Notebook #7

Chapter 26: Density/Image Receptor Exposure

Factors Affecting Density/Image Exposure (3):

1. **mAs as the Controlling Factor**
1. The relationship between mAs and IR exposure = DIRECTLY PROPORTIONAL
2. Changes in mAs control IR exposure
a. RT is responsible for setting correct mAs for a given procedure
3. Digital image histograms are graphic representations of the exposure to the
IR
a. Manipulation of histograms during post-processing can enhance the
image, but it can also obscure information and impede diagnosis
b. Use of histogram = DOUBLE-EDGED SWORD
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4. The relationship between exposure and density = determines shape and

position of D log E curve
a. Important part of D log E curve = area between toe and shoulder
(diagnostic range)
5. mAs is used as the primary controller of IR exposure and film density
a. As mAs increases, x-ray exposure increases proportionally and film
density also increases
6. With film/screen systems, the minimum change necessary to produce a
visible change in film density is 30% of mAs
a. An image must be extremely over or under the acceptance limit to be
repeated
b. RULE OF THUMB for mAs changes:
i. Make adjustments in increments of doubles or halves

2.**kVp as an Influencing Factor**

1. kVp alters the intensity of the beam in 2 ways:
a. kVp controls the energy of the x-ray photons produced at the anode
target
i. a change in kVp alters the intensity of the beam when mAs and
other factors remain the same
b. kVp affects the production of scatter radiation
i. a change in kVp alters the intensity of the beam after it enters
the subject but before it reaches the IR
2. 15% Rule:
a. A 15% increase in kVp = doubling of exposure to the IR
b. A 15% decrease in kVp = halving the exposure to the IR
c. EXAMPLE: A radiograph f the elbow is produced using 4mAs at 60kVp.
What would be required to halve the exposure to the IR?
i. 60kVp (60kVp X 15%)
ii. 60kVp (60kVp X 0.15)
iii. 60kVp (9kVp)
iv. 51kVp
d. The percentage of kVp needed to halve the exposure to the IR is
always as kVp increases
i. Primarily due to increased scatter radiation produced at higher
kVp
1. Scatter radiation increases with increased part thickness
a. You need to increase IR exposure when imaging a
thick part
3. Changing kVp is the primary method of changing image contrast
a. When you want a contrast change
i. You use the 15% rule to maintain density/image exposure
b. When you ONLY want a density/image exposure change
i. You DO NOT want to use the 15% rule because it causes a
contrast change
c. When you want a density/image exposure change
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i. You vary the mAs because it is the controlling factor of

density/IR exposure
4. Configuration of generator = important consideration in how kVp affects IR
exposure/film density
a. Total number of higher-energy photons in the x-ray tube emission
spectrum is controlled by the amount of ripple in the waveform
i. Single-phase waveform has low photon energy = less density/IR
exposure
ii. High-frequency waveform = high density/IR exposure

3.**Other Influencing Factors (8)**

1. Focal Spot Size
a. Large focal spots utilize greater incident electron stream than small
focal spot
b. Large focal spot tend to bloom more at higher mAs
i. Blooming occurs with large mAs because incident electron beam
is not easily focused by focusing cup
ii. Rare of blooming to cause visible density/image exposure
2. Anode Heel Effect
a. Anode heel effect alters the intensity of radiation
i. Intensity is from kVp
1. Therefore, anode heel effect alters density between anode
and cathode ends of tube
2. IR exposure is always greater at cathode end
b. Anode heel effect is more prominent when using smaller angles
c. When you can see an anode heel effect, it can be minimized or
converted to an advantage
i. Minimizing by collimating the beam and getting rid of as much
of the intensity difference at the periphery as possible
ii. Converting objects with greater subject density at one end than
at another
1. Place portion of part with greatest density toward cathode
end
a. *Remember foot x-ray?*
b. Thick part at cathode end and thin part at anode
end
3. Distance (SID and OID)
a. SID: Inverse square law
i. States that the intensity (exposure) varies inversely with the
square of the distance
ii. As distances increase, radiation intensity and IR exposure
decrease
iii. To maintain IR exposure, mAs must be changed to make up for
the exposure change
1. We use the exposure maintenance formula
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2. It is reversed to a direct square law because mAs must

