Concepts of Radiographic Image Quality

• RADIOGRAPHIC IMAGE QUALITY is the exactness of representation of the patient's anatomy on a radiographic image.

• High-quality images are required so that radiologists can make accurate diagnoses.

• To produce high-quality images, radiographers apply knowledge of the three major interrelated categories of
radiographic quality: film factors, geometric factors, and subject factors.

• Each of these factors influences the quality of a radiographic image, and each is under the control of radiologic
technologists.

• Refers to the fidelity with which the anatomical structure that is being examined is rendered on the radiograph.

RESOLUTION

• Resolution is the ability to image two separate objects and visually distinguish one from the other.

• Spatial resolution refers to the ability to image small objects that have high subject contrast, such as a bone-soft tissue
interface, a breast microcalcification, or a calcified lung nodule.

RESOLUTION

Spatial resolution

Screen Blur

Motion Blur

Geometric Blur

CONTRAST RESOLUTION

• Contrast resolution is the ability to distinguish anatomical structures of similar subject contrast such as liver-spleen
and gray matter-white matter.

DETAIL

• Detail / Recorded detail - refer to the degree of sharpness of structural lines on a radiograph.

• Visibility of detail refers to the ability to visualize recorded detail when image contrast and optical density (OD) are
optimized.

NOISE

• Radiographic noise is the random fluctuation in the OD of the image.

NOISE CONTRAST RESOLUTION

4 COMPONENTS OF NOISE

• Film graininess refers to the distribution in size and space of silver halide grains in the emulsion.

• Structure mottle refers to the size and space distribution of phosphor of the radiographic intensifying screen.

• Film graininess and structure mottle are inherent in the screen film image receptor.

• Quantum mottle refers to the random nature by which x-rays interact with the image receptor.

-principal contributor to noise

• The use of high-mAs, low-kVp and of slower image receptors reduces quantum mottle.

SPEED

• It describes the sensitivity of film to x-rays.

RADIOGRAPHIC QUALITY RULES

• Resolution, noise, and speed are interrelated characteristics of radiographic quality.

1. Fast image receptors have high noise, and low spatial resolution and low contrast resolution.

2. High spatial resolution and high contrast resolution require low noise and slow image receptors.

3. Low noise accompanies slow image receptors with high spatial resolution and high contrast resolution.

•Organization chart of principal factors that may affect

radiographic quality.

•In general, the quality of a radiograph is directly related

to an understanding of the basic principles of x-ray physics
and the factors that affect radiographic quality.

FILM FACTORS

• The study of the relationship between the intensity of exposure of the film and the blackness after processing is called
sensitometry.

• The two principal measurements involved in sensitometry are the exposure to the film and the percentage of light
transmitted through the processed film.

CHARACTERISTIC CURVE

• H & D curve

• Hurter and Driffield

• It describes the relationship between OD and radiation exposure.

• Apparatus that are needed to construct a characteristic curve:

1. Optical step wedge / sensitometer

2. Densitometer - a device that measures OD

•Toe

–low radiation exposure level

•Straight line portion

–intermediate radiation exposure level

–the region in which a properly exposed

radiograph appears

•Shoulder

–high radiation exposure level

OPTICAL DENSITY

• The degree of blackening on the radiograph.

• It is a logarithmic function.

• has a precise numeric value that can be calculated if the level of light incident on a processed film (Io) and the level of
light transmitted through that film (It) are measured.

BASE DENSITY

• Base density is attributable to the composition of the base and the tint added to the base to make the radiograph
more pleasing to the eye. Base density has a value of approximately 0.1.

FOG DENSITY

• Fog density results from inadvertent exposure of film during storage, undesirable chemical contamination, improper
processing, and a number of other influences. Fog density on a processed radiograph should not exceed 0.1.

•Higher fog density reduces the contrast of the radiographic image.

• The useful range of OD is approximately 0.25 to 2.5.

• The most useful range of OD is highly dependent on view box illumination, the viewing conditions, and the shape of
the characteristic curve.

• Base plus fog OD has a range of approximately 0.1 to 0.3.

RECIPROCITY LAW

• The reciprocity law states that the OD on a radiograph is proportional only to the total energy imparted to the
radiographic film and independent of the time of exposure.

• Whether a radiograph is made with short exposure time or long exposure time, the reciprocity law states that the OD
will be the same if the mAs value is constant.

Contrast

• The difference in optical density.

-high contrast - radiograph that has marked differences in OD

-low contrast - the OD differences are small and are not distinct

FIGURE 10-9 This vicious guard dog is posed to demonstrate differences in contrast. A, Low contrast. B, Moderate
contrast. C, High contrast. (CourtesyButterscotch.)

