procedures pro IMAGING

Laura Armbrust, DVM, Diplomate ACVR, Kansas State University

Radiology:
Developing Technique Charts

A
ccurate assessment and interpretation STEP BY STEP RADIOGRAPHIC TECHNIQUE CHARTS
of a radiographic image is multifactor-
ial, with one of the most important fac- To develop a technique chart for conventional film-screen radiography, use the following
tors being the acquisition of high-quality guidelines:
radiographs. Many considerations must be
taken into account when assessing radi- Produce a milliampere (mA) chart by using all the available mA settings on
ographs for diagnostic quality: optimal density
and contrast, proper positioning, and minimal
1 your machine and all the time settings less than one tenth of a second. It
should look similar to the chart below. This would be a machine that had set-
patient motion. tings of 100, 200, and 300 mA and 4 time settings.

A reliable, user-friendly technique chart is

Milliampere
important for obtaining consistent radi-
ographic density and contrast. When film, cas- Time (sec) 100 mAs 200 mAs 300 mAs
sette, or machine type is changed, technique 1/80 (0.0125) 1.25 mAs 2.5 mAs 3.75 mAs
charts need to be changed as well. With digi- 1/40 (0.025) 2.5 mAs 5 mAs 7.5 mAs
tal radiography becoming more common, it
1/20 (0.05) 5 mAs 10 mAs 15 mAs
may seem less important to have accurate
technique charts; however, digital systems still 1/10 (0.1) 10 mAs 20 mAs 30 mAs
cannot correct for some underexposure and
overexposure issues. These values (1.25 mAs–30 mAs) will be your options for exposure settings
when generating your techniques.

PROCEDURE PEARL
A general rule of thumb for mA settings for patient weight is:
• < 10 kg = 2.5 mAs–5 mAs
• 10–25 kg = 5 mAs–10 mAs
• > 25 kg = 10 mAs–15 mAs

mA = milliampere

p ro ce d u re s p ro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N AV C c l i n i c i a n’s b r i e f . a u g u s t . 2 0 0 9 . . . . . 5 3
procedures pro CONTINUED

Determine the starting peak potential

2 (kVp) by taking a lateral abdominal
film of a small dog with normal body
A B
condition. Remember to use accurate measuring
calipers and measure the dog at the widest point
(ribs 12 and 13) as depicted in Figure A. A small
dog should be used so the measurement doesn’t
exceed 10 cm, thereby avoiding use of a grid.

Take the measurement in centimeters and multi-

ply by 2, then add the result to the focal film dis-
tance (FFD, Figure B), which is the distance
between your tube head and the x-ray film
(a standard measurement is 36–40 inches). This formula equals your starting kVp:
2 (patient measurement in cm) + FFD = kVp

For example, if the dog measures 9 cm and the FFD is 38:

2 (9 cm) + 38 in = 56 kVp

Take 3 exposures using the same kVp (56 in this

3 case), but vary your mAs. In general, use your
mAs combination with the fastest time to
A
decrease motion artifact. With most equipment, selecting the
200 mA station will enable you to use the 3 fastest time set-
tings (which would be appropriate for a dog of this size). Be
sure to mark your films with the differences in exposure so
you can easily identify them after development.

Remember to develop the films with fresh, clean developing

solutions—old or exhausted developer will not work for
developing technique charts. Examine the films for the set-
ting that gives the best diagnostic quality. In Figure A, the
B
kVp was 56, mA setting was 200, and time was 0.0125 sec-
onds (mAs = 2.5). In this example, the bones are not easily
visualized and the film overall is too white (underexposed).

In Figure B, the kVp and mA were left the same and the
time was changed to 0.025 seconds (mAs = 5). In this
image, the body wall, abdominal organs, and bones can all
be readily visualized; this is a proper exposure. In Figure C,
the kVp and mA were left the same and the time was C
changed to 0.05 seconds (mAs = 10). With this higher expo-
sure technique, the ventral body wall cannot be visualized,
and the abdomen is too dark (overexposed).

FFD = focal film distance; kVp = peak potential; mA = milliampere

5 4 . . . . . N AV C c l i n i c i a n’s b r i e f . a u g u s t . 2 0 0 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p ro ce d u re s p ro
 cm kVp
1 40
The chart can now be constructed because we know that 56 kVp and 5 mAs are appropriate settings 2 42
4 for a dog measuring 9 cm. The chart’s first column should record tissue thickness measured in centime-
ters (1–35 cm) and the second column should contain the kVp (the mAs will be added later). Be sure
3 44
4 46
you are maintaining the same FFD for all radiographs or your technique chart will not work.
5 48
Start with the kVp already calculated from the dog, opposite the thickness for that dog, then: 6 50
• Subtract 2 kVp for each centimeter thickness less than the 9 cm
7 52
• Add 2 kVp for each increase in centimeter thickness up to 80 kVp
• Add 3 kVp for each increase in centimeter thickness between 80 and 100 kVp 8 54
• Add 4 kVp for each increase in cm thickness over 100 kVp. 9 56
At right is an example of what the chart would look like so far. The kVp for 11 to 35 cm is given in the chart below. 10 58

