Radiographic Image Quality:

Photographic Properties
Prof. Wilmary Rivas Morales, B.S., R.T., (R) (ARRT)
RATE 1230 Principios de Exposición y procesado radiográfico
Objectives

 Define key terms.

 State important relationships.
 Define concepts of radiographic quality.
 Differentiate among optimal, diagnostic , and unacceptable radiograph.
 Define radiographic density and discuss the controlling and influencing factors.
 Define radiographic contrast and discuss the controlling and influencing factors.
 Calculate changes in mAs and kVp to adjust radiographic density.
 Discuss the importance of density and contrast in the visibility of recorded detail.
 Identify exposure technique modifications for different considerations.
Introduction

 Primary responsibility of a RT
 Evaluate images to determine whether sufficient information exists for a
diagnosis.
Requires assessment of
 Visibility of recorded detail (photographic properties)
 Sharpness of recorded detail (geometric properties)

 Radiographic quality is the combination of both, visibility and

sharpness of recorded detail.
Photographic properties (Visibility)

 Extent to which structural components of anatomy is visualized on the image.

 Detail visualized sufficiently?
 Detail maximized  optimal radiographic quality
 Detail adequate or acceptable  diagnostic radiographic quality
 Detail not adequately visualized  unacceptable
 Image must be repeated.
 Determine adjustments to improve visualization of recorded detail
 Photographic
Properties

 Visibility of recorded detail is

achieved by proper balance
of radiographic density and
contrast.
 Radiographic Insufficient
density
Optimal
density
Excessive
density
density

 Amount of overall blackness

produced on the image after
processing.
 Radiograph too light
 insufficient density
 Radiograph too dark
 excessive density
Radiographic density

 Controlling factors versus influencing factors

 Controlling  affect directly
 Influencing  affect indirectly
FACTORS AFFECTING DENSITY
Controlling factors Influencing factors
• Milliamperage • Kilovoltage
• Exposure time • Distance
• Grids
• Film-screen speed
• Collimation
• Anatomic part
• Anode heel effect
• Reciprocity law
• Generator output
• Filtration
• Film processing
  Controlling factors
 The quantity of radiation reaching the
image receptor has a primary effect on the
Radiographic amount of radiographic density produced.
Radiographic density can be increased
density or decreased by adjusting the amount
of radiation (mAs).
Increasing milliamperage or time
has the same effect on density.
Radiographic density

Overall less Overall more

Density on image Density on image
Radiographic density

 mA and time have an inverse relationship when maintaining the same

mAs
 To maintain mAs:
Increase mA and proportionally decrease time
Decrease mA and proportionally increase time
Example:
200 mA x 50 ms = 10 mAs
50 mA x 200 ms = 10 mAs
Reciprocity Law

 States that …
 “Density produced on the radiograph will be equal for any combination of
milliamperage and exposure time, as long as the product of mAs is equal.”
Radiographic density

 For repeat radiographs, mAs is adjusted by a factor of 2.

 Minimum change involves doubling or halving the mAs
 If greater adjustment needed, multiply or divide by 4, 8, and so on.
 Visible change in radiographic density requires approximately 30% change in
mAs.
Radiographic density
Influencing factors

 Kilovoltage
 kVp affects density because it determines penetrability of X ray beam
 Increasing kVp increases quantity of radiation and therefore increases radiographic density .
 Overall less Overall more
Density on image Density on image

Radiographic density: Influencing factors

kVp
Radiographic density
Influencing factors

 15% Rule
 Changing kVp 15% will have the same effect on radiographic density as
doubling the mAs
Reducing mAs 50% will have the same the same effect on density as increasing kVp 15%
Using the 15% Rule

 Using the 15% Rule

 To increase density  kVp x 1.15
 To decrease density  kVp x 0.85
 To maintain density
 When increasing kVp  kVp x 1.15, mAs/2
 When decreasing kVp  kVp x 0.85, mAs x 2
Patient Protection Alert!
kVp/mAs

 Whenever possible, higher kVp and lower mAs should be used to reduce
patient exposure.
Radiographic density
Influencing factors

 Distance
 SID (Source to Image Distance)
 Relationship between distance and X ray beam intensity is best described by the inverse
square law.
 Intensity of the X ray beam is inversely proportional to the square of the distance from the source.

