LLEGEOF

RAEIRAPHERS
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Radiography (1998) 4, 129-134

TECHNOLOGY

The relationships between kV, mAs and thickness in

film-based radiography: 25% and 15% rules. OK?

G. S. AI-Balool and D. L. Newman

Department of Radiologic Sciences,
Faculty of Allied Health Sciences and
Nursing, Kuwait University, P.O. Box
31470, Sulaibikhat 90805, Kuwait
(Received I4 April 1997; accepted
22 November I997)
Keywords: exposure factors;
selection; 25% rule; I5% rule.
Purpose: To investigate the validity of the 25% and 15% rules in manual exposure
selection.
Methods: The mAs required to produce a constant film density of 1.5 was determined
over the X-ray tube potential range 50-150 kV for different thicknesses of water, under
grid and no grid conditions.
Results: The mAs change is an exponential function with depth and is dependent upon
the attenuation coefficient. The 25% rule assumes a constant attenuation coefficient
with a half value layer (HVL) equal to 3 cm. The results indicate that for non-grid work
at low X-ray tube potentials and for grid work at higher tube potentials the 25% rule
is applicable. The i5% rule implies an inverse power relationship between mAs and
tube potential, the power term being 5. The results indicate that for both grid and no
grid conditions the I5% rule is obeyed only over the tube potential range 50-100 kV
and for thicknesses up to 15 cm.
Discussion: The 25% and I5% rules have provided useful practical guidelines for
exposure factor selection. It is shown that they are applicable to some but not all
radiographic situations.

Introduction change is proportional to e ±~x where ~ is the

In manual exposure procedures, the selection of the
appropriate X-ray output that provides a given
level of film blackening involves a number of
equipment dependent variables and the transmis-
sion characteristics of the patient. However, this
choice of exposure factors often appears to be more
art than science, with selections made not on any
scientific principles but by empirical rules arrived at
by experience,
In the past, attempts have been made to provide
such a scientifically based exposure selection sys-
tem. In fixed kV techniques, the 25% rule is widely
applied [1, 2]. This states that for every I cm
change in patient thickness a 25% mAs change is
required. This rule derives from the exponential
attenuation relationship in that the required mAs
1078-8174/98/020129 + 06 $18.00
attenuation coefficient and x the thickness, the sign
depending on whether an increase or decrease in
mAs is required, i.e. whether there is an increase or
decrease in patient thickness. Therefore, as the
thickness changes the mAs needs to be changed
exponentially to maintain constant film blackening.
For the 25% per cm rule to apply over the whole
range of diagnostic tube potentials,/a is assumed to
remain constant and equal to 0.23I c m - ~ i.e. a half
value layer (HVL) for soft tissue of 3 cm. This, of
course is a simplification since 1~and hence HVL are
energy dependent. However, the mAs stations
on many X-ray units today follow this rule in that
each consecutive mAs step represents a change of
25%. Thus, in fixed kV techniques, thickness
changes can be compensated by appropriate step
changes in mAs.
© 1998 The College of Radiographers
130
In variable kV techniques the situation is not as
straightforward because there are a number of kV
dependent changes that take place when the tube
potential is varied. These include changes in tube
output, X-ray attenuation (absorption and scatter)
and film screen speed. At a given patient thickness,
adjustment of the tube potential requires a compen-
satory adjustment in mAs so that the resultant
exposure produces the same level of film blacken-
ing. The so-called 15% rule [3-6] has been used as
a guide to the change in mAs that is required. This
rule states that to achieve the same film blackening,
a 15% change in kV requires a compensatory
change in mAs of a factor of 2. If an inverse power
relationship exists between mAs and tube poten-
tial, this rule assumes that the power term is 5,
since 1.15s=2, i.e. mAscz kV -5. This rule results
from the relationships between mAs and tube
potential in determining X-ray output, attenuation
and film screen response. With the introduction of
high frequency generators and energy-dependent
intensifying screens it is possible that these rela-
tionships have changed and hence the rules may
now not be applicable or at least need to be
amended. As a result, an investigation was under-
taken using a high frequency kV generator and a
rare earth intensifying screen in order to determine
the relationship between the mAs and tube poten-
tial for a constant level of film blackening at
different depths of water to simulate varying
patient thickness.
Materials and methods
To simulate patient thickness, a plastic bucket
containing different depths of water was used. The
bucket was placed on a cassette containing two
Kodak Lanex regular screens and T-Mat G film.
The field size was 20 x 20 cm 2 at the level of the
cassette and the focus film distance was 100 cm.
The X-ray beam was generated by a high
frequency Advantx unit (GE Medical Systems)
operated over the range 50-150 kVp in steps of
10 kV. The inherent filtration of the tube was
0.5 mm A1 equivalent and the added filter was
2.5 mm A1.
At a given tube potential and for water depths
of 5 to 25 cm increments, a mAs was selected
which gave an optical density on the film of
1.5 4- 0.05. The film was processed using a Kodak
RP X-Omat, model M6B processor operating at
35°C and a cycle time of 90 s. This procedure was
AI-Balool and Newman
performed with and without a grid. The grid
(specifications: parallel, grid ratio i2:1, grid fre-
quency 40 lines cm, aluminium interspace material)
was placed directly under the bucket. It should be
noted that, particularly for the no-grid condition at
small depths and high tube potential, it was not
possible to obtain some of the required mAs values
as they were less than the lowest mAs station
available on the unit (0.25 mAs).
Results
In qualitative terms, these investigations provided
the expected results. It was found, as would be
expected, that at a given depth in order to achieve
the same film blackening an increase in tube poten-
tial requires a reduction in mAs, and at a given tube
potential as the depth of water increases an increase
in mAs is required.
To examine the quantitative relationship
between mAs and water depth, at each tube
potential, the mAs required at each depth, d was
normalized to the mAs value at d = 25 cm, and this
mAs ratio (i.e. mAsd/mAs2s) plotted on a logarith-
mic scale against depth (Fig. l(a) and (b)). To avoid
an excessive number of data points, the kV sets are
plotted in 20 kV steps over the range 50-150 kV.
Also shown in the figure is the variation of mAs
ratio with depth assuming the 25% rule applies.
The linear relationships between log m A s J
mAsas and water depth indicate that the expected
exponential relationship exists between mAs and
depth under both grid and no-grid conditions. As
indicated in the figure, when the 25% rule applies a
depth change of 25 cm to 5 cm requires a hundred-
fold change in mAs to maintain a constant film
density. It may be seen that for the no-grid
condition this occurs only at the low end of the
tube potential range. Under grid conditions, it is
the higher tube potentials which appear to obey
the rule.
It might be anticipated that mAs and tube
potential are related by an inverse power law. i.e.
mAscz k V - n. If so, there will be a linear relation-
ship between log mAs and log kV with a negative
gradient equal to n. Consequently mAs and tube
potential were plotted on logarithmic scales at each
water depth (Fig. 2(a) and (b)). It may be seen that
the gradient of these curves gradually decreases
with increasing tube potential, implying a gradual
reduction in the power term, n. There is a more
distinct change of slope at 100 kV and therefore we
kV, mAs, thickness relationships 131