• Radiographic contrast is the product of image receptor contrast and subject contrast.

• Image receptor contrast is inherent in the screen-film combination and is influenced somewhat by processing of the
film.

• Subject contrast is determined by the size, shape, and x-ray attenuating characteristics of the anatomy that is being
examined and the energy (kVp) of the x-ray beam.

AVERAGE GRADIENT

• Used to numerically specify the image receptor contrast.

• The average gradient is the slope of a straight line drawn between two points on the characteristic curve at ODs 0.25
and 2.0 above base and fog densities. This is the approximate useful range of OD on most radiographs.

•Most radiographic image receptors have an average gradient in the range of 2.5 to 3.5.

• Image receptor contrast also may be identified by gradient. The gradient is the slope of the tangent at any point on the
characteristic curve.

• Toe gradient is probably more important than average gradient for general radiography because many clinical ODs
appear in the toe region of the characteristic curve.
• Midgradient or shoulder gradient is more important for mammography.

SPEED

• Fast/high speed IR - more than 100

• Par speed - 100

• Slow/low/detail IR - less than 100

• Slow speed? less noise? more patient dose

• Fast speed? more noise? less patient dose QUESTION

• If the ODs of 0.42 and 2.17 on the characteristic curve in the preceding example correspond to LREs of 0.95 and 1.75,
what is the average gradient?

• When image receptors are replaced, a change in the mAs setting may be necessary to maintain the same OD.

• For example, if image receptor speed is doubled, the mAs must be halved. No change is required in kVp.

LATITUDE

• Latitude refers to the range of exposures over which the image receptor responds with ODs in the diagnostically useful
range.

• Latitude also can be thought of as the margin of error in technical factors. With wider latitude, mAs can vary more and
still produce a diagnostic image.

• Wide latitude- long gray scale- low contrast

• Narrow latitude- short gray scale- high contrast

FILM PROCESSING

• Proper film processing is required for optimal image receptor contrast because the degree of development has a
pronounced effect on the level of fog density and on the ODs resulting from a given exposure at a given image receptor
speed.

FILM PROCESSING

• DEVELOPMENT TIME

development time IR speed and fog

IR contrast

• DEVELOPMENT TEMP

development temperature IR speed

Fog

GEOMETRIC FACTORS

MAGNIFICATION

• All images on the radiograph are larger than the objects they represent.

• The smallest magnification possible should be maintained.

• Quantitatively, magnification is expressed by the magnification factor (MF).

• For most radiographs taken at a source to-image receptor distance (SID) of:

• 100 cm the MF is approximately 1.1

• 180 cm the MF is approximately 1.05

• The SID is standard in most radiology departments:

-180cm (72'') for chest imaging

-100cm (40") for routine examinations

-90cm (35") some special studies, such as mobile radiography and trauma radiography.

-50 to 70 cm for dedicated mammography imaging systems

Distortion

• Three conditions contribute to image distortion:

1. Object thickness

2. Object position

3. Object shape

•Object Thickness

–Thick objects are more distorted than thin objects.

–With a thick object, the OID changes measurably across the object. Consider, for instance, two rectangular structures of
different thicknesses.

•Object Position

–If the object plane and the image plane are not parallel, distortion occurs.

–Foreshortening - reduction in image size; related to the angle of inclination of the object

–Elongation - image appear longer than it really is

•Spatial distortion

–Is the misrepresentation in the image of the actual spatial relationships among objects

Focal Spot Blur

• Focal-spot blur occurs because the focal spot is not a point.

• Focal-spot blur is the most important factor for determining spatial resolution.

• If an arrowhead were positioned near the x-ray tube target, the size of the focal spot blur would be larger than that of
the effective focal spot.

• In general, the object is much closer to the image receptor; therefore, the focal-spot blur is much smaller than the
effective focal spot.

* To minimize focal-spot blur, you should use:

Focal Spot OID SID

* High-contrast objects that are smaller than the focal-spot blur normally cannot be imaged.

Heel Effect

• Described as varying radiation intensity across the x-ray field in the anode- cathode direction caused by attenuation of
x-rays in the heel of the anode.

• Another characteristic of the heel effect is unrelated to x-ray intensity but affects focal-spot blur.

• An x-ray tube said to have a 1-mm focal spot, has a smaller effective focal spot on the anode side and a larger effective
focal spot on the cathode side.

•The FSB is small on the anode side and large on the cathode side of the image.

•Images toward the cathode side of a radiograph have a higher degree of blur and poorer spatial resolution than those
to the anode side. This is clinically significant when x-ray tubes with small target angles are used at short SID’s

• This variation in focal-spot size results in variation in focal-spot blur.