increase when distance increases in order to maintain IR
exposure
b. OID: has an effect on density/IR exposure (Air-Gap Technique)
i. Air-gap technique uses increased OID to prevent scatter
radiation from reaching IR
1. By increasing OID, scatter that would normally strike the
IR will miss the receptor which will cause a decrease in
density/IR exposure
4. Filtration
a. Filtration alters beam intensity which affects IR exposure and
density/IR exposure
i. Density/IR exposure decreases when filtration increases
5. Beam Restriction
a. Restricting the beam, collimating, or reducing the primary beam field
size reduces the total number of photons available
i. This reduces scatter radiation and therefore reduces the overall
IR exposure and density/IR exposure
b. Technical factor compensation for changes in density/IR exposure is
required only for the following:
i. Large anatomical part
ii. High kVp
iii. Low grid efficiency
iv. Non-grid exams
6. Anatomical Part
a. Patient is primary attenuator of beam
b. Amount of attenuation is dependent on thickness and tissue type
i. Tissue type is dependent on atomic number and density of
tissue
c. The type of contrast media will alter atomic number and affect
density/IR exposure
d. Pathology can also alter tissue thickness and type
e. Radiolucent contrast media (air)
i. Increase density/IR exposure
f. Radiopaque contrast media (barium)
i. Decrease density/IR exposure
g. Pathology can have additive or destructive effect
i. Additive = decrease density/IR exposure
ii. Destructive = increase density/IR exposure
7. Grid Construction
a. Grids absorb scatter
b. Things that decrease density/IR exposure:
i. The more efficient the grid is
ii. Grid with high ratio
iii. Low frequency
iv. Dense interspace material
c. To compensate for varying grid ratios you need to increase mAs
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i. You DO NOT want to mess with kVp, because it may change the
contrast in the opposite direction which will negate the reason
for using a grid in the first place
8. Image Receptor
a. Both film/screen and digital systems have an effect on density/IR
exposure
b. Film/screen:
i. Relative speed (RS) numbers are the most useful parameters of
film/screen
1. As RS increases, the amount of exposure needed to
maintain the same density/IR exposure decreases
2. You can adjust mAs to compensate for changes in RS
because exposure is directly proportional to mAs
ii. Film density will increase when:
1. The developer solution temperature increases
2. Immersion time increases
3. Replenishment rates increases
c. Digital systems:
i. Exposure index (EI) is the most useful parameter for digital
imaging systems
ii. Response of a digital IR to x-ray exposure is LINEAR
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Chapter 27: Contrast

Factors Affecting Contrast (3):

1.**kVp as the Controlling Factor**
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1. kVp is the controller of contrast!!! (INDIRECT RELATIONSHIP)

a. as kVp increases, contrast decreases
2. RT controls contrast because they are the ones setting the technique
3. Generator configuration that increases the kVp = decreased contrast
4. KVp also controls the amount of scatter radiation produced
a. Increasing kVp = increasing amount of radiation fog = decreasing
contrast

2.**mAs as the Influencing Factor**

1. mAs alters IR exposure and density/IR exposure of the image which then
affects contrast
2. Over or underexposure means reduced contrast
3. For digital systems, the EI should be within the acceptance limits

3.**Other Influencing Factors (8)**

1. Focal Spot Size
a. Focal spot sizes have such a small effect on exposure
i. Unlikely that their effect on contrast can be seen
2. Anode Heel Effect
a. Intensity of radiation is greatest at cathode end
b. Visible difference seen with open collimation and small anode target
angle
c. Anode heel effect has little effect on contrast
3. Distance (SID and OID)
a. SID: inverse square law
i. Greater distance = decreases density/IR exposure
ii. Less distance increase density/IR exposure
b. OID: Air-Gap Technique
i. Air-gap technique increases OID, removes scatter radiation =
increase density/IR exposure
4. Filtration
a. Filtration affects contrast by changing the average photon energy and
decreasing beam intensity
i. Increase in average photon energy causes more Compton
scatter production = decreasing contrast
ii. The decrease in intensity decreases density/IR exposure =
decreased contrast
b. Increase filtration = decrease contrast
5. Beam Restriction
a. Restricting the beam, collimating, or reducing the primary beam field
size = reduced number of photons available
i. This reduces scatter radiation which means an increase in
contrast
6. Anatomical Part
a. Patient is primary attenuator
b. Anatomical part increases
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i. The amount of scatter radiation increases

1. Therefore, contrast decreases
c. As tissue density increases
i. Scatter radiation increases
1. Therefore, contrast decreases
d. As average atomic number increases (by using contrast media)
i. More photoelectric absorption
1. Resulting in increased contrast
7. Grid Construction
a. Using a grid improves contrast
i. It does this by removing scatter before it hits the IR
b. The contrast improvement factor (K) is the best measurement of how
well a grid improves contrast
i. Dependent on the amount of scatter radiation produced
c. Increase in scatter radiation to IR = low contrast and low contrast
improvement factor
d. High grid ratios remove more scatter
i. Therefore, has greater contrast improvement factor
1. Which results in higher-contrast image
8. Image Receptor
a. Film/screen:
i. The physical composition of the film emulsion determines the
shape of the D log E curve
ii. As the slope becomes steeper, the contrast increases
iii. Decrease in slope results in decrease of contrast from these
factors:
1. Increasing film developer time
2. Temperature
3. Replenishment rate
b. Digital systems:
i. Primary determinant of scale of contrast is
1. Post-processing
2. Look-Up Table (LUT)
ii. You can adjust the exposure differences by manipulating the
window width