o
0.1

o.o1!

0.001 I ± I I
5 10 15 20 25
Depth (cm)

1 --

0.1

°°1 t

0.001 I I I I
5 10 15 20 25
Depth (cm)
Figure 1. The variation of the mAs ratio (mAsd/mAszs) with depth of water at different tube potentials for non-grid (a) and
grid (b) conditions. The mAs ratio required by the 25% rule is represented by a broken line. • =50; [] = 70; I~ =90;
C>=110; A = 1 3 0 ; G = I 5 0 .

have approximated the relationship to being linear,
with a gradient of nx between 50 to 100 kV and a
gradient of n z from i00 to I50 kV. The gradients
n 1 and n 2 were calculated and are shown plotted at
each depth in Fig. 3. It may be seen that the power
terms are not substantially affected by the presence
or absence of a grid, over the range of depths used
in these measurements. At depths up to 15 cm, nx
~ 5 , the value to be expected from the 15% rule.
At greater depths, nx increases to 6.5, in which case
a 10% rule would be more applicable. Over the
range 100-150 kV, n z is unaffected by depth and
has a mean value of 3.38, and hence a 20% rule
would be more applicable.
Discussion
The 25% and 15% rules used as guides for the
adjustment of mAs and kV have been established
empirically. In this paper, an attempt has been
made to examine the validity of these rules using a
water phantom as a simulation.
The 25% rule is based on the exponential
attenuation law and assumes that over the full
range of diagnostic tube potentials the attenuation
coefficient g is a constant with a half value
layer = 3 cm in soft tissue. It may be seen from the
results above that the 25% rule is applicable only at
low tube potentials under non-grid conditions, and
only at high tube potentials with a grid. This may
be explained by the effect of scatter on the
transmission characteristics of the X-ray beam.
Table 1 shows the half value layers for water
determined with and without the grid present. The
half value layers were obtained by measurement of
the reduction in the transmitted exposure dose
over the depth range 0-25 cm using an ionisation
chamber (Victoreen 660 with 3.2 c m 3 chamber)
132 AI-Balool and Newman

10 000 10 000
(a) (b)

1000 1000
o

o
A
100 x 100 X
o
o

[] •
X
X O 0

x 0
O • 0
10 [] • 10 ~1, [] x 0
X O O
• x O
O [] •
[] X • x
• o • x
x o []
• x
[] o
• x 0 [] • ×
X
D& x O
1 I [] A
• x 4 •
~, [] • x []
x []
• X
4, []
4' []

0.1 I r , , , I 0.1 I _ , , , ~ I
50 100 200 50 100 200
kV kV

F i g u r e 2. T h e l o g - l o g r e l a t i o n s h i p b e t w e e n m A s a n d t u b e p o t e n t i a l at w a t e r d e p t h s 5 - 2 5 crn for n o n - g r i d (a) a n d g r i d (b)

c o n d i t i o n s . • = 5 cm; ~ = 10 cm; • = 15 cm; x = 2 0 cm; C) = 2 5 cm.

