Factors affecting patient dose in radiography

Individual limits for member of the public

 ICRP recommended that effective dose of 1mSv (stochastic effect)

 For the lens of the eye, the equivalent dose limit is 15 mSv. And 50
mSv average over any 1cm2 area of skin

Individual limits for occupational exposure

Cumulative exposure = 10mSv x age (years)

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 Factors in radiography
Affecting patient dose

• Exposure technique factors (kVp, mA, and exposure time)

• X-ray generator
•Filtration
•Collimation and field size
•Beam alignment
•FFD and SSD
•Patient thickness & density
•Table top
• anti-scatter grid
• image receptor sensitivity
•Film processing
•Repeat radiographic exposure
•Shielding radiographic organs
•Patient orientation

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 Radiographic Exposure
 Exposure Factors influence and determine the quantity and quality
of the x-radiation to which the patient is exposed.
 Radiation quantity refers to the radiation intensity referred to as
mR or mR/ mAs.
 Radiation Quality refers to the beam penetrability and measured in
HVL.

 The radiographic exposure factors are under the control of the

operator except for those fixed by the design of the x-ray machine.
 There are two choices for focal spot.
 With the exception of compensating filters, added filtration is fixed.
 The type of high voltage power is also fixed.

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 Exposure Factors Controlled by the Operator
 kVp
 mA times Exposure Time = mAs
 Determines the quality and quantity of the exposure
 SID, Focal Spot and Filtration are secondary factors
kVp

 kVp controls radiographic contrast.

 kVp determines the ability for the beam to penetrate the tissue.
 kVp has more effect than any other factor on image receptor
exposure because it affects beam quality.

 To a lesser extent it also influences the beam quantity.

 As we increase kVp, more of the beam penetrates the tissue with
higher energy so they interact more by the Compton effect.
 This produces more scatter radiation which increases image noise
and reduces contrast.
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 kVp

 50 kV 79% is photoelectric, 21% Compton, < 1% no interaction

 80 kVp 46% is photoelectric, 52% Compton 2% no interaction
 110 kVp 23% photoelectric, 70% Compton, 7% no interaction
 As no interaction increases, less exposure is needed to produce
the image so patient exposure is decreased.

mA
 1 Ampere = 1 C/s = 6.3 x 1018 electrons/ second.
 The mA selected for the exposure determines the number of x-
rays produced.
 The number of x-rays are directly proportional to the mA assuming
a fixed exposure time.
 100 mA produced half the x-ray that 200 mA would produce.
 Patient dose is also directly proportional to the mA with a
fixed exposure time.
 A change in mA does not affect kinetic energy of the
electrons therefore only the quantity is changed.
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 mA

 Many x-ray machines are identified by the maximum mA or mAs

available.
 A MP 500 has a maximum mAs of 500 mAs.
 A Universal 325 has a maximum mA of 300 and maximum kVp of
125

Exposure Time

 The exposure time is generally always kept as short as possible.

 This is not to reduce patient exposure but to minimize motion blur
resulting from patient movement.
 This is a much greater problem with weight bearing radiography.

 Older machine express time as a fraction.

 Newer machines express exposure time as milliseconds (ms)
 It is easy to identify the type of high voltage generation by looking
at the shortest exposure time.

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Exposure Time

 Single phase half wave rectified fasted exposure time is 1/60 second
17 ms.
 Single phase full wave rectified fastest exposure time is 1/120
second or 8 ms
 Three phase and high frequency can provide exposure time down
to 1 ms.

mAs

 mA and exposure time is usually combined and used as one factor

expressed as mAs.
 mAs controls radiation quantity, optical density and patient dose.
 mAs determine the number of x-rays in the beam and therefore
radiation quantity.
 mAs does not influence radiation quality.

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 mAs

 On many modern machines, only mAs can be selected.The machine

automatically gives the operator the highest mA and shortest
exposure time.
 The operator may be able to select mA by what is referred to as
Power level.

 mAs is one way to measure electrostatic charge. It determines the

total number of electrons.
 Only the quantity of the photons are affected by changes in the
mAs.
 Patient dose is therefore a function of mAs.

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 Imaging System Characteristics
Operator has limited control.
 The following will impact the technical factors based upon the type
of machine.
◦ Focal Spot Size
◦ Filtration
◦ High-voltage Generation
Focal Spot Size
 Most machines limited to two focal spot sizes.
 Common office focal spots are 1.0 mm for the small and 2.0 mm
for large.
 Highly detailed radiography such as mammography use micro-focus
tubes with 0.1 mm and 0.3 mm focal spot sizes.

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Focal Spot Size

 The focal spot size limits the tube’s capacity to produce x-rays.The
electrons and resulting heat are placed on a smaller portion of the
x-ray tube.
 The mA is therefore limited for the small focal spot.This results in
longer exposure times with greater chance of patient movement.
 For single phase machines, the small focal spot use is
limited to extremities and the cervical spine.
 With high frequency, most views can be done on the small
focal spot except for larger patient and ones that cannot
hold still.

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Filtration
 All x-ray beams are affected by the filtration of the tube. The tube
housing provides about 0.5 mm of filtration.
 Additional filtration is added in the collimator to meet the 2.5 mm
of aluminum minimum filtration required by law.
 2.5 mm is required for 70 kVp.
 3.0 mm is required for at 100 kVp.
 3.2 mm is required for operations at 120 kVp.
 Most machines now are capable of over 100 kVp operation.
 We have no control on these filters.

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 High-voltage Generation
 You will determine the type of high-voltage generation when you
purchase your x-ray machine.
 The type of generator will determine the efficiency of the
generator or the amount of ripple in the wave form.
 Single phase has 100% ripple.

Three Phase Generation

 Three phase has a 14% so it is significant improvement in efficiency
increasing both quality and quantity of the beam.
 More x-rays per mAs with higher energy.
 Cost to provide 3 phase power is very high so not practical in
office.

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High Frequency Generation
 Virtually no ripple ( less than 1%.)
 Inexpensive and can use normal incoming power.
 Provides significant reduction is mAs or kVp compared to single
phase. Reduction of mAs by 50% compared to single phase
techniques.

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 Factors in radiography
Affecting patient dose

•Collimation and field size

•Beam alignment
•FFD and SSD
•Patient thickness & density
•Table top
• anti-scatter grid
• image receptor sensitivity
•Film processing
•Repeat radiographic exposure
•Shielding radiographic organs
•Patient orientation

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