each step on any ofthe charts wl ater the ex. posure by approximately 25%. ‘© Fora noticeable change ini density tobe een, ‘the exposure must be altered by at least 25%. 1 11 film's considered tobe to ight or tao dark it wil be necessary to change one of the expo- sure factors by a east three steps un or down (ae | oe bs os a os 5 0s : 090 i 10 8 2 2 520 3 so S no 18 100 eo 1 30 aso se 33 | Seo ig 6-3. mA, mAs and time step charts. TOS ae oy Fig 6-4. FFD (SID) step chart(© Ary step change required to motity an exposure ‘an be applied to any ofthe Step Charts althoueh therfactorswl Influence tis decision (contrast, penetration, patient dose, movement, iitations ofthe Xray unt. ‘© Step changes need not be limited to one chart only. The necessary step changes can be slit up between charts if necessary proving that the ‘overall umber of required step changes s made. Example ‘© Original Exposure = 60kV 20mAs ‘© New kY = 704Y (an increase of 104”) RADIOGRAPHIC EXPOSURES \27 (© Anincrease of 10KV = three steps onthe KV step chart, (© To retain the same density fm, the mas must be reduced by the same number of steps (hee steps) on the mas chart (© New Exposure =70KV Lomas Step charts [step charts reproduced from “Course Notes in Ba sic Radiography" Radiation Protection ranch, South ‘Australian Health Commission Exposure modification for changes in conditions Patholoay Step changes suggested | ascites 2 Asthmatle Lore Bowel Obstruction sore Emaciated ° Empysema | tore "Flabby? Fat Muscular Prysique Osteaporesis Paget’s Disease Peual Efision Poeumoria Pulmonary edema Tuberculosis Plaster of pais Half torz on 8 Wet tors, Fibrelass Oorst a Upto Ratio 81,40 nesem at sokY | 45 Sereens Detal to Fast 3 Fast to Detal 3 Uoealy use mas steps) | L_ _| Nate: These step changes are a guide only You may ne suit your own conditions. modify this chart to Fig 6-5. Suggested step changes for specific changes in conditionsQUALITY ASSURANCE WORKBOOK 128 Notes[MODULE 6. RADIOGRAPHIC EXPOSURES 129 TASK 26 Radiographic exposures You have been asked to complete the exposure chart shown below 2) Calculate all other exposures onthe char, based onthe information given against DP Foot and AP Hip. ) Fl in all other relevant information Exposure chart rea, ww | mas Thickness FFD Grid | Screens ofrat | GID) Foot op 50 0 Oblique Lateral Ankle ae Oblique Lateral ‘Tibia & fibula | a? 100 Detail Later Knee a Lateral Femur (Lover 2/3) ap Lateral Hip AP 7 50 18 Lateral Pelvis AP 00 Bucky Fast Tutors comments: SatisfactoryUnsatisactory aged ITE aI I ooo SIS It Date TutorQUALITY ASSURANCE WORKBOOK 130 TASK 27 Modify an exposure chart Your department has just been supplied with rew intensifying screens and your exposure charts are no longer Accurate. Someone has worked out some exposures already and has asked you to medi the remainder. 2 Modify the following exposure chart. ©) Start by replacing the relevant exposures with the following exposures. HAND,PA SOKV mis SHOULDER,AP 65K 16mAS CHEST. PA 100 kV S mas ©) Now modi all other exposures onthe chart using the step chats 6) Enter the new exposures alongside te of ones. Exposure chart brea w mis FFD em (ID) Grid Sereen Hand Pa 50 16 100 No Detal oblique 50 20 100 No Detail Lateral 50 2 | 100 No Detail wrist PA 50 16 100 No Detal Oblique 50 20 100 No Detall Lateral 50 2 100 No Detail Forearm 1” 55 20 100 No Detal Lateral 55 25 100 No Detail Elbow 1° 3s 2 100 No Detail obique 55 2 100 No Detail Lateral 60 20 100 No Detail Humerus | 1° 60 32 100 Bucky Fast Lateral 60 22 100 Bucky Fast Shoulder a 65 32 100 Bucky Fast st 65 32 100 Bucky Fast Chest PA 90 5 180 Bucky Fast Obie 90 5 120 Bucky Fast Lateral 100 5 180 Bucky FastMODULE 6, RADIOGRAPHIC EXPOSURES 31 “Tutors comments: SatisfactonyUnsatsfactory signes TutorQUALITY ASSURANCE WORKBOOK 132 TASK 28 Creating a new exposure chart ‘Yur department has just been equipped with anew X-ray unt and you have been asked to produce an exposure chart for it a) Select an Xray room. 1 Using the knowledge you have gained to date, establish a completely new exposure chart forthe Xray unit In that room © Drawupa chart and filin allrlevant information on your chart. 9, patient positions, exposure factors, std, screens, FFD SID), patient size. Submit the chart to your tutor for assessment. ‘Tutors comments Satistactony/Unsatistactory Signed Date == Tutor