 SID affects quantity of radiation reaching the image.

 SID increases  Density decreases
Inverse square
law formula
Radiographic density
Influencing factors

 Distance
 Standard SID in radiography  40”, 48”, or 72”
 Circumstances such as trauma or mobiles radiography do not allow standard distances.
 RT must determine change needed in mAs to maintain density.
 Distance
Maintenance
Formula
Radiographic density
Influencing factors

 Distance
 OID (Object to Image Distance)
 Increasing OID results in less density because of divergence of exit radiation.
 Minimize OID whenever possible.
Radiographic density
Influencing factors

 Grids
 Device placed between patient and image receptor to absorb scatter radiation exiting the patient.
 Improves radiographic quality
 Adding, removing or changing a grid requires an adjustment in mAs to maintain density.
 More efficient grid require greater increase in mAs
Radiographic density
Influencing factors

 Grids
 When a grid is added
 Correct grid factor multiplied by mAs to compensate for decreased density.
 when grid is removed
 Correct grid factor divided into mAs to compensate for increased density.
Radiographic density
Influencing factors

 Grids
 When grid ratio is changed
Radiographic density
Influencing factors

 Film screen speed

 Greater speed of film screen system results in greater amount of density.
 Increasing film screen speed requires a decrease in mAs to maintain density.
 Decreasing film screen speed requires an increase in the mAs to maintain density.
Radiographic density
Influencing factors

 Collimation
 Larger field size (decreasing collimation) increases amount of tissue irradiated
and amount of scatter radiation reaching the image receptor, which increases
density.
 Decreasing collimation (wider field size) increases density.
Radiographic density
Influencing factors

 Anatomic part
 Thickness of anatomy affects the amount of X ray beam attenuation that occurs.
 Thick anatomic part decreases density
 Thin anatomic part increases density

 For every change in part thickness of 4 to 5 cm, the RT should adjust mAs by
factor of 2.
Radiographic density
Influencing factors

 Anode heel effect

 Decrease in intensity at the anode
end could affect the uniformity of
densities on the radiographic image.
 Most visible when using
 Short SID
 Large X ray field size
Radiographic density
Influencing factors

 Generator output
 Generator must be calibrated to ensure consistency.
 Tube filtration
 Excessive or insufficient filtration may begin to affect the radiographic density.
Radiographic density
Influencing factors

 Compensating filters
 Produce more uniform radiographic density
 Require an increase in mAs to maintain overall radiographic density.
 Increase in mAs depends on part thickness and type of compensating filter.
Radiographic density
Influencing factors

 Film processing
 Has a mayor effect on both: density and contrast.
Variability in processor temperature, chemistry or film transport can adversely affect
density or contrast.
Digital imaging

 Relationship between mAs and density is not the same for digital
imaging as it is for film screen imaging.
 Exposure factors mAs, kVp and SID and their effect on the intensity of
radiation the image stays the same.
Exposure errors +/- 50% can be adjusted during digital image processing.
Exposure errors beyond +/- 50% can be adjusted, but image quality may be sacrificed and
patient overexposed.
Radiographic contrast

 Radiographic contrast – degree of

difference between adjacent densities.
 Enables differences in anatomic tissues to be
visualized.
 Can be described as high or low.
Radiographic contrast

 High contrast
 Radiograph with few densities, but great difference among
them.
 Described as short scale contrast.
Radiographic contrast

 Low contrast
 Radiograph with large number of densities but little
differences among them.
 Described as long scale contrast.
Radiographic contrast

 2 categories
 Film (image receptor) contrast –inherent properties
 Subject contrast – result of absorption characteristics of anatomy and kVp

Radiographic Contrast
Subject contrast Film (IR) contrast
kVp Film type
Tissue composition Direct exposure or intensifying screens
Contrast medium Processing conditions
Radiographic contrast

 Radiographic contrast can be evaluated best when density is adequate to visualize

density differences.
 Factors that directly affect contrast  controlling factors
 Factors that indirectly affect contrast  influencing factors
Radiographic contrast

Factors Affecting Contrast

Controlling factor Influencing factors
kVp Grids
Collimation
OID
Anatomic part
Contrast media
processing
Radiographic contrast