• Consequently, images toward the cathode side of a radiograph have a higher degree of blur and poorer spatial
resolution than those to the anode side.

• This is clinically significant when x-ray tubes with small target angles are used at short SIDs.
• Patient Positioning for Examinations That Can Take Advantage of the Heel Effect

SUBJECT FACTORS

SUBJECT CONTRAST

• The contrast of a radiograph viewed on an illuminator is called radiographic contrast.

• Radiographic contrast is a function of image receptor contrast and subject contrast.

• In fact, radiographic contrast is simply the product of image receptor contrast and subject contrast.

PATIENT THICKNESS

•Given a standard composition, a thick body section attenuates a greater number of x-rays than does a thin body
section.

•The degree of subject contrast is directly proportional to the relative number of x-rays leaving those sections of the
body.

TISSUE MASS DENSITY

• Different sections of the body may have equal thicknesses yet different mass densities.

• Tissue mass density is an important factor that affects subject contrast.

• These materials have the same thickness and chemical composition.

• However, they have slightly different mass density from water and therefore will be imaged.

•The effect of mass density on subject contrast

EFFECTIVE ATOMIC NUMBER

• When the effective atomic number of adjacent tissues is very much different, subject contrast is very high.

• Subject contrast can be enhanced greatly by the use of contrast media. The high atomic numbers of iodine and barium
result in extremely high subject contrast. Contrast media are effective because they accentuate subject contrast through
enhanced photoelectric absorption.

OBJECT SHAPE

• This characteristic of the subject that affects subject contrast is sometimes called absorption blur.

• It reduces the spatial resolution and the contrast resolution of any anatomical structure, but it is most troublesome
during interventional procedures in which vessels with small diameters are examined.

•The shape of the anatomical structure under investigation influences its radiographic quality, not only through its
geometry but also through its contribution to subject contrast.

•Structure that has a form that coincides with the x-ray beam has maximum subject contrast

kVp

•The absolute magnitude of subject contrast, however, is greatly controlled by the kVp of operation.

•kVp also influences film contrast but not to the extent that it controls subject contrast.

•kVp is the most important influence on subject contrast.

• kVp subject contrast - Long gray scale

• kVp subject contrast - Short gray scale

Low kVp radiography has two major disadvantages:

1. As the kVp is lowered for any radiographic examination, the x-ray beam becomes less penetrating, requiring a higher
mAs to produce an acceptable range of ODs. The result is higher patient dose.

2. A radiographic technique that produces low subject contrast allows for wide latitude in exposure factors. Optimization
of radiographic technique by mAs selection is not so critical when high kVp is used.

MOTION BLUR

• Movement of the patient or the x-ray tube during exposure results in blurring of the radiographic image.

• The radiographer can reduce motion blur by carefully instructing the patient, "Take a deep breath and hold it.

Don't move."

MOTION BLUR

• Patient motion of two types may occur.

1. Voluntary motion of the limbs and muscles is controlled by immobilization.

2. Involuntary motion of the heart and lungs is controlled by short exposure time.

Use the shortest Restrict patient motion Use a large SID Use a small OID possible exposure by providing instruction time.
or using a restraining device.

TOOLS FOR IMPROVED RADIOGRAPHIC IMAGE QUALITY

PATIENT POSITIONING

• Proper patient positioning requires that the anatomical structure under investigation be placed as close to the image
receptor as is practical and that the axis of this structure should lie in a plane that is parallel to the plane of the image
receptor.

• The central ray should be incident on the center of the structure. Finally, the patient must be immobilized effectively
to minimize motion blur

IMAGE RECEPTORS

• A standard type of screen-film image receptor is used throughout a radiology department for a given type of
examination.

• In general, extremity and soft tissue radiographs are taken with fine-detail screen-film combinations.

• Most other radiographs use double-emulsion film with screens.

• The new, structured-grain x-ray films used with high-resolution intensifying screens produce exquisite images with
limited patient dose.

SELECTION OF TECHNIQUE FACTORS

• Before each examination, the radiologic technologist must select the optimum radiographic technique factors, that is,
kVp, mAs, and exposure time. Many considerations determine the value of each of these factors, and they are complexly
interrelated.

• One generalization that can be made for all radiographic exposures is that the time of exposure should be as short as
possible. Image quality is improved by short exposure times that cause reduced motion blur.

SELECTION OF TECHNIQUE FACTORS

• One of the reasons why three-phase and high-frequency generators are better than single-phase generators is that
shorter exposure times are possible with the former.