Notebook 7

What is contrast?

Contrast is a property that makes up the visible detail by the human eye that happens to be the most
technical factor due how easily affected by IR exposure it is. Image contrast is the difference between
adjacent densities/IR exposures. Contrast is any shade (in color) between white and black on an image.
When discussing contrast, dynamic range is a termed used to describe the range in color on a soft-copy
monitor for the digital images created. Window width is also a term used in processing to produce
changes in the dynamic range. All of these terms are used to be applied to a grayscale bit depth (z axis)
which is used to display the bit depth values from the exposure on the individual pixels. Describing high
contrast is as follows:

Black/white = high contrast = steep curve on D log E curve

Lots of gray or minimal color differences = low contrast = slight curve on D log E curve

Low contrast is thought to be better because it permits more information because of the greater ranges
of densities. However, high contrast can be efficient if the correct technical factors are chosen based on
the body part and body habitus of the patient. The term scale of contrast is the useful number of shades
of gray. (See table )

Contrast can be manipulated by the expansion and

compression of range in densities by changes in the D
log E curve, kVp, or window width. It creates the
difference of what can be seen by the human eye and
the contrast that was physically recorded.

Image Contrast

Image contrast is the total amount of contrast from the image receptor (IR) and anatomy part of the
patient (subject contrast). Film image receptor contrast has an optimal range that is on a D log E curve
and is dependent on 4 factors: intensifying screens, film density, and the D & E curve, and processing.
On film, intensifying screens create more contrast most likely because of the exposure of light from the
screen. In film density if the kVp is constant the curve will show that mAs and distance will determine
the value of exposure. When exposure to the film is correct, the densities will be in visible range but if it
is exposed incorrectly (toe or shoulder) the slope will not be steep and contrast will decrease. The shape
of the curve is primarily affected by the make-up of the emulsion. Increasing the developing time,

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temperature and fixing rate will make more fog on the film (decreased contrast) which creates a
decrease in slope of the curve.

Digital image receptor contrast is mainly changed through manipulating window width. Sensitivity
processing algorithms is calibrated to give a linear range of IR exposure and/or density for each image so
the radiographer has a reference point for quality imaging. When the image goes through post-
processing the LUT and histogram will affect the contrast of the final image but will provide a proper
grayscale for the image taken. Although the LUT, histogram, and grayscale assist on creating a good
image it is important that the IR gets the correct exposure by choosing the best technical factors.
Choosing proper kVp is important for differential attenuation because it is what causes signal
differences to the digital detector.

Subject contrast

Subject contrast is the range of differences in intensity after subject attenuation. It is dependent on
kilovoltage and the amount /type of radiation material. As kVp increases, a greater range of photons are
produced and greater penetration to the patient. It then leads to a wider range of exposure on the
image receptor creating lower contrast. When kVp is too low the photons are absorbed by the patient
and do no penetrate the IR creating a high contrast image. When looking at a D log E curve, you will see
that higher kVp creates a compressed graph and lower kVp
creates a wider ranged graph making the exposure fall outside of
the visible IR exposure/densities. (see table )

Using higher kVp increases Compton scatter which creates fog on

the image and contrast is decreased. Other factors that create fog
are heat on film, low ionizing radiation and chemical fumes. In the
developer the contamination and temperature can also create
fog. Just remember increased fog = decreased contrast.

The amount of irradiated material depends on the thickness of

the patient part. The bigger the body part, the more absorption
and the more scatter. This is also true for a larger field size. The type of irradiated material is based on
the atomic number of material and tissue density of patient which both influences subject contrast. The
higher the atomic number means more absorption and greater amount of electrons for interactions. For
example, if we are x-raying a forearm, the bone (high atomic number) will absorb a greater amount of x-
ray beam than the soft tissue (low atomic number) and that creates higher contrast with more densities.

Evaluating contrast

The correct technique for a radiographed body part is not the only consideration in a quality contrast
image. It is important to take into consideration that there may be pathology, abnormal physiology, or
anatomy that will affect the contrast on an image. An image contains a lot more information than the
human eye can distinguish. In other words we may only see 20 shades of gray whereas the information
attained from the image contains 3,200 shades of gray. We may not be able to focus on a certain area

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because of the nearby densities that distract what we are actually trying to see. A contrast mask is used
in this situation to help focus on the contrast in a specified area making the image areas easier to read.

Using the 15% rule is an effective way to change contrast without degrading the image contrast. A
change in contrast will not be physically seen until the kVp is changed to at least 15%. Do not repeat an
exposure unless the image is changed by at least 4-5%. The rule about changing contrast is doing so by 8
or 15 percent increments. The table below shows the acceptable values for applying the 15% rule in
relation to selected kVp.

Contrast can be determined by relating the average incident photon energy with the average inner-shell
binding energy of the subject material. For example, when you want maximum contrast for bone you
want to use the technical factors that increase photoelectric interaction. As PE interactions increase the
kVp decreases.

Factors affecting contrast

Other than kVp, the influencing factors that affect contrast are as follows: mAs, focal spot, anode heel
effect, distance, filtration, beam restriction, anatomical part, grid construction, and image receptor.

mAs: affects the exposure and densities of the IR which affect the contrast. With high mAs,
overexposure can lead to low contrast and with low mAs, underexposure also leads to low contrast.

Focal spot size: although the focal spot size does have an
effect on contrast, it is unlikely it is enough exposure to be a
visible effect on the contrast.

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Anode heel effect: changes the intensity of the x-ray beam because the
cathode side has greater intensity than the anode side. It will only affect
the contrast if the anode target angle is less than 12 degrees.

Distance: the SID will change the intensity of the x-ray beam because a
greater distance will decrease the IR exposure/density and less distance
will increase IR exposure/density. The OID is increased by the air-gap
technique which permits scatter radiation to avoid IR.

Filtration: Inherent, added, and total filtration effect contrast because they increase the effect of kVp by
changing average photon energy of the beam. Increasing the average photon energy means that more
Compton interactions occur and decreasing contrast.

Beam restriction: collimating and reducing beam field size keeps more photons from interact with the
subject/IR which reduces amount of scatter radiation and increases contrast.

Anatomical part: the amount and the type of tissue affect the IR/exposure/density and contrast of the
image. If the size of the patient part is large, the scatter will increase making the contrast decrease but
as average atomic number increases more absorption will occur resulting in increased contrast.

Grid construction: grids are used to improve contrast by removing scatter radiation which results in
increased contrast. The K factor measures how well the grid removes scatter which is dependent on the
amount of kVp used and irradiated tissue. If more scatter reaches the IR the K factor will be lower. The
formula for the K factor is as follows: K= avg. gradient with grid/avg. gradient w/o grid. Most grids have a
K factor of 1.5 and 3.5 which means their contrast is 1.5 or 3.5 better than non-grid image of the same
part.

Image receptor: the shape of the D log E curve is dependent on the composition of the film emulsion.
Light from intensifying screens create higher contrast than when film is exposed to x-rays. This is
because the amount of photons there are to interact are due to the intensity of the screen.

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 References

1. Carlton, R. R., Adler, A. M., & Frank, E. D. (2006). Principles of radiographic imaging: an art and a
science. Clifton Park, NY: Thomson Delmar Learning.
2. Retrieved April 28, 2017, from
http://whs.wsd.wednet.edu/faculty/busse/mathhomepage/busseclasses/radiationphysics/lectu
renotes/chapter6/chapter6part2.html
3. Themes, U. (2015, January 12). Projection Geometry. Retrieved April 28, 2017, from
http://pocketdentistry.com/6-projection-geometry/

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