 Kilovoltage (kVp) or penetrating power of the X ray

beam controls the desired level of radiographic
contrast.
 High kVp creates more densities but with fewer differences
  low contrast / long scale
 Low kVp creates fewer densities but with greater
differences
  high contrast / short scale
Radiographic contrast

Less absorption
More Compton Less radiographic
Higher kVp (Photoelectric
Scattering contrast
effect)

Decreases
Decreasing Increases
Compton Reduces Fog
kVp Contrast
Scattering
Radiographic contrast

 If a repeat radiograph is necessary to increase or decrease contrast

 15% rule provides an acceptable method of adjustment.
Radiographic contrast

 Influencing factors
 Most influencing factors affect contrast by controlling scatter radiation.
Limiting scatter radiation increases radiographic contrast.
Radiographic contrast
Influencing factors

 Grids – absorb scatter radiation that exits the patient.

 Collimation – smaller field size (more collimation) decreases scatter radiation.

 OID – sufficient OID creates air gap that prevents scatter radiation form striking IR.

 Whenever the amount of scatter radiation reaching the IR is reduced, the radiographic
contrast is increased (higher contrast).
Radiographic contrast
Influencing factors

 Anatomic part – composition, thickness, and compactness affect absorption

characteristics which create range of densities (contrast).
 As anatomic thickness increases, scatter radiation increases and contrast decreases.
 Scatter radiation degrades quality because it creates fog, which decreases contrast.
Radiographic contrast
Influencing factors

 Tube filtration – increasing tube filtration increases penetrability of X rays.

 X ray beam with increased energy increases scatter radiation, which decreases contrast.
Radiographic contrast
Influencing factors

 Contrast media – used when imaging anatomic tissues that have low subject
contrast.
 Instilled by injection or ingestion

 Positive contrast agents – absorb more X rays (increase attenuation)

 Require increase in exposure factors.

 Negative contrast agents – transmit more radiation (decrease attenuation)

Digital imaging

 Altering contrast is less dependent on kVp.

 Contrast can be further manipulated on computer.

 Image receptors are more sensitive to scatter radiation than film screen receptors.
 Exposure factor modification

 It is RT responsibility to produce quality radiographs.

 Appropriate exposure factor selection
Recognize multitude of patient
Recognize multitude of equipment variations
Pediatric patients

Technical challenge

Smaller size and motion

Require lower mAs and kVp and faster exposure time.

Values recommended for children

 Skull
 Adult exposure factors can be used for patients 6 years and older because of bone density.
 Patients younger than 6 years, decrease kVp 15%.
 Chest

Chronological maturity Minimum kVp to penetrate the part

Premature 50
Infant 55
child 60
Values recommended for children

 Adapting exposure factors for children based on exposure factors for adults,
excluding chest and skull examinations

Age (in years) Exposure factor adaption

0-5 25% of mAs indicated for adults

6 - 12 50%of mAs indicated for adults

Projections and positions

 Different radiographic projections require more exposure because of increase in amount of tissue
that the primary beam must pass through.
 Eg. Oblique projections
Casts and splints

 Attenuate X rays differently.

 Pay attention to type of material and how cast or splint is used.
 Casts
 Fiberglass – no change in exposure factors
 Plaster – require an increase in exposure factors
 Splints
 Inflatable (air) – do not require increase in exposure
 Wood, aluminum, solid plastic – may require exposure factor increase if they are in the path of the
primary X ray beam
Body habitus

 General form or build of the body, including size.

 4 types
Sthenic
Hyposthenic
Hypersthenic
Asthenic
Body
habitus
 Sthenic Hyposthenic Asthenic Hypersthenic

Body habitus
Pathology

 Can alter absorption characteristics of anatomic part.

 2 categories
 Additive – increase absorption
Increase kVp
 Destructive – decrease absorption
Decrease kVp
 Pathology

Some Common Additive and

Destructive Diseases and Conditions by
Anatomic Area
 Emphysema Atelectasis

Destructive and additive diseases

 Soft tissue

Several situations Exposure factors must

exist, in which soft be altered to
tissue technique may demonstrate soft
be needed tissue.

Eg. Larynx,
throat,
extremities
Soft tissue

 When area of interest requires less density  decrease mAs

 Soft tissue requiring higher or lower contrast  radiograph with change in kVp
 Higher contrast  decrease kVp
 Lower contrast  increase kVp