placed underneath the bucket at the same level as patient thicknesses, whilst grids would be used at
the film-screen cassette. It was found that the higher tube potentials to radiograph thicker body
attenuation was monoexponential and hence parts.
the HVL was a constant over the depth range The 15% rule is based on the inverse power
of the experiment. It may be seen that with relationship between mAs and tube potential
scatter present (no grid), the 3 cm HVL condition where the power term is 5, i.e. mAsa k V - s . The
will only apply at low tube potential. When results of this study suggest that at tube potentials
scatter is reduced by a grid, the HVLs decrease below I00 kV the I5% rule applies only for patient
and hence the 3 cm HVL condition is more thicknesses below I5 cm. For greater thicknesses,
closely met at higher tube potentials. In practice, the inverse power term increases and at the great-
the 25% rule will satisfy most radiographic est water depth used in this study (25 cm) it is
situations. Radiography without a grid is generally 6.5, in which case a 10% rule is a closer practical
conducted at low tube potentials for small approximation. Above I00 kV the power term was
kV, mAs, thickness relationships 133

I I I I
10 15 20 25
Depth (cm)
Figure 3. The variation of the power terms, n 1 and n 2 with depth under non-grid and grid conditions. The 15% rule
requires a power term equal to 5 and is represented as a dashed line. • =n~ no grid; [] =n~ grid; • = n 2 no grid; ~ = n 2
grid.

Table 1. The HVL of water over the range 5 0 - - i 5 0 kV which is performed at the lower end of the tube
for non-grid and grid conditions potential range. For grid work, the 15% rule will
only apply for thicknesses less than 15 cm and tube
HVL (cm) HVL (cm)
kV potentials less than 100 kV. For greater thicknesses
no grid grid
and tube potentials less than 100 kV, a lower
percentage change of i0% is required to change the
50 2.55 2.20 mAs by a factor of two. Above I00 kV, however,
70 3.65 2.50 a percentage change slightly greater than 20% is
90 4.45 2.85
required.
ii0 5.I0 3.I5
There is an alternative rule which is used by
I30 5.70 3.60
150 6.25 3.85
some practitioners for mAs adjustment in variable
kV techniques. This is the so-called i0 kV rule [7].
This states that up to 100kV a factor of two
adjustment in mAs is required for a change in tube
found to be 3.38, in which case a 20% rule would potential of I0 kV. Hence the percentage change
be more applicable. required varies from 20% to 10% over the range 50
There was no significant difference found to 100 kV. This implies an increase in the power
between the grid and no grid conditions over the term from 4 to 50 kV to 7 at 100 kV. Our results
full range of 50 to I50 kV. This would suggest that suggest that over this tube potential range the
the partial removal of scatter by the grid is not a power term does not vary to that extent and is
major factor in determining these power relation- more dependent on thickness changes.
ships. A more likely explanation is the dependence In conclusion, therefore, it can be seen that for
of screen speed upon tube potential. In the case of non-grid work the 25% and 15% rules will largely
the Lanex screen used in this study, there is a apply because it is performed at the low end of the
marked increase in their speed up to i00 kV above tube potential range when the body thicknesses are
which the speed is relatively constant. This would not large. In the case of grid work, the 25% rule is
provide an explanation for the change in slope that applicable since higher tube potentials are generally
occurs at 100 kV (Fig. 2(a) and (b)). employed. In the case of the 15% rule, it is only
To generalize in practical terms, we can say that partially applicable since the actual percentage
the I5% rule is applicable for all non-grid work change which requires a factor of two change
134
in mAs is dependent upon thickness and tube
potential. To a reasonable approximation, a I5%
rule can be used for tube potentials less than
i00 kV when the body thickness is less than i5 cm.
For greater thicknesses, a 10% rule is more appli-
cable. For tube potentials greater than 100 kV, a
20% rule should be applied. These changes to the
I5% rule result from the greater energy depen-
dence of rare earth screens. The screen used in this
study was a Kodak Lanex screen. The extent to
which the results of this study may be applied to
other rare earth screens is the subject of further
investigation.
We are aware that in current working practice
the conclusions of this study have already been
reached by empirical means; however, it is hoped
that this paper has provided some experimental
support to the relationships between tube poten-
tial, mAs and patient thickness.
AI-Balool and Newman
References
i. Kelly A. Black or whi~e?--hit or miss? The Radiographer
i988; 35: 19-26.
2. Why exposure tables with a point system? Siemens Radio-
graphic World News. Siemens, I962.
3. Carlton RR, Adler A. Principles of Radiographic Imaging.
Albany: Delmar Publishers Inc, 1992: 480-1.
4. Malot~ JC, Fodor J. The Art and Science of Medical Radiogra-
phy. 7th edn. St Louis: Mosby Year Book Inc, 1993:
i30-31.
5. Carroll QB. Radiographic Exposure, Processing and Quality
Control, 5th edn. Charles Thomas Springfield, I993: I02-6.
6. Wallace JE. Radiographic Exposure. Principles and Practice.
Philadelphia: Davis Co. 1995 92-6.
7. Chesney DN, Chesney MO. Radiographic Photography, 3rd
edn. Oxford: BlackweI1 Scientific Publications, I971: 293.