When the patient’s measurement is

5 greater than 10 cm, a grid should be
used (this usually means you will be
cm
1
kVp
40
mAs
5
cm
18
kVp
74
mAs
15
putting the cassette in the table rather than putting 2 42 5 19 76 15
the cassette on top of the table). The mAs previ-
3 44 5 20 78 15
ously determined as the best (5 mAs in this case)
4 46 5 21 80 15
should be multiplied by a variable based on the
following grid ratio: 5 48 5 22 83 15
• 5:1 grid: 2 × mAs 6 50 5 23 86 15
• 6:1 grid: 2–3 × mAs 7 52 5 24 89 15
• 8:1 grid: 3–4 × mAs
• 12:1 grid: 4–5 × mAs
8 54 5 25 92 15

• 16:1 grid: 5–6 × mAs

9 56 5 26 95 15
10 58 5 27 98 15
If you do not know the type of grid you are using,
11 60 15 28 101 15
multiply the previously determined mA setting by 2,
3, and 4 if the patient’s measurements are greater 12 62 15 29 105 15
than 10 cm. In the case of a patient that measures 13 64 15 30 109 15
15 cm, the kVp would be 68 kVp and images would 14 66 15 31 113 15
be taken at 10 mAs, 15 mAs, and 20 mAs. 15 68 15 32 117 15
Again, using the same parameters as in Step 3, 16 70 15 33 121 15
determine the most appropriate exposure (in this 17 72 15 34 125 15
example, 15 mAs produce the best exposed image).
c o n t i n u e s 35 129 15
This mA setting will now be used throughout your
chart for all patient thicknesses above 10 cm.

Up to this point, you have only pro-

6 duced a technique chart for the
abdomen. This chart can easily be
mAs
10 cm & Under Over 10 cm
adapted for the thorax and bones by leaving the
first 2 columns the same (cm and kVp) and fol- Thorax 2.5 7.5
lowing these rules for the third column (mAs): Abdomen 5 15
• For the thorax, divide the abdominal chart
Bone 10 30
mAs in half
• For bone, double the abdominal chart mAs.

c o n t i n u e s

p ro ce d u re s p ro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N AV C c l i n i c i a n’s b r i e f . a u g u s t . 2 0 0 9 . . . . . 5 5
procedures pro CONTINUED

If you are using a digital radiography system, the software attempts to adjust bright-
7 ness to correct for over- and underexposure. If a digital image is severely underex-
posed, however, the digital system cannot correct for it. The resulting image will look Articles in Clinician’s Brief on…
very grainy, as in this example of a cat thorax that was extremely underexposed (Figure A). Imaging
Figure B shows the corrected technique.
Digital Radiography Systems: Part 1 in a
Series • July 05
A B Digital Radiography Systems: Part 2—
Image Quality • August 05
Digital Radiography Systems: Part 3—
Picture Archiving & Communication •
October 05
Digital Radiography Systems: Part 4—
Financial Feasibility • December 05
Traditional Radiography Versus Oral
Radiography • April 2006
In most cases, an overexposed radiograph will have soft tissue that cannot be seen, even with
adjustments in brightness (window/level). In Figure C, the digital image is overexposed, which Orbital Imaging Techniques •
results in inability to see the lung in the cranioventral thorax and between the heart and November 07
diaphragm; this area will remain black with increases in brightness. The technique has been cor- Radiology Versus Ultrasound •
rected in Figure D. ■ July 2009
Diagnostic Tree—Radiology & Ultrasound
• July 2009
C D Tips & Techniques for Pelvic Radiography
• July 2009

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PROCEDURE PEARLS
If you are finding machine limitations relative to your technique charts, remember these
rules of thumb:
• Increasing kVp by 15% is equal to doubling the mAs in terms of exposure.
• Decreasing the kVp by 15% is equal to dividing the mAs in half.
• If you have reached maximum kVp on the machine but need more exposure, you can
double the mAs.
• If you have reached maximum mAs on the machine, you should increase kVp by 15%.
• If you have reached maximum mAs and kVp, you can decrease your FFD.

FFD = focal film distance; kVp = peak potential; mA = milliampere

5 6 . . . . . N AV C c l i n i c i a n’s b r i e f . a u g u s t . 2 0 0 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p ro ce d u re s p ro